Sleep Deprivation and Academic Performance

Running head: SLEEP DEPRIVATION AND ACADEMIC PERFORMANCE

Sleep Deprivation and Adolescent Academic Performance

Janie Dam ELM 8845 July 4, 2016 Professor Rick Ansoff Alliant International University, San Diego

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ABSTRACT Sleep deprivation is now a recognized public health concern, including among youth populations and within the school environment. The author’s first-hand observation of and experience with students’ excessive daytime sleepiness, and the associated academic challenges, have motivated the writing of this paper. This paper will discuss the current research on the causes of insufficient sleep, and the impact that sleep deficits can have on adolescents’ academic performance. A social explanation for chronic sleep loss may be the nature of today’s teenage life style, such as staying up late at night texting with friends while completing a heavy load of homework; having to get up extra early the next morning to get to school. The neurological causes behind sleep deprivation include sleeping disorders such as Insomnia, Obstructive Sleep Apnea, Restless Legs Syndrome and Narcolepsy. This writing will also present the various approaches and treatments that researchers and experts in the growing field of somnology are proposing to help teenage students cope with their sleeping disorders as well as develop the hygienic habits necessary to maintain a healthier daily amount of sleep.

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Sleep Deprivation and Adolescents’ Academic Performance Prevalence of Insufficient Sleep Linked to fatal car collisions, disastrous industrial accidents, serious medical or other occupational errors, insufficient sleep is increasingly considered a significant public health concern (Institute of Medicine, 2006). To assess this growing problem the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES) began conducting the Sleep Disorders Questionnaire in 2005 for participants 16 years of age and older.

Data from the 2005–2006 and 2007–2008 survey cycles, which included 10,896 respondents aged 20 years or older, indicated that adults ages 20–39 years and 40–59 years were most likely to have short sleep duration (37.0% and 40.3%, respectively). Adults who reported sleeping less than the recommended 7–9 hours per night were more prone to difficulty in performing daily tasks. By 2009, only 31% of high school students responding to the sleep questionnaire reported that they were getting at least 8 hours of sleep on an average school night, even though the National Institute of Health recommended 9-10 hours of sleep on a daily basis for teenagers. In the 2006 National Sleep Foundation’s Sleep in America poll only 1 out of 5 6th-12th graders reported that they got the optimal 9 hours of sleep on school nights, and more than half reported that they were getting less than 8 hours of sleep on school nights. In addition to shortened sleep duration, poor sleep quality has also been studied in recent years as a factor in impaired student cognitive and school performance (e.g., Johnston, Gradisar, Dohnt, Billows & McCappin, 2010).

Impact of Sleep Deficits on Academic Performance Sleep is essential for maintaining the nervous system’s proper function, and is thus vital to survival. The surprisingly active stages of sleep were first discovered in the 1950s through human brain waves experiments conducted with electroencephalography (EEG). Current studies

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are exploring the ways that brain cells and chemicals operate to regulate sleep and examining the changes that take place in the brain when the individual becomes sleep-deprived (Society for Neuroscience, 2012). Sleep researchers have observed that during roughly the first hour of falling asleep, the brain goes through a series of stages during which its waves slow down. This period of NREM slow wave sleep is characterized by relaxation of the muscles and the eyes and the lowering of heart rate, blood pressure, and body temperature. If woken up during this stage, most people recall only fragmented thoughts (Society for Neuroscience, Brainfacts.org). Over the following half hour or so, brain activity progresses dramatically from deep slow wave sleep to rapid eye movement (REM) sleep, involving neocortical EEG waves comparable to those that occur while the person is fully awake. Heart rate, blood pressure, and body temperature return to their variable states. However, the difference is in the presence of atonia, or paralysis of the body’s muscles, during REM sleep. Only the muscles needed for breathing and eye movement control remain active during this phase, when dreaming can take place (Society for Neuroscience, Brainfacts.org). Through a night of normal sleep, the cycles of quiet NREM and active REM alternate, with the slow wave sleep becoming shallow while the REM periods become more prolonged until the person fully wakes up (Society for Neuroscience, Brainfacts.org).

Per Caskadon, during sleep, the developing adolescent brain carries out the essential tasks of regulation and self-organization, as well as consolidating learning and memory from the previous day (2012). In studying the relationship between hours of sleep and delinquent behavior among juveniles, Clinkinbeard, Simi, Evans, & Anderson argued that the amount of sleep that adolescents get each night does matter because both their brains and bodies are experiencing very rapid growth (2010). In comparing children without sleeping difficulties to those suffering from sleep disturbances, it has been found that the average academic grades of teens suffering from

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poor sleep quality are significantly lower than those of teens who have no sleep problems. Stated Beebe, as principal investigator of the 2010 study on the effects of Obstruct Sleep Apnea on students’ academic achievement: There was an impressive impact of sleep-disordered breathing on academic grades.

