NSF -- Adolescent Sleep Needs and Patterns

8/2/2019 NSF -- Adolescent Sleep Needs and Patterns

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AD O LESC EN T

SLEEP NEEDS

AND PATTERNS

R e s e a r c h R e p o r t

a n d R e s o u r c e G u i d e

PUBLISHED BY TH E N ATIO N AL SLEEP FO UN DAT I O N


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AD O LESC EN T

SLEEP NEEDS

AND PATTERNS

PUBLISHED BY TH E N ATION AL SLEEP FOUN D AT I O N

w w w. s l e e p f o u n d a t i o n . o r g

R e s e a r c h R e p o r t

a n d R e s o u r c e G u i d e


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Table of Contents

Preface .............................................................................................................................................................i

PART ONE: Research Report ........................................................................................................................1

Introduction .............................................................................................................................................1

Ph ysio logica l Patt ern s ......................................................... ...............................................................2

Beh aviora l an d Psycho social Patte rn s................................................................................................2

Con sequences of Poor Sleep in Adolescent s .........................................................................................3

Wh at Can Be Done ..................................................................................................................................4

Reference s.................................................................................................................................................7

PART TWO: Resource Guide .......................................................................................................................11

Pointers for Parent s ...............................................................................................................................11

Tips for Teen s .........................................................................................................................................13

Becom e a sleep-sm art tren dset ter ....................................................................................................13

High School Start Times .......................................................................................................................14

Sum m ary of Find in gs....................................................... ................................................................1 4

Factors to Con sider ..........................................................................................................................15

References.........................................................................................................................................18

The Zs to A s Act ...................................................................................................................................19

Drowsy Driving Fact Sheet ...................................................................................................................20

Wh o Is Most At Risk?............................................................... ........................................................2 0

Wh at Are Effective Cou n term easures? ............................................................................................21

Minn esota Medical Association Resolution s: Models for Ch ange ...................................................22

Sch oo l Sta rt Times............................................. ................................................................. ..............22

Drowsy Drivin g ......................................................... ................................................................. ......22

American Medical Association House Of Delegates Resolution 418: Sleepy Driving ....................23

Oth er Resources .....................................................................................................................................24

Organizations...................................................................................................................................24

Web Resources..................................................................................................................................26


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PrefaceThe National Institutes of Health (NIH) have identified adolescents

and young adults (ages 12 to 25 years) as a population at high risk for

problem sleepiness based on evidence that the prevalence of problem

sleepiness is high and increasing with particularly serious consequences.

(NIH, 1997) This designation evolved from a Working Group on

Problem Sleepiness convened in 1997 by NIHs National Center on

Sleep Disorders Research and the Office of Prevention, Education, and

Control. The group concluded that steps must be taken to reduce the

risks associated with problem sleepiness.

What are these risks? The most troubling consequences of sleepiness are

injuries and deaths related to lapses in attention and delayed response

times at critical moments, such as while driving. Drowsiness or fatigue

has been identified as a principle cause in at least 100,000 police-

reported traffic crashes each year, killing more than 1,500 Americans

and injuring another 71,000, according to the National Highway

Traffic Safety Administrat ion (NHTSA, 1994). You n g dr ivers age

25 or un der cau se m ore th a n one-ha lf of fall-a sleep cra shes.

The National Sleep Foundations (NSF) Sleep And Teens Task Force

developed this publicat ion to summarize existing research about

sleep-related issues affecting adolescents. We hope that this report

will serve as a valuable and practical resource for parents, educators,

community leaders, adolescents and others in their efforts to make

informed decisions regarding health , safety an d sleep-related issues

within their communities.

A nonprofit, private organization, NSF is a leader in public education

efforts regarding the risks associated with drowsy driving and other

issues related to sleepiness and sleep loss. We welcome your comments

about this document and your suggestions for expanding public aware-

ness and supporting positive changes to protect the safety and well-being

of our nations youth.

For more information, and an online copy of this report please visit NSFs

Web site at www.sleepfoundation.org. The Foundation can also be

reached by e-ma il at nsf@sleepfounda tion.org; phone (202 ) 347 -3471;

or fax (202) 347 -3472. NSFs address is 1522 K Street, NW, Suite 500,

Washington, DC 20 005.

Natio nal Sleep Foun dat ion

Sleep And Teens Task Force

C O - C H A I R S

Mary Carskadon , PhDBrown University

Providence, Rhode Islan d

Thomas Roth, PhD

Henry Ford Sleep Disorders Center

Detroit, Michigan

M E M B E R S

Ruth M. Benca, MD, PhD

University of Wisconsin/Madison

Madison, W isconsin

Ronald E. Dahl, MDUniversity of Pit tsburgh

Medical Center

Pittsburgh, Pennsylvania

William C. Demen t, MD, PhD

Stanford University Sleep

Disorders Center

Palo Alto, California

Mark Mahowald, MD

Hennepin County Medical Center

Minneapolis, Minnesota

Jodi A. Mind ell, PhDSt. Joseph University

Philadelphia, Pennsylvania

Kyla L. Wahlstrom, PhD

University of Minn esota

Minneapolis, Minnesota

Amy R. Wolfson, PhD

College of the Holy Cross

Worcester, Massachusetts

N SF STA F F

Susan D. Sagusti

Program Mana ger

Megan Spokas

Intern

Richard Gelula

Executive Director

2000 N ational Sleep Foundation

i


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AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation 1

PA RT O N E

Research Report

In troductionSleep is a basic drive of nature. Sufficient sleep helps us think more clearly, complete complex tasks better

an d m ore consisten tly and en joy everyday life more fully. Altho ugh ma n y questions regardin g the role of

sleep rem ain un an swered, scien tific studies have sho wn th at sleep con tributes significantly to several

importan t cognitive, em otional an d performan ce-related fun ction s.

Sleep is, in essence, food for the brain, and insufficient sleep can be h armful, even life-th reatening.

Wh en h un gry for sleep, th e brain becom es relentless in its quest to satisfy its need and will cause feel-

ings of sleepiness, decreased levels of alertness or con centration , an d, in m an y cases, un an ticipated


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2 A D O LESCEN T SLEEP N EED S AN D PAT T E R N S W National Sleep Foundation

sleep. Excessive sleepiness is also associated with reduced short-term memory and learning ability, nega-

tive mood , in consisten t perform ance, poor prod uctivity and loss of some forms of behavioral con trol

(NIH, 1997).

Researchers have identified several changes in sleep patterns, sleep/wake systems and circadian timing

systems associated with puberty. (Carskadon, 1999) These changes contribute to excessive sleepinessth at h as a negative impact on daytime fun ctionin g in adolescents, including increasin g their risk of

injury. (Wolfson an d Carskadon , 1998) Findin gs are similar in North Am erica an d in indu strialized

countries on other continents. (Carskadon, 1999)

Scientists hypothesize that these sleep-related problems are due largely to conflicts between physiologi-

cally-driven sleep needs and patterns, and behavioral and psychosocial factors that influence sleep habits.

