Author Archives: Dr. Catherine Darley

Progress on Bell Times in Seattle – Press Release

Since spring of 2012, thousands of people in Seattle have been asking for bell times to be aligned with the times teens best times for learning, health and safety.  The District convened a Bell Time Task force in the fall.  Participating on the Task Force, I share some of the concerns about the process that are voiced in this press release from Start School Later Seattle on May 7, 2015.  The press release is copied below.

If you would like improved bell times for Seattle students, please email your support to arrivaltimes@seattleschools.org.  The preferred option from the Task Force is 2 tiers, elementary at 8am, middle and high school at 8:50am.  From independent analysis this option seems financially feasible, allows all students to be in school at their best time to learn, and least disruption to family schedules.

 

 

 

 

Health, Safety and Equity in Education

 

Press Statement by Cynthia Jatul May 7, 2015

Start School Later Seattle Questions the Validity of SPS’s Community Engagement Process on Bell Times

As members of Start School Later Seattle we joined the bell time task force on good faith that the process would include meaningful input.  We are rapidly losing faith in the district’s process in terms of analysis and communication. SPS is currently gathering community input on the question of changing bell times. However there are multiple ways in which the process is flawed.  District staff rejected the inclusion of a two tier option with 8:00 and 8:50 start times despite recommendations by the task force to consider this option. There is no place on the online survey for people to write in comment, effectively preventing the public from suggesting a two tier system.  SPS claims two tiers will cost an additional $20 million dollars but has not substantiated this analysis.  SPS is using two methods to collect data and has no control over how many times individuals respond.  The accompanying FAQs are heavily weighted towards potential negative outcomes of later starts. In summary, we call into question the validity of the data collected given the inconsistency between the two methods used, the lack of comment space, and the overall negative bias of the survey and informational documents.  A full enumeration of our concerns, which have been sent to Pegi McEvoy, Assistant Superintendent of Operations and Sam Markert, Bell Time Analysis Project Manager is provided on page 2.

The Seattle community deserves to know that the task force recommended consideration of a two tier system and that the tools being used to elicit community input were constructed without review by the task force. The community also deserves to know how the district arrived at an estimated $20 million additional cost for the two tier start.

The following members of Start School Later Seattle are available to discuss these issues in more detail.

Cynthia Jatul, NBCT                                                  Samar Hoag MS, RN

Co-chair Start School Later Seattle                            (206)660-8344

(206)799-5853                                                            Skhoag@gmail.com

Maida Chen, MD                                                        Horacio de la Iglesia, PhD

Director, Sleep Disorders Program                           Biology Professor

Seattle Children’s Hospital                                        horaciodelaiglesia@gmail.com

(206)987-2174                                                           (206)335-7901

  1. The process by which the three options were decided upon was done with limited input by the task force.  Although we discussed and voted on a number of options that were generated by the district and the task force, the current options; 1) no change, 2) modified flip, 3) extended day were basically pre-determined by the district.  The extended day option received the least number of votes by the task force because it fails to meet American Academy of Pediatric recommendations for all middle school students and approximately half of high school students.  The task force’s most favored option, a two tier system with elementary schools starting at 8:00 and 8:50 and all middle and high schools at 8:50 was categorically removed from consideration by the district.  The district claims a two tier system will cost an additional $20 million.  By independent analysis we believe the additional cost to be closer to $1.6 million.  SPS changed to a three tier system in 2012 and only saved $2 million (http://www.seattleschools.org/modules/cms/pages.phtml?pageid=268319), thus a return to a two tier system shouldn’t exceed $2 million.
  2. We were promised at a meeting last spring at Roosevelt High School that presentations to the community on the issue would be unbiased.  The 3 options flyer and the option 2 and option 3 FAQs have a greater emphasis on potential negative impacts then they do on the positive.  In none of these documents is there a forthright statement on the major impetus for consideration of adjusting bell times, namely to adjust our schedules to align with the biology of our students in order to improve learning, health, and safety of middle and high school age students.
  3. Community engagement communications, except for the N2N video, have been made without taskforce oversight or review.  The task force has had no input into the wording of the N2N questionnaire, the online survey, or the FAQ documents.
  4. Not only are the FAQ’s skewed toward potential negative impacts but they also contain glaring distortions of reality.  Both option 2 and 3 FAQs claim that the district is collaborating with the medical community to “impart health education”.  There is no evidence that the sleep medicine community nor the school nurses have been called upon to help educate the community on the issues of adolescent sleep and the importance of sleep for brain function (hence learning), health, and safety.
  5. The FAQ’s state, “Currently, there is a Task Force working on a recommendation to address the 24 credit graduation requirement problem, which would be a decision made independent of a bell time change. This issue, along with the 1080 instruction hour requirement, is also a challenge to be addressed. The application of solutions for these state requirements within a new bell time structure would be required for any option under consideration.” (italics added)  The task force has not been informed that meeting 24 credit or 1080 hours must be met by a bell time change. Therefore we haven’t had meeting these state requirements as one of our goals.
  6. While the task force was told that the community would have a chance to suggest alternative bell schedules, neither the N2N questionnaire nor the online survey solicits such input.  The online survey has in fact, no place for comments. How will the task force know what other options the community might favor?
  7. Data gathering through the N2N process is not following the original intent.  The questionnaires are available in so many venues that many respondents will not have viewed the video prior to responding.  These responses will not be based on the educational components of the video and therefore will constitute a very different data set.  Therefore the N2N data shouldn’t be evaluated in the same manner.   What is the purpose of such widespread distribution when SPS is also using an online survey?

