III. The Intersection of School Start Times and Adolescent Sleep, Health, & Potential

“In sum, early school start times clearly contribute to sleep-deprivation in growing teens, making them even more vulnerable to all the challenges of adolescence, and increases the likelihood of accidents, psychological problems, and impaired learning in school.”⁽²⁾—Edward O’Malley, Ph.D., and Mary O’Malley, M.D., Ph.D.

U.S. Start Time Policies vs. Circadian Phase Delay

In the early part of the 20th century, studies showed that children and adolescents in England and Germany, where schools began between 7 a.m. and 8 a.m., slept less than adolescents in the western United States. ⁽²⁹⁰⁾ In 1913, recognizing the association between start times and sleep sufficiency, Lewis Terman and Adeline Hocking counseled, “The American practice of beginning at 9 o’clock is far wiser, and should never be changed unless for very special reasons.” ⁽²⁹⁰^, quoting Terman & Hocking, The sleep of school children; its distribution according to age, and its relation to physical and mental efficiency (1913) J. Educational Psychology, p. 271.)

Most U.S. high schools abandoned this “wiser” practice long ago, although the reasons for doing so may have been less than “special.” Matthew Wolf-Meyer, an Assistant Professor of Anthropology at the University of California, offers this explanation for the shift to earlier school scheduling:

“[T]he basis of modern school start times lies in the 19th century, when public schools were developed to care for the children of day laborers—meanwhile, the elite would send their children to boarding schools. The school day developed alongside the industrial workday to allow parents to drop off their children while they worked. There’s nothing natural about it—it isn’t based on some agrarian past where we were more in balance with nature. Instead, it had everything to do with the need to fill factories with able-bodied adults from dawn until dusk and to keep their children busy. Only slowly did this change, as American work schedules changed.” ^(61,citing Wolf-Meyer, The Slumbering Masses: Sleep, Medicine, and Modern American Life (Univ. Minn. Press, 2012) pp. 176, 196-198.)

As late as the 1950’s and 1960’s, most schools started between 8:30 a.m. and 9 a.m. ⁽²⁹²⁾Over the past several decades, there has been a trend toward earlier school start times. ^(2, 57⁾Although the data are limited, they suggest most U.S. high schools now begin during the 7 o’clock hour,^{(2, 12, 21, 22, 293, 294, 295)}while melatonin still pressures adolescents to sleep. ⁽³^,²⁴⁾Schools begin early for administrative and financial reasons, rather than because of any perceived benefits to student welfare.⁽¹²^,²⁹⁶⁾ Multi-tiered busing schedules often save school districts money.⁽¹²^,²⁹⁶⁾Accommodating athletics also factors significantly into start time determinations. ⁽¹²^,⁵⁸^,²⁹⁷⁾

Most districts schedule classes so that children begin school earlier as they grow older. ⁽¹²⁾“This change to the circadian rhythm is in contrast to the extrinsic demands of an early school start time, resulting in an overall decrease in total sleep duration. In essence, adolescents must be awake and learning at a time of day when their bodies should be sleeping.” ⁽²⁹⁸⁾In 1993, Professor Carskadon, et al., cautioned:

“[T]he widespread practice in U.S. school districts for school buses to run and for the opening bell to ring earlier at high schools than at junior high schools, and earlier in junior high schools than primary schools, may run precisely counter to children’s biological needs. By the same token, teenagers faced with long school bus rides in addition to early starting time for school may confront incremental challenges in conflict with the biological propensities.” ⁽¹⁾

The National Institutes of Health began echoing this concern in 1997, pointing to early school start times as a factor contributing to restricted sleep and its attendant risks among adolescents. ⁽⁵⁵^,⁵⁶^,⁵⁷⁾

“Recent data indicate that regulation of the circadian timing system may change during pubertal development and contribute to delayed timing. This type of sleep phase delay is in direct conflict with early school starting times, which form an uncontrollable and nonnegotiable aspect of a child’s daily program. Youngsters faced with a lengthy commute to school have an even more difficult schedule problem. Oversleeping during the school week is not a legitimate option for adolescents, and early bedtimes may not be achievable for adolescents at the dawning of the 21st century due to biological and psychosocial impediments. [¶] Significant among the adverse outcomes are studies showing that problem sleepiness can lead to degraded school performance, emotional stress, alcohol and drug abuse, and a disturbingly high rate of fatal motor vehicle crashes in older adolescent and young adult males.” ⁽⁵⁵⁾