Key chan ges in sleep p atterns an d n eeds that are associated with pu berty in clude:

PHYSIO LO GI CAL PAT T E R N S

A d o l esc en t s r e q u i r e a t l e a st a s m u c h s le ep as they did as pre-adolescents (in general,

8.5 to 9.25 h ours each n ight). (Carskadon et al., 1980)

Da yt i m e s l ee p i n e ss i n c r e a s es for som e, to p ath ological levels even whe n an adolescen ts

schedu le provides for op tim al amoun ts of sleep. (Carskadon , Vieri, Acebo, 1993)

A d o l esc en t s sl e ep p a t t e r n s u n d e r g o a p h a s e d e l a y , that is, a tenden cy toward later

times, for both sleeping an d waking. Stud ies show th at th e typical h igh school studen ts natu ral

time to fall asleep is 11:00 pm or later. (Wolfson an d Carskadon , 1998)


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AD O LESCEN T SLEEP N EEDS A N D PAT T E R N S W National Sleep Foundation 3

B E H AVIO RAL AN D PSYCH OSOCIAL PAT T E R N S

M a n y U .S. a d o l e sc en t s d o n o t g e t e n o u g h s le ep , especially during the week. Survey data

show th at average total sleep time du ring the scho ol week decreases from 7 h ours, 42 min utes

in 13 year olds to 7 h ours, 4 min utes in 19 year olds. (Wolfson an d Carskadon, 1998) On ly 15

percent of adolescents reported sleeping 8.5 or m ore hou rs on school nigh ts, an d 26 percent of

studen ts reported typically sleeping 6.5 h ours or less each schoo l night .

A d o l esc en t s h a v e ir r e g u l a r s l ee p p a t t e r n s; in particular, th eir weekend sleep schedu les

are much different than their weekday schedules, to some extent as a direct consequence of weekday

sleep loss. Th ese differences in clude both the quantity an d th e timin g of sleep. On e study of more

th an 3,000 adolescent s sh owed th at th e average increase of weekend over weekday sleep a cross ages

13-19 was one h our an d 50 m inu tes. (Wolfson an d Carskadon , 1998) In 1 8-year-olds, the average

discrepancy was more than two hours. In addition, 91 percent of the surveyed high school students

reported going to sleep after 11:00 pm on weekends, and 40 percent went to bed after 11:00 pm on

school nights.

Irregular sleep sched ules includ ing significan t d iscrepancies between weekdays an d

weekends can contribute to a shift in sleep ph ase (ie, tendency t oward morn ingn ess or

evenin gness), trouble fallin g asleep or awaken in g, an d fragmen ted (po or qua lity) sleep.

(Dahl an d Carskadon , 1995)

Consequences of Poor Sleep in Adolescents

Data on children, teens an d adu lts con firm th at sleep loss and sleep

difficulties can h ave serious det rimen tal effects. Research sp ecifically

on adolescents an d youn g adults is relatively new an d limited, butscient ists believe that m an y effects demon strated in studies and

clin ical observations o f adults are similar in ad olescents. Sleep

researchers, therefore, believe that insufficient sleep in teens and

youn g adults is linked to:

I n c r e a se d r i sk o f u n i n t e n t i o n a l i n j u r i e s a n d d e a t h .

As noted, drowsiness or fatigue has been identified as a principle

cause in at least 100,000 traffic crashes each year. In addition,

about 1 m illion , or on e-sixth , of traffic crash es in th e United States

are believed to be attributable to lapses in t h e drivers atten tion;

sleep loss and fatigue significantly increase the chances of such

lapses occurring. A North Carolin a state study foun d th at drivers

age 25 or youn ger cause m ore th an on e-h alf (55 percen t) of fall-

asleep crashes.


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The same sym ptom s of sleepiness th at con tribute to t raffic crash es can also play a role in n on -traffic

injuries, such as those associated with h an dling hazardous equipm ent in th e workplace or in th e

h om e. Furth ermore, adolescents who h ave not received sufficien t sleep and wh o con sum e even

small amou n ts of alcoho l are at greater risk of injury th an th ose who are not lacking sleep because

sleep loss has been shown to h eigh ten th e effects of alcoho l. (Roeh rs et al., 1994)

Lo w g r a d e s a n d p o o r sc h o o l p e r f o r m a n ce . High school students who describe themselves as

h avin g academic problem s and wh o are earning Cs or below in schoo l report getting less sleep, h av-

ing later bedtim es and h aving m ore irregular sleep schedu les th an studen ts reportin g higher grades.

(Note: A causal relation ship h as no t yet been establish ed.) (Wolfson an d Carskadon , 1998)

N eg a t i v e m o o d s (e.g., an ger, sadn ess an d fear), difficulty con trolling em otion s an d beh avior prob-

lems. In one study, female high school students who wen t to sleep on th e weekend two or more h ours

later than their typical weeknight bedt ime reported feeling m ore depressed than tho se who d id no t

stay up late on the weekends. (Wolfson and Carskadon, 1998)

Studies also suggest that sleep loss may be associated with a decreased ability to control, inhibit or

change emotional responses. (Dahl, 1999) Some signs of sleepiness, such as inability to stay focused

on a task, impulsivity, difficulty sitting still, and problems completing tasks, resemble behaviors

com m on also in atten tion deficit hyp eractivity disorder (ADHD) (Dahl, 1999). In addition , a 1995

study of students in transition from junior high to senior high school found that conduct/aggres-

sive behaviors were highly associated with shorter sleep times and later sleep start time. (Wolfson

et al., 1995)

I n c r e a se d l ik e li h o o d o f s t i m u l a n t u se (in cludin g caffeine an d n icotin e), alcoh ol and sim ilar

substances. (Carskadon , 1990)

Teens wh o are h eavily in volved in sch ool an d com m un ity activities, th eir jobs and oth er respon sibilities

appear to be at greater risk for the above effects of sleepiness than those who are less involved in activi-

ties an d wh o either do n ot h old jobs or wh o work fewer h ours. (Carskadon , 1990)

Wh at Can Be Don e

The consequ ences of insufficient sleep am on g adolescents are particularly impo rtant to un derstand

because th ey appear to be closely tied to key element s of hum an developm ent. Achievin g developm ental

goals during adolescence is essential for lifelong success and for what psychologists call social compe-

ten cy. In addition, th e transition from ch ildh ood to adu lthoo d is a critical tim e for seeding the

values an d h abits that will sh ape th eir lives. Th erefore, in tervention to im prove th e sleep pattern s of

adolescents is im portan t.


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Inf luencing Physiolog ical Sleep Pat t erns

Sleep research ers have established th at b asic sleep n eeds within ind ivid-

uals generally remain th e same th rough out t h eir lifetime. Furth ermore,

insufficient sleep accum ulates in to a sleep d ebt th at can ultimately be

relieved on ly through addition al sleep.

Circadian timin g system s are also very resistan t to ch ange. Behavioral

m ethod s, such as con trolled l ight exposure and ch ron oth erapy, can

som etimes h elp shift circadian timin g to more socially approp riate sleep

an d wake times. Because the circadian rh yth m s in teen agers are typical-

ly h igh ly sensitive to erratic sch edules, to effectively adju st th em

requires m akin g gradual, persisten t and co n sisten t chan ges. Adap ting

to a n early sch ool schedule following summ er or oth er vacation peri-

ods d uring wh ich very late sch edules are typically kept, for examp le,

can take several days to several weeks.

It is im portan t to recognize th at excessive sleepiness during th e day an d

oth er sleep prob lems can be an indication o f an un derlyin g biological

sleep d isorder. Accurate d iagno sis of disorders such as n arcolepsy, sleep

apn ea and p eriodic lim b m ovemen t disorder usually requires examin a-

tion by a q ualified sleep specialist and an overnight stay in a sleep labo-

ratory. In m ost cases, sympto m s of sleep disorders can be elim inated o r

minimized through the use of appropriate behavior modifications,

medication or other therapies.

Creat in g Sleep-Fri endl y School s

Scho ol system s can h elp positively influen ce adolescent sleep p atternsin several ways. Suggestion s includ e:

E d u c a t e teachers, school h ealth providers and oth er scho ol

person nel about ado lescent sleep n eeds and patterns, and about the

sign s of sleep loss and oth er sleep or alertn ess difficulties. Teach ers

and sch ool staff shou ld also be inform ed about accomm odations th at

might be n eeded by som e studen ts with ch ron ic sleep disorders.

