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AASM Membership Sections Newsletter
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Issue #6
Childhood Sleep Disorders and
Development
Steering Committee
Profiles
Lynn D’Andrea, MD
(Chair)
Dr. Lynn D’Andrea, MD,
Chair
, is
starting her second year as the Chair
of the Childhood Sleep Disorders and
Development Committee. She is a
Professor of Pediatrics at the Medical
College of Wisconsin/Children’s
Hospital of Wisconsin in Milwaukee,
WI. Dr. D’Andrea is Chief of the
Division of Pediatric Pulmonary and
Sleep Medicine and is the Director of
the Pediatric Sleep Center. She is
board-certified in Pediatric Pulmonary
Medicine and Sleep Medicine, and
specializes in the comprehensive
management of children with
pulmonary and sleep concerns. Dr.
D’Andrea holds a special interest
in children with neuromuscular
weakness and children in need of
home mechanical ventilation.
Hari Bandla, MD
(Vice-Chair)
Dr. Hari Bandla, MD,
Vice-Chair
, is
an Associate Professor of Pediatrics
and Section Chief of the Divisions
of Pediatric Pulmonology and
Sleep medicine at the University
of Chicago. He is also the Medical
Director of Pediatric Respiratory
Care and Pediatric Sleep Program
at Comer Children’s Hospital/
University of Chicago Medical Center.
He is board certified in Pediatric
Pulmonology and Sleep Medicine.
2014 – 2015
CHAIR
Lynn D’Andrea, MD
VICE-CHAIR
Hari Bandla, MD
MEMBERS
Kiran Maski, MD
Althea Robinson-Shelton, MD
Nanci Yuan, MD
Waking Up To the Unique Sleep Needs of Adolescents
By Dr. Althea A. Robinson-Shelton, MD
CP is a 14-year-old girl in the 9th grade who presents with difficulty falling asleep. She gets into
bed at 8:30 pm. Her parents report that all electronics are turned off 30 minutes prior to bed and
there are no electronics in her room. CP reports routinely not falling asleep until between 11:30
pm and midnight. Once asleep, she does not awaken again until her alarm clock goes off at 4:30
am. She is difficult to arouse and often naps on her school bus which picks her up at 5:45 am. She
will fall asleep in her 1st period class, which starts at 6:45 am.
This was a real patient who recently presented to our pediatric sleep clinic. Does the school
start time shock anyone in the reading audience? It surely surprised me and that is one of the
many reasons that on August 25th, 2014, the American Academy of Pediatrics (AAP) issued a
new policy statement addressing adolescent school start times. The policy statement advocates
a school start time no earlier than 8:30 am for children in middle school and high school.
This policy statement tackles a major health concern in adolescents and insufficient sleep.
The causes of insufficient sleep in adolescents are multi-factorial. As sleep physicians, we are
aware that “starting in puberty, the circadian clock of adolescents becomes delayed by up to two
hours and that throughout adolescence there is an altered sleep drive.” The AAP policy ad-
dresses the impact of chronic sleep loss in adolescents, such as poor impulse control, increased
obesity risk and poor academic performance. It also presents evidence that school start time
is a modifiable risk factor for insufficient sleep. For example, one cited study assessed more
than 9000 students over 3 years from 8 public schools in 3 states and results showed that 66%
of students with a start time of 8:55 am (versus 33% of students with a start time of 7:30 am)
slept greater than 8 hours. Also discussed is evidence showing that there is less self-reported
depressed mood and that academic performance improves with later school starts.
The policy statement lays forth evidence that later school start times in middle school and
high school may improve “benchmarks of health”; however, it does still emphasize “that delay-
ing school start times alone is less likely to have significant effect without concomitant attention
to other contributing remediable factors.” In turn, it recommends educating parents, teachers,
school administrators and school-based health care professionals on adolescent physiologic
sleep needs, environmental factors that contribute to sleep deprivation and potential risks of
adolescent sleep loss. The policy encourages students and their families to take ownership in
modifying their sleep environment and sleep hygiene if needed.
Hopefully, this policy statement will spark discussions in communities about improving
adolescent sleep and health.
DISCLAIMER
No part of this publication may be reproduced without the permission of the American Academy of Sleep Medicine
(AASM). The statements and opinions contained in editorials and articles in this newsletter are solely those of the authors
and not of the AASM or of its officers, members or employees. The Editor and Managing Editor of the Membership
Sections Newsletter, the AASM and its officers, members and employees disclaim all responsibility for any injury to
persons or property resulting from any ideas, products or services referred to in articles in this publication.
