The daily cries of parents, pediatricians, the press and the public to reopen schools in the fall are certainly well-intentioned, but they overlook a crucial opportunity to advance the physical and mental health of adolescents long after the end of the school year. COVID-19 pandemic. Delaying the start time of school for teens by an hour, or even two, could optimize a teen’s sleep and ability to learn throughout the day.
Sleep is essential for adolescent health and learning
Adequate sleep is closely linked to adolescent mental health, well-being, learning, and even safety. During a time of unprecedented challenge for teens, one benefit of the new virtual school experience has been the later start times. Teens who started their school day by logging into the classroom around 9 a.m. experienced what research has long suggested: Later start-to-school hours help teens thrive. No more morning rush for families to get sleepy teens out of bed, often skipping breakfast to get out in time for early morning classes, followed by long, busy days.
If we can overcome the bureaucratic hurdles to quickly and successfully launch telehealth and e-learning services, why can’t we use the same drive and resources to implement evidence-based recommendations to delay the back-to-school hours?
One of the few bright spots of the pandemic has been the positive impact that back-to-school time has had on many teens and families. We have heard from families in our practices how this experience with later distant school start times increased their sleep during weeknights, decreased the Saturday nights needed to recover lost sleep, allowed family breakfasts. and eliminated risky journeys in the event of drowsiness. Many families have now seen the significant benefit that later lessons can afford; adolescents feel better physically and mentally, have more energy and are able to concentrate better during class. They also report that they don’t dread mornings so much – isn’t that something we wish for everyone?
As clinicians who care for adolescents and champion their health and well-being throughout this pandemic, and as parents ourselves, we have seen adolescents suffer from loneliness, depression, anxiety. , restrictive diet, loss of learning and difficulties in school during the last year. A common thread in these clinical encounters is the role of sleep, and most often the role of inadequate sleep. We share teen-centric “sleep hygiene” advice with families and teens on autopilot, but we cannot continue an unfair fight against adolescent biology.
Adolescent body clock bedtime is closer to 11 p.m.
Adolescents have a biological need for about 9 hours of sleep per night. However, studies have consistently shown that over 75% of American teens get an average of 7 hours or less. For pre-teens, some of whom are as young as 11, there is a natural biological change in the circadian rhythm of one to two hours, which means that there is a natural delay in the secretion of melatonin from the body. brain, resulting in later bedtime and waking hours. . As a result, the biological change in the circadian rhythm makes it very difficult for teens to fall asleep early enough (read: before 11 p.m.) to get adequate sleep, given the early school start times in most school districts. . Their bodies just aren’t ready for bedtime.
Research has shown that later start-to-school hours lead to more sleep, with many teens getting at least 8 hours of sleep per night. Academics, attendance, mood, and graduation rates are all improving. Decreases in caffeine consumption, depression, drowsiness at the wheel and car crashes, and sports-related injuries are also reported. As a result, many professional organizations, including the American Academy of Pediatrics and the American Academy of Sleep Medicine, and even the CDC, have strongly recommended an early school start time of 8:30 a.m. for teens.
Most middle and high schools start before 8:30 a.m.
Despite extensive research, most schools rejected the recommendation, citing parents’ work schedules or childcare issues, logistical issues such as bus schedules, and after-school conflicts like athletics. which take place in the early evening. Every school district is different and has different challenges and needs. Creativity is essential and working together to be flexible (sometimes between districts) with buses, athletics (including investing in flood lighting where possible) and after-school programs is paramount.
Some argue that it would be problematic for young children to switch to earlier school start times – which could happen if teens started later due to reversal of bus schedules – but a recent study that followed children and teens through a start time change revealed that this is not the case. true. While it’s extremely difficult for teens to force sleep earlier, it’s easier for elementary-age children to go to bed earlier because they haven’t had the change in circadian rhythm yet.
Despite these results, before the pandemic, up to 93% of high schools and 87% of middle schools rang in the morning before the recommended start time of 8:30 a.m.
What should a clinician do?
Talk to your families and adolescent patients, and advocate for a later start to school in your communities. Youth voices are powerful, so welcome your adolescent patients as advocates for this change. Now is a good time to ask families to write to their superintendent and managers to inquire about fall schedules.
Clinicians can also write to local politicians for legislative change and provide their expert opinions to schools and school boards. Coalitions of healthcare professionals such as Start School Later have online resources and advocacy tools for families and professionals, as well as details on how some states, like California in 2019, have done the job. change. Don’t underestimate the value of lending your doctor’s voice to an information leaflet, Facebook post, or local media outreach.
The COVID-19 pandemic has accelerated needed changes in many areas, and in the case of the later start times, many families and teens have enjoyed the real benefits that a later start time can bring. The pandemic has yet to produce many positive long-term effects, but pediatricians, caregivers, educators and mental health experts can seize this opportunity to make lasting and impactful changes for adolescents.
Hina Talib, MD, is an Adolescent Medicine Specialist and Associate Professor of Pediatrics at the Montefiore Children’s Hospital / Albert Einstein College of Medicine in New York City. Shelby Harris, PsyD, is a specialist in behavioral sleep medicine, clinical associate professor of neurology and psychiatry at the Albert Einstein College of Medicine, and author of “Women’s Guide to Overcoming Insomnia.”