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Sleepy Students: A Pediatrician’s Plea For Later School Start Times

(eltpics/Flickr via Compfight)

(eltpics/Flickr via Compfight)

By Dr. Marvin Wang, M.D.

Last August, the American Academy of Pediatrics (AAP) issued a statement regarding school start times, really a plea to all middle and high schools to start the school day no earlier than 8:30 a.m.

The statement emerged as a result of accumulating evidence showing that earlier school start times effectively restrict an adolescent’s ability to get regular healthful sleep.

The timing of the AAP’s statement came on the heels of another sentinel event in my family’s life. Just a month after its publication, my daughter started school. No big deal, except for the fact that she has never been to school before. Until this year, she was exclusively homeschooled here in Jamaica Plain, Massachusetts.

My wife and I didn’t have any major agenda driving this decision, other than the fact that we knew we could do it (we work part-time) and it seemed like it would be more family fun. The many details of our homeschooling adventures are really for another time, though.

The reason I even bring up the topic is that as a homeschooler, my daughter was able to wake up when she wanted to (usually within reason). On a regular day, she was used to getting up at 8:30ish (despite sometimes our having to pry her out later).

After a whole lifetime of this, imagine the draconian lifestyle shift of being asked to get up at 6 a.m. every weekday! This is the routine that is better known to most people as “going to school.” Now, let’s be clear about a few things: 1) our daughter wanted this. She asked to take the exam for the Boston Public Schools, in hopes of going to Boston Latin School, where she watched many of her friends attend; 2) she knew the early mornings were part of the routine; and 3) BLS actually has a relatively benign start time of 7:45 a.m., compared to many of its counterparts in the district and the state.

So what’s all the fuss? It cannot be a novel idea to most adults that the typical school teenager is a surly blob on most weekday mornings. Should we be surprised to learn that we have been breeding generations of sleep-deprived adolescents? Should we, as educators, parents and “concerned citizens” be worried about this?

First, let’s look at what’s new since the AAP statement came out.

Indeed, the movement is picking up steam in some parts of the country, as whole districts have approved later start times. In Massachusetts, districts like Sharon, Easton, Duxbury and Nauset have done so.

And there are some new studies corroborating the AAP’s stance:

In looking at the neurobehavioral issues in teens, it turns out that just one night of sleep deprivation in an adolescent has marked worsening of sustained attention, reaction speed, cognitive processing speed and subjective sleepiness. When the sleep was restored, the teens were able to significantly improve all their cognitive abilities.

One study showed that sleep restricted teens (average of five hours/night) were more likely to be lower academic quartiles than those who slept more (average 6 ½ hours/night…which is still two hours less than optimal!). But looking at the results, one also finds that the perceived sleepiness among the sleep restricted group was at least twice that the sleep appropriate group. Continue reading

Beyond Carb-Cutting: Resolutions After A Trauma — Sleep, Play, Love

(katiebordner/Flickr)

(katiebordner/Flickr)

By Rachel Zimmerman

A friend, trying to cheer me up over the holidays, suggested I find comfort in this fact: “The worst year of your life is coming to an end.”

In 2014 I became a widow, and my two young children lost their father. Needless to say our perspective and priorities have shifted radically.

Last year at this time, my New Year’s resolutions revolved around carbs, and eating fewer of them. This year, carbs are the least of my worries. My resolutions for 2015 are all about trying to let go of any notion of perfection and seek what my mother calls “crumbs of pleasure” — connection, peace and actual joy on the heels of a life-altering tragedy that could easily have pushed me into bed (with lots of comforting carbs) for a long time.

As a mom I know with stage 4 cancer put it, when your world is shaken to its core, your goals shift from things you want to “do” —  spend more time exercising, learn Italian, make your own clothes — to ways you want to “be,” knowing that your life can shift in an instant.

So, with that in mind, here are my five, research-backed, heal-the-trauma resolutions for 2015:

A Restful Sleep

Yes, at the top of my list of lofty life goals is a very pedestrian one: sleep. Lack of sleep can devastate a person’s mental health and without consistent rest, the line between emotional stability and craziness can be slim. (See postpartum depression, for one example.) In my family at least, to ward off depression and anxiety, we need good sleep and lots of it; more Arianna Huffington and less Bill Clinton.

