Article Critique Paper essay

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Brief Communication
The impact of COVID-19 related school shutdown on sleep in
adolescents: a natural experiment
Reut Gruber a, b, *
, Sujata Saha c
, Gail Somerville b, d
, Johanne Boursier c
, Merrill S. Wise e
a Department of Psychiatry, Faculty of Medicine, McGill University, Montr eal, QC, Canada b Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montr eal, Canada c Heritage Regional High School, Riverside School Board, Quebec, Canada
d Riverside School Board, Quebec, Canada
e Mid-South Pulmonary and Sleep Specialists, Memphis, TN, USA
article info
Article history:
Received 16 August 2020
Received in revised form
13 September 2020
Accepted 14 September 2020
Available online 22 September 2020
Keywords:
Adolescents
COVID-19
School Start Time
Sleep Health
abstract
Objective: During the outbreak of the COVID-19 pandemic in 2020, high schools closed or transitioned to
remote teaching. The aim of this study was to describe how the COVID-19 related school shutdown
impacted the sleep behaviors of typically developing adolescents.
Methods: A qualitative study was conducted between April 28 and June 3, 2020 with 45 adolescents
using one-on-one semi-structured phone interviews.
Results: The “natural experiment” caused by the shutdown of schools due to the COVID-19 pandemic led
to a 2-h shift in the sleep of typically developing adolescents, longer sleep duration, improved sleep
quality, and less daytime sleepiness compared to those experienced under the regular school-time
schedule.
Discussion: These findings are consistent with previous studies showing that delaying high school start
times could be an effective way to extend sleep duration, improve sleep quality, reduce daytime
sleepiness and lower adolescents’ stress during the school year. As many countries look for ways to
reduce the number of interactions between students in schools so that physical distancing is feasible,
following teens’ delayed sleep biology could offer an affordable solution. For example, staggering arrival
times by delaying school start time for older adolescents compared with younger adolescents can reduce
the total number of students attending school at the same time. This strategy offers a practical means to
reduce school density and the number of interactions between students which are needed to reduce the
potential transmission of COVID-19 in schools, while improving adolescents sleep health.
© 2020 Elsevier B.V. All rights reserved.
1. Introduction
A large proportion of adolescents in different countries around
the world [1,2] get less than the recommended amount of nightly
sleep [3]. Sleep deprivation has a negative impact on youth
mental and physical health [4,5]. Interventions to extend adolescents’ sleep duration have had limited success [6]. Efforts to
delay school start times have faced logistical barriers and doubts
about whether the shift will translate to improved or extended
sleep [7]. Following the outbreak of the COVID-19 pandemic in
2020, high schools closed or transitioned to remote teaching.
Following the school shutdown, schools’ schedule changed as
follows: the school day started at 10AM with 30 min subject
specific sessions in which students were assigned tasks they had
to complete online until noon. Next, in the afternoon, the students participated in arts or physical education classes and were
able to seek academic support with their teachers in smaller
online group settings. This schedule was different than the typical
school day and aimed to balance online learning and independent
work.
This “natural experiment” allowed adolescents’ sleep patterns
to be studied when they no longer have an imposed rise time. The
aim of this study was to describe how the COVID-19 related school
shutdown impacted the sleep behaviors of typically developing
* Corresponding author. Department of Psychiatry, Faculty of Medicine, McGill adolescents.
University, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
E-mail address: reut.gruber@douglas.mcgill.ca (R. Gruber).
Contents lists available at ScienceDirect
Sleep Medicine
journal homepage: www.elsevier.com/locate/sleep
https://doi.org/10.1016/j.sleep.2020.09.015
1389-9457/© 2020 Elsevier B.V. All rights reserved.
Sleep Medicine 76 (2020) 33e35
2. Material and methods
A qualitative study was conducted with 45 adolescents (32 girls,
Mage13.5 yrs; SD 1.9; 96% Caucasians; 2% Asian; 2% multiethnic).
One-on-one semi-structured phone interviews (30e60 min) were
conducted by trained research assistants between April 28 and June
3, 2020 to explore pre- and during-pandemic sleep schedules,
duration and quality of their sleep, daytime sleepiness and their
methods of waking up. The study was approved by the Institutional
Ethics Review Board of the Douglas Research Centre, Montreal,
Canada.
Interviews were transcribed anonymously and uploaded to
MAXQDA, 2020 (Verbi Software). The transcriptions were independently coded by two researchers, who worked deductively with
an a priori developed system of themes derived from the interview
guide, and inductively from additional contents of the interviews.
Their analyses were compared and the coded themes were modified when applicable. Data triangulation was ensured by seeking
disconfirming evidence in the data. All findings were substantiated
by the most representative quotes (Table 1).
3. Results
3.1. Changes in sleep quality and duration following in-person
school shutdown
The majority of the participants reported that since school
shutdown their sleep improved in quality and/or duration
[quotation 1e3 (Q1-3), Table 1] and that their sleep schedule had
been delayed by about 2 h (they went to bed later and woke up
later) (Q 4e5). They cited not having to wake up early and lower
school-related stress as the main reasons for these changes (Q6-10).
3.2. Daytime sleepiness during the pandemic
55% of the participants described being sleepy during the school
day before the pandemic (Q11) and attributed this to their need to
wake up early to get to school and to getting less sleep (Q12-13).
78% reported that under the pandemic shutdown they were not
sleepy and they attributed this primarily to getting more sleep
(Q14-15).