Seattle’s Early School Start Times – personal experience

It’s 9am Saturday as I write this. My middle school student is still sleeping, despite the household noises. Yesterday, and every school day, she would be finishing math and be headed into science class in 10 minutes. Both essential subjects to master. Yet difficult to master at a time you’d naturally be sleeping.

Over the last 2-3 decades lots of research has demonstrated that puberty shifts natural sleep times later, that secondary students are largely sleep deprived because of early school start times, and that with later school start times students get more sleep, which improves academics, health and safety. You can learn more about this topic at www.startschoollater.net and www.schoolstarttime.org.

Since spring of 2012 thousands of Seattlites, Wa and Seattle PTA, teachers, school nurses, and sleep specialists have asked the Seattle School District to start secondary schools at 8:30am or later, evidence based times. After 2+ years, the district has established a “Bell Time Analysis Task Force” which will look at the issue and make a recommendation to the superintendent in June 2015, for possible implementation fall 2016. As they slowly move on this community-led initiative, the approximately 23,000 secondary students are struggling with sleep deprivation each and every day.
(She woke up now, 9:05am – time for science on a regular school day).

My daughter and family are negatively impacted by Seattle’s early school start times, here’s how:
– My daughter can’t fall asleep at the time she needs to to get enough sleep (9pm for a 6:30am wake-up). She often gets frustrated in the night, and asks for sleep medication. AT 11 years old, it’s a bad sign for her to think she can’t get to sleep on her own and needs medication! What she’s done a couple times this week is to get into bed with me after a couple hours of not being able to fall asleep on her own. She hasn’t gotten into the ‘big bed’ for years! This disturbs my own sleep, and causes sleep deprivation which impacts my day and the people I interact with.
– Getting woken up when she’s still sleepy often sets us up for negative interactions between us and feeling rushed in the morning.
– She’s been sick a lot, missing two full weeks of the 15 weeks this fall. Remember, sleep deprivation impairs immune function.
– It is now so dark at commute time that I drive her for safety, so she misses out on the exercise she needs to get by walking to school. (A child at her school was hit by a car yesterday on the walk to school. She was grazed by the side view mirror, and foot run over by the rear tire).
– At the beginning of the school year she often needed a nap after school, and now needs one on weekends, which cuts our ability to have activities with family and friends. She’s socializing less with her friends.
– When my parents retired they moved into Seattle to be near the grandchildren. It’s been a nice routine over the last years to have family dinner with the grandparents and my brother’s family on Fridays twice a month. Now we no longer can meet because my daughter is so exhausted by Friday afternoon that she is in tears and can’t politely interact with the family. Now the grandparents and cousins feel disconnected and our family ties are weakened.

From this personal experience, I see that the Seattle School Districts slow implementation of evidence-based school start times has a negative ripple effect throughout our community. In our family life alone the impact is felt by: the student, parents, grandparents, cousins, student’s friends, parent’s circle of interactions. That’s a lot of people negatively impacted by one student getting up too early (7 directly, plus more indirectly)!

How are the current early start times in Seattle’s secondary schools impacting your family and community?

