To the editor: I would like to directly address the concerns raised in Dr. Cuebas' letter to the editor regarding the “refutability” of the science on sleep.

While I deeply respect everyone’s right to have their own opinion and encourage the conversation, it is important that we, as a town, accurately understand the current array of scientific evidence and existing areas of debate. Dr. Cuebas' professional impression is that the science to support school start time change is lacking, but this does not represent the majority view in his field of sleep medicine, nor the wider body of physicians and professionals in the adolescent and public health fields.

I encourage anyone who wishes to do so to actually look at the AAP Policy Statement in order to first note it is authored by Judith Owens, MD, MPH, the national leader in pediatric sleep medicine and director of the Center for Pediatric Sleep Disorders at Children’s Hospital Boston, with 4 contributing authors, all leaders in pediatric sleep medicine. It was approved by the Committee on Adolescence and the Council on School Health Executive Committee, before being approved as a policy representing the American Academy of Pediatrics.

The policy’s conclusions are also reflected in the American Academy of Sleep Medicine’s "Health Advisory: Teen Sleep and School Start Times." In other words, adjusting school start times to better accommodate adolescent sleep needs represents the majority opinion in both sleep medicine and in pediatrics. It is also supported by the National Association of School Nurses, and beyond that, physicians and educators interested in public health have taken the same position, as evidenced by the CDC press release of Aug. 2015. This is a remarkably deep and broad consensus for a public health policy issue.

Therefore, while I fully respect his right to express his professional opinion, I worry that Dr. Cuebas’ letter risks mischaracterizing the full weight of evidence behind this consensus. As he notes, the AAP Policy Statement does in fact state, "It is clear that additional research is needed to further document the effects of changes in school start times over time, to examine specific factors that increase or decrease the likelihood of positive outcomes…”

No research is ever final, and no responsible scientist would pretend that we are finished understanding the complexities of this important topic, or really of any complex issue. This statement is not a concession driven by doubt but is instead a clarion call for further research because the findings to date have been so impressive. Read the report, and its 60+ supporting documents, and judge for yourself.

Yet, the reasons to read the AAP Policy Statement go further and deeper. In the Policy Statement, you will see additional support beyond improved physical and mental health, reduced absenteeism, and reduced accidents. For the concerned students and parents, you will see that students do not stay up later, as many people assume, but instead increase their sleep time, sometimes by more than is expected. For the concerned taxpayers, you will see the very robust studies looking at the effect of change in school start times being equivalent to reducing class size by one-third. Just imagine the cost of decreasing class size by one-third with the required teachers and building space, then consider the rather minimal cost being considered for school start time change to bring about a similar effect. A Brookings Institute study, authored by economists, lists changing school start time as one of the three most cost-effective ways to improve education in America.

However, there are some points on which Dr. Cuebas and I would whole-heartedly agree. There should be a concerted effort to better educate students, parents, and faculty about the importance of sleep hygiene. Unfortunately, education alone is not enough to paper over the gap between where we are and where we should be in regards to sleep times. Like the concerns raised about homework and stress levels in the high school, this effort should be addressed in parallel with — and not as a substitute for — school start time change.

I also agree that individuals are ultimately responsible for their own choices about sleep. In fact, that personal responsibility is what gives the 8:30 or later start time the greatest appeal. It offers the promise of maintaining extracurricular activities with enough time for meetings or practices to be moved to the morning. Some families may choose an early morning approach as a way to “prepare for the real world;” some may choose to get up for specific practices during certain seasons, or for occasional meetings, or to talk with teachers. The change allows families to make tailored choices based on their children’s needs, preferences and opportunities for enrichment. It allows for sleep choice.

Let’s all take a second look at the data, and continue the conversation.

Sincerely,

Megan Douglas, MD, MPH

Barrington

Megan Douglas is a doctor of internal medicine-Pediatrics.