ED Talk: Terra Ziporyn Snider

ED Talk: Terra Ziporyn Snider


( applause ) I talk about it all the time but
usually when I talk about this topic I’m talking to a very specific group. For example, policy makers or advocates
who know a whole lot about the topic or students or sleep researchers. And I very rarely talk to
such a diverse group. The problem is that I’m a
science communicator as you heard and to talk to a diverse
group forces you to basically violate one of the cardinal rules of
science communication. Or really any communication and
that is, that you’re supposed to tailor your talk to your audience. Which is very hard to do
when your audience is coming from so many different places. But then it actually occurred
to me that this is the perfect group for what I have to say. And I’m hoping that by the
end of the hour you’re going to understand why I’m saying that. But for now let me just say that it’s
exciting for me to see educators and health people and policy makers
and advocates and students and researchers all together
in the same room. Literally and figuratively. And that truly is at the heart of what
I’m going to be talking about today. And what I’m talking about today
specifically of course is sleep deprivation in teenagers. And we’re going to be covering these
three learning objectives talking about the extent and the impact
of sleep deprivation in teenagers. We’re going to be looking at
the individual and structural roots of that problem. And actually, Julie this is showing
the wrong slide right now, because I’ve changed the Power Point.>>Okay.>>So, I don’t know if
we can fix that.>>Sure. Yep.>>But this is the Power
Point I’m looking at but that’s not what is showing up.>>Oh, I wonder if we maybe
have two files open.>>Yeah I think we have
two files open so let’s make sure it’s showing the right one. But anyway, I will be
discussing these things. And then we’re looking at the impact
of changing school start times on sleep deprivation in teens, as
well their health and performance. And finally, I want the
one that says UT Austin.>>Is that correct?>>That’s the correct one.
Yeah, this is the right one. And finally we’re going to be exploring
some of the aspects, the political, psychological and the cultural aspects
of making a change so that school hours are compatible with the sleep
needs and patterns of teenagers. This is definitely the right one.>>All set. Does that look good?>>Um, yeah. I guess so. Let’s see if it goes to the next one. Yes, so sleep. Sleep seems to
be everywhere you look. At least it’s everywhere I look, it
might just be me but I don’t think so. As a matter of fact, while I was lined up
to get on the plane in Baltimore yesterday the people behind me
were talking about sleep. Because what they were doing was
looking at a display on the newsstand next to us that had consumer reports,
and its cover story was called “The Secrets of a Great Night’s Sleep.” And that just made me laugh because
actually many, many years ago back in the 80s, I wrote a story for Consumer
Reports but with basically the same title. Those were the years where sleep
labs were just coming into being. And of course it was not a cover story,
so it was great to see this as a cover story, but it just seems
to be in the wind. Of course we’re not just
talking about sleep here, we’re talking about teen sleep. But even here unless you’ve been asleep
for the last decade, you’ve undoubtedly seen some of these sorts of
headlines that we have a real problem with adolescent sleep. There is apparently an epidemic of
sleep deprivation in teenagers. And this kind of story in the
national media has been there at least for over ten years. Probably since the
National Sleep Foundation released the results of a poll they did. Which revealed that about 87% of U.S.
high school students were not getting enough sleep on school nights. That really hit the news stands in
2006 and since then we’ve seen many other studies and reports
confirming these findings. You don’t always hear the exact same
statistic about the extent of sleep deprivation and that’s because
researchers define sleep deprivation in slightly different ways or they
measure it in slightly different ways. But however you slice or dice it, it looks
like we have a real problem with teen sleep.
Um, let’s go back a slide. One of the reports that keeps
coming out from looking at the Youth Risk Behavior survey,
which is a national survey that is done every four years among
high school students and I think it’s conducted by the CDC, right? They have found that over two thirds
of high school students are reporting getting less than eight hours
of sleep on school nights. And this is consistently found every
time they do this poll every four years. And when you look at the data even
more closely, you see something that I find even more disturbing and
that is that nearly 40% of teenagers say they’re getting six or fewer hours
on a regular basis on school nights. And this certainly is not the only
finding, in fact a few years ago, a couple years ago there were
headlines saying that basically all U.S. teenagers are sleep deprived. This came out of a study by Charles Bash
at Columbia University Teacher’s College, also looking at the youth risk behavior
survey data, but this time defining sleep needs as at least
nine hours of sleep. So if you, you know, make the barrier,
if you basically define it as nine hours, you’re going to find more
teens are sleep deprived. You can see on these pie
charts how it breaks down. Those blue slivers in the pie charts?