Record of natural wake times on winter break:
Saturday 20th wake time 9:05a
Sunday 21st wake time 8:55a

Light Impacts Sleep

Now that the nights are longer, it’s time to think about the impact light has on our sleep. And oh, does it have impact! This last month it’s been a pleasure to read two books on light, and human’s historical experience of night – The End of Night by Paul Bogard, and At Day’s Close Night in Times Past by A. Roger Ekirch. Let’s dive into some of the details, and then how you can design light exposure to help your sleep.

The negative effect of light at night
Roger Ekirch talks about the human experience of night over the centuries. Streets until the 1600s had only the light spilling from homes to light them. To be out at night was dangerous, and many towns would close their doors at night and enforce a curfew. For safety, fires and candles would be put out before bed. Their use would be conserved to save money, so some poor people would go to bed soon after dark.

Compare that history to the “sky glow” that many of us are now living in, where we can hardly see the stars at night. In The End of Night author Paul Bogard outlines what is lost when we no longer have dark nights. Not only is human physiology influenced, but migrations of birds and the life-cycle of trees is altered.

Melatonin is a hormone secreted by the pineal gland of the brain. Melatonin is nicknamed “the hormone of darkness,” and helps us feel sleepy at bedtime. Unfortunately melatonin is very sensitive to light, particularly blue light, which suppresses it’s release. And what are 90% of us exposed to during the evening? The blue light of electronics which suppresses melatonin!

The positive effect of light during the dayA recent study compared the sleep of office workers who get natural sunlight to those who work on the interior of the building and don’t. Those who got more light during the work day had better sleep quality, slept longer, and had more physical activity. They also reported a higher quality of life – something we’d all like!

Using light exposure to improve sleep
The basic principle is to get historical light levels during both day and night. In other words, bright full-spectrum light it the morning and during the day, then full darkness at night. How can you do that? Here are some ideas:
– in the morning get some bright outdoor light as soon as possible. Maybe go stand on the porch and look out while having your morning tea.
– continue to get bright light in bursts throughout the day
– in the evening, have lights low, and use the yellow-red spectrum if possible (rather than blue or full-spectrum lights). Avoid electronics for the hour before bed.
– if you are up in the middle of the night, again have low lighting. Particularly troublesome in many homes are the bright bathroom lights, instead put a small night-light in the bathroom to use if need be.
– watch out for your neighbors too by turning off outside lights that aren’t truly needed, and if you need outdoor lights, aim them downward so you are not committing ‘light trespass.’ (Interestingly, Bogard cites studies showing that increased lighting does not decrease crime, that criminals like to work in a well-lit area just like everyone else!)

Be purposeful about making all of these lifestyle changes at the same time. Then notice after a week or two how your sleep has changed!

The Problem with Alarm Clocks

Beep-Beep. Beep-Beep. Beep-BEEP. BEEP-BEEP. BEEEP-BEEEEP!

Using the alarm clock each morning to wake up is common for many Americans. It’s a practice that is hard on sleep, and a practice I’d like to do away with for everyone. Here’s some of the problems.

– If you are waking to the alarm, you haven’t gotten enough sleep. Most adults need a solid 8-9 hours of sleep nightly, and there are many negative consequences of being sleep deprived (see the video mentioned in the last post). Allowing yourself to wake on your own helps ensure that you are getting enough sleep.
– If you wake to the alarm, you may be woken out of deep sleep, or “slow-wave” sleep. This can leave you feeling groggy and take some time to “get with it” mentally.
– A feature many people use is the snooze button, giving themselves another 8-10 minutes of rest before the alarm goes off. Really it is disrupting your sleep for 10-20-30-40 minutes before you have to get up, making that sleep much less restorative.

So here’s my recommendations:
– If you’re waking to an alarm, move your bedtime earlier by 15 minutes every 4-5 days until you are waking up on your own at the time you need to. Alternatively, you can shift your committments later so that you can sleep later in the morning.
– Set the clock for the time you truly need to get out of bed. Then place it across the room so you have to be out of bed to turn it off. This will help you avoid the snooze button, and really get quality sleep until it’s time to get up.

Think about this for yourself, and for your kids too. If you are waking your children up for school they’re not getting enough sleep either.

Great video on Sleep Deprivation

Over the years I’ve written a lot about sleep deprivation and it’s effects.  Primarily because Behaviorally Induced Insufficient Sleep ie, chronic partial sleep deprivation, is the most common sleep problem, affecting 47% of adults in America.