I n t e g r a t e sleep-related edu cation in curricula so th at studen ts

can learn abou t th e ph ysiology and ben efits of sleep an d th e conse-quen ces of sleep deprivation. Relevant academic subjects include,

for example, biology, health and psychology. In addition, drivers

education courses shou ld cover the prevalence and prevention of

crashes related to drowsy driving.

CHANGING

SLEEP HABITS

Perhaps the most signifi-

cant behavioral change

that adolescents can

make and that their

parents can encourage

them to make is to

establish and maintain a

consistent sleep/wakeschedule. This is a good

practice for people at

all ages, but may be

especially important

for adolescents.

Understanding and

practicing other behav-

iors that are considered

good sleep habits are

also important. These

include getting enough

sleep, avoiding caffeine

and other stimulants late

in the day and alcohol at

night, gaining exposure

to bright light at appro-

priate times to reinforce

the brains circadiantim ing system, relaxing

before going to sleep

and creating an environ-

ment conducive to

quality sleep.



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Graduated licen sin g regulations to reduce the n um ber of adolescent s driving un supervised at night.

Ch ild labor laws to restrict the n um ber of h ours and t h e time of day that adolescen ts are permitted

to work.

Fun ding to sup port pu blic education an d scient ific research on topics such as the int errelation shipsamo n g sleep loss and injury, learning, an d perform ance, as well as epidem iological data. Relevan t

federal oversight of funded agencies include the National Center for Sleep Disorders Research and

oth er agencies of the Nation al In stitutes of Health, th e Food and Drug Adm inistration , th e

Departmen t of Transportation , the Departm ent o f Education , the Cen ters for Disease Con trol and

Prevention, and military branches.

Initiatives to ed ucate key adults who ha ve frequen t an d regular con tact with a dolescents (eg, caregivers

and auth oritarian s) about sleep, the signs an d h azards of sleepiness, and appropriate interven tion s

for children an d ado lescent s sh owin g signs of sleep difficulties or disorders. Con stituen ts include

parents, teachers, school administrators, school nurses and counselors, coaches, employers, health

providers (family practitioners, adolescen t m edicine specialists, an d th ose who specialize in m en tal

health or learning disabilities) and voluntary group leaders of youth-oriented organizations. In addi-

tion, p olice and emergen cy care personn el sh ould be train ed to recognize problem sleepiness and

distinguish its signs from those associated with drug or alcohol use.

Mak ing New Discoveri es

Sleep research h as established clear relation ships between sleepin ess, health , safety an d p roduct ivity.

However, th e sleep research field in general is relatively youn g, and scient ists still h ave m uch to learn

about th e role of sleep an d th e effects of sleep loss in h um an s. Add ition al stud ies on th e neu robiology,

genetics, epidem iology, and n eurobeh avioral an d fun ctional con sequences of sleepiness are needed.

(NIH, 1997) More studies specifically on the adolescent population are also needed, including interdisci-

plin ary research t o further exam ine sleeps role in adolescent develop m ent , health an d beh avior.

Referen ces

1. Acebo, Wolfson , Carskadon . Relation ship Am on g Self-Reported Sleep Pattern s, Health and Injuries

in Adolescents. Sleep Research Abstract, 1997 .

2. Brown et al. Adolescence, Sleepiness and Driving. Sleep Research 1996, 25: 459.

3. Brownlee, Shan non . Inside the Teen Brain. U.S. News and W orld Report. Augu st 9, 1999, 45-54.

4. Carnegie Foundat ion Council on Adolescent Development , 1996.

5. Carskadon MA, Acebo C, Richardson GS, Tate BA, Seifer R. An approach to studyin g circadian

rhythm s of adolescent h um ans. Journal of Biological Rhythms 1997, 12 (3): 278-289.


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8 AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation

6. Carskadon MA, Harvey K, Duke P, An ders TF, Litt IF, Dem ent W C. Pubertal ch an ges in daytim e

sleepiness. Sleep 1980, 2: 453-460.

7. Carskadon MA, Vieri C, Acebo C. Association between puberty and delayed phase preference.

Sleep 1993, 16: 258-262.

8. Carskado n MA, Wolfson AR, Acebo C, Tzischinsky O, Seifer R. Adolescent sleep pattern s, circadiantimin g, and sleepiness at a tran sition to early scho ol days. Sleep 1998; 21: 871-881.

9. Carskadon MA. Adolescen t sleepiness: Increased risk in a high-risk popu lation. Alcohol, Drugs and

Driving 1990; 5 (4): 317-328.

10. Carskadon MA. Pattern s of sleep and sleepiness in adolescent s. Pediatrician 1990, 17: 5-12.

11. Carskado n MA. Wh en worlds collide: Adolescent n eed for sleep versus societal deman ds. Phi Delta

Kappan 1999; 348-353.

12. Cent er for the Stud y and Preven tion of Violen ce. Youth Violence: A Public Health Co n cern.

Fact Sheet 9. June 1999.

13. Chervin, R. Letter to th e Editor, New England Journal of Medicine. 1999.

14. Dahl RE, Carskadon MA. Sleep an d its disorders in adolescence. Principles and Practices of Sleep

Medicine in the Child . W. B. Saunders Company, 1995: 19-27.

15. Dahl RE. Th e consequen ces of in sufficien t sleep for adolescents: Links between sleep an d em o-

tional regulation . Phi Delta Kappan 1999; 354-359.

16. Dahl RE. The impact of inadequate sleep on childrens daytime cognitive fun ction. Seminars in

Pediat ric Neurology 1996, 3(1): 44-50.

17 . Dem en t W C. The Promise of Sleep . Dell Publishin g, 1999.

18. Kryger MH, Roth T, Demen t W C. Principles and Practice of Sleep Medicine. Ph iladelph ia, PA: W.B.

Saunders Company, 1994.

19. Morrison DN, McGee R, Stan ton WR. Sleep problem s in ad olescence. Journal of the American

Academy of Child a nd Adolescent Psychiatry 1992, 31(1): 94-99.

20. National Highway Traffic Safety Adm inistration, U.S. Departmen t of Transportation . Crash es and

fatalities related to driver drowsin ess/fatigue. Research Notes. 1994.

21. Nat ional Inst itute of Mental Health. This Ch ild Needs Help . 1999.

22. National Institutes of Health, National Cent er on Sleep Disorders Research an d Office of

Prevention, Education, and Control. Working group report on problem sleepiness. Augu st 1997.

23. National Institutes of Health, National Center on Sleep Disorders Research an d Office of

Prevention, Education, and Control. Problem sleepiness in your patient. Septem ber 1997,

NIH Publication No. 97-4073.


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AD O LESCEN T SLEEP N EEDS A N D PAT T E R N S W National Sleep Foundation 9

24. National Institutes of Health, National Cent er on Sleep Disorders Research an d Office of

Prevention, Edu cation , and Con trol. Educating youth about sleep and drowsy driving. September 1998.

25. Nation al In stitutes of Health, National Insti tute of Mental Health. How biological clocks work.

1999, NIH Publication No. 99-4603.

26. National Institutes of Health , Nation al In stitute of Neurological Disorders and Stroke. UnderstandingSleep. 1998, NIH Publication No. 98-3440-c.

27. National Sleep Foundat ion. 1999 Sleep in America Poll Results. April 1999.

28. Pack AI, Pack AM, Rod gma n E, Cucciara A, Dinges DF, Sch wab CW . Cha racteristics of crashes

attributed to th e driver havin g fallen asleep. Accident Analysis and Prevention . 1995, 27 (6).

