Today's #Sleeptember FACT --- Teens sleep (or don't sleep) like that for a reason

By now you've probably heard that late bedtime and sleep-in periods for teenagers are part of the normal final development of their brain.

This delayed sleep phase in adolescents is usually just that--a phase--though adults may never "grow out of it" and end up being night owls. This can be a good or bad thing depending upon the goals of a person with late-night "eveningness," but that is the subject of another piece.

#SLEEPTEMBER

Teenagers are experiencing delayed sleep phase for a variety of reasons but what we all need to remember is that they still very much need their sleep, but aren't getting it. National Sleep Foundation Sleep in America polls annually bear out the truth: our teens are sleep deprived, due to burdensome schedules filled with homework, activities, sports and jobs.

On top of that, they are consuming large quantities of caffeine to medicate away their daytime sleepiness, getting into more automobile accidents than ever before, and suffering sleep-related health issues like anxiety, attention deficit, depression, even obesity, as a result.

To learn more about American teen sleep habits, check out the 2006 Sleep in America poll teen results here.

SLEEP STUFF: Light therapy

It may not occur to some people with sleep problems that light might be both their problem and their solution. Controlling light exposure at key times during the day is important for keeping fixed to normal circadian rhythms.

The people who often struggle most with finding quality sleep are also the ones working night shift or who stay up too late while on their computers. Their exposures to artificial light at these hours makes sleep harder to achieve due to the way that the eyes and skin absorb light; this absorption can literally turn off your brain's melatonin production. It's melatonin that helps the body transition from wakefulness to sleep.

On the flip side, people who are sleepy during the day often live in climates where the fall and winter bring longer periods of darkness during the day. Less exposure to quality light (natural or artificial) first thing in the morning can lead to daytime sleepiness as well as mood changes.

There are a few different products on the market geared to help people gain some better control over their light exposure. As always, discuss these options with your physician. In some cases, they might even be able to prescribe light therapy, if it's warranted, and insurance may then cover some or all of the expense.

Neuro:On Mask with Circadian Lighting
This is a wearable sleep mask that uses a "smart wakeup" technology to help you fall asleep and to wake you up at the optimal time in the morning, usually after you have completed your last REM cycle and have moved into a lighter stage of sleep. It measures several biological signals like brain waves, muscle tension, eye movements, pulse, core temperature and more via Bluetooth 4.0 LE-compliant digital analysis. For those who struggle with an irregular sleep schedule, general restlessness and jet lag, the NeuroOn might be a useful solution. It runs about $300. Learn more

FeelBrightLight Visor
You might have seen these before: visors that have lights built underneath their brims. These lights shine specific kinds of colored light indirectly above the eyes to help improve energy and mood. They offer a device you can clip to any visor you already have for around $110 and a deluxe version that includes a carrying case and a visor for $150. This could be a good option for people who need to move about and desire a hands-free solution to daytime sleepiness. Learn more

Philips Wake-Up Light
This attractive round light props up on a table, desk or nightstand nearby and can be used to help you fall asleep or wake up more gently depending upon how you program it. Its chief job is to stimulate sunrise and sunset lighting. Dimmer light at night is better for achieving sleep onset, while gradual illumination to morning sunlight aids in waking. This device also includes an option so you can awaken to pleasing natural sounds. Priced between $70 and $170, depending upon features. Learn more

Re-Timer 
Here's another wearable light therapy device, worn like a pair of lightweight and nonrestrictive goggles, that uses green spectrum light. It is designed to fit the majority of the population ("one size fits most") and its manufacturers claim it can bring relief to users in as little as three days following specific therapy protocols. It is used by people with delayed sleep phase syndrome (night owls who need to shift their sleep phases earlier), people with advanced sleep phase syndrome (morning larks who need to shift their sleep phases later), shiftworkers and those suffering from chronic jet lag. Prices run around $300. Learn more

WISDOM OF SLEEP: Dr. Mary Carskadon on our sleep-deprived teenagers

Mary Carskadon is a well-known American sleep researcher 

who has made a career of studying pediatric sleep issues. She
is a strong 

advocate for later school start times. She serves in
multiple 

roles, as 

Professor in the Department of Psychiatry
and Human 

Behavior at 

the Warren Alpert Medical School of
Brown University 

and as the 

Director of the Sleep and
Chronobiology Research Lab 

at E.P. 