“The need for sleep may be 9 hours or more per night as a person goes through adolescence. At the same time, many teens begin to show a preference for a later bed time, which may be due to a biological change. Teens tend to stay up later but have to get up early for school, resulting in their getting much less sleep than they need.”⁽⁵⁶^,emphasis in original.)

“For most teens, the school start time means a nonnegotiable wake-up time. Most adolescents would sleep significantly longer if they could. [¶] Older adolescents … are staying up later, rising earlier, and incurring sleep debts. As a result, teachers end up with sleepy students, and teens live under a ‘dark cloud of insufficient sleep’ that may include microsleeps, attention lapses, decreased reaction times, impaired divergent thinking skills, impaired mental functioning, low mood, and a higher rate of accidents and injuries….” ⁽⁵⁷⁾

Around the turn of the nineteenth century, the size of the rural school district was governed by the distance a child could reasonably be expected to walk. ⁽²⁹⁹⁾Now children may be required to ride buses for an hour or more to attend school.⁽³⁰⁰⁾ Many bus riders rise during the 5 o’clock hour (or earlier) to meet the morning bell. ⁽³^,³⁰¹⁾Until later start times went into effect in 2012, middle and high school students in Waldo County, Maine, met school buses at 5:45 a.m. for 7:30 a.m. classes. ⁽³⁰²^,³⁰³⁾ Buses in Fairfax, Virginia, continue to collect high school students as early as 5:45 a.m. for 7:20 a.m. classes. ⁽³⁰⁰⁾

“The starting time of school puts limits on the time available for sleep. This is a nonnegotiable limit established largely without concern for sleep.” ⁽⁵⁾“Ironically, the school starting time moves earlier as children’s grade advances. Although school starts earlier, children cannot adjust their bedtime accordingly, and this could result in sleep deprivation. Subsequently, they are sleepy in the morning and become more alert in the afternoon when school is almost over.” (Cardinali, Chronoeducation: How the Biological Clock Influences the Learning Process, publish. in, The Educated Brain: Essays in Neuroeducation (Battro, Fischer, & Léna, edit., Cambridge Univ. Press 2008) p. 121, citation omitted.)

With relatively few districts moving to later school scheduling, in 2010, Columbia University Assistant Professor of Psychiatry James Gangwisch and colleagues noted the continuing disconnect between adolescent biology and school scheduling:

“Adolescence is associated with a circadian phase delay with an increasing preference to sleep at later hours; despite this, in most U.S. school districts school days begin progressively earlier as students transition from elementary to middle school and then from middle school to high school.” ⁽¹²¹⁾

The Center for Disease Control and Prevention has recently joined the argument, noting both the negative effects of early school scheduling ⁽¹⁸⁾ and the positive value of later start times. ^{(26, 52}^,discussed, infra, §§ III.G., VI, IV.C.)

Early Starting Schools vs. Sleep, Welfare, & Cognition

As previously noted, high school students average about two hours less sleep on school nights than on weekends or weekdays during summer. ⁽⁶^,²⁸^, Mindell & Owens, Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems (Lippincott Williams & Wilkins, 2nd ed. 2010) p. 258.) The 2011 National Sleep Foundation poll found 54% of teenagers (13-18 years) awaken between 5 a.m. and 6:30 a.m. on weekdays, with the majority (81%) getting to bed at 10 p.m. or later. ⁽²⁵⁾Thus, on school days, 6 in 10 obtain fewer than 8 hours of sleep. ⁽²⁵⁾
“Most teenage students would sleep longer on school days if not for the typical 7:30 a.m. or earlier school start-times.” (Rauch, What is Normal Sleep for Children and Adolescents? publish. in, Attention Deficit Disorder: Practical Coping Mechanisms (Fisher, edit., Informa Healthcare, 2nd ed. 2007) p. 175, ns. omitted; see n. 306 [homeschooled students awaken 18 minutes after public and private school students begin morning classes, obtaining 90 minutes more sleep per night].) “[S]chool sleep lag is worse for earlier starting schools. Additional weekend sleep does not alleviate this negative effect.” (Wahlstrom, Accommodating the Sleep Patterns of Adolescents Within Current Educational Structures: An Uncharted Path, publish. in, Adolescent Sleep Patterns, Biological, Social, and Psychological Influences (Carskadon, edit., Cambridge Univ. Press 2002) p. 174, ns. omitted.) Weekend oversleep further contributes to circadian disruption and decreased daytime alertness levels. ⁽⁶⁾

