Adolescent Sleep Research
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Adolescent Sleep Research

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Research that supports school start times after 8:30 am for 6th through 12th grades.

Research that supports school start times after 8:30 am for 6th through 12th grades.

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  • This presentation was created for Ohio, and if you live in the area please consider signing the petition that asks NE Ohio schools to form committees to talk about the research - you can find the petition at SignOn.org and search 'Northeast Ohio'. If you live in other parts of the country check the Start School Later website to see if there are petitions or groups in your area.
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  • 1. Adolescent Sleep Research:School Start TimesStacy Simera, MSSA, LISW-S, SAP
  • 2. In 1998 the 5 public high schools in Fayette County,KY changed start times from 7:30 am to 8:30 am.In the two years afterwards:
  • 3. In 1998 the 5 public high schools in Fayette County,KY changed start times from 7:30 am to 8:30 am.In the two years afterwards:Auto accidents involving teensfrom Fayette Co. decreased 16.5%,
  • 4. In 1998 the 5 public high schools in Fayette County,KY changed start times from 7:30 am to 8:30 am.In the two years afterwards:while auto accidents involvingteens in the state increased 7.8%...Auto accidents involving teensfrom Fayette Co. decreased 16.5%,
  • 5. In 1998 the 5 public high schools in Fayette County,KY changed start times from 7:30 am to 8:30 am.In the two years afterwards:while auto accidents involvingteens in the state increased 7.8%...…a comparable decrease of 24.3%.(Danner and Phillips, 2008)Auto accidents involving teensfrom Fayette Co. decreased 16.5%,
  • 6. This is part of a slide show created by Stacy Simera,MSSA, LISW-S, SAP to educate professionals andcommunities on the research regarding adolescentsleep deprivation and early school start times.This can be shared as long as no references orcitations are changed.You can contact Stacy in NE Ohio via this link:http://www.startschoollater.net/oh---northeast.html
  • 7. The clinical research supporting later schoolstart times for adolescents is abundant,however most of the data has been hiddenaway in scholarly journals. Even our futurephysicians have had little exposure to theresearch…
  • 8. Sleep Education in Medical Schools -Curriculum Reviews - 1990 (Owens, 2005)Among medical schools that didoffer sleep education, theaverage time spent was 2 hours.
  • 9. The Minnesota Medical Association was one of the firstgroups to publicly address the issue. In 1993 the MMAissue a public resolution to educate the public on:• The need for more sleep during adolescence thanduring childhood• The biological shift to a later sleep pattern inadolescence• The impact of inadequate sleep on driving safety andschool performance• The recommendation for schools to eliminate earlystarting times for adolescents(Minnesota Medical Association, mnmed.org)
  • 10. Between the years of 1996 and 2003, grantswere awarded to twenty medical schools for:– developing ‘model’ educational programs in themedical school– promoting ‘interdisciplinary learningenvironments’– improving sleep education and research, includingeducating the public(Owens, 2005)
  • 11. In 2000, the National Sleep Foundationpublished a 26-page report, Adolescent SleepNeeds and Patterns, that includes a discussionof the benefits of delaying school start times.Here is a link to that report:http://www.sleepfoundation.org/sites/default/files/sleep_and_teens_report1.pdf
  • 12. • Gradually other health professionals havebecome more aware of the research, in factmany groups have joined the MMA in formingpolicy statements on later school start times:– The Maryland State Medical Society– The American Lung Association of New England– The Connecticut Thoracic Society– The Virginia, Florida and Maryland chapter of theAmerican Academy of Pediatrics– And more:http://www.startschoollater.net/position-statements.html
  • 13. So what is the research saying?
