Sleep, learning, and the developing brain: early-to-bed as a healthy and wise choice for school aged children.

“Everything possible should be done to favor sleep as deep and sound in quality and usually as long in quantity as possible, and everything that seriously interferes with this end should be sedulously avoided…No one should be allowed to go to school at all without [at least] nine hours of sleep…”—GS Hall 1904. There is a long history of interest in understanding the importance of sleep for normal health, development, and academic performance in children. In a major work 1 published more than a century ago, G. Stanley Hall emphasized the crucial role of sleep for optimal health in youth and warned about the consequences of placing excessive time demands on students in ways that undermined this health priority. Hall—a towering figure in the history of psychology and a pioneer in the modern study of adolescence—devoted a lifetime of work to studying virtually all aspects of development, incorporating work in psychology, anthropology, sociology, neurology, and education among others. Given his truly multi-disciplinary approach, it is perhaps not surprising that he was one of the first to recognize the value of adequate sleep during childhood and throughout adolescence. The scientific evidence to support this type of advocacy—particularly, the kind of experimental data with sufficient rigor to convince skeptics and influence policy makers about the health and academic priorities of sleep—has been accruing slowly but steadily. A critical advance was launched more than 25 years ago, as Carskadon and colleagues began a series of studies examining the development of normal sleep, and the effects of sleep loss in children and adolescents. 2 Over the past few decades, several different research groups have published observational data, clinical data, and results from some cross-sectional studies that provide strong support for an association between inadequate sleep in children (including insufficient time in bed, as well as disruptions or disturbances of sleep) and higher rates of problems with attention, behavior, emotions, and academic difficulties. For example, children with a wide range of behavioral or emotional problems report higher rates of sleep problems, and children sampled on the basis of sleep problems show elevated rates of behavioral and emotional difficulties. There is also a body of data from clinical samples showing that successful treatment of sleep disorders in children and/or improving the quality or quantity of sleep has been associated with functional improvements in these domains. Despite the mounting accumulation of evidence for associations that link together inadequate or disrupted sleep with suboptimal daytime functioning in children (especially in the domain of learning, attention, self-control and academic goals), there has been less evidence regarding the causal relationship between sleep and behavioral, emotional, and academic domains in normal children. At least five previously published controlled studies 2-6 have examined daytime function under experimental conditions of sleep restriction, but only one attempted to change sleep for more than one night. That study, an experimental study in normal children by Sadeh, Gruber, and Raviv (2003), 5 found evidence that restricting or extending sleep for multiple nights in non-clinical samples of children had a direct impact on specific domains of neurobehavioral functioning in children. The paper by Fallone, Acebo, Seifer, and Carskadon 7 in this issue of SLEEP, provides new experimental data showing that restricting sleep times in healthy normal school children for one week resulted in increased teacher ratings of academic problems