That leaves the subjects with moderate to severe sleep apnea at a serious disadvantage…Academic performance in middle and high school has implications for adult outcomes, including high school graduation, college admission and completion, and adult mental illness and substance abuse.

Based on Wolfson and Caskadon’s prior findings that only about half of American teenagers sleep at least 7 hours at night when there is school on the next day, far below the recommended 9 hours, Beebe, Douglas and Amin also set out to experimentally test whether chronic sleep deprivation is causally related to otherwise healthy children’s inattentive behaviors, reduced arousal and poor learning in a classroom-like situation. In their experiment 16 healthy adolescents underwent 5 consecutive nights of sleep restriction (6½ hours in bed) and then 5 consecutive nights of healthy sleep duration (10 hours in bed). At the end of each test condition, participants were given quizzes in a simulated classroom after watching related educational films. Eight of the participants were also subjected to video and electroencephalography (EEG) monitoring to measure levels of inattentive behaviors and arousal. The resulting pilot data corroborated previous correlational reports by showing that limited sleep in adolescents resulted in inattention, lowered arousal and diminished learning in the classroom setting.

Causal Factors of Chronic Sleep Deprivation A number of lifestyle factors can combine to rob teens of their sleep: demanding schoolwork assignments, early school start times, their cell phones. Professor Caskadon at Brown University calls it the “Catch-22” of teenage sleep:

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Teens are naturally inclined to stay up late, but are forced to wake up early [to attend school]... their workloads have increased, their bedtimes are less strictly enforced and their access to light-emitting gadgets at nighttime has increased. The result is an unhealthfully shortened period of sleep each night (2012).

Earlier in 2008 Moore and Meltzer’s research had revealed that 44% of adolescents spend long hours before bedtime surfing online and text messaging.

Students yawning and having to put much effort into staying awake to follow along in class is not an uncommon sight on today’s high school campuses. Invariably, when asked why he/she is so sleepy, the student would reply that he/she had stayed up late the night before doing homework, surfing the Internet and texting friends. While neither quantitative nor qualitative data has been formally collected at the school where the author works, the anecdotal information that can be gathered from conversations between students and their classroom teachers, guidance counselors, Special Education resource specialists and academic deans would seem to corroborate Caskadon’s statement and Moore & Meltzer’s findings. Furthermore, it may be worthwhile to examine whether the school’s recently launched one-to-one Chromebook program has any additional impact on students’ sleeping habits and patterns. Thus far, time-stamped student usage statistics that can be collected from students being on the school-issued Chromebooks do reveal that some students are actively taking screenshots and doing online searches just a few hours before the start of the school day. While this new technology equipment is welcomed by both teachers and students as a useful paperless instructional tool, there may be “side effects” on students’ sleeping health associated with these devices that may be worth studying.

Alongside adolescent lifestyle and life habits, specific neurological disorders may also lead to chronic sleep deficits. Sleeping disorders are disturbances to the normal sleep patterns of

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NREM sleep, REM sleep and also dreaming. Silvestri’s 2012 compilation of scientific articles on the topic indicates a rather lengthy list of sleeping abnormalities that have been identified.

However, the most frequent sleeping disorders among youths are known to be Insomnia, Obstructive Sleep Apnea, Restless Legs Syndrome and Narcolepsy (Gordon, 2013).

Defined as “repeated difficulty with sleep initiation, duration, consolidation or quality that occurs despite adequate time and opportunity for sleep” (American Academy of Sleep Medicine, 2005), Insomnia is prevalent among the teenage population, as it is within the adult population. This condition often gives rise to daytime fatigue, deficient attention, memory or concentration, social or vocational dysfunction, mood disturbances, and drowsiness (Ohayon, Roberts, Zulley, Smirne, & Priest, 2000). Since attention, memory, concentration, awakeness, even mood, all come into play in the process of classroom learning, an argument can well be made that the symptoms of Insomnia could significantly and detrimentally impact students’ academic achievement. According to Robert, Roberts, & Duong (2008), stomach pain, body aches and sluggishness can also follow Insomnia in adolescents. Because physical pain and discomfort are accepted excuses for missing school, certainly a case can be made that Insomnia also negatively impacts school attendance and therefore student learning.

Obstruct Sleep Apnea (OSA) is the sleeping disorder where the individual displays snoring and recurrently stops breathing momentarily while sleeping (Park, Ramar & Olson, 2011). Examined by Beebe, et al, in 2010, this potentially dangerous sleeping abnormality most often occurs in obese youths and youths with Down’s syndrome. As Beebe declared, the long term negative effects of OSA extend beyond the student’s K-12 experience into his/her adult life.