29. Roeh rs T, Beare D, Zorick F, Roth T. Sleepin ess an d eth ano l effects on sim ulated d riving. Alcohol

Clin Exp Research . 1994, 18 (1).

30. U.S. Departmen t of Health an d Hum an Services, Adm inistration for Ch ildren an d Fam ilies,

Adm inistration on Ch ildren, Youth an d Fam ilies, Family an d Youth Services Bureau. Understanding

youth development: Promoting positive pathways of growth. Jan uary 1997, Contract No. 105-94-2017.

31. Wolfson AR, Tzischin sky O, Brown C, Darley C, Acebo C, Carskadon MA. Sleep, behavior, an d stress

at the transition to senior high school. Sleep Research 1995, 24. (Abstract)

32. Wolfson AR, Carskadon MA. Sleep Schedu les and Daytime Fun ctionin g in Adolescent s. Child

Development 1998, 69: 875-887.

33. Wahlst rom, KL and Freeman CM. School Start Time Study: Report Summary. The Center for Applied

Research and Educational Improvement, College of Education and Human Development,

University of Minn esota. 1997.


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PART TWO

Resource Guide

Pointers for Parents

1. Educate yourself about adolescent developm ent, including physical and behavioral chan ges

you can expect (especially those th at relate to sleep needs an d p atterns).

2. Look for sign s of sleep deprivation (insufficient sleep) and sleepiness in your children. Keep in

m ind th at th e signs are n ot always obvious, especially in yo un ger (pre-adolescent ) children .

Signs includ e:

difficulty wakin g in th e mo rnin g,

irritability late in the day,

fallin g asleep spon tan eously during qu iet times of the day,

sleeping for extra long p eriods on th e weeken ds.

Oth er sign s can m imic or exacerbate behaviors com m on ly associated with at tent ion d eficit hyperac-

tivity disorder (ADHD).

3. Enforce and m aintain age-appropriate sleep schedules for all children.

4. Talk with you r children abou t their individual sleep/wake sch edules an d levels of sleepin ess. Assess

how much time they spend in extracurricular and employment activities and how it affects their

sleep patt erns. Work with t h em to ad just th eir schedu les to allow for enou gh sleep, if necessary.

5. Provide a hom e environment conducive to heal thy sleep. Establish a quiet t ime in the evening

wh en th e lights are dimm ed an d loud m usic is n ot perm itted. Do n ot allow use of th e television ,

computer an d teleph one close to bedtime.


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6. Encourage your ch ildren to comp lete a sleep diary for 7 to 14 con secutive (and typical) days. The

diary can provide immediate information on poor sleep habits, and it can be used to measure the

effectiveness of efforts to change. Be sure to share the sleep logs or diaries with any sleep experts

or oth er h ealth p rofessional wh o later assesses your ch ilds sleep or sleepiness. Wh y n ot keep your

own sleep diary as well? (Sleep diaries are available from the National Sleep Foundation or from

you r local sleep center.)

7. If your childs sleep schedule during vacation is n ot synchron ous with upcomin g school or work

dem an ds, h elp him or h er adjust their schedu le for a sm ooth transition. Th is process can take

from several days to several weeks, so plan ahead!

8. If con servative m easures to shift your childs circadian rhythm s are ineffective, or if your child

practices good sleep h abits and still has d ifficulty stayin g awake at times th rough out th e day:

Consult a sleep expert. Excessive daytime sleepiness can be a sign of narcolepsy, sleep apnea,

periodic limb m ovemen t disorder and oth er serious bu t treatable sleep d isorders.

Discuss with teachers and sch ool officials ways to accom m odate your ch ilds needs, if needed.

Excessive daytime sleepiness due to sleep disorders or other medical conditions are covered

un der th e Am ericans with Disabilities Act an d t h e Disabilities Edu cation Act of 1997 (IDEA 97).

9. Be a good role mod el: make sleep a high priority for yourself and your family by practicing good

sleep habits. Listen to your body: if you are often sleepy during the day, go to sleep earlier, take

n aps, or sleep lon ger when possible. Consult a sleep exp ert if n eeded. Above all, dont allow an y

fam ily m emb er to drive when sleep deprived or drowsy.

10. Actively seek posit ive chan ges in your comm un ity by increasing public awareness about sleep an d

th e h armful effects of sleep deprivation an d b y supp orting sleep-smart p olicies. Request th at sleep

education be included in sch ool curricula at all levels and in drivers education courses. En courage

your school district to provide optimal environments for learning, including adopting healthy and

approp riate school start tim es for all stud ents.


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Tips for Teen s

1. Sleep is food for the brain. Lack of sleep can m ake you

look tired an d feel depressed, irritable o r an gry. Even

m ild sleepin ess can h urt your p erform an ce from taking

sch ool exam s to p layin g sports or video gam es. Learnhow m uch sleep you n eed to fun ction at your best

most adolescents need between 8.5 and 9.25 hours of

sleep each n igh t an d strive to get it every nigh t. You

shou ld awaken refresh ed, no t tired.

2. Keep con sistency in mind : establish a regular bedtime an d

waketime schedule, and maintain this schedule during

weeken ds an d sch ool (or work) vacations. Don t stray from

your schedule frequen tly, an d n ever do so for two or more

consecutive nigh ts. If you m ust go o ff schedule, avoid

delaying your bedtime by more than one hour. Awaken

the next day within two hours of your regular schedule,

an d, if you are sleepy du rin g th e day, take an early after-

noon nap.

3. Get into br ight l ight as soon as possible in the m orning,

but avoid it in th e even ing. Th e light h elps to signal to th e

brain when it sh ould wake up an d when it should prepare

to sleep.

4. Understand your circadian rhythm s. Then you can t ry tomaximize your schedule throughout the day according to

your int ernal clock. For examp le, to com pen sate for your

slump (sleepy) times, participate in stimulating activities

or classes th at are in teractive. Try to avoid lectu re classes

an d p oten tially un safe activities, includin g drivin g.

5. After lun ch (or after noon ), stay away from caffeinated

coffee and colas as well as nicotine, which are all stimu-

lants. Also avoid alcohol, which disrupts sleep.

6. Relax before going to bed. Avoid h eavy reading, studying

and compu ter games within on e hou r of going to bed.

Dont fall asleep with the television on flickering light

and stimulating content can inhibit restful sleep.


Become a sleep-sm arttrendsetter

Be a bed head, not a

dead head. Understand the

dangers of insufficient sleep

and avoid them! Encourage

your friends to do the same.

Ask others how much sleep

theyve had lately before you

let them drive you somewhere.

Remember: friends dont let

friends drive drowsy.

Brag about your bedt im e.

Tell your friends how good

you feel after getting more

than 8 hours of sleep!

Do you st udy wit h a buddy?

If youre getting together after

school, tell your pal you need

to catch a nap first, or take a

nap break if needed. (Taking a

nap in the evening may make

it harder for you to sleep at

night , however.)

St eer clear of raves and

say no to all-nig ht ers.

Staying up late can cause chaos

in your sleep patterns and your

ability to be alert the next day...

and beyond. Remember, the

best thing you can do to pre-

pare for a test is to get plenty of

sleep. All nighters or late-night

study sessions might seem to

give you more time to cram for

your exam, but they are also

likely to drain your brainpower.


