Evaluation of novel school-based interventions for adolescent sleep problems: does parental involvement and bright light improve outcomes?

OBJECTIVES: The current study aimed to evaluate school-based motivational sleep education programs (SEPs) with adjunct bright light therapy (BLT) and/or parental involvement (PI). DESIGN: Randomized controlled trial. SETTING: Six high schools, matched on socio-economic status (SES). PARTICIPANTS: A total of 193 adolescents (mean age, 16.3 ± 0.4 years, 79%f). INTERVENTION: Classes were randomly assigned to (i) SEP + BLT, (ii) SEP + PI, (iii) SEP + BLT + PI, or (iv) classes-as-usual (CAU). Sleep education programs involved 4×50 minute classes (over 4 weeks) based on a Motivational Interviewing framework (Sleep Med 2011;12:246-251). Students in BLT groups attempted a weekend phase advance using portable green light LED glasses (500 nm; 506 lux). Parents of PI groups watched a series of 4 YouTube clips (2-3 minutes in length) outlining their adolescent's learning in class and how they could assist. Students in the CAU groups continued their regular classes. MEASUREMENTS: Online questionnaires measuring sleep knowledge, sleep patterns (bedtime, sleep latency, total sleep time [TST], etc) and mood at preintervention and postintervention and 6-week follow-up. Intervention groups also completed a motivation-to-change questionnaire and provided qualitative feedback. RESULTS: Improvements in sleep knowledge (d = 0.59-0.88), sleep onset latency (d = 0.45-0.50), TST (d = 0.32-0.57), and mood (d = 0.24-0.46) were observed in all intervention groups relative to the CAU group. Similar improvements were observed in a subgroup of students identified as having delayed sleep timing (ie, sleep knowledge: d = 0.45-0.92; sleep onset latency: d = 0.59-0.82; TST: d = 0.82-1.18). Increases in motivation to regularize out of bedtimes, obtain morning bright light (BLT groups), and avoid sleeping-in on weekends occurred (all P < .005). CONCLUSIONS: This motivational SEP produced meaningful and similar benefits for adolescents in all intervention groups. Longer BLT (ie, over school holidays) and more intensive parental inclusion should be investigated in future studies.

A motivational school-based intervention for adolescent sleep problems.

OBJECTIVE: The current study aimed to develop and evaluate a motivational school-based intervention for adolescent sleep problems. METHODS: The intervention was implemented in three co-educational secondary schools in Adelaide, South Australia. Two year-11 Psychology classes from each school participated, with one as the intervention class (N=53) and one as the control class (N=51). Students in the intervention classes attended four 50-min sleep education classes, held once per week. The lessons were modified from those of Moseley and Gradisar [23] to incorporate a motivational interviewing framework. Students completed an online questionnaire battery measuring school day and weekend sleep parameters, daytime sleepiness, and depression at pre- and post-program and follow-up, and completed motivation to change questionnaires during the program. RESULTS: Students in the intervention group significantly increased their knowledge about sleep relative to the control group (p=0.001). During the intervention, students' motivation to regularize their out-of-bed times improved (p=0.03), and there was a trend towards improved motivation to increase average total sleep time (p=0.11). But despite improvements in sleep and daytime functioning for adolescents in the program group (p<0.05), these changes were not significantly different from the control group (all p>0.05). CONCLUSIONS: School-based interventions are promising for educating adolescents about sleep. Future programs should translate increased motivation into long-term behavioral change. The identification of barriers and support to assist this change is recommended.

Evaluation of a school-based intervention for adolescent sleep problems.

STUDY OBJECTIVES: The present study investigated the effectiveness of a school-based intervention in increasing sleep knowledge and improving adolescent sleep problems. DESIGN: A randomized, controlled trial using 2 groups (program class, classes-as-usual: [CAU]) assessed over 3 time points (pre-program, post-program, 6-week follow-up). PARTICIPANTS/SETTING: Eighty-one students (mean age = 15.6 +/- 0.6 y; 33% male) from 2 schools in South Australia. Schools provided one class to participate in the sleep intervention program (N = 41) and a second class to act as a control class (N = 40). INTERVENTION: Four 50-minute classes across a 4-week period. Classes consisted of educating adolescents on promoting and maintaining a healthy lifestyle based on a cognitive-behavior therapy framework. MEASUREMENTS AND RESULTS: Data were collected pre-program, post-program, and at 6-week follow-up using an online questionnaire. Qualitative student and teacher data were collected at post-program. Baseline data indicated sleep problems were prevalent (53.1% insufficient sleep on school nights [< 8 h] and 77.8% discrepant school/weekend rise times [> 2 h]). These 2 criteria identified 36 adolescents with a delayed sleep timing (DST; Program, N = 21; CAU, N = 15). The program increased sleep knowledge (P = 0.001); however, analyses revealed no significant effects on target sleep variables as compared with the CAU class for the entire group (all P > 0.05). For DST adolescents, there was a significant interaction for reducing the discrepancy between school and weekend out of bed times (P = 0.002). There was no impact on other sleep parameters or depressed mood. CONCLUSIONS: School-based sleep interventions for adolescents are a novel method for addressing a prevalent problem. Future programs should develop ways to motivate adolescents to change sleep practices.