Right now I’m working with a group of shift workers to help them create a lifestyle that promotes healthy sleep on work nights and days off, and optimal alertness when awake.  People can be very motivated to work nights because of the increased pay, and often shorter work week because of longer, 12 hour shifts.  But trying to sleep during the day is hard, and often shift workers are sleep deprived.  To help them stay motivated to get enough sleep, I’ve been teaching them about the negative impact of sleep deprivation.  This excellent youtube video about “25 scary and surprising effects of sleep deprivation” by List25 tells it well.  Enjoy!

http://www.youtube.com/watch?v=pbJxLITdt_E

 

Reducing Night Nurse Fatigue

Lately it’s been a pleasure to provide an intervention program for night-shift nurses to help them sleep well during the day, and thereby improve their alertness at night. For many nurses working nights a typical shift is 12 hours, often from 7pm to 7:30am. This requires them to function well during the hours that human beings are designed for sleep. Many of these employees like to sleep during the night on a similar schedule to their loved ones when not working, which keeps them in a perpetual state of circadian misalignment, making it even more difficult to function well at night.

In December 2011 the Joint Commission issued Sentinel Event Alert #48 on the effect of extended work hours and cumulative work hours on patient safety and nurse health. They summarize the extensive research on the performance effects of working at night. Some of the results of fatigue include:
– impaired information processing and judgement
– inability to focus attention
– reduced motivation
– loss of empathy
Fatigue among healthcare workers increases the risk of adverse events, decreases patient safety, and negatively impacts the health of the night shift workers.

The Commission report goes on to suggest steps organizations take to improve employee alertness and thereby improve patient safety. Fatigue management typically includes steps for both individual employees and the administration. Sleep training for employees so they can sleep well during the day, and entrain their circadian rhythm to the schedule, is one step. Another is fatigue reducing strategies such as precisely-timed caffeine and light to increase alertness on the job. Administrations can optimize their scheduling practices, and provide an alerting work environment. You can see the full Sentinel Event Report of the Joint Commission here: http://www.jointcommission.org/sea_issue_48/

Over the next 6 months I hope to continue this work for Seattle-area hospitals, and expand to help other public safety organizations that are providing 24/7 service, including the police and fire departments. Around the clock service is a must for public safety, and helping these night-shift staff to sleep well during the day, so they can be alert and healthy during the night is extremely rewarding!

Sleep Impacts Cancer

We have become a 24-hour society where people can work, shop and exercise at all hours of the day or night. But just because we can, does that mean we should?

Humans evolved in a rhythmic world, with daily and seasonal variations in light, temperature, and food availability. In our modern world we can control all these environmental factors so they are the same throughout the year, but our body is still programmed for circadian variation. Cancer incidence increases when people live out of sync with natural rhythms, like those who do shift work.

Shift Workers at Increased Cancer Risk

Those people who work graveyard shift have an increased risk of breast cancer. This risk increases with the number of years graveyard shift has been done. Getting bright light at night suppresses our natural melatonin surge. Melatonin is a powerful anti-oxidant, protecting our cells from damage.

Shift workers also are at increased risk for:
•Hypertension
•Cardiovascular disease
•Duodenal ulcer
•Elevated stress hormones
•Menstrual irregularities

Cancer Causes Sleep Disruption

The sleep – cancer relationship goes both ways. For those people undergoing cancer treatment, sleep disruption can be a symptom. This can be a side-effect of chemotherapy, or of pain, or other factors.

The good news is that several studies have shown that sleep of cancer patients can be improved by doing Cognitive-Behavioral Therapy for Insomnia. Specifically, after treatment, cancer patients ended up sleeping a higher percentage of the time they were in bed, had improved mood, and decreased fatigue. Another study additionally found that the people had fewer nights on medication, and that the improvements were maintained for 12 months afterwards.

Similarities between Childrens Sleep and Gambling?

Okay, you may think this is a stretch.  What similarities could there possibly be between children’s sleep and gambling?  Well, let’s talk about it.

Remember from a psychology class the idea of “intermittent reinforcement?”  This is when a behavior is only sometimes rewarded.  Researchers found that in animals, if a behavior was only rewarded about 50% of the time, that behavior would persist longer than if the action always gave a reward.  The same is thought to be true in human beings. 

We see this in gambling, because the gambling behavior is only rewarded by winning on an occasional basis, people will continue gambling for long durations in the hope of getting the reward.

Let’s relate this to helping your young child learn to fall asleep on their own.  After the bedtime routine you say “Goodnight” to your child, leave the room and close the door.  However, your child prefers to fall asleep with you there, so gets up and comes out to get you.  You return to the bedroom with your child, tuck them in, say “Goodnight” leave the room and close the door.  And the cycle repeats, with your child coming to get you, and both of you returning to the bedroom. 