17/30

14 AD O LESCEN T SLEEP N EED S AN D PAT T E R N S W National Sleep Foundation

High School Start Tim es

Sum mary of Findi ngs

Does chan gin g sch ool schedu les m ake a positive difference on adolescent sleep patt erns? Does this

approach affect academic achievemen t, beh avior and safety? Th e Cent er for Applied Research an d

Education al Im provem ent (CAREI) at th e Un iversity of Min n esota has stud ied th ese issues am on g bothsuburban an d urban sch ools. (Wahlstrom an d Freeman , 1997) Current d ata reveals th at after daily high

sch ool schedu les are delayed from early m ornin g start times:

Subu rban stud ents report th at, in general, th ey gain an extra hou r of sleep each sch oolday because

they m aintain th e same bedtime and extend th eir sleep in the m orning.

Most teachers observe that m ore studen ts are alert during th e first two periods of the school

sch edule an d fewer studen ts fell asleep at th eir desks. Som e studen ts feel th ey are better able to

com plete more of their ho m ework during sch ool h ours because th ey are m ore alert and efficien t

during the day.

Overall studen t atten dan ce increases and tardiness decreases.

Som e studen ts report eating breakfast m ore frequ ently.


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Teachers in suburban sch ools report n oticeable improvem ent s in studen t beh avior, as evidenced by

quieter h allways between classes and less m isbeh avior in t h e lun chroom . Similarly, coun selors from

suburban sch ools describe th e sch ool atm osph ere as calm er, and report th at fewer stud ent s seek

help for stress relief due to academic pressures. Urban teachers, however, observed no general

improvement in student behavior.

Suburban teachers and students did not report any remarkable change or conflict in students

participation in n on academic activities, including work. However, teach ers an d studen ts from t h e

urban schools reported th at fewer stud ent s were in volved in extracurricular an d social activities,

an d th e later sch ool sch edules resulted in con flicts or comp romised earnings for studen ts who

worked after school.

Individual comm un ities can vary greatly in th eir priorities an d values, and ad optin g a policy of later

start tim es in h igh sch ools might n ot be opt imal for every comm un ity or even for every school within

a com mu nity.

Factor s t o ConsiderAdop ting later start times in h igh schools is a com plex process that touch es in some way n early every

aspect of the surrounding community. The list below provides insight into common issues and poten-

tial option s for chan ging high sch ool sch edules.

B el l sc h e d u l es of e le m e n t a r y a n d m i d d l e o r j u n i o r h i g h s ch o o l s in th e district. To a ccom -

modate for the shift in the schedule of school buses, food service and other nonacademic services

provided as part of th e sch ool experience, a chan ge in h igh school bell times often forces a shift in

local schools at oth er levels. For instan ce, som e districts h ave foun d th at switch ing times with th e

elem entary schoo ls is th e least cum bersom e in term s of scho ol system resources (an d is mo re in lin e

with both groups of studen ts sleep pat terns). In oth er districts, lower level schoo ls as well as high

sch ools have sh ifted th eir schedu les.

Tr a n sp o r t a t ion services and related issues. Transpo rtation services m ay be th e sin gle most

com plex, costly and co n sisten tly significant factor am on g scho ol districts, especially if schedule

chan ges result in t h e n eed for additional sch ool buses. Issues related to transportin g studen ts at all

grade levels to an d from school m igh t in volve public scho ol buses, forms of general pu blic trans-

portation (such as buses or subway systems) an d personal tran sportation p rovided by parents an d

high schoo l students.

Oth er con sideration s includ e availability of drivers and parking spaces for school bu s drivers;

chan ge in th e num ber of ho urs that drivers work, which can be influenced by the am oun t of oth er

traffic while en rou te; and t h e effect of the t imin g of schoo l buses on com m uter traffic. The im pact

of th e schoo l bus sch edule on availability of tran sportation for extracurricular activities may also

be imp ortant.


19/30


At h l et i c p r o g r a m s a n d o t h e r ex t r a c u r r i cu l a r a c t i v i t ie s. The im pact on student ath letic

programs appears to be of h igh impo rtance consisten tly with in school districts th at h ave examined

th e plausibility of chan gin g sch ool bell tim es. Ch an gin g sch ool bell times directly in fluen ces the

timin g of athletic programs an d extracurricular activities, and studen ts who participate in ath letic

programs or extracurricular activities arrive hom e later as the schedu le chan ge generates a dom ino

effect. A m ajor concern for districts th at h ave outd oor ath letic programs is the shorten ed periodof daylight after the school day ends. Also, if school hours differ significantly among schools in

the same competitive league, further adjustments or negotiations may be needed to maintain the

same program.

The availability of coaches can become either a problem or a plus with delayed bell times. For example,

if coach ing staff work for a local elem en tary or m iddle schoo l as well as th e high schoo l, the int erre-

lation ship o f the school schedu les is significan t. On th e oth er han d, a later sch edule m ight facilitate

additional involvemen t by wo rkin g parents because th e time wo uld likely interfere less with th eir

professional sch edules. (This th eory could apply also to o th er extracurricular activities.)

U se o f t h e sc h o o l f o r c o m m u n i t y a c t i v it i e s, such as group m embership or adult education

programs, held d uring n on -schoo l h ours.

Th e imp act of bell times on th e accessibility of sch ool facilities for com m un ity grou p m eetings, adu lt

education al or religious programs an d oth er activities can generate great con troversy within th e

community. Some organizations may object to a request for even minimal schedule changes and, in

some cases, revenue potential from leasing facilities or providing other services must be considered.

Also, cleanin g services m ay have lim ited time between th e end of th e scho ol day and th e begin n ing

of evenin g activities.

Sc ho o l f ood s e r v i c e . Factors to be con sidered include wh eth er later start times would requ ire a

chan ge in m eal times or th e addition of breakfast services. Such service chan ges may be furth er

complicated by related issues such as the level of service provided by school cafeterias (onsite versus

offsite food preparation), auxiliary use of kitchen facilities for oth er com m un ity programs (such as

Meals on Wh eels or child care programs) and th e adapt ability of food service workers to tim e

chan ges. (Wah lstrom an d Freeman , 1997)

Em p lo ym en t of adolescents. Based on interviews with employers of high scho ol studen ts

(Wahlstrom an d Freeman , 1997), the n um ber of h ours available for teens to work would n ot be

significantly affected, alth ough some accom m odation s for after-school schedu les m igh t n eed to

be m ade by emp loyers. However, child labor laws that restrict th e nu m ber of h ours and time of

day th at adolescent s are permitted to work n eed to be studied in relation to sch ool ho urs.

Safe ty i s sues related to daylight and darkness. A significant issue in school schedule discussions is

the impact on safety for both students and others in the community. This can be reviewed from

several perspectives and with regard to all scho ol levels. First is the am oun t of dayligh t th rough out

the school year during the t ime th at students are com mu ting to an d from schoo l. Many wh o advo-


20/30


cate for older studen ts to begin th eir schoo l days earlier than youn ger stud ent s (e.g., grade school)

base th eir preference on th e belief th at older, m ore self-sufficient children walking to school or

waitin g for sch ool buses in m ornin g darkness is safer than sim ilar comm utes by youn ger studen ts,

for example.

Cr i m i n a l a n d o t h er r i sk y b e h a v io r s. Th e hou rs shortly after scho ol appear to be a critical time

for assessing safety risks among adolescents. Latch-key students, or those who return home from

school to an empty house, are more prone to risky behaviors during this time than their peers who

h ave supervision at h om e. (Carnegie Foun dation , 1996)

National stud ies an d an alysis of data from th e Federal Bureau o f In vestigation reveal th at on sch ool

days, 45 percent of juvenile violen t crim e takes place between 2:00 pm an d 8:00 pm , with th e

sharpest rise occurrin g between 2:00 pm an d 4:00 pm . (Wah lstrom an d Freeman , 1997; CSPV, 1998)

During these times, unsupervised adolescents are more likely to engage in acts of violence, as well

as sex an d recreation al use of alcoho l or drugs. Propon ents of delayed h igh sch ool start times sug-

gest th at th e resultant delayed sch ool closin g times could limit th e amou n t of tim e that ad olescents

are un supervised after schoo l.

