Books: “Snooze…Or Lose! – 10 “No-War” Ways To Improve Your Teen’s Sleep Habits” by Helene A. Emsellem, MD

Snooze%20or%20Lose.jpgMy regular readers are probably aware that the topic of adolescent sleep and the issue of starting times of schools are some of my favourite subjects for a variety of reasons: I am a chronobiologist, I am an extreme “owl” (hence the name of this blog), I am a parent of developing extreme “owls”, I have a particular distaste for Puritanical equation of sleep with laziness which always raises its ugly head in discussions of adolescent sleep, and much of my own research is somewhat related to this topic (see the bottom of this post for Related Posts).
So, I was particularly pleased when Jessica of the excellent Bee Policy blog informed me of the recent publication of a book devoted entirely to this topic. Snooze…or Lose! by Helen Emsellem was published by National Academies and Jessica managed to get me an Advanced Reading Copy to review.


You can also read the book online (or buy the PDF). Much more information on the topic can be found on the book webpage, on the National Slep Foundation website, on Dr.Emsellem’s homepage and the Start Later for Excellence in Education Proposal (S.L.E.E.P.) website. I strongly encourage you to look around those webpages.
Her daughter Elyssa wrote one of the chapters in the book and is promoting the book and the information relevant to teenagers at the place where teenagers are most likely to see it – on MySpace (you see – it’s not just music bands who caught onto this trick – serious information can be promoted at MySpace as well).
The main audience for this book are teenagers themselves and their parents – I think in this order although officially the order is reversed. Secondarily, the audience are teachers, administrators and officials in charge of school policy. Who this book is not targeted to are scientists and book reviewers because there are no End Notes!
On the other hand, what I got is an Advanced Reading Copy so the actual book may have end notes for all I know. I detected only a couple of typos, a reference to “see page X” in place of “see page 122″, and a reference to Process S as a “clock” (p.15) which it is not – Process C is a clock, Process S is an hourglass timer and mixing the two metaphors is confusing (but metaphors are tricky anyway). I am assuming that those errors were fixed in the real edition of the book.
Anyway, considering that the main audience are teens, their parents and teachers (i.e., laypeople), the book is admirably clear and readable. The book starts out with presenting the problem – the chronic sleep deprivation of adolescents in modern society – and provides ample evidence that this is indeed a wide-spread problem. It continues with a simple primer on physiology of sleep and circadian rhythms, followed by a review of the current knowledge of the negative consequences of chronic sleep deprivation: from susceptibility to diseases, through psychological and behavioral problems, to problems of physical and mental performance.
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A whole chapter – the one I found most interesting – is devoted to the role of sleep in various kinds of memory and the negative effects of sleep deprivation on learning – both declarative and episodic memory, as well as kinesthetic memory needed for athletic performance and safe driving. This is where I missed the end notes the most.
Throughout the book, Dr.Emsellem makes statements of fact about sleep that are obviously derived from research. I’d like to see the references to that research so I can evaluate for myself how strong each such statement is. Although my specialty is chronobiology (physiology, development, reproduction, behavior, ecology and evolution) of birds, and secondarily that of mammals, reptiles, invertebrates and microorganisms (I could never quite get excited about clocks in fish, fungi and plants, or molecular aspects of circadian rhythms, or medical aspects of human rhythms), I am quite familiar with the literature on sleep, including in humans.
Thus, I know that the statements in the book reflect scientific consensus but that the meaning of “consensus” is quite elastic. In some cases, it means “there is a mountain of evidence for this statement and no evidence against it, so it is highly unlikely that this will change any time soon”. In other cases it means “there are a few studies suggesting this, but they are not perfect and there are some studies with differing results, and this can stand for now but is likely to me modified or completely overturned by future research”.
Having end notes would help the expert reader see how weak or strong each one of these findings is, and would also be suggestive to lay readers that the statements in the book are supported by actual research and are not just the author’s invention as seen in so many self-help books. End notes and references add to the believability of the text even if one does not bother to check the papers out.