  • 14. Adolescent Sleep Needs• Adolescents require an average of 8.5 to 9.25hours of sleep each night for optimum health
  • 15. Adolescent Sleep Needs• Adolescents require an average of 8.5 to 9.25hours of sleep each night for optimum health• In a study by O’Brien and Mindell (2005), only9.2% of adolescents studied received 8 ½ hoursof sleep or more during the week
  • 16. Adolescent Sleep Needs• Adolescents require an average of 8.5 to 9.25hours of sleep each night for optimum health• In a study by O’Brien and Mindell (2005), only9.2% of adolescents studied received 8 ½ hoursof sleep or more during the week• On average, most teens sleep 6.75 hours onschool nights(Carskadon et al., 1980; National Sleep Foundation, 2009)
  • 17. Circadian Rhythm• Our internal mechanism that controls thesleep/wake cycle (localized to thesuprachiasmatic nucleus).• The circadian rhythm among humans averages24.27 hours, but it ‘entrains’ to a 24-hour daybased primarily on light exposure.(Crowley, Acebo and Carskadon, 2007)
  • 18. MelatoninMelatonin is a hormone secreted by the pinealgland in response to the circadian rhythm:– Rising in the evening near the person’s usualbedtime– Remaining constant through sleep– Decreasing during the person’s usual wake time(Wahlstrom, 2003)
  • 19. Melatonin Shift in Adolescence• Measuring of melatonin levels in saliva:- later onset of higher levels of melatonin amongadolescents – as compared to younger childrenand older adults• Observed in other countries around the world:- a developmental condition of adolescence – not acultural or scheduling phenomenon(Carskadon et al., 1979; National Sleep Foundation, 2009;Wahlstrom, 2003)
  • 20. Thus adolescents naturally do not becomesleepy until later in the evening, approximately11pm, and are not alert until later in themorning -- therefore attempts at early bedtimes tocompensate for early school times do notsucceed.
  • 21. Pubertal Maturation Correlation:Delay of circadian phase preference correlateswith degree of pubertal maturation in a 1993study by Carskadon et al:– Over 400 6thgraders were scored according to their self-report of pubertal development– Those same students were then questioned on theirpreferences for daytime activity: morning or evening– Results showed that more mature students showed apreference for delayed phase compared to less developedstudents
  • 22. Meta-Analysis of Phase Shift by Age(Crowley, Acebo and Carskadon, 2007)
  • 23. Is Weekend Catch-Up OK?• No: Adolescents who sleep more on theweekend experience a ‘jet-lag’ effect, withnegative effect on school performance. (Bergin andBergin, 2009)
  • 24. Why is sleep so important?• For our body: During stage 3 sleep we engagein tissue growth and repair and release ofhormones.• For our brains: During stage 4 sleep our brainis active and is it suspected that we engage inreorganizing similar to ‘de-fragmenting’ incomputers…
  • 25. Non-REM Stage 1Falling AsleepLight SleepNon-REM Stage 2Fully AsleepBody Temp DropsNon-REM Stage 3Deep SleepRestorativeTissue Repair/GrowthHormone ReleaseREMEvery 90 min.Brain is Active, DreamsEach course gets longerthrough the night
  • 26. Impacts of Chronic Sleep Deprivation• Academic• Cognitive• Mood• Behavior• Health• Obesity• Safety
  • 27. Academic Functioning• Poorer performance in morningclasses• Poorer academic performance overall• Absenteeism• Tardiness(Bergin and Bergin, 2009; Carskadon et al, 1998; Kahn et al, 1989;Noland et al, 2009; Wahlstrom, 2003; Wolfson et al, 2007)
  • 28. Grades related to sleep patterns(O’Brien and Mindell, 2005)School Night Total Sleep TimeGradesLow:≤ 405 min(≤6 ¾ hrs)High:≥ 495 min(≥8 ¼ hrs)As & Bs 52.9% 62.9%Bs & Cs 32.9% 28.6%Cs & Ds 12.9% 8.6%Ds & Fs 1.2% 0%
  • 29. Grade FailureStudents with more sleep deprivation aremore likely to fail a grade compared tostudents with less sleep deprivation -- even when amount of homeworkcompletion is similar.
  • 30. Cognitive Functioning• Decreased Attention• Deficits in Problem-Solving Abilities• Decreased Complex Decision Making(Gibson et al, 2006; Kilgore et al, 2007)
  • 31. Mood and Behavior• Increased impulsivity• Increased irritability• Lower tolerance for frustration• Missing social and sports events(Bates et al, 2002; Gibson et al, 2006)
  • 32. Mood and Cognitive Functioning: Sufficient vs. Insufficient Sleep(Gradisar et al, 2008)
  • 33. Risk-Taking BehaviorAdolescents with insufficient sleep (less 8.5 hours of sleepon week nights) engaged in more risk-taking behaviors(violence, unsafe behaviors, drug use, and sexual activities)than students who reported sufficient sleep. (O’Brien andMindell, 2005)Kahn, et al (2006): “[Our] findings suggest thatsleep deprivation significantly weakens theinhibition of aggression and willingness tobehave in ways that facilitate effective socialinteraction, possibly through reduced metabolicactivity in prefrontal regions of the brainimportant for personality, affect, and inhibitorybehavior.”