Bradley Hospital.

"Kids are too sleepy to learn well. They're too sleepy to be happy. And they're at great risk for such things as traffic accidents."

"This can put their circadian rhythm, or biological clock, in conflict with the school bell. ... And their fatigue often leads to behavior problems that contribute to a negative overall school performance and experience."

"It's a double whammy. They're not getting enough sleep to recharge their brains, and we're asking their brains to be on duty at the wrong time."

~ Mary Carskadon

SHED SOME LIGHT || Ask the Expert: Misconceptions about Circadian Rhythm Disorders

Today SHC hosts a great summary of misconceptions about circadian rhythm sleep disorders from Peter Mansbach, PhD and president, founder and webmaster of the Circadian Sleep Disorders Network. 

Peter Mansbach PhD, President
of the Circadian Sleep Disorders
Network

_______________________________


I would like to clarify some things about Circadian Rhythm Sleep Disorders that are often glossed over or not widely recognized.

First and most importantly, there are TWO problems contributing to these disorders. One is that the timing of the body's clock is off. The other is that the sufferer is UNABLE to shift that timing.

Many people are "night owls": their body clocks run late, they want to go to sleep later than is customary in our society, and they get up later in the morning. But many night owls can, with a little attention to proper sleep hygiene, adjust their schedule to be able to work normal daytime hours.

This preference rises to a disorder only when the night owl is UNABLE to adjust their hours without more rigorous treatment. It is called Delayed Sleep Phase Disorder, or DSPD [1].

What do I mean when I say a person is unable to adjust their sleep hours? I mean that they can set their alarm and force themselves to get up at the desired time, day after day, but when it comes time to sleep, they cannot fall asleep. Their mind becomes active, they toss and turn for hours until their body clock finally decides it's sleep time. By sticking with this schedule they are not getting enough sleep, night after night. They are increasingly tired during the day, find it difficult to function, and this causes long term damage to their bodies. Yet they still do not fall asleep at the desired bedtime.

I've been asked many times to get up early for a doctor's appointment, repairman visit, relative's kid's baseball game, whatever. "Can't you just set an alarm and get up, just this once?" ("Just this once" ... right.) Well, yes I could--but don't try to hold an intelligent conversation with me that early, because I can't even process what you say, let alone formulate an answer, and that's if I don't crash the car on the way there. Once, when I did try to get up really early for an urgent business meeting, I drove onto the highway and found myself facing two lanes of cars coming at me at 60 mph: I had accidentally driven onto an off ramp. Not recommended.

What causes Delayed Sleep Phase Disorder? DSPD refers to a set of symptoms, and there may be different underlying physical abnormalities in different patients. These may include long intrinsic circadian period, lack of sensitivity to light, over-sensitivity to light, deficiencies in the ipRGC cells [2] of the retina, lack of melatonin production, long elimination time of melatonin, differences in timing of sleep relative to internal circadian rhythms, differences in tolerance to phase mismatch, and possibly others. So it's not necessarily a single disorder with the same cause in all patients.

DSPD is treated using bright light in the morning, avoiding light in the evening, and/or taking melatonin. Timing is critical. Yet not everyone responds well to treatment. Some researchers mentioned a 40 percent success rate, though treatments have improved since then. Why so low? I suspect because different people have different underlying causes, and the researchers tried a one-size-fits-all treatment.

How many people are we talking about? The studies that I'm familiar with estimate the prevalence of DSPD at about 0.15 percent, or 3 in 2000. That's half a million adult Americans! It's also a lot more prevalent in teens, perhaps 7 to 10 percent of them, most of whom will grow out of it.

Regarding Non-24-Hour Sleep-Wake Disorder (Non-24), I want to distinguish between Non-24 in blind people versus in sighted people. The Non-24 diagnosis refers to a set of symptoms in which the patient cannot entrain their schedule to a 24-hour day. Instead, their sleep time progresses later and later each day, going all the way around the clock. It is also called Free Running Disorder.

