Original ArticleSchool-based sleep education program improves sleep and academic performance of school-age children
Introduction
Low academic achievement in children is a common and serious problem that affects a large number of students [1], [2]. School outcomes largely determine long-term social and economic success and a successful start to formal learning in school is formative to these outcomes [3], [4]. Insufficient or poor quality sleep is a significant risk factor for poor academic performance [5], [6], [7], [8], [9], as they affect cognitive processes that underlie academic performance [10], [11], [12], [13], [14], [15], [16], such as executive functions [17], [18], memory [19], and attention [9].
Previous research efforts have sought to promote good sleep habits and extend sleep durations among adolescents in light of the delayed circadian timing associated with the onset of puberty and the bedtime-delaying psychosocial factors observed in this age group [20]. However, a sizeable proportion of elementary school children sleep on average 8 h [21], which is significantly less than the recommended 10 h per night [22], [23]. In a large survey, 27% of school-age children were reported to obtain fewer hours of sleep than their parents/caregivers thought they needed [24], and a recent objective study using wrist actigraphy showed that children aged 4–10 years slept less than the recommended amount of sleep per night [21].
Our work seeking to promote good sleep habits and extend sleep duration has focused on younger children for several reasons, as follows: 1) sleep deprivation in prepubertal children is likely to be caused by lifestyle habits and culturally normative bedtimes and thus may be addressed by sleep education programs that target lifestyle choices; 2) school-age children can suffer from significant sleep deprivation and will therefore benefit from acquiring healthier sleep habits as well as increased and improved sleep; 3) school-age children are more receptive to guidance from adult figures (eg, parents and teachers) and are therefore more likely than adolescents to internalize the healthier sleep habits promoted by a school-based sleep education program; and 4) developing healthy habits at a young age has been shown to create a foundation for integrating these habits into daily life in later years, suggesting that early education on the importance of sleep could set the stage for an easier transition to adolescence.
Schools are ideal venues for prevention and intervention programs as they reach large segments of the youth population, provide a platform for health education and promotion [25], and can play an active role in encouraging children to adopt and maintain a healthy lifestyle. It has been shown that using the preexisting infrastructure of the educational system can offer a cost-effective route for delivering health-promoting programs [26], [27]. Despite the critical importance of sleep in the daytime functioning and health of elementary school students, and the high prevalence of sleep deprivation among school-age children, the topic of sleep is not addressed in most school health curricula. Only one school-based sleep intervention for elementary school has been reported [28], but there is no information regarding its effectiveness as the study did not use objective sleep measures or outcome measures pertaining to the potential impact of the program on daytime functioning. The other reported efforts in sleep education/promotion have focused on school-based interventions for adolescents [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], and have suffered from multiple limitations, including the use of knowledge (not actual sleep behavior) as an outcome measure [36], [37], [38], [39], the lack of objective measures of sleep [30], [31], [32], [33], [34], [35], [36], [37], [39], [40], [41], and the lack of relevant secondary measures, such as academic performance [29], [30], [32], [35], [36], [37], [41] (and see [40], [42], [43]).
To address the problem of insufficient sleep in school-age children, we developed and evaluated a school-based intervention designed to increase children's total sleep time. This program, “Sleep for Success™” (SFS), was developed through a partnership between a team of researchers from McGill University and a team of educators and communities served by the Riverside School Board (RSB), Quebec. The educational program involved a 6-week classroom curriculum for children, plus tools aimed at eliciting the involvement of parents and teachers. This report describes the results stemming from the implementation of SFS.
The primary goal of this study was to evaluate the impact of SFS on objective measures of sleep duration, efficiency, and latency in healthy, typically developing school-age children. The secondary goal was to examine changes in report-card grades following students' participation in this sleep promotion program. We hypothesized that the sleep and academic performance of children in the intervention group would improve compared to baseline following the implementation of SFS, whereas children of the control group would show no change over the study period.
Section snippets
Participants
A total of 192 students participated in the program activities. Of them, 74 (33 boys and 41 girls, aged 7–11 years (mean = 8.46, standard deviation (SD) = 1.8) agreed to participate in the study and completed all measures at both time points. A participant was excluded if he/she 1) had a history of psychiatric illness, developmental disorder, learning disability, or psychosis that might affect academic performance; 2) reported a sleep disorder; or 3) had a medical or psychiatric condition that
Demographic, behavioral, and biological characteristics
No significant between-group difference was found for reported race or SES. The race distributions were similar between the groups. However, there was a larger proportion of girls in the control group compared to the intervention group (χ2 = 3.57, p <0.05). We therefore conducted MANOVAs to examine potential sex differences in the sleep measures and report card marks. No significant difference was found in any examined measure.