  • 34. Health• Decreased immune functioning• Decreased insulin secretion and decreasedability to utilize insulin• Association between MS and shift workbefore age 20 (after 9pm or before 7am)• More aggressive forms of breast cancer• Decreased collagen 1 production• More…(Buxton, 2012; Hedstrom et al, 2012; Lancer, 2009; National SleepFoundation, 2009; Thompson et al, 2012, more…)
  • 35. Obesity• Extensive research had been disproving theassumed link between TV and obesity.• Instead, researchers are finding a linkbetween chronic insufficient sleep andobesity.• This link occurs along all ages, but the link isstrongest among children.(Must and Parisi, 2009; Noland et al, 2009; Taheri et al, 2004)
  • 36. Research by Taheri et al (2004):(Research on 1,024 people in a 15-yr sleep study)Findings:• Association between increased BMI andinadequate sleep (less than 8 hours per night)• Hormonal changes:– decreased leptin levels by 15.5% (a hormone thatsuppresses appetite) among people with inadequatesleep– increased ghrelin levels (a hormone that stimulatesappetite) by 14.9%
  • 37. SafetyDriving while drowsy is a ‘major contributor’ to anestimated 100,000 motor vehicle crashes per yearand results in more than 1,500 deaths nationwide(National Highway Traffic Safety Administration, 2005)“Adolescents are more likely than older drivers to besleep-deprived because of school schedules, socialactivities, and shifting circadian rhythms.”(Danner and Phillips, 2008)
  • 38. Sports Injuries68% reduction in sports injuries among teens who slept at least 8 hourscompared to teens who were chronically sleep deprived- ‘not acute lack of sleep before the big game’(Milewski et al, 2012 – presented at AAP Oct 2012 Conference)Factors associated with injuries: chronic sleep deprivation, higher grade levelFactors NOT associated with sports injuries: gender, weeks of participation insports per year, hours of participation per week, number of sports theteen engaged in, strength training, private coaching, and subjectiveassessments of "having fun in sports”"Our study shows that everyones mom was right when she said you needto get a good nights sleep. While this was felt to help you get good gradesin school, we now see that it helps prevent sports injuries.“- Dr. Matthew Milewski, Reuters interview, 10/23/12
  • 39. Farm FamiliesAgricultural work is more hazardous than non-agricultural occupations, with increased risk toyoung workers. (Chapman et al, 1998; Myers et al 2002)“Sleep deprivation is of particular concern amongadolescents residing and working on farms”(Chapman, 2006)
  • 40. School start times for 6th- 12thgrades(and even into college) after 8:30am or ideally after 9:00am.(Bergin and Bergin, 2009; Carskadon, et al 1998; National Sleep Foundation,2009; Noland et al, 2009; Wahlstrom, 2003; Wolfson et al, 2007; and manymore…)So what do the experts say?
  • 41. Schools that have acted:Hundreds, if not now thousands, of schools have changed inresponse to the research. Here are two sites that provide asampling:http://schoolstarttime.org/2011/06/12/schools-recently-delaying-start-times/http://www.startschoollater.net/success-stories.html
  • 42. And here’s just a few examples of themeasured benefits:
  • 43. In 1997…Minneapolis Public School District’s 7 highschools changed from:7:15 am - 1:45 pm school daysto8:40 am - 3:20 pm school days(Affecting 18,000 students)
  • 44. In a study 4 year after changes:“Contrary to the fears and expectations that alater start would result in students stayingawake an hour later on school nights…Minneapolis high school students get fivemore hours of sleep per week than their peers[with early school start times].”(Wahlstrom, 2003)
  • 45. Benefits of Later Start TimesIn Minneapolis (statistically measured):– Increased total sleep– Increased attendance– Reduced tardiness– Increased enrollment– Slight improvement in grades(“difficult to measure”)(Wahlstrom, 2003)
  • 46. Benefits of Later Start TimesAnecdotal and Survey Reports from Minneapolis:• According to the faculty and staff:– Less students falling asleep in class– Students more alert during first two periods– Improved student behavior– Quieter hallways• According to the students:– Learning was ‘easier’(Wahlstrom, 2003)
  • 47. Rhode Island Comparison:Late Starting (8:37 am) compared toEarly Starting (7:25 am) Middle Schools:(Wolfson et al, 2007)
  • 48. Rhode Island Comparison:Late Starting (8:37 am) benefits compared toEarly Starting (7:25 am) Middle Schools:– Increased total sleep times– Less daytime sleepiness– Improved grades among females in 7thgrade(no statistical difference among males)– Improved grades among both genders in 8thgrade(Wolfson et al, 2007)