Multiple surveys of high school students conducted in the 1980′s and 1990′s found that students who start school at 7:30 a.m. or earlier obtain less total sleep on school nights than students at later starting schools. ⁽²¹⁾ A study published in 1992 found 12th graders beginning school at 7:40 a.m. reported getting less school-night sleep, more sleep problems, and sleeping later on weekends than 12th graders starting school at 8:30 a.m. ⁽³⁴⁾(Subjective measures of sleep from children and adolescents are correlated with objective measures.) ⁽³⁰⁷^,³⁰⁸⁾In 1994, a study of 3,120 adolescents attending four Rhode Island high schools with start times ranging from 7:10 a.m.–7:30 a.m. found most students were sleep deficient. ⁽³⁵^,³⁶⁾87% of the students reported needing more sleep than they were getting. ⁽³⁵^,³⁶⁾

A 1998 study evaluated the impact of a 65-minute start time advance for forty students transitioning from junior high (9th grade, 8:25 a.m. start time) to high school (10th grade, 7:20 a.m. start time). ⁽³⁸⁾ Objectively documented sleep records demonstrated that only 62% of the students in 9th grade, and fewer than 50% of the students in 10th grade obtained an average of seven hours or more of sleep on school nights. ⁽³⁸⁾ Students woke significantly earlier on school days in 10th grade than in 9th grade. ⁽³⁸⁾ In 10th grade, students also displayed atypical sleep patterns on a laboratory nap test of sleep sleepiness (Multiple Sleep Latency Test, MSLT). ⁽³⁸⁾ As a group, the 10th grade students “bordered on pathologically sleepy” by 8:30 a.m. ⁽³⁸⁾

“As discussed in the original study, this unusual pattern is disturbing because it mimics the clinical findings of patients with narcolepsy—a major sleep disorder. These findings have been attributed to a combination of too little sleep occurring at a time mismatched to circadian rhythms. In other words, these 10th graders were expected to function in school at a time when their bodies were meant to sleep.” (Wolfson & Richards, Young Adolescents: Struggles with Insufficient Sleep, publish. in, Sleep and Development (Oxford Univ. Press, El Sheikh edit. 2011) p. 269, citations omitted.)

Studies published in 2007, ⁽³⁰⁾ 2009, ⁽²⁸⁾and 2011 ⁽³⁰⁹⁾ also found that students attending schools with early start times obtained significantly less sleep than students at later starting schools. These outcomes are consistent with the findings of other published studies.⁽²^,³⁷^,³⁹⁾An exhaustive search has failed to uncover any contrary research findings.

“Thus, early school start time—the main predictor of an earlier wake time among adolescents on school days— conﬂicts with adolescent circadian biology. The fact that these adolescents spent 2 hours less time in bed on school days is consistent with the ﬁndings of another study of 60 high school seniors that found an average 2-hour reduction in sleep on school days. Another study found that students attending schools with later start times (8:37 a.m. vs 7:15 a.m.) obtained almost 1 hour more sleep. [O]ur ﬁndings conﬁrm that on school days, adolescents are obtaining less sleep then they are considered to need, and school start time is the factor with the greatest impact. If sleep loss is associated with impaired learning and health, then these data point to computer use, social activities and especially school start times as the most obvious intervention points.” ⁽²⁸⁾