We know what causes Non-24 in blind people: lack of response to light. People's body clocks do not run at exactly 24 hours. On average, they run about 10 minutes longer than that [3], but exact timing varies among individuals. The body syncs its clock to the 24-hour day-night cycle through light entering the eyes [4]. In blind subjects, this synchronizing often does not occur [5].

In sighted people, the causes of Non-24 are believed to be similar to the causes of DSPD. I think we need to view these as two different disorders--Sighted Non-24 and Blind Non-24--since they have such different causes.

I'll close by touching on what I call "the myth of the good night's sleep" in relation to circadian rhythm sleep disorders. 

The literature describes DSPD and Non-24 by saying that, if allowed to sleep on their bodies' natural schedules, patients would sleep well and arise fully rested. 

For many people this has not been the case. Although they function far better on their own schedule than if they force themselves into a normal sleep schedule, they may still sleep fitfully, or be tired during their wake time.

Thanks to Tamara Sellman at SleepyHeadCENTRAL for this opportunity to post.



[1] Earlier medical classifications referred to Delayed Sleep Phase Syndrome, DSPS, and this is still a popular term. The current classifications use the term Delayed Sleep Phase Disorder, DSPD.
 [2] ipRGCs: Intrinsically photosensitive retinal ganglion cells. These cells in the eyes are receptive to light even in the absence of the rods and cones in the eye used to "see" light.
 [3] Early studies suggested 25 hours, but that has been discredited. It resulted because the study subjects used light in the evening.
 [4] There was an experiment which claimed light at the back of the knees could entrain the body clock, but that data could not be replicated, so the theory has been abandoned.
 [5] It can still occur, even without visual perception, if the ipRGCs in the retina are unaffected.

SHED SOME LIGHT || Guest post: Terra Ziporyn Snider, PhD, on later school start times

The Start School Later Movement

by Terra Ziporyn Snider, PhD

When I moved to Maryland in 2000, plans were in the works to delay our county’s brutal 7:17 a.m. high school start time. Sleep research was already clear that these hours were unhealthy and counterproductive, and school leaders were leading the charge for change. With my oldest child in seventh grade and my baby in kindergarten. I assumed the problem would be solved by the time my kids were affected. Nearly 15 years later, my baby is in college, and nothing has changed.

Nothing has changed in most of the 15,000 or so school districts around the US either. Education Secretary Arne Duncan may have tweeted his view that later start times are a “common sense way to improve student achievement,” but fewer than 15 percent of US high schools start before 8:30 a.m., the minimum acceptable time for middle and high schools recommended by the American Academy of Pediatrics. Nearly 43 percent of high schools start before 8 a.m., and 10 percent before 7:30 a.m.

This inaction shocks sleep researchers and health professionals, as well as many parents who know the grim reality of trying to rouse sleep teenagers before sunrise. For decades, sleep scientists have been telling us why: at puberty, circadian rhythms shift later, not only in humans, but in other mammals as well. Typical sleep cycles begin around 11 p.m. for teenagers and continue through 8 a.m. This means that an early wake-up call (5 or 6 a.m. in many cases) not only allows a maximum of only six to seven hours of sleep, but it also requires students to wake in the middle of deep sleep. 

Since the average teenager needs 8.5-9.5 hours of sleep per night, it’s no wonder that nearly 70 percent of US high school students get under 8 hours – and 40 percent get six or fewer. In addition, they’re getting this insufficient sleep at the wrong time, sleeping in on weekends or napping after (or in) school, creating a situation that amounts to chronic jet lag or shift work.

This wasn't always the case. A hundred years ago, most schools (and places of business) started the day around 9 a.m. In the 1970s and 1980s, many schools shifted to earlier hours. Back then the importance of sleep and adolescent circadian shifts were little understood, and cost savings of running the fewest possible buses in multiple cycles was appealing. Even schools that didn't run buses often found it helpful to match hours to those of nearby schools. As a result, many students today are required to be in class much earlier than their parents and grandparents had been. 