I m p a c t on t h e f a m i l y. Research on th e degree to which ch anging school start tim es or m aking

oth er chan ges in t h e sch edules an d beh aviors of adolescents im pacts family mem bers is lim ited and

largely an ecdotal. Th e effects vary widely, depend ing o n family com position , socioecon om ic status,

cultural backgroun d an d values and ot h er factors.


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Issues to con sider when assessing th e poten tial im pact on th e fam ily wh en chan ging sch ool start

times include the contributions of the adolescent to the care of younger siblings or other household

m embers, preparing meals or han dling oth er househo ld chores, tran sportation n eeded an d used by

the adolescent as well as other household members (e.g., sharing the use of an automobile) and the

level of dependen ce on incom e generated by th e teen.

Household members would theoretically benefit indirectly from the positive effects of improved

sleep patterns and beh aviors on th e adolescent, such as improved m oods, behavior and int eractions

with others.

References

Carnegie Foundation Council on Adolescent Development, 1996.

Center for the Study and Prevention of Violence (CSPV). Youth Violence: A Public Health Concern.

Fact Sh eet 9. Jun e 1999.

Fairfax Cou nt y Public Scho ols. Report of the task force to study h igh sch ool open ing times. 1998.

Wahlstrom , KL an d Freem an CM. Sch ool Start Time Stu dy: Final Repo rt Sum m ary. The Cen ter for

Applied Research and Educational Improvement, College of Education and Human Development,

University of Minn esota. 1997.


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Th e Zs to As ActA bi ll i nt rod uced i n Cong ress by U.S. Represent at ive Zoe Lof gr en (D-CA) t o encourage

later school st art t im es for secondary student s.

106t h CONGRESS / 1st Session

H.R. 1267

To provide grants to local education al agen cies that agree to begin sch ool for second ary stud ents

after 9:00 in the morning.

IN THE HOUSE OF REPRESENTATIVES

March 24, 1999

Ms. LOFGREN int roduced t h e following bill; which was referred to th e Com m ittee on Education and

th e Workforce.

A BILL

To p rovide gran ts to local educational agen cies th at agree to begin scho ol for second ary studen ts after

9:00 in the m orning.

Be it enacted by the Senate and House of Representatives of the United States of America

in Congress a ssembled,

SECTION 1. SHORT TITLE

This Act m ay be cited a s th e Zs to As Act.

SEC. 2. PROGRAM AUTHORIZATION.

(a) IN GENERAL Th e Secretary of Edu cation is auth orized to p rovide a gran t of n ot m ore

th an $25,000 to each local education al agency th at agrees to begin sch ool for second ary

students after 9:00 in the morning.

(b) ELIGIBILITY To be eligible to receive a grant un der t h is section , a local ed ucat ion al

agency shall subm it an application to th e Secretary providin g assuran ces that

(1) at th e time of th e application , secon dary sch ools served by th e local education al

agency begin sch ool before 9:00 in th e mo rnin g; an d

(2) n ot later th an 2 years after th e date of subm ission of the ap plication, second ary

sch ools served by such agency shall begin classes after 9:00 in th e m ornin g.

(c) USES OF FUNDS A local educat ion al agency t h at receives a grant un der th is Act m ay

use such grant fund s to pay for the adm inistrative and op eratin g costs associated in ch an gin g

th e h ours of operation o f second ary schoo ls served by such agency.

(d) DEFINITIONS For p urp oses o f th is Act

(1) th e term secon dary sch ool h as the same m eanin g given such term in section 141 01(25)

of the Elemen tary and Second ary Education Act of 1965

(20 U.S.C. 8801(25)); and

(2) the term Secretary means the Secretary of Education.


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Drowsy Driving Report

It is difficult to attribute crashes to sleepiness because there is no test to determine its presence as

th ere is for in toxication (i.e., a breath alyzer). In addition , th ere are no standardized criteria for dete r-

m inin g driver sleepiness and t here is little or n o police trainin g in ident ifying drowsin ess crash factors.

Also, to date, six states (Alabam a, Missouri, Arkansas, Delaware, Massachusetts, an d Wiscon sin ) do n ot

have a code for sleepiness on th eir crash rep ort forms.

The U.S. Nation al Highway Traffic Safety Adm inistration (NHTSA) estim ates th at ap prox ima tely

100,000 police-reported crashes annually (about 1.5% of all crashes) involve drowsiness/fatigue as a princi-

pal causal factor. A con servative estim ate of related fatalities is 1,500 an nually or 4% of all traffic crash

fatalities. At least 71,000 people are in jured in fall-asleep crashes each year. NHTSA estimates th ese crashes

represent $12.5 billion in mo n etary losses each year.

Drowsiness/fatigue may play a role in crashes attributed to other causes. About one million crashes

an nu ally one-sixth o f all crashes are th ough t to b e produced by driver ina ttention /lapses. Sleep

deprivation an d fatigue m ake such lapses of attention m ore likely to occur.

In a 19 99 NSF po ll, 62% of all adults surveyed reported driving a car or ot h er vehicle while feeling

drowsy in th e prior year. Twen ty-seven percent reported th at th ey had, at som e time, dozed off

while driving. Twenty-three percent of adults stated that they know someone who experienced a

fall-asleep crash within the past year.

People tend to fall asleep m ore on h igh-speed, lon g, boring, rural highways. New York police

estim ate th at 30% of all fatal crash es alon g th e New York Thruway occurred because th e driver

fell asleep at the wheel.

Who Is Most At Risk?

All drivers who are: Sleep-deprived o r fatigued

Driving lon g distances withou t rest breaks

Driving through the night, the early

afterno on, or at oth er t im es wh en th ey are

normally asleep

YOUN G PEOPLE

Sleep-related crashes are m ost comm on in you n g people, who ten d to stay up late, sleep too little, and

drive at night. In a North Carolina state study, 55% of fall-asleep crashes involved people 25 years old

or younger. 78% were males. The peak age of occurrence was 20.

SHIFT WORKERS

25 m illion Am ericans are rotating sh ift workers. Stud ies suggest th at 20% to 30% of th ose with n on -

traditional work schedules have h ad a fatigue-related d riving m ish ap with in t h e last year. Th e drive

h om e from work after th e n igh t shift is likely to be a p articularly dan gerous on e.

Taking m edication th at increases sleepiness

or drin king alcoho l

Driving alon e

Driving on long, rural, borin g roads

Frequ en t t ravelers, e.g., business travelers


24/30


CO M M ERCIAL DRIVERS

Truck drivers are especially susceptible to fatigue-related crashes. In addition to the high number of

m iles driven each year, man y truckers m ay drive du ring th e nigh t wh en t he b od y is sleepiest. Truckers

m ay also h ave a h igh prevalence of a sleep an d breath ing disorder called sleep ap n ea. Studies suggest truck

driver fatigue m ay be a con tributing factor in at least 30 to 40 p ercent of all heavy truck acciden ts.

PEO PLE WITH UN TREATED SLEEP DISO RDERS

The presence of an untreated sleep disorder increases the risk of crashes. Disorders such as sleep apnea,

n arcolepsy, and p eriodic lim b m ovemen t disorder, all of wh ich frequen tly lead to excessive daytime

sleepiness, afflict an estim ated 30 m illion Am ericans. Most p eople with sleep d isorders remain un diag-

nosed and un treated.

W hat Are Ef f ect ive Count erm easures?