That’s the percentage of teenagers who are getting at least nine to
ten hours of sleep a night. Basically 8% of girls, 9% of boys. And that red slice to the right? It’s the
percentage of teenagers getting five or fewer hours of sleep a night. It’s over one in five teenager girls. They also found something that’s even
more disturbing perhaps, and that is that the older teens were in high school,
the fewer of them got enough sleep. So these are percentages of teenagers in
various grades who get sufficient sleep. Defined as nine hours a night. By 12th grade it’s maybe 5%. And then we heard about
a “Great Sleep Recession.” It turns out that it’s not
just that teenagers are not getting enough sleep now, but there’s been a steady decline in the
percentage of teenagers who are getting enough sleep
since the early 1990s. I have to say that this study was
co-authored by my host, Julie Maslowsky. That’s not why I put it in my talk,
I always include it in my talk. But really was a highly publicized
and very disturbing study. That looked at trends over,
you know, the last 20 years or so. And we have seen a number
of very disturbing things. Including the fact that the proportion
of teens in all age groups and this wasn’t just high school, but
ages 12 to 18, the proportion of those teens regularly getting at least
seven, they were just asking for seven hours of sleep. That percentage decreased from 1991
to 2012, and I forgot to mention that this is based on monitoring the Future study,
which is another huge, huge study of a data pool. Almost 300
thousand teenagers, I think. And over these years the proportion
of all age groups getting enough sleep continually declined and again, they found
that the older teenagers got, the fewer of them were getting enough sleep. Something was going on throughout
high school that was making it harder and harder to get enough sleep. The largest decline, which I find very
interesting, and don’t really understand was during the 1990s. Not recently. There is a continual decline, but the
largest drop off was in the 1990s. And in the most recent years that
they did the survey, only 20% of 18 year-olds were getting even
seven hours of sleep a night. There were some other concerning
trends that came out of this study. That are worth thinking about. One was that girls were less likely than
boys to get seven hours of sleep. Minority students and urban students
and students from lower socioeconomic groups got relatively less
sleep than their peers. And paradoxically, these same students,
the one who were getting relatively less sleep, were more likely to say
that they did get enough sleep. Now this is a different kind of data
that I just find endlessly fascinating. This is not data from surveying
students about how much they sleep, this is data from a company that
distributes sleep apps to teenagers all over the world. Sleep Cycle. They measure not when teen
say they’re going to sleep, but when the app says they do actually
fall asleep and when they wake up. And just looking at this chart,
gives you a little clue as to what is going on with teenagers. These are average times that
teenagers fall asleep around the world on school nights. Look at the distribution of times,
the very earliest average fall asleep time is among Swiss students. It’s 11:37 PM. Look at South Korea at the end. 1:20 AM. These are average times. I mean, obviously some students
are falling asleep earlier and some later. But in the U.S. we’re kind of on
the early side at almost midnight. Our teenagers are night owls, clearly. Whatever we’d like them to do,
they’re going to sleep very late. And they’re also not getting very much
asleep according to this data either. In South Korea, you probably could
predict, they’re getting the least sleep. They’re getting five hours
and 46 minutes on average. On school nights, according
to this Sleep Cycle data. The longest sleep time was
not eight hours in any group. American teenagers on
average get a little over seven hours of sleep, a night. So clearly there’s a sleep problem
in teenagers, however you look at it. And it wouldn’t matter
if sleep didn’t matter. But of course we all know
that sleep does matter. At least we know
that theoretically. We’re told by the Public
Health Experts that sleep is just as important as diet and exercise. And there’s good reason for that,
most of us, at least theoretically, spend about a third of our lives asleep. And we’re learning more and more
about the critical role that sleep plays in health and in safety, in
functioning and basic overall well being. And that’s true for everybody, not just
teenagers, of course, but it’s a particular concern to find these
sleep problems in adolescents just as it would be say in babies
and children because there are different sleep needs and
patterns at different stages of life, and of course all children
and adolescents, these are human beings who are still
growing and developing. So when they have sleep problems
there are unique concerns that we have to think about. We know that we change our sleep
patterns over a lifetime and our needs. We all know that babies
sleep a lot, right? Babies sleep 14 to 17 hours
out of every 24. And elementary school children
generally need about 11 hours of sleep a night to thrive. By the time they reach adolescence,
they need on average about nine. And of course there is
individual variation, but the typical teenager needs
nine hours to do well. And clearly this isn’t happening
from the data I just showed you. You can pick any study you
want, but it is not happening. And it turns out we shouldn’t
only be worrying about the quantity of sleep teens are getting. We should be worrying about
other aspects of their sleep. Because one of the really
interesting things that’s coming out of sleep research in the
past few decades is that it turns out that sleep’s affects,
are measured not just by how much sleep you get,
but the quality of your sleep. Anyone with sleep apnea
knows what I’m talking about. As well as the timing of that sleep
and the consistency of that sleep. What I’m talking about
is that timing is when you sleep in the course
of a 24 hour period. Human beings are really
hard wired to sleep at night. And when we don’t sleep at the
times our bodies are telling us to sleep, we don’t get the benefits of sleep
and in fact our health is jeopardized, and there are many studies showing this. What’s even worse than not sleeping
at the time you’re hard wired to sleep is to sleep at inconsistent times. And that’s why we keep seeing
these studies of shift workers who have all sorts of increased
rates of serious health problems like diabetes and heart disease. Our teenagers are not sleeping at
consistent times either, as we will see, so when I’m going to be talking about why
this is a problem, you have to think about these four variables as being affected. And school start times