Play, Sing, Dance

The beautiful thing about children is that despite tragedy and loss, they remain kids; they are compelled to play, climb, run and be active. Resilience, as the literature says. In their grief, they can still cartwheel on the beach, play tag or touch football in the park. Shortly after my husband died, I tried very hard to play the games my kids liked, which often felt like that scene in the “Sound of Music” where the baroness pretends to enjoy a game of catch with the children. Soon I learned to broaden my definition of play — really anything, physical, or not — that serves no other purpose other than to elicit pure joy. Continue reading

Stick To That Book. Your Tablet-Reading May Hurt More Than You Think

(eef llc/Compfight)

(eef llc/Compfight)

If the holidays brought you a device or two, here’s something to consider.  That nighttime reading from your brand new iPad?  Maybe not such a good thing.

A new study from Brigham and Women’s hospital, published in the Proceedings of the National Academy of Sciencesfound that the use of light-emitting (LE) e-readers in the evening and even the early night may harm your sleep.

How?

The blue light produced by these specific electronic devices can actually shift your circadian rhythm by suppressing sleep hormones.  This means that that late night horror reading didn’t just give you nightmares, it actually makes you less alert in the morning. “We found the body’s natural circadian rhythms were interrupted by the short-wavelength enriched light, otherwise known as blue light, from these electronic devices,” said lead author Anne-Marie Chang, PhD,

Dr. Chang, associate neuroscientist in Brigham and Women’s Division of Sleep and Circadian Disorders and an assistant professor of behavioral health at Pennsylvania State University explains that twelve participants were monitored for two weeks in the hospital. Researchers compared their sleep patterns when reading text from an iPad and reading from a printed paper book.  (Images and puzzles were never included).  Volunteers were asked to read for four hours before bed for five nights in a row.  The same process was then repeated with a printed book. Participants who read from iPads took nearly 10 minutes longer to fall asleep and their sleep had less rapid eye movement (REM) compared with when they did late-night reading from a printed book.

The real eye-opener?

In a press release, Chang said she and her team were most surprised by the morning-after–iPad readers were less alert and more groggy after waking up.  Continue reading

Foggy Days, Sleepless Nights: When Alzheimer’s Care Goes Nocturnal

(Ronel Reyes/Flickr via Compfight)

(Ronel Reyes/Flickr via Compfight)

By Jessica Alpert

Marion Tripp was what you might call a quintessential “Yankee.” From impeccable pie crusts to crackshot deer hunting, she regularly impressed people with her wide range of skills. When her daughter and son-in-law started an organic farm in rural Maine, she’d bundle up in a snowmobile suit and sell their rutabagas at the local farmer’s market. I never knew Marion but her grandson — my husband — loves to remember her this way.

Not the way she was at the end.

Alzheimer’s ravaged Marion’s brain and left her confused, “mean,” paranoid, and violent. The last three years of her life, she had round-the-clock care since she rarely slept more than a few hours at a time. Her nocturnal habits were not unique. Indeed, in the world of Alzheimer’s, this tendency toward nighttime wakefulness is known as “sundowning.”

“Several things go awry with Alzheimer’s that affect the person’s brain chemistry and changes their circadian rhythm,” says Dr. Paul Raia, vice president of clinical services for the Massachusetts/New Hampshire chapter of the Alzheimer’s Association. He says there are various reasons for this nocturnal shift including lack of melatonin, diminished access to natural light and less rapid eye movement or REM sleep.

But it’s not just about being unable to sleep for long stretches of time. Like Marion Tripp, many Alzheimer’s patients are often agitated, angry, even violent. “During that period [of REM sleep], you are ridding the toxins from your brain and you’re stabilizing memory and you’re dreaming and essentially you are paralyzed with your body in a relaxing mode,” says Raia. “[The patients] may take a series of small naps throughout the day and when they wake up, they may not be fully awake. They can’t navigate well or negotiate well in their environment.” Continue reading

Sweet Dreams: Study Finds Later Nights, Less Sleep Linked To Negativity

(eltpics via compfight)

(eltpics via compfight)

Sleep is the new Prozac. Or, put another way, sleep is emerging as one of the most potent weapons you can use to stave off depression, anxiety and a whole host of other physical and mental ills.

Here’s the latest pro-sleep research by psychologists at Binghamton University in New York. Their new paper, “Duration and Timing of Sleep are Associated with Repetitive Negative Thinking” is just published in the journal Cognitive Therapy and Research.