  • 49. Wilton, ConnecticutChanged start times in 2003• A local sleep disorders center survey, one yearlater, showed that Wilton high-schoolstudents were obtaining an hour more sleepper night.“Six years later, no one is even looking back…Our students are happier, performing at thehighest levels academically, and our sportsteams continue to be the among the best in
  • 50. In 1998 the 5 public high schools in Fayette County,KY changed start times from 7:30 am to 8:30 am.In the two years afterwards:while auto accidents involvingteens in the state increased 7.8%...…a comparable decrease of 24.3%.(Danner and Phillips, 2008)Auto accidents involving teensfrom Fayette Co. decreased 16.5%,
  • 51. Even US Air Force Academy cadets (remember,puberty extends a few years beyond high school)benefited greatly from later class start times. A quotefrom the researchers is on the next slide, and a link tothe study is here:http://teensneedsleep.files.wordpress.com/2011/05/carrell.pdf
  • 52. “Our findings have important implications foreducation policy; administrators aiming to improvestudent achievement should consider the potentialbenefits of delaying school start time. A later starttime of 50 minutes in our sample has the equivalentbenefit as raising teacher quality by roughly onestandard deviation. Hence, later start times may be acost-effective way to improve student outcomes foradolescents.”Carrell et al, A’s from Zzz’s,American Economic Journal: EconomicPolicy 3 August 2011): 62–81, pg 80
  • 53. The Brookings Institute’s Hamilton ProjectPolicy Brief 2011-08: ‘Organizing Schools to Improve StudentAchievement’ is a report written by economists who estimatea ‘conservative’ 9 to 1 benefit to cost ratio in moving middleand high schools one hour later.That means communities get back $9 (or more) for every $1spent on making the basic change. Most communities don’thave to spend anything, so the benefits can be limitless.Here is a link to that report:http://www.hamiltonproject.org/files/downloads_and_links/092011_organize_jacob_rockoff_paper.pdf
  • 54. Options for Schools1) Delay all school start and end times2) Exchange high school/middle school times withelementary school times– Elementary age students can adapt better to earlierbedtimes and waking times– No scientific reasons found in the literature on whydistricts tend to start high schools earlier than elementaryschools3) Compress high school and middle school days todelay the start time but retain current end time4) Synchronize all school start and end times5) Other? Come on – we can be creative for our kids!
  • 55. Transportation Costs• Minneapolis, MN– No increase in cost– Shifted the same bus routes to later• Edina, MN– No increase in cost– Shifted the same bus routes to later• Hudson, OH– Decreased cost– Moved from 3-tier to 2-tier system– Changed to an external vendor– Consolidated routes, altered some pick-ups
  • 56. Transportation Considerations• Transportation to Private Schools– In Hudson, a private school changed start time tocoincide with Hudson schools• Transportation to Joint Vocational Schools– Many schools are looking at changing start times dueto overwhelming research – ideally entire countieschange times• Transportation to Alternative Schools– Seek cooperation, or even changes, from thealternative schools
  • 57. And the million dollar question:What about sports?
  • 58. Smart coaches remember that sleep deprivationincreases sports injuries, reduces endurance,reduces speed, and reduces accuracy.But coaches also want to know what hashappened to sports among schools thatchanged start times.So I contacted schools around the country andasked the people at the front lines and thesidelines, and these are some responses(shared with permission):
  • 59. After changes in school start times in 2003:• Participation in high school athletic programs‘continued to rise’• Upper elementary extracurricular involvementincreased• Other schools in the conference accommodated latearrivals to events – with some of those schools‘looking at making the change themselves’(CT LWV, 2009 Statement)In Wilton, Connecticut‘a self-described sports town’:
  • 60. St. George’s School, RI“We have found it (switching to 8:30 start) one of thebest things our school has ever done. The impact onathletics is minimal. Coaches have given up 5minutes per day of practice time, willingly…”John R. MackayDirector of AthleticsHead Football Coach(2/8/2011 email)St George’s School maintains 48 teams in 22 sports.Students are required to play at least 2 sports per season.
