Sleep Loss in School Children : Fact or Myth

Purpose – Sleep habits play an important role in the health of young children. Sleep is often compromised either because of parents by pressuring children to study into late hours or due to sleep habits of children themselves. The aim of study was to assess the sleep habits of school going children in the capital state of Delhi, India. Methods – A total of 1457 students aged 9-17 years participated and filled validated ‘School sleep habit survey’ form. A performa was also developed to collect information on usual presleep habits of school children. Data was analysed using SPSS ver 20. The form was filled by parents and children together. Results – Sleep onset latency >30 min was reported by 8.6% of the students. Mean bedtime of students was 10.49±1.14h on schooldays and 11.10±1.37 h at weekends. On weekends, students woke up later at 8.08h±1.76h than schooldays 5.46±1.41h. Older age category (>15 years) slept for lesser duration than the younger age. On weekends girls slept longer than boys. Majority of the students considered themselves to be ‘good sleepers’. Lower academic grades in school were found to be associated with insufficient sleep. Number of family members played a significant role on quality of sleep. 23.7% reported to be active on electronic gadgets prior to sleep. Students reported a reduced parental influence on bedtime with increasing age during schooldays. Boys felt that parents influence the sleep time more on schooldays. Conclusionsleep problem in the form of increased sleep onset latency was reported by 8.6% children themselves. Use of electronic gadgets, lack of parental influence on setting bed times was seen. J Physiol Pharmacol 2019; 63(2) : 105–112 *Corresponding author : Dr. Karuna Datta, Armed Forces Medical College, E-Mail : karunadatta@gmail.com (Received on May 03, 2018) Introduction In today’s modern society, sleep is restricted to meet the work and social requirements. Parents, though inadvertently, make their children to try improving their performance at the cost of sleep hours. Children themselves also reduce their sleep hours by playing video or computer games at times late into night. Many a times, there is a subtle peer pressure on adolescents to stay up late and interact on social networking sites. A recent study in USA showed an increase in use of gadgets like tablets, computers, etc. by children 106 Arora, Datta, Singh, Sreedhar and Mallick Indian J Physiol Pharmacol 2019; 63(2) and was found to be associated with sleep problems (1). Firstly because the child tries to procrastinate his sleep, secondly just before sleeping the practise of indulging in games creates a problem in sleeping. Thirdly the blue light emitted from these devices entrains our circadian rhythm and leads to further sleep problems due to an interaction in process S and process C i.e. process Sleep and Circadian process, the principal controllers of sleepwake interaction. The prevalence of use of these gadgets in Indian population is not known. It is also important to increase awareness about good sleep and good sleep hygiene principles in schools. Problems in s leep are of ten assoc ia ted with decreased at tent ion span, memory problems, excessive daytime sleepiness, emotional stress, mood swings, irritable behaviour, aggressiveness, difficulty in relationships (children will be found having problems with teachers, friends, parents, siblings, etc.). The lapses in performance are found to increase with sleepiness. A study done by Short et al on 385 adolescents found that poor sleep is associated with sleepiness, fatigue, impairments in academic performance, poor work ing memory, depression, anxiety, risk taking, use o f drugs and alcohol and, diminished quality of life (2). Another study by Gruber et al studied well rested school children in the age group of 7 to 11 years and found that the longer sleep duration of children was associated with higher IQ and short sleep duration was associated with poor performance on IQ measures even in the absence of effects of sleep deprivation (3). The investigators were involved in a symposium, conducted on ‘Importance of sleep in school children’ for school teachers. Following this many requests were received from schools to address the audience and increase awareness amongst students. It was also felt by the school teachers that probably the students do not get adequate time to sleep. There was a felt need to study the habitual sleep duration of school children and know the prevalence of sleep problems in school children of a developing country. Thus the present study was planned with the following objectives: to assess the sleep time schedule and sleep habits of school going children; to estimate prevalence of sleep problems in school children; and to estimate prevalence of using gadgets/ distracters before sleep by school children. Material and Methods SubjectsThis cross-sectional, observation study was conducted among school children of urban capital. 1500 school children in the age group of 9 to 17 years (grades V-XII) were identified for the study. The study protocol was approved by the Institutional ethics committee of the medical school. Permission of the school principal was taken prior to conduct of the study. The participation was voluntary and informed written consent to participate in the study was obtained from both the parent and the child. InstrumentsSchool Sleep habits survey form ava i lab le a t h t tp : / /www.s leep forsc ience.org / contentmgr/showdetails.php/id/93(4) was used to collect the data. This survey consists of 63 questions about the demographic data of the individual and the various sleep habits. The survey also assesses sleepiness, sleep wake problem and morningnesseveningness from the questions given in the survey form (5), (6). Apart from this survey form, a performa was developed enquiring about number of family members, the usual habits of students before sleep and practice of gadgets before sleeping. Both the survey form and the Performa were filled by the students quest ion wise by t rained facil i tators explaining each question. The filling of these forms was done in small groups. The forms were collected and the data was taken without any names or identity numbers making the ent i re data anonymous. Parameters calculated from the sleep habits survey form were bed time, wake up time, sleep durationon both schooldays and weekends, schoo l performance, sleepiness scale , sleep wake problem scale (SWPS), morningness/eveningness scale (ME) (7) along with their use of gadgets and family details from the performa. Data Analysis-Data was analysed using SPSS version 20 (IBM Corp., Armonk, USA). Descriptive statistics was presented as frequencies (%) and means (SD). Chi-square tests were used for categorical variables and t-tests for continuous variables. Sleep duration during schooldays and Indian J Physiol Pharmacol 2019; 63(2) Sleep Loss in School Children: Fact or Myth 107 weekends were compared using paired ttests . Unpaired t tests and One-way ANOVAs with multiple comparisons were performed to evaluate gender and age differences respectively for each of the dependent variables. Pearson’s rank correlation assessed the relationship of school performance and sleep duration. A p value less than 0.05 was considered statistically significant.