From the news release:

When you go to bed, and how long you sleep at a time, might actually make it difficult for you to stop worrying. So say Jacob Nota and Meredith Coles of Binghamton University in the U.S., who found that people who sleep for shorter periods of time and go to bed very late at night are often overwhelmed with more negative thoughts than those who keep more regular sleeping hours…

Previous studies have linked sleep problems with such repetitive negative thoughts, especially in cases where someone does not get enough shuteye. Nota and Coles set out to replicate these studies, and to further see if there’s any link between having such repetitive thoughts and the actual time when someone goes to bed.

They asked 100 young adults at Binghamton University to complete a battery of questionnaires and two computerized tasks. In the process, it was measured how much the students worry, ruminate or obsess about something – three measures by which repetitive negative thinking is gauged. Continue reading

Pediatricians: Middle And High School Should Start No Earlier Than 8:30 AM

(eltpics/Flickr via Compfight)

(eltpics/Flickr via Compfight)

It’s one of the great joys of early parenthood: Finally being able to sleep until a reasonable hour — say, 6 a.m. Then, before you know it, you’re facing the opposite problem: Homeroom is just half an hour away, and your tween or teen remains an immovable lump beneath the covers.

As any parent who’s observed it would suspect, this is deep biology at work. Today, the American Academy of Pediatrics issues both an up-to-date explanation of research on adolescent sleep and a ringing call to the country’s schools to heed it and begin school later for “pathologically sleepy” older students. Sleep deprivation in youth is a common — “and easily fixable” — public health issue, the academy says in a policy statement.

From the press release, whose headline begins “Let Them Sleep:”

“The research is clear that adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores and an overall better quality of life,” [statement lead author Dr. Judith] Owens said. “Studies have shown that delaying early school start times is one key factor that can help adolescents get the sleep they need to grow and learn.”

Many studies have documented that the average adolescent in the U.S. is chronically sleep-deprived and pathologically sleepy. A National Sleep Foundation poll found 59 percent of 6th through 8th graders and 87 percent of high school students in the U.S. were getting less than the recommended 8.5 to 9.5 hours of sleep on school nights.

This medical stance on sleep deprivation is not new; the research has been accumulating for many years. But the academy reports that about 40 percent of American high schools still start before 8 a.m., and only 15 percent launch the school-day at or after 8:30. Among middle schools, it says, more than one-fifth begin at 7:45 or earlier.

If schools are not shifting later as fast as pediatricians might like, that could be because, like virtually everything in education, it’s not as simple as it might seem.

‘Life is going on right now in hyperspeed for most of our young people.’

“Once you go deeper into the lives of kids today, things become more complex,” says Dr. Bob Weintraub, who was the headmaster of Brookline High School from 1992 to 2011 and is now a professor of educational leadership at Boston University. Based on the research, Brookline High shifted start times for most students to 8:30 during his tenure, he said, but such shifts do raise issues.

“One of the practical problems has always been for high school athletics and school activities,” he said; if school ends later, sports and other activities must start later, and outdoor sports are hindered when darkness descends. Continue reading

Pop Awake At Night? Researchers Blame ‘Sleep Switch’ In Your Aging Brain

(eflon via Compflight)

(eflon via Compflight)

If you’re on the older side and find yourself popping hideously awake in the middle of the night or far-too-early morn, here’s your line for the next time it happens: “Oh, that darned ventrolateral preoptic nucleus of mine! How I miss my old galanin!”

Researchers have just reported in the journal Brain that they’ve found a group of neurons — in the aforementioned nucleus — that function as a kind of “sleep switch,” and whose degeneration over the years is looking very much like the cause of age-related sleep loss. It’s also looking pivotal in the insomnia that often causes nocturnal wandering in people with Alzheimer’s disease.

“This is the first time that anyone has ever been able to show in humans that there is a distinct group of nerve cells in the brain that’s critical for allowing you to sleep,” said the paper’s senior author, Dr. Clifford Saper, chair of neurology at Beth Israel Deaconess Medical Center and professor of neurology at Harvard Medical School.

You may well be wondering exhaustedly how soon this insight — based on the post-mortem analysis of 45 human brains — will lead to better sleeping pills for older folks. I asked Dr. Saper that, too. No promises with timeframes at this point, but he does see the prospect for better-targeted sleeping pills for seniors, with fewer side effects like Ambien’s balance-related problems.

Our conversation, lightly edited:

Can this group of neurons actually explain the lion’s share of sleep problems that older people and people with Alzheimer’s disease have?