These changes might have saved bus money, but they shifted costs to students and families. Sleep-deprived teens not only risk eating disorders and obesity, heart disease and diabetes, immune disorders, substance abuse, anxiety, depression, and suicide, but they put their safety and that of others at risk by walking to the bus or driving themselves to school on dark, deserted streets. Judgment, focus, and memory are impaired, and risks of tardiness, truancy, and dropping out increase, reducing chances of school success, particularly in disadvantaged children.

When public school times changed, the whole community's rhythms changed, too: Today, "after" school stretches out to four hours (and fills up with activities), leaving many kids unsupervised at the peak period for adolescent crime and risky behavior. Elementary schools often start as late as 9:15 or 9:30, forcing working parents to send young children to before-school care as well as after-care. Families whose children are in multiple school levels often have start and end times that span two hours in the morning and another two in the afternoon. 

Most people now perceive these adaptations as inevitable and normal. And this perception is the key to understanding why schools aren’t listening to sleep research. People who have adapted their lives to current school hours assume that they cannot adapt to changing them again. Fearing that new hours will disrupt commutes, daycare, teacher training, after-school activities, and so forth, they protest shifted schedules vehemently, sometimes to the point that superintendents have lost their jobs. It’s no wonder that school officials find ways to make later school start times sound as complicated and expensive as putting a man on Mars. 

“One of the hardest things you can ever do as a superintendent…is to begin to tinker with the bell schedule,” said Deb Delisle, Assistant Secretary of the US Department of Education. “People go absolutely bananas over that. You can change textbooks, you can change report cards, [but] as soon as you tinker with that bell schedule – whoa, too scary!”

The good news is that finding ways to run schools at safe, healthy hours is not rocket science. Schools have, and continue to, run at many different times around the world, and community life always adapts to them. We now have plenty of success stories providing data that put the many dire speculations blocking change to rest. 

Even the common sense speculation that later hours would just lead teens to stay up even later has 
been felled. In every study to date, students actually go to bed around the same time, and get significantly more sleep, when morning bell times are delayed.

The hundreds of examples of schools that have found ways to run schools at later, healthier hours by prioritizing sleep, health, and learning provide empirical evidence that the challenge to later start times isn’t daycare or jobs or sports or even the cost of running more buses. The real challenges are fear of change and failure of imagination.

Combating these challenges will take more than sporadic local advocacy efforts. It will also take more than sleep research, however compelling. Instead, it will take treating sleep and school hours as fundamental matters of public health rather than as negotiable school budget items.

Once we start viewing sleep and school hours as equivalent to other public health issues like child labor, smoking, and seatbelts, objections to later start times will melt away. Making that happen, however, will require health practitioners, sleep researchers, educators, policymakers, and advocates to join forces, with a common goal of consciousness-raising and collective action on local, state, and national levels.

 --------

Terra Ziporyn Snider, PhD, is the Executive Director of Start School Later, a nonprofit organization dedicated to increasing public awareness about the relationship between sleep and school hours and to ensuring school start times compatible with health, safety, education, and equity.

Sleep Hygiene Tip of the Week || SHED SOME LIGHT: Teens can benefit from "happy lights"

One of the biggest circadian rhythm problems relates to Delayed Sleep Phase Disorder (DSPS), in which teenagers, due to the developmental nature of their changing brains, tend to fall asleep later and require sleeping later in the morning.

It's a challenge because teens have been shown to be at risk for sleep deprivation because of late bedtimes mixed with school start times which are too early. Also, those kids who are active in sports or jobs which have challenging hours may also struggle to get more than 5 hours a sleep a night because they have practices or shifts that cut into their homework and sleep schedules.

Society, on the one hand, demands that we keep our kids busy, but the price they often pay to stay out of trouble is sleep deprivation, which can contribute to other kinds of trouble: poor grades, motor vehicle accidents, mood disorders.

So how are we to get adolescents out of bed in the morning with so much stacked against them? Using phototherapy can help.

In one randomized parallel clinical trial, the use of bright light (compared to dim light) as part of a sleep phase adjustment protocol was shown to improve morning sleepiness in the subjects. Bright light was defined as measuring at 2700 lux, while dim light was measured as 0.1 lux. Phototherapy in this study was delivered via a special mask.