The book then turns to variety of factors, both biological and social, that conspire to deprive our teens of sleep, both from the perspective of a sleep researcher and from the perspective of teenagers. Little snippets of teenagers’ thoughts on the topic are included throughout the book and add an important perspective as well as make the book more fun to read. Otherwise, the “case studies”, the bane of so many psychology books, are kept to the minimum, discussed very briefly, and used wisely..
In the next section, Dr.Emsellem turns to solutions. First, she present several tests of sleep deprivation that readers can administer themselves in order to self-diagnose the problem. She then describes ten different strategies that parents and teens can work on together in order to solve the problem of sleep deprivation and all the concomittant negative effects (and Alyssa adds her own chapter on the teen perspective on how those can work). If that does not work, she describes additional methods that a sleep doctor may prescribe to help solve the problem. There is also a short chapter describing a couple of other sleep disorders, e.g., sleep apnea, that also contribute to sleep deprivation in affected individuals.
The last portion of the book addresses the social aspects of sleep deprivation and changes that parents and teens can make in their homes, as well as broader community, towards solving the problem. For adults, being a role model for the child is important and this requires paying attention to one’s own sleep hygiene.
The very last portion is really the raison d’etre of the book – how to make one’s community change the school starting times. The author presents a couple of examples of school districts in which such change was enacted, the strategies parents used to force such changes and the incredible positive results of such changes. The whole book is really designed to provide information to parents and teens who are working on changing their local attitudes toward school starting times.
The schools used to start about 9am for most of the century (and before). Then, due to the pressure from business and economic (read “busing”) woes of school districts, the school starting times started creeping earlier and earlier starting back in 1970s until they reach the horirbly early times seen today in many places, requiring kids to get up as early as 5am in order to catch the school bus on time. As a result, high schoolers (and to some extent middle schoolers and college students) sleep through the first two periods in school, feel weak and groggy all day long, more eaily succumb to diseases, have trouble learning and performing well in school and the athletic field, and are in too bad mood to be pleasant at home – this is not the natural state of things as much as the stereotype of the “grouchy teen” is prevalent in the society, it is mainly due to sleep deprivation and the biggest factor causing sleep deprivation are early school starting times.
In places in which enlightened and progressive school boards succumbed to the wishes of parents and students, i.e., in places in which parents and students used smart diplomatic tactics to engender such change, the positive results are astounding. The grades went up. The test scores went up. The students are happy. The parents are happy. The teachers are happy. The coaches are happy because their teams are winning all the state championships. There is a decrease in tardiness and absences. There is a decrease in sick days and even in numbers of diagnoses of ADD and depression in teens. There is a drop in teen crime. There is a drop in car accidents involving teens (by 15% in one place!). The whole county feels upbeat about it!
While the book makes me – a scientist – thirsty for end notes and references, it does remarkably well what it was designed to do – arm the parent and kids with knowledge needed to make a positive change in their communities – a change that is neccessary in order to raise new generations to be healthy and successful, something we owe to our children.
We should do this no matter how much it costs, but the experiences from places in which the changes were made, contrary to doom-sayers, is that there was no additional cost to this at all. The changes were implemented slowly and with everyone involved pitching in their opinion and their expertise until the best possible system was arrived at, adapted to the local community situation. No new buses were needed to be rented. No unexpected new costs appeared. And having a safe, happy community saved money elsewhere (e.g., accidents and crime rate decline). And it worked wonderfully everywhere.
So, get the book and let your child read it, you read it, give a copy to other people in your community: the teachers, the school principal, the pediatrician, the child psychologist, the school board members, the superintendent of education and the governor. This is something that is easy to do, there are no good reasons against it and the health and the future of our kids is at stake. It is something worth fighting for and this book is your first weapon.
Related posts:
Sleep Schedules in Adolescents
ClockNews – Adolescent Sleep
More on sleep in adolescents
When Should Schools Start in the morning?
All Politics Is Local
Adolescent Sleep Schedule
Everything You Always Wanted To Know About Sleep (But Were Too Afraid To Ask)
Nicotine and Depression