As the night wears on, you are becoming tired, and think “well, if I just lay down with my child until he is asleep, I’ll finally be able to get some rest myself.”  If you sometimes stay with the child until he is asleep, and not other times, you’ve just given intermittent reinforcement, which will keep the child’s behaviour of seeking you out at bedtime to persist.

So for parents, first decide what the ideal scenario and expectations are for your child.  Then, be consistent so there is no “intermittent reinforcement” of the bedtime behaviors you don’t want.   Writing down the plan so that both parents are in agreement, and so you can remember and stay motivated when you are tired can make all the difference.

An Ergonomic Bed

Regularly there are new sleep products on the market. Just last week I saw one that really impressed me, so much so that I’d like to share. Rest assured, I have no affiliation with this company, financial or otherwise.

It is a new bed which was designed ergonomically so the body can be in a neutral side-lying position during sleep. There is a cut-away so that the lower arm is supported underneath the body, while the head and shoulders are supported above. In this position the spine is not twisted, as it commonly is when side-lying. The support system allows the shoulders to be in a neutral position also, instead of rolled inwards as commonly happens.

The mattress is wedge-shaped so that the head is elevated. There’s been some work showing that when the body is supine, edema can re-distribute and cause narrowing of the airway. That airway narrowing increases the risk of apnea.

The bed is made of foam, and when I first heard that my alarm bells went off. However, I’ve learned that they only use pure foam that has not been treated with the harmful chemicals found in some foam. There were no fumes evident in the store, either when first walking in or after spending time looking at the bed.

So many people have pain conditions which interrupt their sleep, and the improvements to their sleep are limited until the pain can be eliminated. This bed gives me hope for some of those pain patients

In the next weeks someone will be trying it out for me, and I post an update here after the test. If you’d like more information, you can find it on the inventors’ site http://www.squiresleep.com/

Start School Later meets with the Dept. of Health

Tomorrow, July 18, the leaders of the national Start School Later initiative will be meeting with directors at the Substance Abuse and Mental Health Services Administration of the Department of Health. There is a connection between early school start times and depression and suicidal thoughts that needs to be addressed.

The full press release is below, and I’ll post the update from the meeting in the next few days. If you’d like to weigh in with your support of later school start times you can sign the petition at www.startschoollater.net
RELEASE: July 16, 2012: GRASSROOTS GROUP ASKS FEDERAL AGENCY TO ADDRESS LINK BETWEEN EARLY HIGH SCHOOL START TIMES, MENTAL HEALTH, AND TEEN SUICIDES:

Contact: Heather Macintosh, 410-279-4569 heathermac@verizon.net
Dr. Terra Ziporyn Snider, Co-Director, 410-262-6616

Start School Later, a national coalition advocating for sane, humane high school start times, is meeting with Dr. Anne Mathews-Younes, Director of the Division of Prevention, Traumatic Stress and Special Programs, and Dr. Richard McKeon, Director of the Suicide Prevention Resource Center, at the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the US Dept of Health and Human Services (HHS), Wednesday, July 18, in Rockville, MD.

Compelling scientific research shows that adolescents’ sleep needs are being dangerously compromised by the extremely early school schedules of many US high schools. Waking at 5:30 to catch a bus and begin school in the 7 o’clock hour is incompatible with adolescent sleep needs and causing teens to miss out on the crucial sleep they need for physical and mental health and development and optimum academic achievement. Sleep deprivation is strongly linked to anxiety, depression, and suicidal ideation, among other health effects.

SAMHSA is an agency of the U.S. Department of Health and Human Services (HHS), which, in turn, is increasingly recognizing the importance sleep plays in the health and wellness of young people.

“We’re looking forward to discussing ways federal agencies might be helpful in raising awareness and facilitating policies to ensure safe, healthy school hours for all children,” says Terra Ziporyn Snider, PhD, Start School Later’s Co-Director. “This has been impossible to achieve in many local school systems, where all too often politics and myth trump student health and well-being.”

Start School Later is an all-volunteer, national coalition working to ensure that all public schools can set hours compatible with health, safety, equity, and learning. Coalition members attending the SAMHSA meeting include Dr. Terra Ziporyn Snider and Kari Oakes, PA-C, both from Maryland, as well as Terry Cralle, RN, of Virginia, and Debbie Coleman, MBA, faculty member at the Miami University (Ohio).