It really can. Let me give you a little background. We discovered this cell group in the brains of rats in 1996. We found that there’s a group of of nerve cells in a part of the brain called the hypothalamus that fire when animals are asleep. And we later found that if you eliminate those nerve cells, that animals lose up to 50 percent of all their sleep time, and the remaining sleep is fragmented. They can’t sleep for long bouts at a time; they keep waking up all the time.

At that time, we weren’t sure whether this would be the same in other species. So we looked at the brains of half a dozen other species — of mice and cats and monkeys — and we found that all of them have this cell group and that the cells were active during sleep in all of them. In every species we looked at, this same cell group had a particular neurotransmitter in it, called galanin.

I’ve never heard of that neurotransmitter before… Continue reading

The Migraine-Body Clock Connection: New Genetic Clues

migraine

Wikimedia Commons

If you’re one of the 36 million Americans who suffer from migraine headaches, you probably already know that if your sleep routine is thrown off, you’re asking for head-whanging trouble.

New research suggests that the migraine-sleep connection goes far deeper than that, and revolves around the brain’s hypothalamus, which helps control our body clocks among other functions.

The Dana Foundation, which supports brain research, has just posted an intriguing scientific yarn about how insights gained from a family of extreme “morning larks” — as in, up at 4:30 every morning, asleep by 7:30 at night — may help point to a better understanding of migraine that could lead to better treatments. Read the full story here. The crux:

The spark of insight that brought the two fields together occurred recently when migraine researcher Robert Shapiro realized that his patient, who was seeing him for migraine with aura, was a member of an extended Vermont family of extreme morning larks. Continue reading

Study: Insomnia Linked To Heart Disease Deaths In Men

New research says anti-anxiety and insomnia drugs can increase the risk of death

As if it weren’t bad enough that insomnia in and of itself can be torture. New research just out in the journal Circulation suggests that insomnia may increase a man’s chances of dying from heart disease — though just modestly.

The study adds yet another incentive for the estimated one-third of Americans who suffer from insomnia to work on sleeping better. It comes on the heels of other findings that curing your insomnia could double your chances of recovery from depression.

From the Brigham and Women’s Hospital press release on the Circulation study:

“Insomnia is a common health issue, particularly in older adults, but the link between this common sleep disorder and its impact on the risk of death has been unclear,” said Yanping Li, PhD, a research fellow in the Channing Division of Network Medicine at BWH and lead author of the paper. “Our research shows that among men who experience specific symptoms of insomnia, there is a modest increase risk in death from cardiovascular-related issues.”

Specifically, researchers report that difficulty falling sleep and non-restorative sleep were both associated with a higher risk of mortality, particularly mortality related to cardiovascular disease.

Researchers followed more than 23,000 men in the Health Professionals Follow-Up Study who self-reported insomnia symptoms for a period of six years. Beginning in 2004 through 2010, researchers documented 2025 deaths using information from government and family sources. After adjusting for lifestyle factors, age and other chronic conditions, researchers found that men who reported difficulty initiating sleep and non-restorative sleep had a 55 percent and 32 percent increased risk of CVD-related mortality over the six year follow up, respectively, when compared to men who did not report these insomnia-related symptoms.

Why To Sleep Tonight: So You Don’t Strangle Your Spouse

I can personally vouch for this research finding: lack of sleep can turn a little spat with your spouse into a major emotional war.

According to a new study that asks the question, “Do Sleepless Nights Mean Worse Fights?” by researchers at U.C. Berkeley, couples who get a bad night’s sleep tend to fight more about their relationship. Psychologists Amie Gordon and Serena Chen conclude that without sleep, couples have a harder time managing conflict. The study was published online in the journal, Social Psychological and Personality Science.

Janesdead/flickr

Janesdead/flickr

I can remember falling to the ground into a weepy ball during one exhaustion-fueled fight with my husband when our daughter was an infant. Indeed, everything seems much more bleak, and your partner seems far less sympathetic, at 3:30 am. Conflict-resolution skills go out the window.

Even without young children, I know loving couples who sleep apart as a way to keep their marriages in tact.

Here’s more on the Berkeley study from the news release:

Researchers collected data on the sleep habits of more than 100 couples who had been together, on average, for nearly two years. They gauged participants for depression, anxiety and other stressors in order to focus solely on the link between the couples’ sleep quality and relationship conflicts.

In one experiment, 78 young adults in romantic relationships provided daily reports over a two-week period about their sleep quality and relationship stresses. Overall, participants reported more discord with their partners on the days following a bad night’s sleep. Continue reading