3.3. Methods used to wake up during the pandemic
During the pandemic most participants reported waking up
naturally; a few cited being awakened by a parent or alarm (Q16-
20).
4. Discussion
The “natural experiment” caused by the abrupt shutdown of
schools due to the COVID-19 pandemic led to a 2-h shift in the sleep
of typically developing adolescents, longer sleep duration,
improved sleep quality, and less daytime sleepiness compared to
those experienced under the regular school-time schedule. In
addition, participants reported decreased daytime sleepiness and
Table 1
Quotations substantiating Adolescents’ responses.
Quotation No. Quatation
Question Since you have been off school how has your sleep changed?
Better and Longer Sleep Following the pandemic
Quotation #1 I’d say I’m probably getting better sleep. Because I’m, I go to bed later, a bit later, but I’m also sleeping in a lot more so I’m getting pretty good
sleep
Quotation #2 It’s been ok. I’ve been going to sleep. like I feel like I’ve been going to sleep way faster.
Quotation #3 I sleep longer and I’m less stressed, so it makes my sleep more enjoyable
Changes in sleep schedule following the pandemic
Quotation #4 Can wake up a bit later than usual because I’d still do work, So I can sleep more in the morning
Quotation #5 I started going to bed at 10pm well I started having to bed around 10 and I wake up later like an hour later so my entire sleep schedule has kind of
just moved an hour.
Question Why has it changed?
Lower School-Related Stress
Quotation #6 My sleep has been a bit better as in I haven’t been as anxious so it’s been easier to fall asleep and I’ve been going to bed later. But, it’s been helping
me fall asleep quicker. So, it’s been getting better ever since we stopped going to school.
Easier To Fall Asleep when Going To Bed Later
Quotation #7 Honestly, I think it’s easier because since I go to bed later, I get more tired and it’s easier to fall asleep.
Later School Start Time
Quotation #8 Well I think it’s because since I don’t have to get up early in the morning and I can sleep in, so I don’t have to go to bed as early.
Quotation #9 Can wake up a bit later than usual because I’d Still do work, but later. So I can sleep more in the morning
Quotation #10 Now it’s like, I can wake up later in the morning, so I just go to bed later. I’m kind of night person
Day Time Sleepiness
Question How sleepy do you feel during the day? How sleepy did you feel during school?
Daytime sleepiness during School
Quotation #11 I can be sleepy just like I’m just still paying attention just like laying my watching the teacher. Usually after school if I’m tired I try taking a little
nap before supper
Daytime sleepiness during the pendemic
Quotation #12 Not sleepy at all, fully awake
Question Way has it changed?
Quotation #13 Cause since I get a good amount of sleep. So I don’t really feel sleepy during the day
Quotation #14 Probably more than I do now, I probably felt more sleepy than I do now because I got less sleep than I do now
Methods used to wake up in the morning
Quotation #15 Uh, during school, I put an alarm. And currently, by myself.
Quotation #16 I just wake up
House Noise
Quotation #17 The shower, my brother yelling at his friend, or the dog running around to go outside.
Quotation #18 My parents make noise so I wake up
Theme Set up an Alarm
Quotation #19 I try to set one at 8.45 because I don’t want to waste my whole day
R. Gruber, S. Saha, G. Somerville et al. Sleep Medicine 76 (2020) 33e35
34
increased daytime alertness consistent with extended and
improved sleep. This suggests that the improved sleep could
translate into improved daytime performance if later start times
could be implemented through the school year.
Societal changes caused by the response to the COVID-19
pandemic, such as the potential staggering of school schedules to
decrease the number of students in classes, flexible parental work
schedules, and fewer extracurricular activities, afford a unique
opportunity to overcome previous barriers that limited our ability
to better align school start times with the delayed circadian biology
of adolescents. Allowing adolescents to follow their naturally
delayed sleep pattern by delaying school-start time could be a
feasible, affordable and efficient way to improve their sleep health.
This is expected to improve their resilience in the face of the
challenges and stress caused by COVID-19.
Staggering arrival times by delaying school start time for older
adolescents compared with younger adolescents can reduce the
total number of students attending school at the same time. This
strategy offers a practical means to reduce school density and the
number of interactions between students which are needed to
reduce the potential transmission of COVID-19 in schools, while
improving the adolescents’ sleep health.
Limitations of this study include a disproportionate number of
girls, non-representative sample, and the lack of objective sleep
measures.
Funding/support
This study was funded by CIHR Grant# 418638 and SSHRC
Grant#4352018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online0708.
CRediT authorship contribution statement
Reut Gruber: Conceptualization, Methodology, Formal analysis,
Writing – original draft, Funding acquisition. Sujata Saha:
Conceptualization, Writing – original draft. Gail Somerville:
Conceptualization, Writing – review & editing. Johanne Boursier:
Conceptualization, Writing – review & editing. Merrill S. Wise:
Formal analysis, Validation, Writing – review & editing.
Acknowledgments
The authors with to thank Gabrielle Gauthier-Gagne, Denise
Voutou, Estefania Cordova,Sabrina Musacchio for their hard work,
and to the students and their families for their participation in the
study.
Conflict of interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of
Interest associated with this article can be viewed by clicking on the
following link: https://doi.org/10.1016/j.sleep.2020.09.015.
Appendix A. Supplementary data
Supplementary data to this article can be found online at
https://doi.org/10.1016/j.sleep.2020.09.015.
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