Abstract
This research proposal seeks to investigate effects of cognitive and behavioral sleep education on adolescent sleep patterns. From several cases of problems that adolescents experience due to poor sleep habits, it has been a matter of concern that a sleep education program, as an intervention, be implemented. The study will use both longitudinal survey and grounded theory designs to solicit quantitative and qualitative data. It is conjectured that cognitive and behavioral sleep education has positive effects on student sleep habits: It enables students to think about harmful consequences of poor quality sleep, and respond with appropriate behaviors of better sleep habits. Findings of this study are expected to be helpful to the school and the family on how adolescents can be educated to manage their own healthy sleeping habits.
The Background
Sleep is an inevitable food for the brain. During sleep, pertinent brain activities and important body functions occur. Everybody needs about 8 to 10 hours in sleep for such activities and functions to occur properly. Studies have indicated that teens usually sleep for less than the standard time of 8-10 hours. For those who attempt to sleep for the standard time, they have been manifesting irregular sleeping patterns. There are those that have been staying up to around 11 p.m. before they get to bed. 1 This happens mostly during the weekend when adolescents watch movies or play video games up to late night hours. The consequence of this has been that adolescents would wake lately due to extended hours of their sleeps. This can indeed affect their biological clocks and even hurt qualities of their sleeps. Poor sleep has led to several psychological disorders: insomnia, restless legs syndrome and narcolepsy. 2 Particularly for school teens, lack of quality sleep can negatively affect one’s ability to listen, learn, concentrate and solve problems. Moreover, some studies have indicated that lack of sleep can be causal to acne and other skin problems. Visible signs of an individual with poor sleep qualities have been aggressiveness, drowsiness and other inappropriate behaviors such as yelling. 3
Studies indicate that teens need more sleep than adults need, because the former are normally at an important of stage of growth and development. Adolescent sleep problems can begin as early as 13 years. Several causes have been attributed to these likely sleep problems: rapidly changing bodies, busy schedules, active social lives and wrong views of sleep. 4 As a result, adolescents have been demonstrating later sleep practices and subsequent sleep problems during day times because of forced rise times in the school. 5 It has been an opportunity for this study to investigate if school-based sleep education programs can be effective in alleviating the problem. The study will employ longitudinal research and ground theory analyses to determine if effective school-based education programs can serve to alleviate the sleep problems among adolescents. The experiment will thus be done on three-year basis, with intervals of six months for measuring the program effectiveness. In the longitudinal research, measurements will be those concerned with sleep start times, wake up times, sleep hours, cases of depressive moods and daytime sleepiness. These measures will help the researcher to determine whether the education program was effective in preventing sleep problems or not. Qualitative measurement will be important in enabling the learner to realize any qualitative behavioral improvements in students due to improved sleep patterns after taking the education course.
Hypotheses
Hnull 1. There are no significant differences among six measures of each sleep factor in the longitudinal studies.
2. The education program is not effective in addressing the sleep problem among adolescents.
Halternative 1. There are significant differences among six measures of each sleep factor in the longitudinal studies.
2. The education program is effective in addressing the sleep problem among adolescents.
The Proposal
Methodology:
This study will employ both quantitative and qualitative approaches. The qualitative approach with a longitudinal survey design will be used to test the effectiveness of school-based educational program in alleviating the sleep problem among adolescents. There will be two groups involved: study group and control group. The study will also employ a Two Factor without Replication ANOVA technique to test significant differences among measures of sleep start times, wake up times, and sleep hours, cases of depressive moods and daytime sleepiness. Measures of the aforementioned sleep parameters will take place after every six months in the whole period of three years. This will result in six arrays of data for each factor. There will be also qualitative feedback forms about how each individual in the experiment fair on with matters such as attention to learn and listen in class.
The study will involve 240 high school students in Australia. The number will be divided into equal halves, so that equal experiment and control groups can be formed. Belonging in two private schools and two public schools, the students will have a mean age of 15 years. Each school will be required to produce one class as a control group and another class as an experiment group. The four schools will have to agree with the time that sleep educational programs would be conducted so that they do not clash with mandatory curriculum classes. Researchers have identified three scales to measure the aforementioned quantitative factors of sleep as, the Sleep Patterns Questionnaire, the Depression Anxiety Stress Scale and the Pediatric Daytime Sleepiness Scale. Data in qualitative research will be collected by semi-structured interview questionnaires. The researcher will also have to obtain the permission from the university research ethics committee in the institutions and free consents from participants.