The National Institutes of Health has identified adolescents and emerging adults (ages 12-25) as populations at “high risk” for problem sleepinesss. ⁽⁵⁵^,²⁶⁵⁾While less likely than their older peers to draw an early start time, middle school students may also be compelled to attend early starting schools. “[I]ncreasing societal demands promoted by a 24/7 culture over the past three decades have contributed to even earlier school start times for both middle and high school students.” ⁽²⁾Consistent with biological evidence establishing the arrival of adolescent changes in sleep (delayed sleep phase and disrupted sleep) with, ^{(1, 2}^,¹⁰³⁾or even before the onset of puberty, ⁽^250.5⁾ studies of middle school students have found early school schedules associated with sleep deficiency and its associated difficulties.⁽²²^,²³^,³⁰⁾

In 2004, researchers studying a cohort of 2,259 students, aged 11 to 14 years, found that students who obtained less sleep in sixth grade exhibited lower initial self-esteem and grades and higher initial levels of depressive symptoms.⁽²³⁾ Similarly, students who obtained less sleep over time reported heightened levels of depressive symptoms and decreased self-esteem. ⁽²³⁾ A 2007 study of New England middle school children found that “[i]n addition to the sleep deficit, school records indicated that students at the earlier starting school [7:15 a.m.] were tardy four times more frequently, and eighth graders at the earlier starting school obtained significantly worse average grades than the eighth graders at the comparison, later starting school [8:37 a.m.].” ⁽³⁰⁾ “The often serious impact of this chronic under-sleeping is now evident in both high school and middle school students.” ⁽²⁾

“[E]arlier start times are associated with significant sleep deprivation, daytime fatigue, irregular sleep schedules, and the tendency to fall asleep at school… [¶] This clash between bodily rhythms and contextual factors can have a wide variety of negative consequences. … Insufficient sleep results in an increased risk for school absences because of physical illness, falling asleep in school, oversleeping in the morning, fatigue, and irritability, all of which are detrimental to academic outcomes[.]” ⁽²³⁾

Students attending early starting schools may carry “significant chronic sleep debt.” ^(38,italics added.) Children “may feel adapted to being tired, but performance tests show the opposite.” ⁽³¹⁰^,³¹¹⁾“[P]eople who are sleep-deprived are less efficient, thus a cycle develops in which a student takes longer to complete the same amount of work, leading to her staying up later, and starting the vicious cycle all over again.” (Mindell & Owens, Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems (Lippincott Williams & Wilkins, 2nd ed. 2010) p. 258.) Although conventional wisdom holds that individuals can ‘train’ themselves to adapt to less sleep, “laboratory tests belie this.” ⁽³¹²⁾Researchers have found a “general ‘cloud’ of negative daily affect that is associated with chronic patterns of inadequate sleep among adolescents….” ⁽¹¹⁸⁾“Chronically sleep-deprived teens often become so used to the feeling of sleepiness that they don’t recognize that they are settling for less than they are capable of in creativity, academic performance, and communication both in and out of the classroom.” (Rauch, What is Normal Sleep for Children and Adolescents? publish. in, Attention Deficit Disorder: Practical Coping Mechanisms, supra, p. 175.)

Early rise times also interrupt a critical sleep phase. “Getting adequate dream (rapid eye movement [REM]) sleep is essential to perceptual, cognitive, and emotional processing. Selective REM sleep deprivation has been demonstrated to cause symptoms of irritability and moodiness, as well as problems with memory. The issue of under-sleeping in adolescents takes on added significance when one considers that waking up too early costs the sleeper mostly REM sleep which predominates during the last two to three hours of a night’s sleep.” ⁽²⁾

In REM sleep, many parts of the brain are as active as at any time when awake. ⁽¹⁹⁰⁾One study found that REM sleep affects learning of certain mental skills. People taught a skill and then deprived of non-REM sleep could recall what they had learned after sleeping, while people deprived of REM sleep could not. ⁽¹⁹¹⁾ Associate Professor of Psychology Avi Sadeh, a leading authority in this field, has concluded that in teens, “A loss of one hour of sleep is equivalent to [the loss of] two years of cognitive maturation and development.” ^{(62, 142)}

