Lessons Learned from Sleep Education in Schools: A Review of Dos and Don'ts

Abstract

Study Objectives: Sleep duration and quality are associated with negative neuropsychological and psychosocial outcomes in children and adolescents. However, community awareness of this is low and sleep education programs in schools are attempting to address this issue. Several studies now exist assessing the effi cacy of these sleep education programs for improving sleep knowledge, sleep hygiene and sleep patterns. This paper presents these sleep education programs, most particularly, it presents the strengths and weaknesses of the current available studies in the hope that this can identify areas where future sleep education programs can improve. Methods: A systematic search of all school-based sleep education studies in adolescents was undertaken. Studies were scrutinized for author, teacher and participant comment regarding strengths and limitations of each study, which were then extracted and summarized. Results: Two specifi c types of sleep education programs emerged from the review, those that sought to change sleep behavior and those that sought simply to disseminate information. Issues that dictated the strength or weakness of a particular study including who delivers the program, the theoretical basis, the tools utilized to measure sleep patterns, the content, and their capacity to engage students were assessed. Sleep education was considered important by teachers, students and parents alike. Conclusions: Future sleep education programs need to take into account lessons learned from previous sleep education efforts in order to maximize the potential for sleep education programs to improve the sleep health of our young people. Commentary: A commentary on this article appears in this issue on page 595.

The SENSE Study: Treatment Mechanisms of a Cognitive Behavioral and Mindfulness-Based Group Sleep Improvement Intervention for At-Risk Adolescents

“…27 Furthermore, the study provides evidence that a cognitive behavioral and mindfulness-based group sleep intervention can improve sleep hygiene awareness among at-risk adolescents, with large effect sizes, consistent with research showing that school-based sleep intervention programs lead to improvements in students' knowledge about sleep and insomnia. [17][18][19] However, the magnitude of the effect size found in the current study was larger than those reported in RCTs of school-based sleep education programs. 70,71 This might be due to several factors.…”

“…Many adolescent sleep education programs have been implemented on the premise that knowledge guides behavior. [17][18][19] However, the findings from the present study highlight that simple learning and retention do not always elicit behavior change, consistent with social cognitive models of health behavior, such as the Theory of Planned Behavior , all of which posit that factors other than knowledge and awareness can influence an individual's decision about whether or not to engage in a positive health behavior. These factors include expectations of improvement, self-efficacy, attitudes, perceived barriers, and peer and family attitudes.…”

“…However, recent reviews have suggested that while these psychoeducational programs are effective in increasing students' knowledge about sleep, they are less effective in improving sleep behavior or mental health. [17][18][19] These findings are consistent with research showing that simple sleep hygiene education does not guarantee positive outcomes in adults 20 , and that targeted interventions are more effective than universal interventions in preventing child and adolescent mental health problems. 21 In sum, these findings suggest that active sleep interventions that incorporate supported decision-making tools and that are delivered to students who are already experiencing early signs of sleep and mental health problems may be more effective.…”

A cognitive-behavioral and mindfulness-based group sleep intervention improves behavior problems in at-risk adolescents by improving perceived sleep quality

“…Sleep disturbance in adolescents can be treated using a range of approaches. Recent reviews have suggested that while school-based sleep education programs are effective for improving students' knowledge about sleep and insomnia, they are less effective for improving sleep behavior or mental health (Blunden & Rigney, 2015;Blunden, Chapman, & Rigney, 2012;Gruber, 2017). This is consistent with research showing that targeted interventions are more effective than universal interventions in preventing child and adolescent mental health problems (Rohde, 2015), and that simple sleep hygiene instruction does not guarantee positive outcomes in adults (Irish, Kline, Gunn, Buysse, & Hall, 2015).…”

Sleep in adolescents and young adults

“…A review of these by Blunden and Ridgney, demonstrated the importance of including others, such as parents, as sleep is affected by both cultural and environmental factors within the home. 44 Importantly, it was noted that a generic sleep programme would be unlikely to benefit all individuals. Identifying specific problems was a more useful approach and imparting knowledge alone was not enough to effect a change in behaviour.…”