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Restless Legs Syndrome (RLS) is the neurological disorder described as throbbing, pulling, creeping, crawling, tingling, or other unpleasant sensations in the legs accompanied by an overwhelming urge to move the limbs to relieve the discomfort. Symptoms occur primarily at night when the individual has remained motionless for a period of time (National Institute of Neurological Disorders and Stroke, 2016). Like the other prevalent sleep disorders mentioned above, RLS serves to disrupt normal sleep patterns, and presents the same schooling challenges to the adolescent. To avoid the onset of symptoms resulting from sitting down for too long, the classroom teacher should accommodate the student with RLS by permitting him/her to periodically stand up and move around in the classroom.

Narcolepsy is a chronic brain disorder entailing loss of control of the sleep/wake cycles.

People with narcolepsy suffer from bouts of extreme daytime sleepiness and unavoidable “sleep attacks” that can strike at any time. (National Institute of Neurological Disorders and Stroke, 2016). Narcolepsy can obviously dramatically affect a student’s school life. The adolescent may suddenly and involuntarily fall asleep when having a class discussion, taking a test, eating lunch, or, most dangerously, when driving a car to or from school. Other major symptoms include cataplexy (sudden loss of voluntary muscle tone while awake that makes a person go limp), vivid dream-like images and hallucinations, total paralysis just before falling asleep or just after waking-up. Homeschooling or enrollment in a self-paced independent study program is likely the most appropriate educational setting for teens with this medical condition if it cannot be effectively treated. Full inclusion would necessarily involve the assignment of a one-on-one classroom aide to assist the student, as well as responsive support from the school nurse and other health office staff.

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Sleep Loss Prevention and Treatment for Greater Academic Achievement With respect to sleep deprivation resulting from the student’s lifestyle and habits, raising awareness of the problem among parents, students, teachers, school counselors, psychologist and administrators would be the necessary first step in the treatment. Existing school structures can be put to use to inform all parties involved. For example, informational flyers and/or links to videos on the topic, including how to look for or recognize the signs and symptoms of sleep deprivation, can be disseminated and shared at new parent/student orientation meetings, parentteacher conferences, Student Success Team or IEP meetings, etc. Relevant statistics on teenage sleep deprivation can be visibly posted on the school’s website to draw attention to the matter.

Summer transition academy assemblies would be an appropriate setting for introducing to incoming high school freshmen the National Sleep Foundation’s concept of, or steps to, “Sleep Hygiene”: 

Avoid napping during the day.

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Avoid stimulants such as caffeine too close to bedtime.

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Exercise rigorously to promote good sleep.

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Avoid large meals and dietary changes close to bedtime.

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Ensure adequate exposure to natural light.

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Establish a regular relaxing bedtime routine.

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Avoid emotionally upsetting conversations and activities before trying to go to sleep.

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Associate your bed with sleep, not with other activities such as watching TV, doing homework, texting on your cell phone.

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Make sure that the sleep environment is pleasant and relaxing. The bed should be comfortable, the room should not be too hot or cold, or too bright.

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Students may be encouraged to keep a sleep diary to track their own progress toward healthier sleeping habits. If greater intervention is needed, evidence-based programs such as Sleep, Sleep, Sleep Disorders and Biological Rhythms Curriculum Supplement, Teacher Enrichment Initiatives Unit: ZZZZzzzWorld, and Reconnecting Youth may be appropriate (Gordon, 2013).

Melatonin is available as an over-the-counter dietary supplement to induce restful sleep. It would, however, be advisable for the school’s medical staff to first discuss with and seek the consent of the student’s parent or legal guardian before recommending this hormone as a natural sleep aid to the student (National Sleep Foundation).

On a different note, Caskadon advocates for school administrators to start the school day at a later time to allow for more sleep, since “the weight of the evidence from decades of studies suggests that creating conditions to encourage student sleep would improve the students’ mood, energy, alertness, and academic and student performance.”

Treatment for the four main adolescent sleep related neurological disorders varies. For example, the Mayo Clinic (2014) recommends cognitive behavioral therapy in lieu of sleeping pills for Insomnia. The University of Maryland Medical Center prescribes the options of breathing devices, dental devices or oral appliances, and surgery, depending on the type and severity of the Obstruct Sleep Apnea; but also suggests life style changes as needed. For Restless Leg Syndrome, commercial websites like Healthline (2013) suggest comforting home remedies along with life style changes and vitamins to supplement mainstream medicine. There does not appear to be a cure for Narcolepsy currently. As explained by the Narcolepsy Network organization (2016), in a narcoleptic brain the special cells that produce Hypocretin (Orexin) to regulate the sleep/wake cycle have died and cannot be safely replaced. Therefore, the only way to treat Narcolepsy is to relieve its symptoms by (1) combining modern medications, lifestyle

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adjustments and alternative therapy (herbal remedies, prayer, meditation, imagery, acupuncture, acupressure, massage) and (2) balancing between treatments for sleepiness and REM intrusion under the supervision of a medical professional. However, considering the recent major discovery by Dr. Haruko Obokata at the Riken Centre for Developmental Biology in Japan regarding the possibility of “reprogramming” blood cells with acid to induce pluripotent stem cells, perhaps there is hope that regenerative medicine research will in the near future yield a viable cure for Narcolepsy.