After obtaining free consents from participants and the permission from ethics committees, students will be randomly selected from the classes given by managements of their institutions. It is important to note that each institution will have to give 60 students. In every institution, one class will give 30 students for experimental group. The other 30 students for control group will have to come from a different class. One hour lesson that instill cognitive and behavioral competencies in how an adolescent can improve his or her wellbeing through quality sleep will be taught three days every week. The lessons will be themed in the whole framework of cognitive and behavioral therapy; sleep related components such as adolescent sleep needs, habits and needs, sleep regularization, good sleep hygiene, consequences of poor sleep and stimuli control will be taught. At the end of every 6 months, the Sleep Patterns Questionnaire, the Depression Anxiety Stress Scale and the Pediatric Daytime Sleepiness Scale will be used to measure information concerning sleep start times, wake up times, sleep hours, cases of depressive moods and daytime sleepiness. Qualitative information will be assessed using grounded theory. In quantitative approach, measures of the aforementioned factors will be taken so that they can be analyzed using the Two Factor without Replication ANOVA technique. Differences in means and variances of outcomes of every factor will be analyzed after six months. Using the ANOVA techniques, p-values and F-values of analyses in both experimental and control groups will be noted. In the experiment group, observed p-values will have to be less that the α value of 0.05 to show that there were differences in outcomes of the education program on the sleep problems. This will mean that the program was effective in changing or improving the sleep patterns of the students. Conversely, if observed p-values will be higher than the α values of 0.05, there will be no significant differences in outcomes of the education program to change the sleep problems among the adolescents. F critical values also have to be smaller than F observed values for the education program to be deemed effective. Using the grounded theory, recurring themes among all students will be used to generalize the findings of the experiments.
Results
Of the 240 students, twenty students from experimental and control groups were eliminated. The students had dropped out or transferred to other schools. Thus, the experimental group and the control group had 50 participants each. ANOVA results in sleep start times, wake up times, sleep hours, cases of depressive moods and daytime sleepiness indicated that significant differences in means and variances. All observed p-values were less than the α value of 0.05. Contrary to control groups, in experimental group, f-value analyses indicated that critical values were less than observed values. Results in experimental groups indicated that F critical values were smaller than F observed values. This is another indication that indeed the education program enabled improvements in the sleeping habits of the students. Students adopted better cognitive and behavioral techniques in improving their sleep habits. Results in qualitative studies found that the cognitive and behavioral therapy framework of teaching was successful in enabling the learners to reduce sleep problems. Students had improved experiences in class due to increased attention. Conversely in the control group, no significant improvement was reported.
Interpretations
The study results indicate that education program can be effective in imparting cognitive and behavioral skills in the learner for him to adopt healthy sleep pattern. Grandisar et al. (2011) noted that an effective program can make adolescents to record better sleep characteristics such as earlier rise time, earlier sleep time and reduced fatigue and sleepiness during the day. 5 The Moseley and Grandisar (2009) study found that a sleep education program increases sleep knowledge and has significant effect on sleep. 6 Over 77% of participants reported positive results of the education program in improving sleep patterns. Education program can enable one to identify his sleeping problem, so that cognitive and behavioral responses can be adopted to deal with it. Short et al. (2013)7 and Short et al. (2012)8 indicated that that adolescents that delayed in sleeping or had odds in sleeping, reported increasing sleep problems. Only a third of self-identifying participants reported correctly about their sleeping problems. For parents, only a sixth of them could report sleeping habits of their children correctly. According to Brand and Kirov (2011), the role of sleep on the wellbeing of an adolescent is quite complex. 4 Sleep inefficiency can trigger and maintain sleep-related, psychiatric and somatic/organic problems. Particularly in adolescents, Wong, Brower and Zucker (2010) noted that depressive symptoms, aggressive behaviors, nightmares and substance related problems are likely when a participant is having troubled sleeps. 3 In the Lytle and Pasch (2012) article, it was found that lack of sleep among adolescents increased the risk of obesity. Adolescents are at critical moments when sleep disruptors are many and assertive.1 In King et al.’s (2013) study, violent video-gaming for more than 150 minutes led to a decrement of 7% of sleep efficiency among adolescent. 2 An education program in a cognitive and behavioral therapy will enables adolescents to adopt new sleeping habits and avoid harmful sleeping habits that have detrimental somatic and psychological consequences.
Extrapolation
References
Lytle, L A, Pasch, K E.The relationship between sleep and weight in a sample of adolescents. Obesity.2011;19(2).
King, L et al. The impact of prolonged violent video-gaming on adolescent sleep: an experimental study. Journal of Sleep Research. 2013; 22(2).
Wong, M M, Brower, K J, Zucker, R A.Sleep problems, suicidal ideation, and self-harm behaviors in adolescence. Journal of Psychiatric Research. 2011; 45 (4).
Brand, S, Kirov, R. Sleep and its importance in adolescence and in common adolescent somatic and psychiatric conditions. International Journal of General Medicine. 2011; 4:425-442.
Grandisar, M et al. A Randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder. Sleep. 2011; 34(12).
Moseley, L, Grandisar, M. Evaluation of a school-based intervention for adolescent problems. Sleep. 2009; 32(2).
Short, M A et al. Identifying adolescent sleep problems. PLoS ONE.2013; 8(9):e75301. doi:10.1371/journal.pone.0075301.
Short, M A et al. The discrepancy between actigraphic and sleep diary measures of sleep in adolescents. Sleep Medicine. 2012; 13(4).
