On average, reading and mathematics proficiency among adolescents has not improved significantly for approximately 30 years. Similarly, proficiency in mathematics and science is significantly reduced in children educated in the United States, compared with children trained in other industrialized nations. Although a variety of educational, psychological, and social factors are likely responsible for the lack of improvement in learning proficiency, the mental and physical health of children (or lack thereof) might play a significant role in a child's ability to both concentrate and learn within the classroom environment. In accordance with this statement, recent findings have suggested some maturing adolescents might not be meeting national academic expectations because their ability to learn novel information is compromised by a reduction in sleep quality and quantity (i.e., sleep deprivation). This reduction is occurring despite strong scientific evidence that an increase in sleep quantity is required as adolescents mature.

The reasons that sleep hygiene is altered in adolescents are numerous and include a reduction in parental control of sleep and wake time, increased social opportunities, increased employment opportunities and academic workload, early school starting times, and in some adolescents the existence of a relatively common and treatable sleep disorder known as obstructive sleep apnea. The resultant side effects may include inattention and poor performance in the classroom and emotional and behavioral changes. Indeed recent evidence suggests that sleep deprivation in its severest form may be wholly or in part responsible for behavioral and learning problems exhibited by some students diagnosed (or misdiagnosed) with attention deficit/hyperactivity disorder.

Inattention, emotional responses, and behavioral problems are likely elicited because of the impact that sleep deprivation has on the function of the prefrontal cortex, which is located in the central nervous system. The prefrontal cortex is responsible for the regulatory integration of sleep/arousal and affection/attention and functions to integrate cognition and emotion into goal-directed behaviors. The prefrontal cortex continues to develop throughout childhood and adolescence, with important neurobiological changes occurring during puberty. Puberty, therefore, is an important period during which sleep and behavioral regulation are coupled with cognitive processes.

Given the impact of sleep deprivation on learning and behavior in the classroom, countermeasures must be employed in an effort to ensure that students obtain the required amount of sleep. The most recent countermeasure employed in some school districts to improve sleep hygiene in healthy adolescents has been to change school start times to later in the morning to ensure that students are obtaining the required amount of sleep. Recent findings by the Center for Applied Research and Educational Improvement (CAREI) located at the University of Minnesota suggests that this countermeasure might have a positive impact on adolescent learning and behavior, although the impact on other issues such as family life, busing schedules, and safety may not be as beneficial. Although altering school start times might be an important intervention, other recommendations that will enable adolescents to maintain proper sleep hygiene must be considered. Promoting healthy sleep includes establishing a regular, relaxing routine to unwind from the day to signal the body that it is time to prepare to sleep; avoiding computer games, books, or television programs that are violent, frightening, or controversial prior to going to bed; avoiding ingestion of caffeine in the afternoon and evening; avoiding naps and horseplay with younger siblings prior to bedtime. Additionally, adjusting extracurricular and employment activities may be necessary to ensure adequate sleep hygiene.

Although providing a home environment that promotes healthy sleep is the first step to eliminating sleep deprivation in adolescents, increased public awareness and education of the impact of sleep on learning and behavior is important. This increased awareness must occur first within the classroom. Exciting discoveries in the field of sleep are occurring rapidly, and these discoveries can be shared with children from grammar, middle, and high school. Just as nutrition is included in health curriculums, students could learn about the body's need for sleep requirements and the role that sleep plays in memory and learning. Additionally, the impact of many sleep disorders on other health-related issues could be addressed. For example, snoring, which afflicts many individuals, might lead to the development of other health problems, such as hypertension and stroke. Thus, education is important to ensure that children begin to understand that sleepiness and fatigue is not a weakness that can be overcome by will power but rather may lead to inappropriate emotional responses and reductions in intellectual performance. With this understanding in mind, parents and educators must encourage children to obtain the required amount of sleep to maximize their potential both in and out of the classroom. A number of possibilities exist to inform teachers and parents about this important matter. Courses in sleep medicine, which address this important issue and cater to a wide audience, have been developed recently at a number of academic institutions and thus would be an ideal course for teachers interested in this subject matter. Educational pamphlets written in laymen's terms and distributed by the American Academy of Sleep Medicine (http://www.aasmnet.org) can be obtained as a source of information for both educators and parents. Lastly, numerous Web pages (e.g., http://bisleep.medsch.ucla.edu) are dedicated in part to discussing the biological need for sleep in children. If educators and parents are informed of these sites, further investigation may ultimately lead to a greater appreciation and understanding of the role that sleep has in a child's daily life as it relates to behavior and mental performance.

Published Monday, Oct. 20, 2003