1. Beal, Judy A. DNSc, RN, FNAP, FAAN

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Several years ago, the American Academy of Pediatrics Adolescent Sleep Working Group, Committee on Adolescence, and Council on School Health (AAP, 2014) issued a policy statement advocating for delaying start times of middle and high schools to allow teens to get more sleep. The report was based on numerous studies with evidence that children and adolescents with chronic sleep loss are more likely to be overweight, depressed, and at increased risk from motor vehicle accidents, sports injuries, and occupational injuries (AAP).


A Centers for Disease Control and Prevention (CDC) analysis of 50,370 high-school students found direct and significant correlations between sleep deprivation (defined as less than 7 hours a night) and risky behaviors including: infrequent seat belt and bicycle helmet use, riding with an intoxicated driver, drinking and driving, and texting while driving (Wheaton, Olsen, Miller, & Croft, 2016). Using self-reported data from the national Youth Risk Behavior Surveys from 2007, 2009, 2011, and 2013, the CDC researchers concluded that 68.8% of students in grades 9 to 12 slept on average of less than 7 hours each school night. Greater sleep deprivation was progressed steadily from 59.7% in 9th grade to 76.6% of students in 12th grade. Recently, the American Academy of Sleep Medicine (2017) published their report also recommending that the school day should start at 8:30 a.m. or later for middle- and high-school students citing research associating sleep deprivation with poor school performance, metabolic dysfunction, cardiovascular morbidity, and suicidal ideation in addition to those risk factors cited in the AAP (2014) report.


In spite of the abundant and rigorous research pointing to increased risk of adverse outcomes for teens with sleep deprivation, there is still significant resistance to delaying start times in the majority of school districts. The National Sleep Foundation (2017) identified eight commonly cited major obstacles to delaying school start times that included impacts on: the cost for transportation systems, delayed after-school activities, changes for younger students, impacts on teachers, stress for families, an uneducated community as to the benefits of a delayed start, and resistance from students. This report details many suggestions that can lessen or alleviate all of the barriers repeatedly cited. In a report published by the Rand Corporation, Hafner, Stepanek, and Troxel (2017) noted delaying school start times to 8:30 is cost effective, far outweighs the immediate costs, and can contribute $83 billion to the United States economy. To date, some schools in 45 states have pushed back start times and have successfully dealt with the many roadblocks that have been identified and often challenged (Weller, 2017).


Nurses are in a key position to advocate for delayed start times in their communities by explaining the supportive research and the significant benefits to delayed school start times to improve sleep for teens. Working with parents and children, nurses can stress the importance of 8-10 hours of sleep on a regular basis to promote wellbeing and decrease very risky behaviors. Pediatric nurses can have an impact far beyond their clinic practice sites when they are engaged in the community and work to encourage evidence-based strategies to promote the health of teens.




American Academy of Pediatrics Adolescent Sleep Working Group, Committee on Adolescence, & Council on School Health. (2014). School start times for adolescents (Policy Statement). Pediatrics, 134(5), 642-649. doi:10.1542/peds.2014-1697 [Context Link]


American Academy of Sleep Medicine. (2017). AASM position: Delaying middle school, high school start times is beneficial to students. Retrieved from[Context Link]


National Sleep Foundation (2017). Eight major obstacles to delaying school start times. Accessed from[Context Link]


Hafner M., Stepanek M., Troxel W. M. (2017). Later school start times in the U. S.: An economic analysis. Santa Monica, CA: The Rand Corporation. [Context Link]


Weller C. (2017). Schools around the US are finally pushing back their start times - and it's working. Business Insider. Retrieved from[Context Link]


Wheaton A. G., Olsen E. O., Miller G. F., Croft J. B. (2016). Sleep duration and injury-related risk behaviors among high school students-United States, 2007-2013. Morbidity and Mortality Weekly Report, 65(13), 337-341. [Context Link]