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25 responses to “Books: “Snooze…Or Lose! – 10 “No-War” Ways To Improve Your Teen’s Sleep Habits” by Helene A. Emsellem, MD

  1. I hope they fixed that big “Viscious” typo, too.

  2. Sounds like a fascinating read. From my limited experience here in Alberta as both a student and now a teacher, I think that the US clearly has some odd ideas. When I was in high school (back in ’79-’82), we started at 8:55 and ended at 3:25. Now where I’m teaching, we start at 8:45 and end at 3:25 (shorter lunch than I had, back in the day). And this is actually five minutes later than it was two years ago, ironically (wrt your comment about busing) because the buses chartered from the city can’t get here early enough.
    I can only speak for my city’s schools, but the majority of us start at 8:30 or later. What’s a typical start time where you are?

  3. The image is from the website. I was toying with the idea of inserting a disclaimer that I actually know how to spell ‘vicious’.

  4. Nope, no end notes in the final version… it’s definitely aimed towards a lay audience. Some of our trade books do have endnotes, though, and you’re right that that’s a good way to make the book appeal equally to experts and non-experts. Some popular science writers have some references in the book but put the majority on an associated website… maybe we can get Dr. Emsellem to do that.

  5. It would be great if she could put here end notes and references online as I intend to use her book as a guide/scaffolding for a series of future posts.

  6. They start around 8:30 here, too, and the problem is, I think, far worse. I tutored some middle schoolers who were working on 4 hours sleep every night. Wednesday night, I was there until 11pm and they were still looking at three or four hours of homework.
    High school is like jail here. The kids are there for 12-15 hours a day, from 8:30am to mandatory study halls until as late as midnight. With Korea’s dependence on standardized testing for even high school admission, it’s sad that especially their middle schoolers are so overwhelmed that few of them can possibly be performing their best.

  7. Ahhhh, that’s why I love homeschooling. I get up at 4:30 and get back from work by 3:30. My slugabed wife and kids get up at 9 and finish school around 4.
    and at least they didn’t spell it ‘viscous’

  8. The vicious typo is fixed. thanks for pointing that out. I must not have had enough sleep that night. :) THis is a great review of the book. By the way, I linked your blog review to the reviews on the site page.

  9. I recently had a chance to skim “Snooze or Lose” and found the last part – the part about the social impact of sleep deprivation – very insightful. I could definitely relate.
    The reason I picked up the book in the first place is because I have sleeping problems and suffer many of the “social impacts” mentioned. Long story short, I got so fed up with feeling sluggish and irritable during the day that I decided to try a self-help approach to solving my problem.
    So I picked up a book called “Good Night – The Sleep Doctor’s 4-Week Program to Better Sleep and Better Health” by Michael Breus. The book was AMAZING – it provided a sleep diary, charts, graphs, tips, etc.
    It was a great supplement to “Snooze or Lose”.

  10. Hank Roberts

    Our neighbors asked why we’d started using low-blue evening lights.
    When we showed them the research on the melatonin clock controlled by blue-green light
    http://scholar.google.com/scholar?hl=en&lr=&scoring=r&q=brainard+light+melatonin&as_ylo=2001&btnG=Search
    they brought up their teenager’s problem, staying up into the early hours using the computer then unable to wake up.
    We gave them a sheet of the Rosco theatrical filter gel, #10 yellow I think (or maybe Canary) and he taped it so he can flip it down over his laptop screen around 8 or 9pm (two or three hours before he’d like to fall asleep); and one of the low-blue lights for room lighting.
    Problem solved. They sent a friend over, who tried it. Worked. I sent some to other friends, they’ve tried it. Works.
    Anecdotal, but read the research. I haven’t gotten to the Viscious website (grin) to see if they included this in their approach. Hope so.

  11. Yes, I wrote about it briefly.

  12. microbiologychick

    And what happens when these kids get to the real world that doesn’t revolve around them? Research won’t matter to the boss or the college prof. Might as well let them get used to it now.

  13. Luna_the_cat

    microbiologychick — great, so we should cripple their ability to learn NOW, just because they will have to deal with hard things in the future. Boy, that makes sense — Not. Heck, why not start off kids in the same situations they will face as adults? Maybe, possibly, because we think there ought to be a period of sheltered and concentrated learning, first, and we now recognise that kids are not adults?
    By the time adolescents hit university, they will have had a few more years of brain development under their belts. And since adolescence is a really unique time of brain growth and development, it would only make sense to make maximal use of it if we can.
    Anyway, aside from that — I just want to second the request that we see endnotes/bibliography here if possible, because I am really very interested. And, I wish you guys had been writing on this 25 years ago.

  14. Luna_the_cat

    …a few more years of brain development under their belts. — So to speak.
    Why don’t I recognise how this sort of thing will come out sounding BEFORE I hit post? >_

  15. I urge everyone to peruse the “Related” links at the end of the post for more information.
    But just briefly: there is not “getting used to” the schedule, this is an impossibility, thus forcing kids to such schedules is an inefficient and useless form of mild torture, which leads to all sorts of other problems, from obesity to learning disabilities.
    Second, remember that this phase-delay is in adolescents, i.e., it is temporary. It starts in early-to-mid teen years and ENDS in late twenties, upon which one settles into one’s adult phase. Then, some people are Larks, well suited to the traditional corporate world of nine-to-five. Others are Owls, better suited to the more enlightened 21st century world of work: independence, telecommuting, self-scheduling, self-employment, as well as some traditional modes, e.g., working 2nd shifts, or working in art or theater.