Before motorists embark on their trips, they should:

Get a good n igh ts sleep. Wh ile th is varies from individual to individual, th e average adu lt

requires about 8 h ours of sleep a n igh t; adolescents n eed 8.5 to 9.25 hou rs each n igh t.

Plan to drive long trips with a companion. Passengers can help look for early warning signsof fatigue or switch drivers wh en n eeded. Passengers shou ld stay awake to talk to th e driver.

Schedule regular stops, every 100 miles or 2 hours.

Avoid alcoh ol and m edication s (over-th e-coun ter and prescribed) th at m ay impair performan ce.

Alcohol in teracts with fatigue; in creasin g its effects just like drin king on an emp ty stom ach.

Con sult your ph ysician or a local sleep d isorders cen ter for diagno sis and treatmen t if you

suffer frequen t daytim e sleepiness, have d ifficulty sleeping at n ight often , and /or sn ore

loudly every n igh t.

Once driving, motorists should look for the following warning signs of fatigue:

You can t rem em ber th e last few miles driven.

You drift from your lan e or h it a rum ble strip.

You experience wand erin g or discon n ected tho ugh ts.

You yaw n rep eatedly .

You h ave difficulty focusing or keepin g your eyes open .

You tailgat e or m iss traffic signs.

You h ave trouble keeping your h ead up .

You keep jerking your veh icle back into th e lane.

If you are tired, recognize that you are in danger of falling asleep and cannot predict when a microsleep may occur.

Dont count on the radio, open window or other tricks to keep you awake.

Respond to sym ptom s of fatigue by fin ding a safe place to stop for a break.

Pull off into a safe area away from traffic and take a brief nap (15 to 45 minutes) if tired.

Drin k coffee or an oth er source of caffeine to prom ote sh ort-term alertn ess if n eeded.

(It takes about 30 m inu tes for caffeine to ent er the b loodstream.)


25/30


Minnesota Medical Association Resolutions: Models for Change

The Min n esota Medical Association (MMA) has been a catalyst for policy ch an ges regardin g sch ool start

times and education related to d riving and fatigue. MMA h as demon strated th e impact th at applying

sound policies based on scientific evidence can have on local, statewide, and national levels.

School St art Times

In 1993, t h e Minn esota Psychiatric Society subm itted a resolution ent itled Sleep Deprivation in

Adolescents t o th e Minn esota Medical Association . MMA subsequent ly passed th e resolution , wh ich

provided for an ed ucation al cam paign explaining th e need for more sleep during adolescen ce than

durin g childhoo d, th e biological sh ift to a later sleep patt ern in adolescence, and th e impact of inade-

quate sleep on driving safety and school performance. The MMA will urge local school districts to

elim inate early starting h ours of schoo l for teenagers.

Th is resolution led to th e n ations first sch ool district (Edina, Min n esota) to adop t d elayed schoo l start

times based on scientific evidence of ph ysiological chan ges in sleep n eeds and patterns associated with

pu berty. This landm ark decision op ened th e doors to additional research about sleep in adolescents and

its imp act on their cognitive and oth er fun ction s, and sparked heightened p ublic awaren ess about th is

issue across the United States.

Drow sy Driving

On September 28, 1999, the Minnesota Medical Association adopted two sleep-related resolutions

highlighting the dangers of drowsy driving. Similar language was submitted to the American Medical

Association (AMA) for con sideration by its Hou se of Delegates at th e 1999 In terim Meetin g. AMA

consequently adopted Resolution 418 (I-99) with slight modifications.

RESOLUTIO N 31 4

RESOLVED, that th e Minn esota Medical Association d efine sleepiness behin d th e wheel as a m ajor pub lic

h ealth issue through the d evelopmen t of a public education campaign , and be it further

RESOLVED, th at th e Min n esota Med ical Association delegation to t h e Am erican Med ical Association

(AMA) submit a resolution to the AMA calling on the AMA to define sleepiness behind the wheel as

a m ajor public health issue through the d evelopmen t of a n ation al public education campaign.

RESOLUTION 315

RESOLVED, th at th e Min n esota Medical Association wo rk with in terested o rganization s to p rom ote th e

incorporation of an edu cational compo nen t on th e dan gers of drivin g wh ile sleepy in all drivers educa-tion (for all age groups) in the state of Minnesota, and be it further

RESOLVED, th at th e Minn esota Med ical Association delegation to t h e Am erican Med ical Association

(AMA) submit a resolution to the AMA calling on the AMA to encourage all state medical associations

to prom ote th e incorporation of an education al com pon ent on the dangers of driving wh ile sleepy in

all drivers education (for all age groups) in each state.


26/30

AD O LESCEN T SLEEP N EED S AN D PAT T E R N S W National Sleep Foundation 23

Am erican Medical Association Hou se Of Delegates

Resolut ion 418: Sleepy Drivin g

I N T R O D U C E D BY : Minn esota Delegation

R E F E R R E D T O : Reference Com m ittee D Public Health (Willarda Edwa rds, MD, Chair)

The following incorpora tes a mend m ents a s a dopted by th e AMA House of Delega tes, Decemb er 1999.

Source: Preliminary reports of the AMA House of Delegates at its 1999 Interim Meeting. AMA

cau tions th a t such reports should not b e considered fina l an d th a t only the Officia l Proceedings

of th e House of Delega tes reflect officia l policy of th e a ssocia tion .

Wh ereas, Motor veh icle crash es are a leading cause of inju ry and death in th e United States; and

Whereas, The safe operation of a motor vehicle requires alertness as well as quick and accurate

perception, judgment, an d action; and

Wh ereas, An alyses perform ed b y th e Nation al Highway Traffic Safety Adm inistration (NHTSA)

estim ate th at 1%-3% of U.S. h ighway crash es and 4% of fatal mo tor veh icle crash es are caused b y

driver sleepin ess; and

Wh ereas, Surveys indicate th at m any individuals have experien ced excessive sleepiness while drivin g,

while 60% of sleep-related crash es are attributab le to d rivers younger th an 30; and

Whereas, The reasons for sleepiness in drivers include sleep disorders (e.g., obstructive sleep apnea),

sleep d eprivation, an d cu m ulative sleep loss; and

Wh ereas, Physician s have an impo rtant role in preventin g sleep-related in juries and death s by

assessm ent an d follow-up of excessive sleepiness in th eir patients an d d iscussion of possible h ealth an d

safety implications; and

Wh ereas, Ph ysician s sh ould be alert to th e possibility th at patient s may be imp aired by alcoho lism an d

oth er med ical cond itions th at can affect drivin g capabilities; an d

Whereas, Physicians need to understand the range of sleep disorders, including their diagnosis, treatment,

and consequences; and

Whereas, Many drivers, without impact, instinctively open the windows, turn up the radio, and/or

drink caffeine to fight sleepiness while driving; and

Wh ereas, Drivers education courses provide an im portan t opp ortun ity to teach n ew drivers about t h e

dangers of driving while sleeping; and

Wh ereas, Education al campaigns to em ph asize the fact that sleep is a biological im perative and th at

sleepiness is n either a mino r ann oyan ce nor th e sign of a personality defect are recom m end ed to

add ress sleepiness while driving; th erefore be it

RESOLVED, Th at th e Am erican Medical Association define sleepiness beh ind th e wh eel as a major pu blic

h ealth issue an d en courage a n ational pu blic education cam paign by approp riate federal agencies an d

relevant advocacy group s, an d be it furth er

RESOLVED, That the American Medical Association encourage all state medical associations to promote

th e in corporation of an edu cational comp on ent o n t h e dan gers of drivin g while sleepy in all drivers

education classes (for all age groups) in each state.