The sleep phase adjustment protocol in this experiment was designed for nine weeks: one week to establish a baseline sleep schedule for each subject, then four weeks of chronotherapy treatment which included one-hour shifts in bedtimes per week with no naps or bright light after 5pm, followed by four weeks of followup.

Not only did bright light help improve morning sleepiness, but the overall treatment protocol for DSPS in this study ultimately suggested that complete adjustment therapies using chronotherapy without bright light treatments were not as effective.

If you have a teenager who struggles to get out of bed in the morning, and there are no other options for them (such as delayed school start time), it might be a good idea to visit the doctor to discuss the possibility of a sleep phase adjustment using both phototherapy and chronotherapy. A doctor will, at this time, want to rule out other causes for daytime sleepiness, such as narcolepsy or sleep apnea. If the doctor determines that your teen has DSPS, they will wish to work with you and them on a behavior therapy that the teen must follow to reset their rhythms; it requires strict adherence to a bedtime protocol, careful use of lighting, and a sleep diary, among other things. It has been shown to be helpful and doesn't usually require medication.

This Verilux product, the Rise & Shine Serenity series,
gives timed light that mimics natural sunrise and sunset times.
It may be useful in resetting circadian rhythms in teens
suffering from DSPS. Image courtesy Verilux.

In addition, the investment of a so-called "happy light" can be very useful. Full-spectrum lighting systems which adjust light brightness in the teen's bedroom on a gentle timed schedule can gradually help them to adjust to nature's circadian rhythms and light cues.

Some of these come equipped with alarms, as well. Verilux offers two different systems which may work well for you. Avoid bright lighting with ultraviolet rays; most full-spectrum systems do not include it for safety reasons.

SHED SOME LIGHT on CIRCADIAN DISORDERS

In order to understand what a circadian rhythm disorder is, you need to know what circadian rhythms are.

Circadian rhythms are also referred to collectively as "the body clock," as they mark the way in which the human body processes time cues from the environment. These time cues include sunlight and seasons and temperature changes.

Our bodies are influenced strongly by these exterior cues, as they help to inform many internal processes in the human body as well, including sleep drive and digestion, among other things.

Hence, our bodies cycle in tandem with these rhythms, which occur following the same 24-hour pattern that represents one Earth day.

Think about it: The typical human being rises with the sun and goes to bed after the sun has set. When this very basic programming of the human body is diverted, many basic biological functions can be changed, thwarted or otherwise negatively impacted.

Research into sleep health and circadian rhythm dysfunction continues to show consistently how these kinds of disruptions to our rhythms can lead to cardiovascular problems, slower metabolism (leading to obesity), higher risk for cancer, and connections with mental health problems.

Some common circadian rhythm disorders can come as the result of lifestyle choices: jet lag occurs because of air travel across time zones, and those who work the graveyard shift can have a hard time achieving "recovery" sleep after working long overnight hours.

But some circadian rhythm problems are the result of internal disruptions.

Teenagers often has delayed sleep phase disorder, in which their drive to sleep launches later in the evening than their younger or older peers; these changes in "sleep phase" are brought about by chemical responses inside the bodies of teens that relate to their rapidly changing brain and body biology.

Keep in mind, delayed sleep phase problems are not just reserved for teenagers, but for anyone who can't fall asleep at a "typical" hour. Extreme night owls of all ages can find this problematic for keeping morning appointments or getting to work on time if it means they must cut short their nightly sleep due to delayed sleep phasing.

Elderly people often have advanced sleep phases, the opposite of what adolescents experience, which can explain why they are in bed by 6pm at night.

But again, people of any age can also suffer advanced sleep phasing, which can get in the way of work and family life as it often means these people cannot stay awake to participate in social time or work shifts that are scheduled in the early evening.

In addition, there are people whose rhythms do not match the 24-hour cycle... their days are typically longer than 24 hours, and this makes it difficult for them to live normal lives. They suffer because their sleep-wake cycles can become extremely desynchronized with the rest of the world.