obviously play a role, not just in the quantity of sleep,
but in the timing of sleep. So just keep that in
the back of your mind. I don’t have time to go into
all the horrible that happen to you if you don’t get healthy sleep. But this chart is really, it’s called,
“The Effects of Chronic Deficient Sleep.” And the reason I use the term deficient,
which I got from Judy Owens, a leading pediatric sleep researcher
and pediatrician, is that, deficient captures the idea that
it’s not just how much sleep you get, but when you sleep that affects your
health and your learning and your mood and your behavior
and your thinking. And even how well you do on various
measures of school performance. Like attendance and
tardiness and graduation. Grades and test scores. And there really is a growing body
of evidence that links poor sleep, whether it’s quantity, quality or timing
to all of the measures on this chart. So we are seeing these affects,
this chart is really targeted at what happens to teenagers
who get poor sleep. And as you can see we’re talking
about some very serious issues. The inability to stay attentive and
alert or process information or recall information or
solve problems in class. Rising rates of tardiness, truancy,
problems with dropout rates and test scores and grades. The mood and behavior problems are huge. Sleep really does control our
ability to manage our mood. When teenagers don’t get quality
sleep they’re more impulsive, they can’t tolerate frustration,
there’s much more signs of depression suicidal ideation even, aggression,
fights, health risk behaviors increase. And the health and safety
concerns are vast as well. In teenagers in particular we think about putting these sleepy teens
behind the wheel. And there’s a lot of evidence that
car crash rates go up in teens who don’t get healthy sleep. Athletic injuries are more common, the
healing of athletic injuries is slower. There’s more. I don’t even have
this on the chart but, they tend to get more colds and infections because
immune system is affected by sleep. And there’s even some evidence
that by depriving teens of sleep on a long term basis during adolescence, we put them at risk of some very
serious long term health problems. Including diabetes, heart disease,
stroke and multiple sclerosis. So we’re talking about
a serious issue here. We don’t want teens to be
sleep deficient obviously, and the question is then well why? Why are we seeing these trends? Why are teens so sleep deficient? Why are they getting less sleep apparently
than they did earlier in the century? And here, there have been many
culprits put forward as explanations. And it’s clearly a multi factorial
problem, as much as I believe in later start times as a solution we all know that they are not the be
all and end all of teen sleep deprivation. There are many roots of the problem. And some of them, just to name
some of the leading ones include the 24/7 society we now live in. Where we can be up, shopping or
web surfing or watching TV or texting or doing anything really pretty much anytime
we want, because we have these lights that allow us to do that. Another culprit that’s put forward a lot
is not only the changes in work and business hours but just
the general devaluation of sleep.>>I’m so sorry.>>That’s okay.>>We have some breaking news,
but something will still be on it.>>Okay, thank-you. I thought this
was the most important problem in the entire universe, but I guess not. It is important though, our culture really
doesn’t value sleep though so we don’t think it’s that important.
We think sleep is a sign of weakness, we think it’s a sign of lack of dedication
and motivation and teenagers pick up on that, so that’s a
possible explanation. And then there are personal reasons
that these teenagers might not be getting sleep, they might have poor
sleep hygiene, not know how to get good sleep. They may be up
with their phones texting. They may be in a room
that’s too cold or too noisy. They might have a sleep disorder. Those things have
been put forward as well. Changes at puberty in the
way sleep is controlled, which we’ll be discussing
at length later certainly play a role. And everybody of course talks
about social media and screens and phones as playing a role. And other people have said these
kids are up later than they ever were doing homework. They’re
pressured to take AP courses. They have to be at sports
practice until ten in the evening. They have jobs after school
and of course then they have to wake up extremely
early for school. So these are some of the leading
causes that have been thrown out there to explain what we’re seeing. And think about it for a minute,
some of these are clearly not unique to teenagers, right? Some of them aren’t unique
to our current society. Many of them are interrelated. And some of them aren’t changeable. But some of them are
unique to teenagers and I think they’re worth
looking at more closely to see if they might explain
what we’re seeing. One of them is one that,
I have to tell you that I don’t have enough fingers and toes
to count the number of people per month who tell me that the real
problem of course is the phones. Everybody says, well the reason we’re
seeing this decline is that the kids are up on their electronics all the time. On top of that they’re exposed to
light that we know makes it difficult to sleep, and truly is correlated
with problems sleeping. There is some truth to this, there are
studies that show that teens who use electronic devices before bed or
frequently during the day have trouble sleeping, they have trouble
falling asleep and they don’t get as much sleep as other
teens, that is true. On the other hand though,
there really are no studies to date showing that if you take phones
away or take these things away that sleep deprivation is reduced in teens. There was just a study that came out
this week where they tried to take phones away from athletes. Had no impact at all,
at all on their sleep. There’s even less evidence
about the stuff about homework and APs and sports. All of us, if you’re a parent you
have anecdotal evidence about your child up there doing homework. There’s no question we have
anecdotal evidence about it. But we don’t really have any studies
showing that decreasing the time of a sports practice or homework
load is going to help the sleep problem. It might, but we don’t
have that evidence to date. Where we do have really
strong evidence is biology. What we know from sleep
studies in the past 30, 40 years, is that at puberty, there are changes
in the way sleep and wake are controlled that make it very, very difficult for
teenagers to fall asleep as early in the evening as they did
when they were young children. Or that they will when
they’re older adults. And I’m not going to go into the
technical details but basically there are two systems that control sleep,
and they both change at puberty. One is the ability to resist