While the complexity and demands of a modern teenager’s life may forever perpetuate the problem of insufficient respite for the human brain, continued research into the sleep functions of this all important organ will help to provide clues and answers as to how adolescents and their families can better manage daily activities, in order to make the best of its gifts to humankind.

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REFERENCES American Academy of Sleep Medicine (2005).The International Classification of Sleep Disorders, Diagnostic and Coding Manual. Westchester, IL: American Academy of Sleep Medicine; 2005.

Beebe, D. W., Douglas, M., & Amin, R. (2010). Attention, learning, and arousal of experimentally sleep-restricted adolescent in a simulated classroom. Journal of Adolescent Health, 47, 523-525.

Caskadon, M. (2012). For better student health, start school later. Retrieved from https://news.brown.edu/articles/2012/09/hssleep Centers for Disease Control and Prevention (2016). Insufficient sleep is a public health problem.

Retrieved from www.cdc.gov/Feature/dsSleep/index.html Clinkinbeard, S., Simi, P, Evans, M.K., & Anderson, A.L. (2011). Sleep and delinquency: Does the amount of sleep matter? Journal of Youth and Adolescence, 40(7), 916-930.

Gordon, G. (2013). Raising awareness about positive sleep habits and academic achievement among middle adolescents in high school (Order No. 3598810). Available from ProQuest Dissertations & Theses Global. (1459817395). Retrieved from http://0search.proquest.com.library.alliant.edu/docview/1459817395?accountid=25255 Healthline (2013). Best treatments for restless leg syndrome. Retrieved from http://www.healthline.com/health/restless-leg-syndrome/treatments#Overview1 Institute of Medicine (2006). Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: The National Academies Press; 2006.

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Mayo Clinic (2014). Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills.

Retrieved from http://www.mayoclinic.org/diseases-conditions/insomnia/indepth/insomnia-treatment/art-20046677 Moore, M., & Meltzer, L.J. (2008). The sleepy adolescent: Causes and consequences of sleepiness in teens. Pediatric Respiratory Reviews, 9, 114-121.

Narcolepsy Network (2016). Treatment. Retrieved from http://narcolepsynetwork.org/aboutnarcolepsy/treatment/ National Sleep Foundation (2016). Sleep hygiene. Retrieved from https://sleepfoundation.org/ask-the-expert/sleep-hygiene National Sleep Foundation (2006). 2006 Sleep in America Poll Summary of Findings. Retrieved from https://sleepfoundation.org/sites/default/files/2006_summary_of_findings.pdf National Institute of Neurological Disorders and Stroke (2016). Narcolepsy fact sheet. Retrieved from http://www.ninds.nih.gov/disorders/narcolepsy/detail_narcolepsy.htm National Institute of Neurological Disorders and Stroke (2016). Restless legs syndrome fact sheet. Retrieved from http://www.ninds.nih.gov/disorders/restless_legs/detail_restless_legs.htm Ohayon, M.M., Roberts, R.E., Zulley, J., Smirne, S., & Priest, R.G. (2000). Prevalence and patterns of problematic sleep among older adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1549-1556.

Park, J.G., Ramar, K., & Olson, E.J. (2011). Updates on definitions, consequences, and management of obstructive sleep apnea. Mayo Clinic Proceedings, 86(6), 549-555.

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Robert, E., Roberts, C.R., & Duong, H.T. (2008). Chronic insomnia and its negative consequences for health and functioning of adolescents: a 12-month prospective study.

Journal of Adolescent Health, 42, 294-302.

Silvestri, R. (2012). Sleep - Physiology, Functions, Dreaming and Disorders: Sleep Disorders in Neurology. Hauppauge, US: Nova; 2012. Retrieved from http://0www.ebrary.com.library.alliant.edu Society for Neuroscience. (2012).Brain activity during sleep – Brainfacts.org. Retrieved from http://brainfacts.org/.../Sleep/Articles/2012/Brain-Activity-During Sleep University of Maryland Medical Center (2016). Obstruct sleep apnea. Retrieved from http://umm.edu/health/medical/reports/articles/obstructive-sleep-apnea Wolfson, A.R., Caskadon, M.A. (1998). Sleep schedules and daytime functioning in adolescents. Child Development, 69, 875–887. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15018092 Wolfson, A.R, Caskadon, M.A. (2003). Understanding adolescents’ sleep patterns and school performance: A critical appraisal. Sleep Medical Review, 7, 491–506. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9768476