Finally, the person who suffers from irregular sleep-wake phase suffers from the interruption of at least 3 sleeping periods during their waking day.

You can see how having intrusive periods of sleep or wakefulness at the wrong times of the day can make life hard for some. Employers and educators function on fairly regular working periods, so jobs can be hard to keep. Falling asleep at inappropriate times can be embarrassing, can lead to relationship stress, and can keep circadian rhythm disorder sufferers from leading full lives; they might even be dangerous.

Employers are starting to honor flex hours to respond to the needs of those who have dysfunctional circadian rhythms. Scheduling in hospitals and other workplaces where 24-hour shift work is the norm can help to give these employees a fair chance to recover from their overnight schedules so they can be better, safer workers. It's not unheard of for corporations to now have a nap room available to those who may need to catch a few midday winks.

Later school start times are one attempt to help teenagers to endure their naturally later sleep phases so they can be more productive and alert in class and so that they can avoid the sleep deprivation that delayed sleep phase can cause, which can lead to automobile accidents from drowsy driving and poor decision making in social situations.

Still, families can struggle when one or more members has a circadian rhythm disorder. Circadian dysfunction can lead to misunderstandings, unfounded assumptions about laziness, concerns that the sufferer has mental health problems, and mistakes that can make a home unsafe (kitchen fires, bad falls, and harm to unsupervised children are all potential risks).

To learn more about circadian rhythms, please visit the Circadian Sleep Disorders Network for in-depth information on each of these conditions and for resources for treating these conditions and raising awareness.

Daylight Saving Time || Let the Phase Shifting Begin!

This month at SHC, the theme will center on sleep phase disorders, also known as circadian rhythm disorders, in which the brain responds inappropriately to changes in light and temperature. These are often (but not always) indicative of a switch to longer nights and shorter days.

Look for posts on time cues and sleep, non-24 sleep phase disorder, jet lag, advanced and delayed sleep phasing, shift work disorder and phototherapy before November is through.

You'll note the posts regarding circadian rhythm sleep dysfunctions by the icon, SHED SOME LIGHT, which is a play on the idea that while we lose light during the late fall and early winter, we can still be enlightened to these circadian rhythm changes and make healthy changes in our lifestyle to protect our sleep schedules.

In addition, we're playing with the image here of the first lightbulb lit by famous American scientist Thomas Edison; historically, the advent of electric light has had a major impact on sleep health, a subject to be explored in November at SleepyHeadCENTRAL. Stay tuned!

Lifespan || Back to School: Have You Reset Your Kids' Bedtimes?

Kids are usually not ready to go back to school in the fall, and to confuse matters, they sleep following a summer schedule which generally puts them in bed later than is recommended for school-aged kids needing to get up early for school the next day. This can mean a tough transition from summer to school days for many families, with many elements to blame for this challenge.

Daylight hours are still long and late enough to make it hard for kids to go to bed at a normal time. The sky doesn't darken early enough in August, even in early September, and that means parents may have to double their efforts to get their kids to bed at a healthy time.

On top of that, many schools still have earlier start times than are recommended by most sleep health organizations. This is a particularly significant problem for teenagers as their sleep phases tend to delay at this time in their lives, as they are literally unable to fall asleep until later as a result of major developments in the brain combined with considerable changes in hormone levels. Many school districts have become aware of the need for teens to sleep in and start school later and have adjusted their start times so elementary aged children start off the day earlier (between 7 and 8 AM), allowing junior high and high schoolers the later (around 9 AM) slots. But there are still many school districts across the country which have not made these changes, perhaps at the peril of the kids in those communities. Some research shows that test scores for teens with early start times are considerably lower than those who get to sleep in, and other studies indicate that teens with early start times are also more likely to get into motor vehicle accidents as a result of sleep deprivation which may partly be blamed on this lack of allowance for sleep imposed on them by their school district.

Warmer temperatures in late summer and early fall can also make it harder to fall asleep, as the human body must be able to "cool off" at night in order to achieve sleep onset; warm days, especially in humid areas east and south, can interfere with sleep hygiene in this regard.