the pressure to fall asleep. That’s called the homeostatic sleep drive. And it just becomes easier not to
fall asleep when you feel sleepy, as you turn into a teenager. The other thing that happens is that your
circadian rhythms, that’s your internal body clocks that control so many
physiological processes including the release of hormones. These clocks shift two to three hours
later at puberty so that you naturally feel sleepy two to three hours later, and wake up two to three hours later
than you did when you were younger. Now you may say they’re falling asleep
later because they’re up on the phones. And a lot of people do. But there are actually studies in other
mammals including primates and rodents, that show that they also release
melatonin, which is the hormone associated with sleepiness, they
release melatonin considerably later when they go through puberty. And I assure you that these
animals are not up texting. This really is a phenomenon. The other thing that happens is that,
of course, they wake up naturally later. And we’ve learned now that the REM sleep,
Rapid Eye Movement sleep where the bulk of learning and memory
consolidation take place. That is concentrated in
the last third of the night. So for teenagers that’s going to
be in the early dawn, early morning hours from about 5 to 8AM. That’s when this very critical REM
sleep is occurring and keep that in mind as we
talk about school hours. And by the way, this shift at
puberty occurs in everybody it’s not just people that are
natural night owls. Even if you, we talk sometimes
about chrono types. People who naturally are
morning people or larks. Or evening people
who are owls. And there have been studies
looking at the change over the lifetime, the graph on the bottom are larks,
over the course of a lifetime, and the owls, and you can see that larks
get up earlier than owls, no matter how old they are. But at puberty everybody gets
up later than they did before, if they can . You’ve probably seen this
if you know children. You don’t need studies to tell you
that little kids have different sleep patterns, right? Little kids usually go to
bed early and wake up early. and parents usually know
what’s going on. They can control when their
children fall asleep, they can put their child to bed,
and usually, not newborns I know but older, elementary school kids can
be put to bed at 8 or 8:30 and they usually fall asleep
and parents know it. Teenagers are a completely
different story. You can put a teenager to bed
but you cannot make a teenager sleep, and often parents don’t know
whats going on once they close the bedroom door. And say I don’t certainly want to open
the door of my 16 year old son to see if he’s asleep at
two in the morning. We just don’t know
what’s going on. And many teenagers say even if
they try and go to sleep they lay in bed for hours. They just can’t fall asleep
until 11 or 12. So this is of course where the
school start times come into the picture. Because the average US High Schools you can see from this graph this
is data from the US Department of Education. The average US high school
starts at about eight in the morning. But that’s the average, there are many
many high schools that start in the seven AM hour. I know a couple that start at 6:50
for regular class. And about 10% start before 7:30 AM,
and 43% before 8 AM. Remember when I tell you the
time that class is starting that’s not even considering what time the
buses are picking these kids up, or the kids are getting out on the road,
behind the wheel. County where I live has the
first pickup at 5:23 AM, and the children are asked to be
there ten minutes before that. And then you can think back
about waking up, eating breakfast, showering, walking to the bus stop,
and you start to realize, that teenagers in this country, many of them,
are waking up, at 4:30, 5, 6 in the morning,
to get to class. They have no choice in the matter. They’re actually
being woken in the middle of this critical
period of REM sleep, so they can go to school. And this is why of course recently
The American Academy of Pediatrics, and The American Medical Association
and the Centers for Disease Control, have all recommended that middle and
high schools begin classes no earlier than 8:30 AM. It’s really not a radical proposition,
but it is clearly not happening as you can see on this map. This map is a map,
by state, of the percentage of public middle,
high school, and combined middle and high schools that start
before 8:30 AM. And the ones in dark blue,
which is most of them, are the ones where 75-100% of those schools
start before 8:30 AM. So basically this is a pervasive problem,
over four in five US middle and high schools
start before 8:30 AM right now. And they start at times that
are incompatible with adolescents sleep needs and patterns, and they basically mean that if
a teenager is going to get quality sleep, and not even quality sleep,
but just enough sleep, and rise at five or six AM,
they can’t. Even if they go to bed at a decent time. Forget about the
biology I told you about. If you could get a teenager
to go to sleep early, look at the times they would
have to be asleep, to get nine hours of sleep,
and wake up at these times. You take a typical 15 or 16
year old, the middle line, who has to wake up at 5:45
or 6 in the morning, that teenager would not only
have to be in bed, but sound asleep at 8:45 or 9 at night. Now some teenagers
do and can do this, but most can’t. We know they have school
activities running later than these hours, and this is really a problem. So we basically see that whether
you want to talk about physiological reasons or cultural reasons,
it’s unrealistic to expect teenagers to get enough sleep
when we are waking them up at these times. Here is another way to think
about the problems, just in graphic form. That big red arrow on the left
is showing you the physiologic delay in circadian clocks that happens
as teens go from their old childhood bedtime,
to their teenage bedtime. And the gray square in the middle
is how much sleep time they get. And that would be one thing if
they can sleep later in the morning, but what’s happening is that
they’re getting pushed from the other end of the chart
as their school hours tend to get earlier and earlier. Now ironically I know that here
in Austin the high schools start later
than the Elementary schools. But that’s actually the exception. In most US communities it’s the
high schools that start earlier than the elementary schools. So basically that rectangle in the middle, that sleep rectangle, gets narrower and narrower. And so you see what the problem here is. It’s not just that teenagers are
not getting healthy sleep. It’s that with current school
hours they can’t get healthy sleep. And they can’t really make
up for it by napping either. Or by sleeping in on weekends
or by drinking caffeine, or using energy drinks.