Advancing School Start Times; i.e., Inviting Injury

While some districts have implemented later school scheduling, ⁽^{31, 37, 41,} see, Appendix, infra, Schools Recently Delaying Start Times, etc.), most retain earlier or later scheduling over time. ⁽¹²⁾Still others advance secondary school start times to increase instructional hours, or more often, to address budgetary, busing, or athletic concerns (see, e.g., Appendix, infra, Schools Recently Advancing Start Times, etc.), despite longstanding evidence that “[t]his advance of the school day is in direct conflict with a putative pubertal/adolescent phase delay.” ⁽³⁸⁾ In 2002, Stanford Professor emeritus of Sociology Sanford Dornbusch surmised that adult nescience could explain early secondary school scheduling. ⁽⁵⁹⁾“Adults, unaware of the sleep needs of adolescents, require them to start school earlier in the day than is required of younger children.”⁽⁵⁹⁾

More than a decade later, “a burgeoning literature” demonstrating the ill effects of early school scheduling ⁽³¹⁵⁾ should compel reconsideration of Professor Dornbusch’s theory. As the examples below and elsewhere illustrate (see, e.g., Appendix, infra, Incognizant “Educators”), few school leaders demonstrate awareness of, or interest in, the pertinent evidence, despite science-based objections by fellow educators, ⁽²⁹⁷⁾sleep experts, ⁽³¹⁶^{, 317)}students, ⁽³¹⁷⁾and/or parents,⁽³²⁰⁾often preceding such a change.

In May of 2012, when Pittsburgh Public Schools proposed advancing 2012-2013 high school start times by 30 minutes to 7:36 a.m., or by 60 minutes to 7:06 a.m., in order to save $1.2 million in transportation costs, Wendy Troxel, Assistant Professor of Psychiatry at the University of Pittsburgh School of Medicine, joined by more than 50 colleagues, warned against implementing such a plan. ⁽³¹⁷⁾

“Robust evidence has long demonstrated the adverse consequences of early school start times for teenagers’ academic, mental, social and physical well-being. And no, they can’t just go to bed earlier — their hormones won’t let them. [¶] Keeping the ultimate goal of our education system in mind (to prepare students to become contributing members of society), evidence suggests that earlier school start times are associated with significant reductions in academic achievement — with the strongest effects among the most economically disadvantaged students. [¶] We understand there is no easy fix for the Pittsburgh public schools’ budget problems. But making a short-sighted decision that flies in the face of unequivocal scientific evidence would, in the long term, cost the city of Pittsburgh far more in terms of lost wages, higher rates of crime, more motor vehicle accidents and increased rates of obesity and associated health complications. [¶] Before deciding to move up start times — whether by an hour or a half hour — the Pittsburgh school board should weigh against a negligible savings in dollars the considerable costs to our children and to our society. [¶] As scientists, parents and members of the Pittsburgh community, we strongly oppose making school start times earlier, even by a half hour.” ⁽³¹⁷⁾

The 2012-2013 bell schedule posted at the Pittsburgh Public Schools website reflects a 7:11 a.m. start time for Pittsburgh Perry High School, 7:34 a.m. at Pittsburgh CAPA 6-12, and 7:36 a.m. for all other high schools and 6-12 schools, suggesting school leadership favored short-term fiscal gains over student well-being and achievement.

In June of 2012, when Orchard Park Secondary School in Canada announced a plan to advance its start time from 8:30 a.m. to 8 a.m., McMaster Assistant Clinical Professor of Medicine Raymond Gottschalk, who runs a sleep disorder clinic in Hamilton, cautioned that “the 30-minute change will have a huge impact on students’ academic performance and their morale at school. … ‘This is really counter-productive. It’s a very ill-advised recommendation.’ ” ⁽³¹⁶⁾