  • 61. Fayette County, Kentucky“The time issue has never been a problem for us. Ourschools start time is 8:25 and practice after usuallystarts around 3:30 or 3:45.”- Donald Adkins, Athletics DirectorFayette County Schools, Kentucky1/12/12 email
  • 62. Lexington, Kentucky“The first question you asked was ‘do we have to get off thegolf course before leagues?’ We have a great relationshipwith our home course. They give us four tee times Monday toThursday. Typically, any leagues start after our practices.…For bowling the additional time has not been an issue… InLexington our leagues usually start around 6:30 and we havebeen able to practice for two hours before then.”- Bob Farquhar, Bowling and Golf CoachLexington High School5/15/12 email
  • 63. Hudson, OH“It has actually worked out better than we anticipated.”~“We have not really had any problems getting everything donebefore dark.”-Ray Ebersole, Athletic DirectorHudson Public High Schools12/8/2011 and 5/13/2012 emails
  • 64. Two Main Issues in Minneapolis, MN:1) “Middle School students get out over an hour later than highschool students. Basically, if a 7/8th grade studentparticipates on a high school team then they are forced tomiss class on game days (the latter part of the day). Also, theymiss practice because the times are staggered. If high schoolsand middle schools started/stopped at the same time wewould not have this issue.”2) “We utilize our Minneapolis Public Parks for athletic fields. Weare forced to be off most of them by 5:45pm. We dont startmany of our games until 4pm so this proves to be a bigchallenge.”- Darren Ginther, Athletics DirectorEdison High School (12/8/11 email)
  • 65. One solution in Minnesota:“Make connections.”- Al Frost, Athletics DirectorRoosevelt High School, Minnesota(12/9/11 phone conversation)Mr. Frost made a deal with the park system, on whom theschool relied for baseball and softball fields, to push the adultsoftball leagues a little later in exchange for the use of theschool’s football field by the park system’s pee-wee footballleague.
  • 66. Counterproductive ResponsesChanges that defeat the purpose of early start-timesor minimize the focus of education within theeducational system:– Shifting athletic practices or club meetings to beforeschool– Extending extra-curricular activities past 9pm(not recommended by researchers)– Having students leave during the last period(s) of school toget to athletic or club events
  • 67. Childcare– Schools need to give adequate notice– Collaborate with daycares and extracurricular programs– Develop tutoring programs after school for youngerchildren if elementary is moved earlier– Think outside the box: allow young students to ride thebus home with older siblings if schools choose to ‘flip-flop’ high school with elementary
  • 68. Short-Term Recommendations– Give standardized testing after 10am, whenadolescents are more alert– Decrease nightly homework hours– Give plenty of notice for large assignments– Educate schools, physicians, mental healthproviders on the impact of sleep deprivation– Educate parents that weekend ‘catch-up’ isnormal, however sleeping beyond 2-3 hours pastnormal wake time is not recommended(Hansen, et al 2005; Wolfson and Carskadon, 2005)
  • 69. Get Involved!• Ask your school to look at the research.• Ask groups in your area to write letters ofendorsement.• Start or sign local petitions. Go to www.signon.org tosee if a petition already exists for your area – such asNortheast Ohio or Seattle.• Check out the national group Start School Later onFaceBook or at their website, where you can find anational petition: www.startschoollater.net
  • 70. For more information:www.schoolstarttime.orgwww.startschoollater.netwww.sleepfoundation.org
  • 71. References• Bates, J., Viken, R., Alexander, D., Beyers, J., & Stockton, L. (2002). Sleep and adjustment inpreschool children: Sleep diary reports by mothers related to behavior reports by teachers.Child Development, 73(1), 62-74.• Bergin, C., & Bergin, D. (2009). Sleep: The E-Z Z Z Intervention. Educational Leadership, 67(4),44-47. Retrieved from Academic Search Complete database.• Carskadon, Mary. 2002. Frontline Interview. Available at:http://www.pbs.org/wgbh/pages/frontline/shows/teenbrain/interviews/carskadon.html• Chapman, LJ. Summary of NIOSH-Funded Research in Agriculture at University of Wisconsin.2006. http://www.cdc.gov/niosh/nas/agforfish/pdfs/app2-11.pdf• Chapman LJ, Taveira AD, Newenhouse AC, Meyer RH, Josefsson KG. Causal factors inproduction agriculture injuries: working children and youth versus adults. In S. Kumar (Ed.)Advances in Occupational Ergonomics and Safety. Washington DC:IOS Press 1998:73-76.• Crowley, S., Acebo, C., and Carskadon, M.A. Sleep, circadian rhythms, and delayed phase inadolescence. Seep Medicine, Sep 2007, Vol 8, Issue 6, p602-612.• Danner F, Phillips B. Adolescent sleep, school start times, and teen motor vehicle crashes. JClin Sleep Med 2008;4:533—5• Gibson, E., Powles, A., Thabane, L., OBrien, S., Molnar, D., Trajanovic, N., et al. (2006)."Sleepiness" is serious in adolescence: Two surveys of 3235 Canadian students. BMC PublicHealth, 6116-9. doi:10.1186/1471-2458-6-116.