What can parents do?

• Know what your child's sleep needs are first, then factor in bedtime rituals, morning rituals and transportation to school, then subtract these from your child's school start time to find the right bedtime to which your child acclimates.
• Preschoolers (up to age 6) need 10 to 12 hours
• Pre-adolescent school-aged kids (ages 7-12) need 10 to 11 hours
• Teens (13 to 18) need 8 to 9 hours
  
  Picking a bedtime (example): If your child is 10 years old, and they need about half an hour to get to bed, half and hour to get ready in the morning and half an hour to get to school, and their school start time is 8am, then they need to start going to bed at about 830 at night. This allows them to get ready between 830 and 9pm, to sleep until 7am, then they can get ready from 7 to 730am and head off to school promptly to meet the 8am start time. 
• Gradually put your kids to bed earlier over the course of the late summer, if they are pre-adolescent. 
• In the case of older kids in late summer, ask them to try to be home earlier or go to bed earlier so they can adjust to the more structured sleep schedule they'll have to deal with in the fall. If you have teens in sports or other activities that meet before school, discuss with them the importance of getting enough sleep so they can better manage the demands these early schedules can place on their energy and alertness while in class.
• Go cold turkey: the night before school starts, put the kids to bed at the time you want them to go to bed. Prepare for them to be tired or unruly or otherwise less functioning for the first couple of days. Many school districts start in mid-week to prepare for this reality anyway.
• If you have to choose one time to be consistent about, make it the morning wake-up time. All human beings do better if they rise at exactly the same time every morning and allow the day's activities and their own natural circadian rhythms to determine their bedtimes later. 
• Don't give your teens too hard a time about the fact they can't get to sleep at an earlier time. This is something they physiologically have no say over and is, in fact, a normal part of their development.
• Institute "screen rules" at bedtime. Kids in 2014 are essentially "plugged in" through their phones, laptops, and video game consoles. The problems with screens are two-fold: first, these devices emit blue spectrum light, which is scientifically proven to shut off melatonin production in the brain (melatonin is a hormone that is secreted in order to prepare the body for sleep); in addition, the content of movies, television shows, Skype phone calls, video games, Facebook and other electronic communications can be tantalizing enough to make it difficult for kids to shut their minds down at bedtime. If your kids can't learn to police these activities now, the odds of their ever getting a good night's rest even beyond college life are likely to be next to nothing. Old habits die hard. Don't let them form these poor sleeping habits in the first place and they'll be healthier adults in the long run.
• Make sure your kids are not eating late or having snacks right before bedtime. Especially be vigilant about stopping their consumption of caffeine-laced products like chocolate, soda, coffee, cocoa and energy drinks after 5pm at night. 
• Put room-darkening window treatments in your kids' rooms if they have many windows which bring in a lot of light. An eastern or northern exposure window will always be darker at night than a western or southern one, but don't forget to factor in streetlights outside their rooms, house lights or any lights from passing traffic, which can continually illuminate their bedrooms just as they are trying to fall asleep.
• Make sure your kids are not physically exerting themselves until bedtime. The adrenaline rush that commands the bloodstream following a period of exercise takes a couple of hours to wear off, and that could mean your kids might end up being too hyper to sleep right afterward.
• Remove distractions from your kids' sleeping environment. That means having them pick up the clutter of their day, if possible, so that they don't have in their sight lines the reminders of interesting activities to thwart their attempts to sleep.
• Stick to a relaxing bedtime ritual. For younger kids, this could be a bath, teeth brushing and bedtime stories or prayers. For older kids, it could also be a shower or bath and other self care and reading a book, if they can't fall asleep right away. 
• Teach your children meditation. Meditation is a great way to practice mindful living, as it helps with the practice of shutting down the active mind. Meditation also involves healthy breathing practices which can be the basis for a good night's sleep if practiced at bedtime. Meditation can also be especially useful for kids dealing with the stresses of daily living: family problems, bullies, challenging subjects at school, budding romances, pressures derived from competitive activities. If kids can manage their stress levels, they will be better equipped to deal more successfully with all the very real challenges that childhood and adolescence can bring.