Accepted Manuscript: 10.1016/j.sleep.2016.09.022

Accepted Manuscript
Morningness−eveningness correlates with sleep time, quality, and hygiene in

secondary school students: A multilevel analysis
Christian Vollmer, Konrad S. Jankowski, Juan F. Díaz-Morales, Heike Itzek-Greulich,

Visiting researcher, Peter Wüst-Ackermann, Christoph Randler
PII: S1389-9457(16)30264-7
DOI: 10.1016/j.sleep.2016.09.022
Reference: SLEEP 3223
To appear in: Sleep Medicine
Received Date: 1 July 2016

Revised Date: 16 September 2016
Accepted Date: 17 September 2016
Please cite this article as: Vollmer C, Jankowski KS, Díaz-Morales JF, Itzek-Greulich H, Wüst-
Ackermann P, Randler C, Morningness−eveningness correlates with sleep time, quality, and
hygiene in secondary school students: A multilevel analysis, Sleep Medicine (2016), doi: 10.1016/
j.sleep.2016.09.022.
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Running head: SLEEP – TIME, LENGTH, QUALITY, AND HYGIENE 1
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1 Morningness−eveningness correlates with sleep time, quality, and hygiene in secondary
2 school students: A multilevel analysis
3
4 Christian Vollmer a,*, Konrad S. Jankowski b, Juan F. Díaz-Moralesc, Heike Itzek-Greulich,
5 Peter Wüst-Ackermann e, Christoph Randler d,e
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6
a
7 Institute of Psychology, University of Education Heidelberg, Heidelberg, Germany
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b
8 Faculty of Psychology, University of Warsaw, Warsaw, Poland
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c
9 Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
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10 Institute of Science, Technology & Geography, University of Education
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11 Heidelberg, Heidelberg, Germany
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e
12 Department of Biology, University of Tuebingen, Tuebingen, Germany
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14 ARTICLE INFO
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16 Article history:
17 Received
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18 Received in revised form

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19 Accepted
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21 Keywords:
22 Adolescents
23 Chronotype
24 Morningness–eveningness
25 Circadian rhythm
SLEEP – TIME, LENGTH, QUALITY, AND HYGIENE 2
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1 Sleep hygiene
2 Sleep quality
3 School type
4 School start time
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6 *Corresponding author at: Institute of Psychology, University of Education
7 Heidelberg, Keplerstr. 87, D-69120 Heidelberg, Germany. Tel.: 49 6221 477176; fax: 49
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8 6221 477432.
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9 E-mail address: vollmer@ph-heidelberg.de (C. Vollmer).
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1 ABSTRACT
2 At the onset of puberty, students shift their sleep to later hours, but school starts early.
3 It is suggested that evening orientation and early school start times do not go well together.
4 Therefore, the aim of this study was to investigate sleep problems in adolescence, and it was
5 expected that the adolescents’ eveningness orientation is associated with many sleep-related
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6 problems. Students of secondary education (n = 3201; mean = 13.8 ± 1.8 years) filled out a
7 self-report questionnaire containing measures of morningness–eveningness, sleep time
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8 (midpoint of sleep, social “jetlag”), sleep length (on schooldays and on weekends), sleep
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9 quality, and sleep hygiene as well as questions on electronic screen media use. The impact of
10 circadian preference on sleep time (midpoint of sleep and social jetlag), sleep length (on
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11 schooldays and on weekends), sleep quality, and sleep hygiene of adolescents was tested via
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12 multilevel analyses while controlling for covariates on the student level (age, sex, screen
13 media use, and time leaving home) and on the class level (school type, grade level, and school
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14 start time). Morningness–eveningness was a significant predictor of all dependent variables

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15 and associations were highest (β > 0.40) for midpoint of sleep, social jetlag, problems in
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16 going to bed, problems in falling asleep, and problems in returning to wakefulness. Providing
17 guidance for parents on sleep hygiene behavior routines for their child, an educational
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18 program in sleep hygiene, and later school start times could help to synchronize adolescents’
19 circadian rhythms to daily educational and social demands.