They certainly do all of these things. The early high school start times
mean early release times, and a lot of teenagers who aren’t
doing anything else will come home, and if you’re lucky they will take a nap. They can do other things as well,
like those risky health behaviors, but many of them will nap
all afternoon, and then they can’t fall asleep
till very late at night, so it becomes this vicious circle. Naps also cannot make up
for that loss of that REM sleep in the early morning hours. And that oversleeping on the weekends,
it can make teens feel better, but what it really does is it
sets them up, so that they’re in a state of
permanent social jet lag. Which is exactly like jet lag you
get when you fly from coast to coast. But you don’t have to
go anywhere for it, all you have to do is sleep at very
different hours on the weekend, and physiologically you are in
the same state. It’s like flying from coast to coast
and back every single week, and this is what most,
many many teenagers are doing. And of course caffeine
and other stimulants, they can perk you
up temporarily, but they don’t make
up for sleeps benefits. Sleep researchers always say that the
only substitute for sleep is sleep, and it is true. So we really do have to get,
we have to address the problem. And to do that we have to look at
the roots we are talking about, we are talking about and see
how many of them we can change. Here it is very useful I think to divide the causes of the problem
into individual roots, and structural roots. And what I mean by that is,
individual roots are things you can fix by fixing an
individual person. You can help teens sleep is for
example they have poor sleep hygiene, you can help them fall
asleep under more ideal conditions, or you can address an underlying
sleep disorder, but you also have to look
at the structural roots of the problem. Which are larger than the
individual– things in society that you have to address
to fix a problem, and that would be things like
institutional practices, homework, extra-curricular demands, and
of course, these very early hours, but also environmental problems,
like the fact that we light up our houses very late at night and
that keep us awake. Or even social norms like our
attitudes that celebrate sleep deprivation. and both individual and structural
roots are really important, they all need to be addressed, but I think what’s important
to think about here, is that, if you address individual roots of a problem
like sleep deprivation, you can only get, so
far unless you also address, those underlying structural roots. So that explains a little bit about
why I am focusing on school hours except there are other structural
roots besides school hours so why am I looking at school
hours in particular. And here the explanation
here is actually fairly straightforward. Of all of the factors that I have
mentioned only one has been shown with empirical evidence
to play a major role, and a remediable role,
in teen sleep deprivation. In other words, of all of these
factors we talked about, there’s actually good empirical evidence
that when you move bell times later, more teens get more sleep. Again, when you move school hours
later more teens get more sleep, were not speculating on this,
we know this. and that’s of course why all
of these organizations, have issued these statements, because the evidence is strong enough
for the AMA, and AAP, and the CDC to say this is a way we can actually help
a large proportion of the population. But we’re not doing it, as you have seen,
so why not? And in order to understand that we have to go and take a
a little whirlwind tour of the history of bell times
in the United States. How did we get here and
why can’t we change? And I think that by doing this
you’re gonna see that this is not only a systemic problem but one
that we’ve created for ourselves, and relatively recently at that. So just look at that picture for a
minute cause I’m going to get back to it. That’s a start school later
sticker on the Department of Education Bell,
by the way. This is out little civil disobedience
we removed it afterwards. (audience laughs) I have to tell you that this
history I’m about to give you is still very much
a work in progress. And there is a couple
of reasons for this. It’s very hard to get data
about bell times that school systems have
had throughout history. One of the reasons is that
we have a highly decentralized school
system in this country. And we have actually nearly
13,500 school systems with almost 100,000
schools within them. And they kind of do things their own
way not just their hours but everything. So you can’t really go to a centralized
clearing house for most things and see how one individual school has
changed its practices over the years. But the other reason that it’s hard
to get the data, is that even if we did have this kind of information it’s highly unlikely we’d find very
much about bell times. And the reason for this is that we don’t
measure what we don’t think matters. And until recently nobody
really thought that it mattered what times schools started or ended. Or really what time anything
started or ended. We measured how long
students were in class. We measured how
long workers worked, but nobody understood this whole business
about the timing of sleep and that it mattered what times
thing began or ended. So the data just isn’t there.
The data just aren’t there, but fortunately historians have other ways of getting information,
more indirect ways, diaries and letters and town records, sometimes even
popular songs or literature will give us clues, and from that information
we’ve been able to piece together a pretty clear story about what has
happened, so I’m going to share that with you. One of the things that pops out right
away is that however it is we do things now, we have not done very long. In fact, just think back to that one
room school house I showed you and you’ll realize what I’m talking
about. I mean it really wasn’t that long ago when we would put 5
to 19 year olds all together in one room with one teacher all day long. And these students by the way
all started the school day at exactly the same time, right? That time as it looks, from what we
can tell was about nine in the morning until the middle of the 20th century. Yes, kids woke up earlier sometimes
to slop the pigs or milk the cows or whatever it was they did. But they weren’t required to be in a
classroom until about nine in the morning. One of the way we knows these
things are from town records. This is a report from New Haven,
Connecticut in 1878 and it’s a directive to teachers about what
time to be in the classroom. And from this you can piece together
that the schools ran this way. Students where in class
from nine to noon. Then they got a nice two
hour lunch break. And then they came back from two
to five for an afternoon session. Now, some schools around the
world still work this way but I assure you that no teenager in
the United States has a school schedule like this at all. Things really have changed tremendously,
and in a relatively short period of time. Another what they’ve changed is the
fact that teenagers even go to school. I mean, think about it. Free,
compulsory education is a really relatively new phenomenon. Particularly for high school students
but it boggles my mind when I realize that it was only in 1917, literally a
hundred years ago, when every U.S. state started requiring even
all elementary school students to be in school. Most teenagers just didn’t go to school. In the early 20th century maybe
6 to 11% went to high school, much less graduated. And by the early 1970s over 90%
of high school students were in school so you see there was a
huge change in the way we did things in a relatively
short period of time. So if you want to talk about the
way we’ve always done things in terms of bell times, you really only
have to go back as far as about the early 1970s and in fact 1970 to
see anything remotely even like what we do today.
So let’s do that. 1970 is many ways was a watershed
year in both school start times and in, well in school reform and in
sleep research. And unfortunately not for
the same reasons, the two had nothing to do with each other. In sleep research, 1970 was a watershed
year because that was the year when William Dement who was known as the
father of sleep medicine, opened the very first sleep research
center at Stanford. For schools, however, 1970 was a time
when many of the trends that had been building throughout the century reached
a point when people realized they just weren’t sustainable. And to simplify these trends
they were these four things. There were more students, there were
fewer schools, they were consolidated, there was more busing and
there were longer commutes. These were all very expensive trends,
and unfortunately the 70s was a terrible time to have expensive trends because
there were a large number of economic problems that hit in the early 70s, starting
with the stock market crash and then a recession, inflation, couple of
energy crises, mounting fuel costs and tremendous pressure on the
schools to save money on bus costs. So what did they do? They came up with a brilliant solution. Instead of sending all these
kids to school at the same time, they would stagger the start times. And they would take their
fleet of buses and shrink it down and recycle the same
fleet several times over. And that would save some money
and at the same time these schools were being pressured to add
time onto the school day and they usually did it by tacking on a
few minutes every year onto the beginning of the day. They did it incrementally. Communities adjusted and
everything was great. Except of course it wasn’t great. Because ironically during these very
same years, sleep research was coming of age and during the 70s
and 80s Mary Carskadon and her group at Brown University were
beginning to see that teen sleep needs and patterns were
different than everybody else’s. They were documenting that circadian
shift that I talked about earlier and they were finding ways to actually
measure the impact of sleep problems in teenagers, and at the
same time other researchers were documenting the critical role sleep
was playing in learning and memory. And by the early 1990s this research
was so clear and so strong that sleep researchers starting speaking out and
saying that these early school hours that had been implemented in the last
decade or so were incompatible with teen sleep and health and learning. But of course by then the
damage had been done. Now to give credit where credit is due
the medical community jumped on this pretty early on. As early as 1993, the Minnesota
Medical Association issued a statement that these early hours that
had been implemented in the past decade were detrimental and
they needed to move back. But that was 25 years ago and you saw
the graph I just showed you, so they didn’t have too much of an impact. So just to review this history, everyone
hasn’t always started school so early. People think that but they really haven’t. The shift to these early hours
occurred before we knew very much about teen sleep
needs and patterns. And the moves to the earlier hours
primarily reflected budgetary considerations, they did not reflect the sleep needs of
children or their health, learning, well being or even the
convenience of adults. They were about money. Well, we’ve learned
a lot in those 25 years. We haven’t moved the start times
all that much but we have learned some very important things. One of the things we’ve learned is
when you move bell times later, many of the things that we were worried
about with sleep deprivation are improved and there are other
benefits that we didn’t expect. But the biggest benefit and the
most pertinent one to this conversation is that when school
starts later, more teens get more sleep. And obviously I think this, but you
know it’s actually contrary to what many people would expect cause
you might think if you move bell times later, these kids are just going
to sleep later it seems very, very logical But that actually isn’t what happens. You know, there’s speculation
on one hand and there’s empirical evidence on the other. And the imperial evidence is that
the schools that have moved bell times find that teens generally go
to bed at around the same time. And their cumulative amount of sleep
on school nights is significantly greater. The first time we saw this was in
2001 when Kyla Wahlstrom at the University of Minnesota looked
at two school systems in Minnesota and it’s not coincidental that
they were in Minnesota, one was Minneapolis and
the other was Edina which is a suburb
outside of Minneapolis. They moved their bell times
back to the more traditional hours and they found
these wonderful effects. School performance, dropout rate,
attendance, academic performance improved, there were fewer tardies,
there were less signs of depression. Less sleeping in class, and very
interestingly homework was completed much more efficiently. So that’s kind of interesting in
terms of those interrelated causes I was talking about. Because one reason teens may have
so much homework is that they’re sleeping through it. Well, since that study has came out,
the findings have been confirmed and extended by many other studies
culminating in another very large study again by Kyla Wahlstrom and her
team that came out in 2014. And this one involves, I think it
was six schools, no, six states. Schools in six states, multi-state study. And it showed the same
things we had seen earlier. Plus, very interestingly, a reduction
in signs of, fewer mood swings, signs of depression, but new
findings involved the use of illegal substances as well as
less use of caffeine and energy drinks in teens whose
schools had shifted later. And very importantly they also
found a reduced rate of car crashes in teens who schools
started later in the morning. This study came out this week. And it’s not a study of schools
that have moved their bell times, but a very simple plot of the average
amount of time that teenagers in Canada got compared to the time
their schools started in the morning. Now as you’ll notice in Canada, no school
starts before 8AM, so if we’re going to look at this graph and think what it means
for us in the U.S. you’d have to extrapolate that left line down lower. But there’s a very, very clear linear
correlation between the time– This was also a huge study, by the way. It’s out of McGill. Showing that the earlier school
starts, the less teens– Oh, I’m already five minutes away,
I’ve really got to pick up the pace here. Anyway, only one in three
Canadian teens is deprived of sleep. So figure it what you will. Recently, there’ve been other findings from these studies. One is that if you move
bell times later, students from disadvantaged backgrounds
actually benefit twice as much. I don’t have time to go into the
details now but that was a surprise. And it’s really important, this
is a study by economists at Brookings that documented that. They also found that
change is cost effective. Schools can change their bell
times at low or no cost, but even if they have to add buses,
it turns out that the benefit to cost ratio calculated by these
economists was at least nine to one. So it doesn’t need to be pricey. So we know this is a fixable problem. And the question is why
aren’t we fixing it? So for this last five minutes or
whatever I have I’m going to talk about why we’re not fixing it. And here I like to quote
Schopenhauer, the philosopher who said that “All truth passes through
three stages. First, it is ridiculed. Second, it is violently opposed. Third,
it is accepted as being self-evident.” This is very, very applicable to this
issue. Because it really isn’t about the science or the truth, it’s
about the politics of the problem. Actually, this is almost always a
problem when you try to turn public health into policy. Because people don’t change
their behavior or their policies based on science, reason
and evidence or at least not only
on the basis of science, reason and evidence. They change based on things
like their emotions and their values, social norms,
their pocket books. The classic example of
course is cigarettes, where we knew for years that lung
cancer and cigarettes were linked but there was no change
in policy for decades. And so the way this plays out in
the start time world is that when people first hear about the issue,
they do often respond with ridicule. And the ridicule is based on long
seeded beliefs about sleep and to some extent teenagers. Teenagers are lazy! Just put
them to bed earlier! Or just throw cold water on
them in the morning. We have a lot of these myths and
misconceptions on our website. And that usually is a reaction by
people who are just hearing about the issue for the first time. When communities actually are faced with
a change, however, we move to the second stage, which is venomous opposition. And this opposition is usually based
on fears that are quite legitimate fears. After all, community life in many ways
revolves around school schedules, right? And when you propose changing a school
schedule, people start worrying how it’s going to affect their commute and
their day care arrangement, and the after school sports
practice. They worry about how they’re going to pay for it. Now it turns out that most of
these fears are unfounded. We’ve found that in school systems
that have moved their bell times, and they’re all resolvable. But they’re incredibly powerful
politically and I can’t emphasize that enough. Deb Delial who was
a former superintendent and was at the U.S. Department of
Education until recently said that probably the most difficult thing you
can do as a superintendent is try to fool around with the bell schedule. People go absolutely bananas over that. And while we’re talking about produce,
Kyla Walstrom has called this a political hot potato. And she’s absolutely right and this
is because, again, communities adapt to the hours they have, they push back when you suggest a
change, sometimes to the point where superintendents have
lost their jobs. They don’t want to touch the issue
because they know there’s going to be push back. Now my fellow advocates hate when I say
this because they think that I’m going to scare everyone away. But I will end on an upbeat note,
because this situation is changing. But this is why we still
start school so early. As Upton Sinclair said, “It’s hard to
get a man to understand evidence when his job depends on his
not understanding it.” So you can take all the science you want
and bring it to your school board, but it’s not going to be heard. So, and yet know that many
schools have changed. It’s not all hopeless. From those
schools in Minnesota to the schools in 70 districts who were recently
studied by Judith Owens and her team, we know it can be done.
We list many on our website. In fact there’s been so many that
Judith Owens and her team who were then at Children’s National, They issued a blueprint for change,
where they called out many lessons about what you need to
do for successful change. Their basic findings is that
there’s no one size fits all. But there are certain shared components
of communities that do this. One of them is a leadership that
believes in this cause. That reaches out to educate
stakeholders about why the change is happening and about sleep. That builds consensus among stakeholders
and authentically listens to these fears and concerns, to address them. But the biggest lesson of all that
jumps out of this report, and please read it if you’re thinking
of changing your school system, is that where there’s
a will, there’s a way. Again and again they found that in
school communities that prioritized health and learning, there are creative, affordable ways,
many creative, affordable ways to run schools at safe and healthy hours. So how do we build political will? And I will try to close in the
next minute or two with this.>>We’ll see. I’ll give you 30 to do this.>>Okay, political will is obviously a
very challenging thing to change. But what we’re finding is that
the solution to this problem is a re-framing of the issue. We need to treat sleep and school
hours as public health items. Not as negotiable school budget items. And those of you who are in public
health are probably thinking, well, it is a public health issue, obviously.
But it really isn’t in many school systems. For many school leaders, sleep
and school hours are negotiable budget items that have to be weighed
against other negotiable budget items like whether to pay
teaches or buy textbooks. And they have trouble
making this change. But the minute that these are framed
as absolutely non-negotiable public health needs, everything flips. And suddenly what seemed difficult,
even impossible, becomes, to paraphrase Schopenhauer, inevitable. So, basically I’m saying that we have
a call to action to create a climate that allows for healthy school
hours by re-framing this issue and building political will. And obviously that’s going to
take more than stockpiling studies. It’s going to take, really, coming out
of our comfort zones, in interacting with all the different stakeholders,
on every different level, local, state and national. To build this political will through
a variety of steps and really this is how all public health reform happens. It’s not just school start times. But it is a public health issue,
and it has to be treated that way. We have to do grassroots advocacy and
education from the ground up, and we have to change policy from the top down through
position statements, legislation, and maybe even litigation. And the good
news is this is starting to happen. People are working together from different
fields to get legislation passed. We’ve had three bills passed already in
the past three years. Two have been studies. One is an incentive program to
recognize school systems that move their start times to healthy hours. This was
just passed in Maryland last April. That’s a later school-start-time team in
the back, with the governor signing the bill. We are seeing all kinds of
outreach, education, and advocacy efforts where sleep researchers are coming out of
the woodwork and working with advocates, educators are working with policy makers,
and they’re going beyond their usual boundaries of what they’re supposed to do
in their disciplines to advocate and educate. Some of these are students,
in fact, who are talking on media shows or working with social workers or
educating school leaders at conferences. We’re even having a national conference
at the end of April where we are bringing all these stakeholders together.
And finally, and I think this is the most promising, I think all these statements
by not just the American Medical Association but also local and state PTAs and teacher’s unions and youth sports groups, all saying that school
start time need to move later. These are real signs of progress. They are
really gonna turn this situation around by making it impossible, really, to even
consider running schools at these hours. They’re really changing the way we think
about sleep and school-start times. So that, I do think finally we’re in a
position where, we’re gonna look back and we’re gonna wonder how on earth we
could ever have done this! We’re really– I think Schopenhauer is right.
We’re getting to the point where, because of these sorts of changing in social norms, the education
and the advocacy and the statements, and the legislation, we really will think
that running schools in safe and healthy hours is nothing short of inevitable.
So I am gonna close. Thank you very, very much, if you want more information you
can check out our website. These other two websites as well:
school start time dot org, start school later dot net is our website,
there’s lots of excellent references and I hope I have at least a
few minutes for questions.>>Great, thank you.
(Applause) (Applause) We have time for questions, and if we
don’t get to your question, Terra will have a a few minutes afterwards. While you’re thinking of your questions,
I wanted (inaudible) that we have local Texas start-school-later chapter leaders
here. If you wanna raise your hands, so these guys are working on the issue
locally in Texas, so feel free to talk with them afterwards if you’re thinking
about local. Any questions? I have one but I’ll – Okay.
>>Hi, I’m – Oh, I don’t think this works.>>It’s just for the camera.
>>Oh, okay. Hi, I’m a student here in our Health Behavior Health Education program,
a graduate student. Thank you so much for your talk. It was very exciting. I also
have family that works in school districts in Los Angeles, so I’m excited to talk
to you more at lunch. So my question that I kept thinking about as you were
talking is, also those hours from three to six PM where we see so much adolescent
risk behavior happening with – you’re talking about substance use, risky sexual
behavior, delinquency, and it seems like this later school start time could also
potentially impact that, and I think of all the community organizations that
really focus on those three to six PM hours and I wonder if y’all have
collaborated with those folks. Okay.>>We’re starting to talk to them,
and there’s definitely a lot of talk about the flip side of this whole thing – a lot
of our group says things like “Teens don’t get pregnant at six in the morning.”
Right? But we’re leaving this very, very large window of time open after school
that also has changed, historically. Schools didn’t always get out at 1:55 or
2:05 PM, but there’s not a lot of really good data as Julie will tell you because
she’s looking at it. But, there’s not a lot of good idea showing that for sure,
those changed make a difference, but it seems really logical so we are looking
into that. It seems highly likely that those problems are related to the
early release times, right? Yeah definitely.
>>Hi, I’m James (inaudible). Towards the end of your talk you seemed to be arguing
that the effort now is towards or should be towards advocacy, education, outreach. I’m just wondering, do you see any sort of critical research needs still out there?
>>There are many, many research needs. I mean there’s an interplay between
advocacy and research, right? The advocates need good research or their
whole advocacy effort doesn’t have any credibility. The problem that I’ve seen,
and it’s a problem that goes well beyond this field, is that researchers are often
trained not to advocate. And in fact that if they advocate, it casts doubt on the
lack of bias, right? Their objectivity and their research. And that’s been a real
problem for social movements because if you really believe your research at a
certain point, how much responsibility do you have to go out there and see that
people understand it, and there’s an interplay between those things.
There’s a lot of things we don’t know. I mean a lot of the things I’ve mentioned
are correlations rather than absolute proof, and there are many theories with
just the idea that you proposed that have not been confirmed. We have a lot to learn
but we can’t wait to make decisions till we know everything. If we did that we’d
never do anything. We have to make decisions in the face of uncertainty,
because these are real people, real children who are living this life and we
already know we’re doing damage, so I do emphasize the advocacy and the policy
change now but absolutely there’s lot of research to be done. I’d just like to see
the researchers working hand in hand with the advocates and educating them and
speaking outside their own communities. We’ve had too much preaching to the choir.
And you can see the impact it’s had because there hasn’t been much change.>>(inaudible)>>Hi, my name is (inaudible). I’m actually
from China, so when you showed those datas that when Chinese students are
going to sleep, it was really surprising because, I actually started school – I – Yeah, I was in a boarding
school so we had a certain time for the lights
to turn out, and – so we slept around 10 PM, and also in our schedule we have the time for, like a noon nap. So students can get a power nap during the – at noon after lunch
so I think it’s really beneficial, for me at least that I feel really energized for
my afternoon courses. So do you think that power nap would be more – would be also a strategy that
schools can use to resolve the sleeping deprivation?
>>There are ways that you can help the situation and a nap in the middle of the
day – there are lots of creative ways to run a school schedule. But if you were
going to sleep at 10 o’clock, I mean that’s only an hour earlier than most teens can fall asleep, and so a nap could
probably compensate for that to some degree. One of the things we have to
remember is that humans can do many things. It doesn’t mean that they should
do those things. It doesn’t mean they’re ideal. Might have been better if you got
to sleep in a little later in the morning, but, you certainly – what you experienced
isn’t anywhere near as extreme what most teenagers are experiencing, and I’m not sure they could
make up for staying up until 1 and 2 AM and waking up at 5 with
a nap. But with a schedule which is enforced in a boarding school, I think
you could. And some of the studies that I mentioned, by the way, were done in
boarding schools, where the students did have their sleep regulated. But they even
found that moving that bell time a little later was still helpful, but absolutely.
Naps have their place, and they can help. Just not totally. Yeah.
>>Alright, I think we should wrap up. Terra can take individual questions if
you’d like. Let’s thank her again. (applause)
>>Thank you.

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