  16. Your links to “the National Slep Foundation website” and “Dr.Emsellem’s homepage” are giving me 404s now on Friday morning.

  17. Thanks for this very timely info. My night owl 15 yr old daughter has just signed up for an extra class next year, which means starting school at 7:00 AM instead of 8:00 AM. I’m delighted that she wants to take AP Bio and Chem as a sophomore in HS, but I have no clue how she’s going to get up early enough. I’m sure this book will help and we’ll both be reading it this summer.
    DD has always been a night person, I don’t think adolescence has made much difference in that, except maybe she has more stamina to stay up even later now. I’ve always been a morning person myself. Even as a college student I preferred early classes and chose to work the breakfast shift at the dining commons.

  18. Hank Roberts

    > blue blockers, etc.
    Yep, I appreciated your thread and put what I knew in it.
    I found I can’t search this book at Amazon, or I wouldn’t bother you.
    I’m curious whether the authors of this book mention that aspect of sleep and how to manage it.

  19. Hank Roberts

    Am I the first to point out I was being stupid? Yes, I found the “read the book online” link a moment after I posted the previous nonsense. I’ll look into it.

  20. Yes, pages 138 and 141.

  21. Hank Roberts

    Dang. This is outdated on the blue light receptor work.
    It’s good on morning bright light/blue light treatment and good on dawn simulators. But it’s talking about prescribing melatonin.
    It says:
    “… The spectrum of the wavelengths may also make a difference, and studies are now being done to measure their effects. Blue light appears to have stronger circadian effects than red light.”
    Well, yeah. Check the earlier topic, I posted links to the whole mess of info.
    Briefly, see the ledmuseum site for spectra
    for computer screen
    http://home.att.net/~ledmuseum/spectra.htm (page down to see “Spectrum of the white on a 19″ Soyo LCD computer monitor.”
    and for fluorescent lights.
    Both have a huge emission spike right smack in the narrow blue-green range that affects the newly discovered receptor that keeps melatonin from starting to be produced (somewhere above 400 to around 500nm) until hours after blue light ends for the day. Hours after sunset, eh?
    And the amber yellow of firelight or even the yellow-green of gaslight don’t affect that receptor, unless you get those other wavelengths of light insanely bright.
    Without knowing that and taking that blue light out of the evening, no wonder they’re dosing kids with melatonin:
    “melatonin secretion begins approximately 10 hours after wakeup and six hours before sleep.) To help her feel sleepy closer to 10:30, she would take a small amount of melatonin six hours earlier, at around 4:30 or 5:00 in the afternoon, after she gets home from school. By doing this for approximately six to eight weeks, the melatonin would help entrain your daughter to a more comfortable and healthful sleep-wake cycle.”
    Well, yes, oral melatonin works, but yellow lenses/lights to block the blue band will let the body make its own in plenty of time to feel sleepy — a few hours after the blue goes away.
    http://jcem.endojournals.org/cgi/content/abstract/86/1/433
    http://jcem.endojournals.org/cgi/content/abstract/88/9/4502
    When we dose with something we also produce naturally, don’t we risk downregulation?

  22. NoAstronomer

    A huge thank you for posting this. My 13-year old daughter is going through exactly these problems right now. Her day starts at 6:30am, school starts at 7:30am. Four days out of five she essentially sleep walks to the bus stop. Fortunately she doesn’t have to cross the street!

  23. Hank Roberts

    Hm, so this still recommends dosing with melatonin pills instead of using blue blockers so the body produces it. I think they’re a bit behind the research front on this, and consider downregulation a real concern. I tried a longer post but it didn’t make it apparently. See http://scholar.google.com/scholar?q=brainard+melatonin
    and the ledmuseum site for spectra of common lights.

  24. D. C. Sessions

    Mostly OT, but:
    Is there any research on the corresponding problems for young “larks?” Getting up in the morning has never (even as a teen) been an issue for me, but that didn’t mean I wasn’t short on sleep. It just meant that I had trouble getting to sleep in time to get any rest before my internal alarm went off at 0530 or so.
    It only sounds good if you’ve always had the opposite problem.

  25. D. C. Sessions

    Mostly OT, but:
    Is there any research on the corresponding problems for young “larks?” Getting up in the morning has never (even as a teen) been an issue for me, but that didn’t mean I wasn’t short on sleep. It just meant that I had trouble getting to sleep in time to get any rest before my internal alarm went off at 0530 or so.
    It only sounds good if you’ve always had the opposite problem.