Orchard Park tenth graders presented school leaders with a petition signed by 500 of about 1,100 students. ⁽³¹⁶⁾Students cited changes to academic performance, breakfast disruption, increases in stress and obesity levels, and possibly, an increase in suicides. ⁽³¹⁶⁾ Officials from the Hamilton-Wentworth District School Board responded that the shift was needed to save $150,000 by using 12 fewer buses and “everyone will get use[d] to it.” ⁽³¹⁶⁾ Apparently persuaded of her students’ biological uniqueness, Superintendent Pam Reinholdt added, “I believe in this school and their ability to make change.”⁽³¹⁶⁾

A recent study of Chicago public high schools likely not considered by Orchard Park administrators found that students beginning classes at 8 a.m. showed marked deficiencies in first period courses throughout the term. ⁽³¹⁸⁾As in other early starting schools, ⁽²^,^{30, 41)}the students were more likely to be absent in first period relative to other periods. ⁽³¹⁸^,see discussion, n. 578, infra.) Harvard Professor of Sleep Medicine Susan Redline, M.D., M.P.H., notes that 8 a.m. classes begin too early for adolescent students to obtain sufficient sleep and serve to interrupt REM sleep. ⁽³¹⁹⁾

On November 19, 2012, the Cherry Hill Public Schools Board of Education voted unanimously to advance 2013-2014 middle and high school start times by 30 minutes to 8 a.m. and 7:30 a.m., respectively, after contract negotiations with teachers resulted in the addition of 30 minutes to the school day. ⁽³²⁰⁾Parents cited studies suggesting the decision would be contrary to the scientific evidence, imploring that the students were already “stressed out” and “sleep-deprived.” ⁽³²⁰⁾

Superintendent Maureen Reusche responded, “If an opportunity [arises] to engage in quality instruction for a longer period of time, I’m going to pursue that. I don’t see how [starting earlier] is going to add more pressure on students.” ⁽³²¹⁾ School Board President Seth Klukoff spoke at length about the decision, concluding, “In the end, we realized the benefits of adding the 30 minutes…outweighed any of the challenges.” ⁽³²⁰⁾ A statement posted at the Cherry Hill Public Schools website advises that the new schedule reflects concerns about retaining tiered busing and “about the impact on after-school activities, especially inter-scholastic sports at the high school level, if we added the time at the end of the day.”

Department Chair and Professor of History and Education at New York University, Jonathan Zimmerman, took exception to the decision, noting several studies demonstrate improved academic performance as a result of later times. ⁽²⁹⁷⁾ The Professor also commented on “[s]ports supremacy” in school scheduling. ⁽²⁹⁷⁾ “[H]ow much virtue is there in sending all our kids to school before they’re awake enough to learn, just so some of them can play more sports? What does that say about our character as citizens, taxpayers, and parents?” ⁽²⁹⁷⁾

Notwithstanding Superintendent Reusche‘s dubitations, according to Michelle Gall and William Stixrud, a specialist in the evaluation of children with learning disabilities and Assistant Clinical Professor of Psychiatry and Behavioral Sciences at George Washington University School of Medicine, ”American teenagers will tell you that they are on a first-name basis with stress, and scientific studies bear this out.” ⁽³²²⁾Using an average self-reported nightly sleep duration of eight to nine hours as a reference, a 2010 study of older adolescents and young adults (17-24) found a “linear association between sleep durations of less than eight hours and psychological distress.” ⁽¹³⁶^,¹⁴³⁾ The increase in levels of distress reported over the past decade may reflect “temporal changes in young people’s sleep patterns.” ⁽¹³⁶⁾

Even apart from dismissing decades of science, early school scheduling fails inherently to consider the many associated human and fiscal costs, ⁽³¹⁷⁾and, as discussed infra (see, § IV), any savings realized by advancing morning classes may be undone by the corresponding diminished academic performance; ⁽²⁴^,⁴⁴^,⁴⁹⁾i.e., lower achievement means lower wages ⁽⁴⁹⁾and slower growth in the economy. ⁽³²³^,³²⁴^,³²⁵⁾In most jurisdictions, school schedules are determined by the administration of budgets, busing, and athletics. ⁽¹²⁾ School leaders seldom consider student potential and well-being when deciding when to ring the opening bell. ⁽¹²⁾

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The Impact of School Start Times on Adolescent Health and Academic Performance