  • 72. • Gradisar, M., Terrill, G., Johnston, A., & Douglas, P. (2008). Adolescent sleep and workingmemory performance. Sleep & Biological Rhythms, 6(3), 146-154. doi:10.1111/j.1479-8425.2008.00353.x.• Hansen, M., Janssen, I., Schiff, A., Zee, P., & Dubocovich, M. (2005). The Impact of SchoolDaily Schedule on Adolescent Sleep. Pediatrics, 115(6), 1555-1561. doi:10.1542/peds.2004-1649.• Kahn, A., Van de Merckt, C, Rebauffat, E., Mozin, M., Sottiaux, M., Blum, D., et al. (1989).Sleep problems in healthy pre-adolescents. Pediatrics, 84(3), 542-546.• Kahn-Greene, E., Lipizzi, E., Conrad, A., Kamimori, G., & Killgore, W. (2006). Sleep deprivationadversely affects interpersonal responses to frustration. Personality & Individual Differences,41(8), 1433-1443. doi:10.1016/j.paid.2006.06.002.• Killgore, W., Kahn-Greene, E., Lipizzi, E., Newman, R., Kamimori, G., & Balkin, T. (2008). Sleepdeprivation reduces perceived emotional intelligence and constructive thinking skills. SleepMedicine, 9(5), 517-526. doi:10.1016/j.sleep.2007.07.003.• Kubow, P., Wahlstrom, K., & Bemis, A. (1999). Starting Time and School Life. (Cover story).Phi Delta Kappan, 80(5), 366. Retrieved from Academic Search Complete database.• Meyers, J, Miles, J, Faucett, J, Janowitz, I, Tejeda, D, Weber, E, Smith, R, Garcia, L. (2002)Priority risk factors for back injury in agricultural field work: Vineyard ergonomics. Journal ofAgromedicine, (1), 37-52.• Must, A., & Parisi, S. (2009). Sedentary behavior and sleep: paradoxical effects in associationwith childhood obesity. International Journal of Obesity, 33S82-S86. doi:10.1038/ijo.2009.23
  • 73. • National Highway Traffic Safety Administration. Drowsy driving. Ann Emerg Med2005;45:433--4.• National Sleep Foundation. 2009. Washington, DC. www.sleepfoundation.org• Noland, H., Price, J., Dake, J., & Telljohann, S. (2009). Adolescents’ Sleep Behaviors andPerceptions of Sleep. Journal of School Health, 79(5), 224-230.• OBrien, E., & Mindell, J. (2005). Sleep and Risk-Taking Behavior in Adolescents. BehavioralSleep Medicine, 3(3), 113-133. doi:10.1207/s15402010bsm0303_1.• Owens, J. (2005, January). Introduction to special section: NIH Sleep Academic Awardprogram. Sleep Medicine, pp. 45-46. doi:10.1016/j.sleep.2004.11.001.• Taheri, S., Ling, L., Austin, D., Young, T., & Mignot, E. (2004). Short Sleep Duration IsAssociated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index. PLoSMedicine, 1(3), 210-217. doi:10.1371/journal.pmed.0010062.• Wahlstrom, K. (2003). Later High-School Start Times Still Working. Education Digest, 68(6),49. Retrieved from Academic Search Complete database.• Wolfson, A., & Carskadon, M. (1998). Sleep schedules and daytime functioning inadolescents. Child Development, 69(4), 875. Retrieved from Academic Search Complete.• Wolfson, A., & Carskadon, M. (2005). Meeting Teen Sleep Needs Creatively. Education Digest,71(1), 47-51. Retrieved from Academic Search Complete database.• Wolfson, A., Spaulding, N., Dandrow, C., & Baroni, E. (2007). Middle School Start Times: TheImportance of a Good Nights Sleep for Young Adolescents. Behavioral Sleep Medicine, 5(3),194-209. doi:10.1080/15402000701263809.