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1 1. Introduction
2 1.1. Sleep problems in adolescence
3 Adolescents are familiar with late bedtime, short sleep, irregular sleep pattern, low
4 sleep quality, and insufficient sleep hygiene, and they accumulate a dramatically high
5 prevalence of such sleep-related problems [1,2]. However, sufficient sleep length and good
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6 sleep quality are critical for health [3] and everyday performance. In fact, the poor sleep of
7 adolescents leads to daytime impairments that may result in poorer quality diet [4], aggressive
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8 and antisocial behavior [5−7], common psychiatric disorders [8], and poor academic
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9 achievement [9−11]. Adequate sleep hygiene could be considered as a protective factor [12],
10 but adolescents do not follow sleep hygiene recommendations [13] and thereby aggravate
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11 their sleep-related problems.
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12 Although adolescents’ sleep habits and the negative consequences for health and
13 academic achievement are recognized, the causes of these sleep problems are not well known.
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14 This study investigates morningness–eveningness, age, sex, screen media use, school start
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15 time, and school type as predictors of sleep time, sleep quality, and sleep hygiene.
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16
17 1.2. Predictors of sleep problems in adolescence

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18 1.2.1. Morningness–eveningness
19 Morningness–eveningness, circadian preference, or chronotype is an individual’s preference

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20 for early or late bedtimes and rise times. A shift toward eveningness during puberty is
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21 observed, and physicians label the adolescent sleep latency as a clinical condition, delayed
22 sleep-phase disorder [14], requiring medical treatment. The insufficient sleep, irregular sleep
23 pattern, reduced sleep quality, and daytime fatigue on weekdays [15] is due to a conflict
24 between biological and social clocks that has been coined “social jetlag” [16] and which
25 arises in this developmental stage.
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1 1.2.2. Electronic screen media
2 Adolescents often engage in evening leisure activities that interfere with sleep, such as
3 prolonged electronic screen media use [17−19]. Electronic screen media use is correlated with
4 shorter sleep length [20], late midpoint of sleep [21], and poor sleep quality [22], because the
5 blue light emitted by these media delays the onset of melatonin secretion [23]. Adolescents’
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6 screen media use has increased in recent decades, and therefore this major disruptor of
7 circadian rhythmicity should be targeted when studying the sleep of adolescents [24].
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8
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9 1.2.3. School start time
10 Contributing to inadequate sleep is the fact that class times are early and the
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11 commuting time to school often increases with the transition to secondary school and thus
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12 reduces the sleep duration of adolescents even further [25]. Social norms prescribe a
13 normative and strict 24-hour timetable with specified times for withdrawal into sleep and
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14 social life and do not account for adolescent developmental changes in the sleep−wake
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15 rhythm.
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16
17 1.2.4. School type

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18 Sleep problems are also reinforced by increasing demands and opportunities from
19 familiar, educational, job-related, leisure, and peer backgrounds [26]. In the present study, the
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20 school type was used as an indicator of different social and educational backgrounds.
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21
22 1.3. Present study
23 None of the previous studies have analyzed all listed factors in conjunction with
24 limiting their ability to detect or overestimating effects of morningness–eveningness on sleep-
25 related variables. The present study sampled a large number of classes, collected information
26 on morningness–eveningness, sleep time, sleep length, sleep quality, and sleep hygiene, and
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1 used multilevel analyses to address the clustering of the data. This allowed us to check for
2 differential effects of morningness–eveningness on several sleep-related variables in
3 adolescents while taking into account the nested data structure in classes from different grade
4 levels and school types with diverging school start times.
5 Although most previous studies have indicated negative effects of morningness–
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6 eveningness on sleep time, sleep quality, and sleep hygiene, these studies have not
7 investigated the causes of these sleep-related problems of adolescents in one coherent study.
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8 The present study aimed to estimate adolescents’ differences in sleep time, sleep length, sleep
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9 quality, and sleep hygiene by morningness–eveningness. Besides age and sex, electronic
10 screen media use was also addressed as a predictor of sleep problems, because previous
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11 studies have reported their harmful effects on adolescents’ night sleep [21,27]. Moreover,
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12 because German school starts early in the morning between 07:30 and 08:10, the time when
13 students leave their homes in the morning was assessed. Also, because the students are
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14 clustered into classes and schools, and because different schools start at different times, the
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15 start time of the first lesson at the various German school types (special needs, lower track,
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16 intermediate track, and upper track) was operationalized.
17 We formulated the following hypotheses: Eveningness is related to late sleep time and
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18 to short sleep length (hypothesis 1). Morningness is associated with better sleep quality and
19 better sleep hygiene (hypothesis 2). Electronic screen media use, age, sex, school start time,
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20 grade level, and school type were used as covariates because it is suggested that these
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21 variables also contribute to the variance in the sleep-related outcome variables.
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23 2. Methods
24 2.1. Sample
25 Participants were 3201 students from 169 school classes of grades 5 to 10 from 28
26 schools of secondary education in three adjacent German administrative districts (Heidelberg,

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1 Mannheim, and Rhein-Neckar-Kreis). Classes were selected by the principals in reasoned
2 consideration of the class schedule. Participation was voluntary and anonymous. The students
3 completed the self-administered questionnaire in normal classroom settings in the presence of
4 a researcher and a teacher. Informed consent was obtained from the authority
5 (Regierungspräsidium Karlsruhe), school principals, parents, and students. Written consent
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6 was obtained from the authority and the parents. The research method met the ethical
7 principles and standards of human research proclaimed by the University of Education
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8 Heidelberg. The field work took place from November 13, 2009, to March 22, 2010.
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9
10 2.2. Measurement instruments
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11 2.2.1. Morningness–eveningness
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12 Morningness–eveningness was measured with the Composite Scale of Morningness
13 (CSM) [28], a Likert-type scale. The psychometric properties of the CSM have been validated
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14 with cortisol levels (Randler & Schaal, 2010) [29], and higher scores have been found to
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15 correlate with an earlier midpoint of sleep (r = −0.46 [30] and r = −0.52 [31,32]). The CSM
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16 has been adapted to German children and adolescents by making the wording a bit easier,
17 which was done by considering some aspects of the Basic Language Morningness Scale
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18 (BALM) [33]. The German CSM is available in different versions (adults, adolescents, and
19 parent report) [34]. In detail, some of the items were adapted to match the school background
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20 of adolescents (items 1, 6, 8, and 10), and some items were rephrased to suit the language of
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21 the younger adolescents and students from the special needs track (items 1, 2, 3, 6, and 12)
22 [34,35]. Furthermore, Tonetti et al. [32] reported some evidence for the validity of the
23 German scale. A short version of the scale (containing items 1, 2, 5, 6, 9, 10, and 12) was
24 given to the students of the special needs track. The scores were normally distributed (Fig. 1)
25 and CSM’s Cronbach’s α of the present study indicated good reliability of the scale
26 (Cronbach’s α = 0.85).
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1
2 2.2.2. Electronic screen media use
3 Two questions about time use of electronic screen media (item 1: “How much time do
4 you spend on a regular schoolday at the computer/game console?” and item 2: “How much
5 time do you spend on a regular schoolday watching TV and videos?”) on a six-point Likert-
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6 type scale (0 = “no time at all”; 1 = “less than ½ hour”; 2 = “½ hour, up to 1 hour”; 3 = “more
7 than 1 hour, up to 2 hours”; 4 = “more than 2 hours, up to 3 hours”; and 5 “more than 3
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8 hours”) were combined to an index of screen media use (Cronbach’s α = 0.54).
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9
10 2.2.3. Sleep time and sleep length
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11 Students reported their usual bedtimes and rise times on schooldays and on weekends. Four
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12 variables were calculated from these four clock times: midpoint of sleep, social jetlag, sleep
13 length (time spent in bed) on schooldays, and sleep length (time spent in bed) on weekends.
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14 Because the data are not based on actual sleep data, we used “time in bed” as an
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15 approximation of sleep length. The midpoint of sleep was adjusted for individual sleep debt
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16 on schooldays (MSFsc) [36] and, in the present study, was not based on actual sleep data
17 (sleep onset/awakening) but on self-report measures on bedtimes and rise times. Therefore,
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18 bedtimes and rise times were used as approximations of actual sleep length. Social jetlag is
19 considered as the absolute difference between mid-sleep on schooldays and mid-sleep on

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20 weekends [16].
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21
22 2.2.4. Sleep quality
23 The Adolescent Sleep−Wake Scale (ASWS) [37] measures sleep quality on five
24 subscales (going to bed, falling asleep, maintaining sleep, re-initiating sleep, and returning to
25 wakefulness; 28 items total). A short version of the scale, containing 11 items, was given to
26 the students in the special needs track.

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1
2 2.2.5. Sleep hygiene
3 The Adolescent Sleep Hygiene Scale (ASHS) [37] measures behaviors that may inhibit sleep
4 onset in five subscales (physiological problems, cognitive problems, emotional problems,
5 sleep environment, and use of substances; 28 items total). A short version of the scale,
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6 containing 6 items, was given to the students in the special needs track.
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8 2.3. Data analyses
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9 Items on the ASWS and ASHS were analyzed with confirmatory factor analysis in
10 Mplus 7 [38] to confirm the model fit of the data to the latent structure proposed by
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11 LeBourgeois et al. [37]. Factor scores were used for subsequent analyses (ASWS: five-factor
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12 model, χ2 = 5821, df = 340, χ2/df = 17.1, p < 0.001, root mean square error of approximation
13 (RMSEA) = 0.07, comparative fit index (CFI) = 0.88, TLI = 0.87; ASHS: five-factor model,
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14 χ2 = 4276, df = 160, χ2/df = 26.7, p < 0.001, RMSEA = 0.09, CFI = 0.83, TLI = 0.80).
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15 After the investigation of descriptive statistics and bivariate correlations in SPSS 22

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16 (SPSS Inc., Chicago, IL, USA), multilevel regression analyses were calculated in Mplus 7
17 with sleep time (MSFsc, social jetlag), time in bed (on schooldays, on weekends), sleep
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18 quality (ASWS, five subscales), and sleep hygiene (ASHS, five subscales) as dependent
19 variables. Morningness–eveningness, age, sex, screen media use, and time leaving home were
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20 used as predictors at the student level. Moreover, because students were nested in classrooms
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21 and schools, class was introduced as a cluster variable, and school type (dummy variables
22 with the reference group upper track), grade level, and school start time (start of the first
23 lesson) were used as predictors at the class level.
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25 2.4. Missing data

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1 Before the analyses, 161 students from 20 classes with fewer than 10 participants were
2 removed from the dataset, because a class size of at least 10 students is recommended for
3 multilevel analysis. The resulting dataset contained 3040 students in 149 classes (mean class
4 size = 20.40, SD = 6.09). The amount of missing data for each variable in these 149 classes is
5 due to questionnaire design (a shorter questionnaire was used for the special needs track) and
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6 nonresponse to single items or scales (Table 1). In the multilevel analyses, full information
7 maximum likelihood (FIML) [39] was used to take the missing data into account. In addition
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8 to morningness–eveningness, the other predictors were included in the multilevel regression
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9 analyses to make the assumption of missing-at-random more plausible.
10
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11 3. Results
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12 3.1. Descriptive statistics and bivariate correlations
13 Descriptives of all study variables are shown in Table 1. The mean value for
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14 morningness–eveningness was 34, and values were normally distributed around the scale’s
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15 dead center (Fig. 1). On average, the students left home 36 minutes before the start of the first
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16 lesson. Time in bed (proxy for sleep length) on schooldays was 1 hour 20 minutes shorter than
17 on weekends. Problems with the sleep−wake rhythm were highest in returning to wakefulness
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18 (mean = 2.97) and going to bed (mean = 2.50). The sleep hygiene problems were highest on
19 the cognitive subscale (mean = 2.96).

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20 Concerning the predictors, morningness–eveningness did not differ by sex (boys,

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21 mean = 33.89 ± 7.11; girls, mean = 34.09 ± 7.14; p = 0.431). Morningness–eveningness was
22 negatively associated with age, screen media use, and time leaving home. Age was positively
23 correlated with screen media use but not with time leaving home. