Elsevier

Sleep Medicine

Volume 21, May 2016, Pages 93-100
Sleep Medicine

Original Article
School-based sleep education program improves sleep and academic performance of school-age children

https://doi.org/10.1016/j.sleep.2016.01.012Get rights and content

Highlights

  • A sleep education program was created using a participatory research approach.

  • The program was evaluated using objective sleep measures and report card grades.

  • Children's sleep and academic performance improved following participation in the program.

Abstract

Study objective

The objective of this study was to develop and evaluate the effectiveness of a school-based sleep education program aimed at improving the sleep and academic performance of school-age children.

Methods

Using a community-based participatory research approach, we created a school-based sleep education program, “Sleep for Success”™ (SFS), composed of four distinct modules that addressed the children, their family and community, the school staff, and decision makers within the school setting. Implementation was carried out in three elementary schools. Seventy-one students participated in the evaluation of the program. The effectiveness of the SFS program was evaluated using non-randomized controlled before-and-after study groups (intervention and control) assessed over two time points (pre- and post-program implementation). Before (baseline) and after implementation, sleep and academic performance were measured using actigraphy and report card marks, respectively.

Results

In the intervention group, true sleep was extended by 18.2 min per night, sleep efficiency improved by 2.3%, and sleep latency was shortened by 2.3 min, and report card grades in mathematics and English improved significantly. No changes were noted in the control group.

Conclusion

Participation in the sleep education program was associated with significant improvements in children's sleep and academic performance.

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.

. ICMJE Form for Disclosure of Potential Conflicts of Interest form.

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)

  • C.A. Kushida et al.

    Comparison of actigraphic, polysomnogrpahic, and subjective assessment of sleep parameters in sleep-disordered patients

    Sleep Med

    (2001)
  • N. Perkinson-Gloor et al.

    Sleep duration, positive attitude toward life, and academic achievement: the role of daytime tiredness, behavioral persistence, and school start times

    J Adolesc

    (2013)
  • L.B. de Carvalho et al.

    Symptoms of sleep disorders and objective academic performance

    Sleep Med Rev

    (2013)
  • R. Gruber et al.

    Sleep efficiency (but not sleep duration) of healthy school-age children is associated with grades in math and languages

    Sleep Med

    (2014)
  • S.M. Schmid et al.

    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

    (2009)
  • G. Atkinson et al.

    Relationships between sleep, physical activity and human health

    Physiol Behav

    (2007)
  • M. Nores et al.

    Benefits of early childhood interventions across the world: investing in the very young

    Econ Educ Rev

    (2010)
  • D. Bonnar et al.

    Evaluation of novel school-based interventions for adolescent sleep problems: does parental involvement and bright light improve outcomes?

    Sleep Health

    (2015)
  • U. S. Department of Education, National Center for Education Statistics et al.

    NAEP 1999 Trends in Academic Progress

  • S. Aud et al.

    The condition of education 2012 (NCES 2012-045)

    (2012)
  • J.S. Zax et al.

    IQ, academic performance, environment and earnings

    Rev Econ Statist

    (2002)
  • G.J. Whitehurst et al.

    Child development and emergent literacy

    Child Dev

    (1998)
  • S. Ravid et al.

    Kindergarten children's failure to qualify for first grade could result from sleep disturbances

    J Child Neurol

    (2009)
  • E. Touchette et al.

    Associations between sleep duration patterns and behavioral/cognitive functioning at school entry

    Sleep

    (2007)
  • A.M. Meijer

    Chronic sleep reduction, functioning at school and school achievement in preadolescents

    J Sleep Res

    (2008)
  • G. Fallone et al.

    Effects of acute sleep restriction on behavior, sustained attention, and response inhibition in children

    Percept Mot Skills

    (2001)
  • R. Bull et al.

    Executive functioning as a predictor of children's mathematics ability: inhibition, switching, and working memory

    Dev Neuropsychol

    (2001)
  • D. DeStefano et al.

    The role of working memory in mental arithmetic

    Eur J Cogn Psychol

    (2004)
  • R. Bull et al.

    Short-term memory, working memory, and executive functioning in preschoolers: longitudinal predictors of mathematical achievement at age 7 years

    Dev Neuropsychol

    (2008)
  • H.L. St-Clair-Thompson et al.

    Executive functions and achievements in school: shifting, updating, inhibition, and working memory

    Q J Exp Psychol (Hove)

    (2006)
  • K. Supekar et al.

    Neural predictors of individual differences in response to math tutoring in primary-grade school children

    PNAS

    (2013)
  • T.E. Froehlich et al.

    Mediators of methylphenidate effects on math performance in children with attention-deficit hyperactivity disorder

    J Dev Behav Pediatr

    (2014)
  • J. Lim et al.

    A meta-analysis of the impact of short-term sleep deprivation on cognitive variables

    Psychol Bull

    (2010)
  • B. Anderson et al.

    Associations of executive function with sleepiness and sleep duration in adolescents

    Pediatrics

    (2009)
  • C.J. Calamaro et al.

    Adolescents living the 24/7 lifestyle: effects of caffeine and technology on sleep duration and daytime functioning

    Pediatrics

    (2009)
  • K. Spruyt et al.

    Sleep duration, sleep regularity, body weight, and metabolic homeostasis in school-aged children

    Pediatrics

    (2011)
  • National Sleep Foundation

    2006 Sleep in America Poll

  • National Sleep Foundation

    Sleep in America poll: communications technology in the bedroom 2011

    (2011)
  • National Sleep Foundation

    Sleep in America poll: sleep in children survey

    (2004)
  • Canada. MHCo

    Changing directions, changing lives: the mental health strategy for Canada

    (2012)
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    This work was performed at the Douglas Mental Health University Institute and the Riverside School Board, Québec, Canada.

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