Wellness Check: Sleep

2 Minute Medicine is pleased to announce that we are launching Wellness Check, a new series dedicated to exploring new research evidence focused on wellness. Each week, we will report on articles examining different aspects of wellness, including (but not limited to) nutrition, sleep, reproductive health, substance use and mental health. This week, we explore the latest evidence-based updates in sleep.=]’/

COVID-19 instructional approaches differentially impacted sleep patterns among students

1. In this study, a greater percentage of students who received online/asynchronous instruction and later school start times reported more sufficient sleep than students who received in-person scheduled instruction and earlier school start times.

2. Students with later school start times reported more sleep hours than students with earlier school start times. This trend was observed across all instructional approaches.

Evidence Rating Level: 2 (Good)

The COVID-19 pandemic has transformed various aspects of society, including instructional approaches for many students. Sleep among the adolescent population has also been shown to be profoundly affected. However, there is a paucity in research addressing how altering instructional approaches (online and in-person) may impact adolescent sleep. The objective of this study was to examine the association between varying instructional approaches, school start times, and sleep among students during the pandemic in the United States.

In this observational cohort study, 5,245 racially and geographically diverse students (~50 percent female) were recruited through social media outlets (Facebook and Instagram) over six weeks. Students included were enrolled in grades 6-12 at the time of the survey, had internet access, and a United States residency. Students reported on instructional approach (in-person, online/synchronous, online/asynchronous), school start times, and bedtimes (BT) and waketimes (WT) on weekdays and weekends (no school days).

Results showed that BT and WT were earliest for students on in-person instructional days, followed by students on online/synchronous days and then online/asynchronous days. Sleep opportunity (ie the interval between BT and WT) was longer for students without scheduled instruction, with online/asynchronous students reporting 1.5 h sleep more than in-person students. Finally, students with online/synchronous instruction reported more sufficient sleep compared to students who were taught in-person.  However, this study was limited in that sleep data was self-reported, and the variable sleep opportunity did not account for sleep onset latency or wake after sleep onset. Nonetheless, this study was significant because it was the first to reveal the effects of different secondary school instructional approaches on the sleep patterns and potential health of students.

COVID-19 restrictions may improve sleep quality of narcolepsy and idiopathic hypersomnia patients

1. In this study, narcolepsy and hypersomnia patients reported an increase in sleep time and delays in bedtime (BT) and wake time (WT) during the COVID-19 pandemic lockdowns.

2. Narcolepsy patients reported significant improvements in cataplexy and sleep-related hallucinations during lockdowns.

Evidence Rating Level: 2 (Good)

Throughout the COVID-19 pandemic, strict regulations have been enforced in many countries to minimize the spread of the virus. Telework has normalized globally, and evidence has demonstrated profound alterations in human sleep patterns that emerged from this condition. In this observational cohort study, the impact of COVID-19 lockdown measures on sleep habits and symptoms of narcolepsy type 1 (NT1) and type 2 (NT2) and idiopathic hypersomnia (IH) patients in France was investigated.

A total of 219 (of 851 recruited) NT1, NT2, and IH patients from the Pitié-Salpétrière hospital, France completed a 78-question survey that assessed a variety of factors, including demographics, sleep habits, hypersomnia symptoms, and Epworth Sleepiness Scale (ESS) score, which measures excessive daytime sleepiness (scale 0-3, 0=no sleepiness, 3=high) in individuals. Participants who did not complete the survey were excluded from the study. Furthermore, this study looked at comparisons between patients who worked as teleworkers and in-person at their occupations.

Participants reported a significant increase in night sleep time and decrease in ESS. Furthermore, 46.1% of participants reported a delay in bedtime, and 59.6% of participants reported a delay in waketime (primarily by IH patients). Teleworkers reported a significant increase in night sleep and a mean decrease in sleepiness score. 54.1% of NT1 participants reported a decrease or disappearance in cataplexy, and a large percentage of NT1 and NT2 patients indicated decreases in sleep-related hallucinations. However, half of the respondents reported experiencing insomnia at some point during lockdowns. This study was limited in its low response rate (25.7%). Nonetheless, the study was significant in revealing the changes in sleep patterns, health, and severity of symptoms of hypersomnia patients that occurred during COVID-19 lockdown measures.

Later start times may be preferred by secondary school teachers

1. In this study, the majority of surveyed teachers reported a preference for later school start times.

2. Preference of teachers was shown to be determined mainly by their own sleep behaviors and perception of students’ sleepiness and receptiveness in morning lessons.

Evidence Rating Level: 2 (Good)

Obtaining sufficient sleep is a challenge for adolescents. A contributing factor are school schedules requiring secondary school students to wake up early, which are misaligned with their biological sleep pattern. However, studies on how teachers view school start times (SSTs) remain limited. In this observational cohort study, the attitudes of high school teachers for later school start times (SSTs) were investigated.

A total of 694 teachers (17 different high schools) in Zurich, Switzerland completed a cross-sectional online survey that spanned from May to July 2017. Participants were excluded if they did not report, school, sex, or age. The survey assessed whether teachers endorsed later SSTs and how they would compensate for later SSTs. Furthermore, the survey examined: 1) sociodemographic characteristics; 2) school & work-related characteristics; 3) sleep characteristics; 4) perception of students in the morning.

The results demonstrated that 51% of teachers preferred later STTs, with the preferred options to compensate for later SSTs being to shorten lunch breaks or to cancel free afternoons. 53.5% of teachers rated current stress as “rather strong” or higher. Teachers also demonstrated shorter sleep–wake patterns and sleep duration on school days than free days, and their median daytime sleepiness score was 7 (scale 0-10, 10=strong sleepiness). Moreover, students’ sleepiness and receptiveness were reported as 5 and 6, respectively. However, the study was limited due to the possibility of teachers working at multiple schools and thus affecting data, it points out two main factors affecting teachers’ preference for SSTs: their own sleep behavior, and their perception of students in the morning. Overall, teachers themselves might benefit from later SSTs, and psychoeducation about students’ sleep biology and associated cognitive performance would influence teachers’ attitudes about later SSTs.

Image: PD

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