Sleep before and after implementation of SFS
Table 1a presents the means and SDs of the actigraphic sleep
Discussion
Our main findings are that participation in this sleep education program yielded improvements in objective measures of sleep and report card grades. To our knowledge, this is the first intervention to document improvements in sleep duration in elementary school children using objective measures of sleep. Specifically, to our knowledge this study is the first to 1) use objective measures of sleep to determine the impact of a sleep education program on the sleep of school-age children; 2) examine
Funding
Supported by a Canadian Institutes of Health Research grant (#187977, to Reut Gruber).
Conflict of interest
The authors have no conflict of interest to disclose.
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2016.01.012.
Acknowledgments
We would like to formally acknowledge the participation and contributions of the following individuals from Riverside School Board:
Paul Enros
Jennifer McNeil
Dan Brouillette
Enzo DiIoia
Deborah Angelus
Elizabeth Poitras
Myra Kestle
James Stadnyk
Nathalie Guenefeld
We would like to thank the students, parents, and teachers who participated in the program and the study.
References (80)
- et al.
The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review
Sleep Med Rev
(2010) - et al.
Attentional requirements of learning: evidence from performance measures
Cognit Psychol
(1987) - et al.
Sleep and memory in healthy children and adolescents – a critical review
Sleep Med Rev
(2010) - et al.
Education in children's sleep hygiene: which approaches are effective? A systematic review
J Pediatr (Rio J)
(2014) - et al.
Knowledge of sleep in Italian high school students: pilot-test of a school-based sleep educational program
J Adolesc Health
(2004) - et al.
Can a school-based sleep education programme improve sleep knowledge, hygiene and behaviours using a randomised controlled trial
Sleep Med
(2015) - et al.
A motivational school-based intervention for adolescent sleep problems
Sleep Med
(2011) - et al.
Are sleep education programs successful? The case for improved and consistent research efforts
Sleep Med Rev
(2012) - et al.
Developmental aspects of sleep hygiene: findings from the 2004 National Sleep Foundation Sleep in America Poll
Sleep Med
(2009) - et al.
School-based sleep promotion programs: effectiveness, feasibility and insights for future research
Sleep Med Rev
(2013)
Comparison of actigraphic, polysomnogrpahic, and subjective assessment of sleep parameters in sleep-disordered patients
Sleep Med
Sleep duration, positive attitude toward life, and academic achievement: the role of daytime tiredness, behavioral persistence, and school start times
J Adolesc
Symptoms of sleep disorders and objective academic performance
Sleep Med Rev
Sleep efficiency (but not sleep duration) of healthy school-age children is associated with grades in math and languages
Sleep Med
Short-term sleep loss decreases physical activity under free-living conditions but does not increase food intake under time-deprived laboratory conditions in healthy men
Am J Clin Nutr
Relationships between sleep, physical activity and human health
Physiol Behav
Benefits of early childhood interventions across the world: investing in the very young
Econ Educ Rev
Evaluation of novel school-based interventions for adolescent sleep problems: does parental involvement and bright light improve outcomes?
Sleep Health
NAEP 1999 Trends in Academic Progress
The condition of education 2012 (NCES 2012-045)
IQ, academic performance, environment and earnings
Rev Econ Statist
Child development and emergent literacy
Child Dev
Kindergarten children's failure to qualify for first grade could result from sleep disturbances
J Child Neurol
Associations between sleep duration patterns and behavioral/cognitive functioning at school entry
Sleep
Chronic sleep reduction, functioning at school and school achievement in preadolescents
J Sleep Res
Effects of acute sleep restriction on behavior, sustained attention, and response inhibition in children
Percept Mot Skills
Executive functioning as a predictor of children's mathematics ability: inhibition, switching, and working memory
Dev Neuropsychol
The role of working memory in mental arithmetic
Eur J Cogn Psychol
Short-term memory, working memory, and executive functioning in preschoolers: longitudinal predictors of mathematical achievement at age 7 years
Dev Neuropsychol
Executive functions and achievements in school: shifting, updating, inhibition, and working memory
Q J Exp Psychol (Hove)
Neural predictors of individual differences in response to math tutoring in primary-grade school children
PNAS
Mediators of methylphenidate effects on math performance in children with attention-deficit hyperactivity disorder
J Dev Behav Pediatr
A meta-analysis of the impact of short-term sleep deprivation on cognitive variables
Psychol Bull
Associations of executive function with sleepiness and sleep duration in adolescents
Pediatrics
Adolescents living the 24/7 lifestyle: effects of caffeine and technology on sleep duration and daytime functioning
Pediatrics
Sleep duration, sleep regularity, body weight, and metabolic homeostasis in school-aged children
Pediatrics
2006 Sleep in America Poll
Sleep in America poll: communications technology in the bedroom 2011
Sleep in America poll: sleep in children survey
Changing directions, changing lives: the mental health strategy for Canada
Cited by (77)
Socioeconomic disparities, nighttime bedroom temperature, and children's sleep
2023, Journal of Applied Developmental PsychologyEarly life socioeconomic differences in associations between childhood sleep and academic performance
2022, Journal of Applied Developmental Psychology
This work was performed at the Douglas Mental Health University Institute and the Riverside School Board, Québec, Canada.