Sleep Expert Argues Good Rest Is a Public Health Issue
March 18, 2022
For many, losing an hour of sleep at the end of daylight savings time is enough to throw off a week. Congress appears to agree; last week, the Senate approved the Sunshine Protection Act that, if signed into law, would make daylight savings time permanent. But the proposal may miss the mark for achieving good sleep, according to Old Dominion University sleep researcher Mariana Szklo-Coxe.
"I do agree seasonal time changes twice a year should be eliminated, and a permanent time established. But with daylight savings, there is an increased risk for social jet lag, which is when your work, school and other responsibilities are chronically misaligned with your natural biological circadian rhythm," said Szklo-Coxe, an associate professor of community and environmental health in the College of Health Sciences. She notes the American Academy of Sleep Medicine supports year-round standard time.
"National year-round fixed standard time aligns best with human circadian rhythm biology and would be best for public health and safety. Permanent Daylight Savings Time may even work against the changes we're trying to make with delaying school start times. With DST, we get less light in the morning, so it disrupts this zeitgeber - an external cue that influences our internal circadian clocks."
Szklo-Coxe has spent her career studying how sleep research can inform public policy to better align the rhythms of our daily lives with the rhythms of our sleep. She recently published a chapter in the first textbook ever published on sleep as a matter of public health.
Sleep was once a fringe research topic, but public interest has grown in recent years. Smart watches track sleep, apps help you fall asleep and sleep products have become more popular.
While Szklo-Coxe does not use sleep tracking technology, she appreciates the attention to her field. She began her career as a behavioral scientist with an interest in public health and injury risk, exploring how to prevent unintentional injuries by understanding and addressing modifiable risk factors.
"We wouldn't call it a car accident - we would call it a crash. We don't consider outcomes like crashes and adverse medical events mere 'errors,'" she said. She wanted to understand what factors, including sleep and fatigue, led to preventable adverse events.
Szklo-Coxe was a doctoral student at Johns Hopkins University when the NIH's National Center on Sleep Disorders Research started. She applied for funding to study drowsy driving, injury risks and shift workers, specifically resident physicians. Studying these sleep and work-schedule risks started her career in sleep research.
Szklo-Coxe approaches sleep from a public health perspective. "Foundations of Sleep Health," published by the National Sleep Foundation, is the first of its kind to focus on public health rather than sleep disorders and clinical diagnosis.
Her chapter explores the psychosocial aspects of sleep, applying health behavior theory to sleep behavior and sleep health. She also offers approaches health professionals can use to promote healthy sleep behaviors across the lifespan.
"The book is innovative; it's the National Sleep Foundation's first textbook on sleep health and gave me a chance to address psychosocial aspects of sleep health that are often neglected," Szklo-Coxe said.
She invited two other researchers to participate in the study for her chapter in the textbook when they were at ODU as a professor and student, respectively: Kendall Leser from Miami University and Margaret Lubas from Radford University. The chapter is called "Psychosocial Dimensions of Sleep Health." In it, the researchers write about how we think about sleep health and sleep behaviors and provide guidelines for sleep health promotion in one's community.
For Szklo-Coxe, promoting sleep health has included advocacy for later high school start times. She serves on the advisory board of the nonprofit Start School Later and has worked with colleagues to share research findings with school boards and administrators around the state.
She worked with other researchers to study and address the impact of sleep on students' mental health in Fairfax County Schools. The study found later start times could reduce suicide, depression and other risky behaviors in teens, and in 2014, Fairfax County Schools pushed high school start times to 8 a.m. or later. The research was published in the Journal of Youth and Adolescence.
She has continued to advocate closer to home in Hampton Roads and worked on a Virginia Academy of Sleep Medicine position paper acknowledging the need for later school start times for teens, which can improve sleep, attention, safety, performance, mental health and overall well-being.
"It also speaks to a health-equity issue," she said. "Some students in certain neighborhoods have to go to their bus stop before 6 a.m."
She is now studying college students and sleep deprivation, aiming to develop effective interventions to address sleep issues in young adults and prevent adverse outcomes.
Szklo-Coxe tries to practice what she preaches, though she recognizes it can be challenging to limit exposure to electronic devices and blue light at night. She highlights the benefits of taking effective naps.
"I think we should have nap bays at ODU, but that's another story," she said.