27/30


Other Resources

Readers are encouraged to review the references listed in the Research Report and in the Resource Guide, a s

well as th e resources below. Please n ote th at th e following lists are inten ded to serve as a startin g poin t

for addition al information an d d o n ot represent an exhau stive list of available resources.

Organizations

A AA Fo u n d a t i o n f o r T r a f f i c Sa f e t y

1440 New York Avenue, NW

Suite 201

Wash ington , DC 20005-6001

www.aafts.org

Am e r i ca n Ac a d e m y o f Ch i ld &

A d o l esc en t P s y ch i a t r y

3615 W iscon sin Ave., NWWash ington , DC 20016-3007

www.aacap.org

Am e r i ca n Ac a d e m y o f P e d i a t r i c s

141 North west Poin t Boulevard

Elk Grove Village, IL 60007-1098

www.aap.org/family/sleep.htm

A m e r i c a n A ca d e m y o f Sl ee p M e d i c in e

6301 Band el Road

Suite 1 01

Rochester, MN 55901

www.aasm.org

A m e r i c a n As so c i a t i o n o f

Sc h o o l Ad m i n i st r a t o r s

1801 N. Mo ore Street

Arlington , VA 22209

www.aasa.org

A m e r i c a n Sc h o o l H e a l t h A sso c i a t i o n7263 State Route 43

P.O. Box 708

Kent, OH 44240-0013

www.ashaweb.org/

Bo a r d o n Ch i l d r e n Y ou t h ,

a n d F a m i li es

Nation al Academ y of Sciences

Institute of Medicin e

2101 Con stitution Avenu e, HA 156

Washington, DC 20418

www.nation al-academies.org/cbsse/bocyf

Ce n t e r f o r A p p l i e d R ese a r c h a n dEd u c a t io n a l I m p r o v em e n t

College of Education & Human Development

265-2 Peik Hall

159 Pillsbury Drive SE

University of Minn esota

Minn eapolis, MN 55455-0208

http://carei.coled.umn.edu

D ep a r t m e n t o f Ad o l e sc en t a n d

Sc h oo l He a l t h ( DASH)

National Cen ter for Chron ic Disease

Prevention and Health Promotion

Cent ers for Disease Cont rol and Prevention

1600 Clifton Road, NE

Atlan ta, GA 30333

www.cdc.gov/nccdphp/dash

I n s u r a n c e I n s t i t u t e f o r

H i g h w a y Sa f e t y

1005 N. Glebe Road , Suite 8 00

Arlin gton , VA 22201www.iihs.org

www.hwysafety.org


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AD O LESCEN T SLEEP N EED S AN D PAT T E R N S W National Sleep Foundation 25

M i nn e so t a M e d i c a l As soc i a t i on

Suite 300 Broadway Place East

3433 Broadway Street NE

Minn eapolis, MN 55413

www.mnmed.org/

N a t i o n a l A sso c i a t i o n o f S ch o o l

Nur s es , In c .

P.O. Box 1300

Scarborou gh , ME 04070

www.nasn.org

N a t i o n a l Ce n t e r o n Sl e ep

Di so r de r s Res ea r c h

National Heart, Lun g, and Blood In stitute

National In stitutes o f Health

9000 Rockville Pike, Building 31

Bethesda, MD 20892

www.nhlbi.nih.gov/about/ncsdr/index.htm

Na t i o n a l Ce n t e r f o r I n j u r y P r e v en t i o n

a n d C on t r o l

4770 Buford Highway, NE

Atlan ta, GA 30341 -3724

www.cdc.gov/ncipc

Na t i o n a l Ed u c a t i o n A sso c i a t i o n1201 16th Street NW, Suite 521

Wash ington , DC 20036

www.nea.org

Na t i o n a l H ig h w a y T r a f f ic

Sa f e t y A d m i n i st r a t i o n

400 Seventh Street SW


www.nhtsa.dot.gov

N a t i o n a l P a r e n t T e a c h e r A sso c i a t i o n

330 N. Wabash Avenu e

Ch icago, IL 60611

www.pta.org

Na t i o n a l Sc h o o l B o a r d s Fo u n d a t i o n , I n c .

1680 Du ke Street

Alexandria, VA 22314

www.nsbf.org

N a t i o n a l Sl e ep Fo u n d a t i o n1522 K Street, NW

Suite 5 00


www.sleepfoundation.org

P a r e n t s Ag a i n s t T i r ed T r u c k e r s

P.O. Box 209

Lisbon Falls, ME 04252-0209

www.patt.org

Soc i e t y f o r Ado l e s c en t M e d i c i n e

1916 NW Copp er Oaks Circle

Blue Springs, MO 64 015

www.adolescenthealth.org/

St u d e n t s A g a i n s t D e st r u c t i v e D ec i si o n s

101 Depot Road

Chath am, MA 02688

U.S. De p a r t m e n t o f H e a lt h a n d

H u m a n Se r v ic esDivision of Children an d Yout h Policy

200 Indep end ence Avenu e, SW


h ttp://aspe.os.dh h s.gov/h sp/cyph om e.h tm


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26 A DO LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation

Web Resources

See also Website addresses under Organ izations.

Adol e sc e nc e D i r e c t o r y On -L in e

A service of the Center for Adolescent Studies at Indiana University, this site provides information for

profession als, parent s, and teens abo ut a wide ran ge of adolescent issues.

http :/ /www.education .ind iana.edu/cas/adol/adol.htm l

AMA Ado l e sc e n t He a l t h On- Li n e

Sponsored by the American Medical Association, this site includes details about the AMA Guidelines for

Ado lescen t Preven tive Services (GAPS); abstracts of selected recent reports a n d o th er resources.

http://www.ama-assn.org/adolhlth

Ed u c a t i o n R eso u r c e Or g a n i za t i o n s D ir e ct o r y

Published b y th e U.S. Departmen t of Education th is directory is in tend ed to h elp users identify and

contact organization s th at provide in forma tion an d assistan ce on a broad ran ge of education-related to pics.

http://www.ed.gov/Programs/EROD/

Fa m i ly Ed u c a t i o n N et w o r k

Sponsored by a consortium of public sector and private sector relationships including major education-

al an d profession al association s th is on lin e compan y provides education al an d ch ild-developm en t

resources and services for fam ilies, corporate em ployers, schools and comm un ities. Th e Nation al Parent

Teacher Associations exclusive Intern et p artner prom oting family involvemen t, Fam ilyEducation

Network produces familyeducation.com, teachervision.com, myschoolonline.com, and infoplease.com.

www.familyeducation.com

Sl e ep H o m e P a g e s

Fun ded in part by a grant from th e National Institute of Mental Health, th is Website offers a com pre-

h ensive resource of sleep-related information for consum ers, research ers, educators, studen ts an d

clinicians. www.sleephomepages.org

Sl e ep f r o m A t o Z z z

Developed by an international group of adolescents, this site covers a wide range of sleep-related infor-

m ation for teen s and earned a Silver Award in th e 1999 ThinkQu est In ternet Ch allenge, Sports &

Health Category. http://www.thinkquest.org/library/25553.shtml

Yo u t h I n f o

A project of the U.S. Department of Health and Human Services, this site includes a fact sheet profile

of Americas youth; full texts or summaries of various reports, publications, and speeches from govern-

mental and non-governmental sources; grant information and other resources. http:/ /youth.hhs.gov


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Nat ion al Sleep Found ati on

1522 K Street, NW, Suite 500, W ashington , DC 20005

Tel 202.347.3471, Fax 202.347.3472

E-mail n sf @sleepfou n dat ion .org

2000 National Sleep Foundation

NSF -- Adolescent Sleep Needs and Patterns

Documents

Transcript of NSF -- Adolescent Sleep Needs and Patterns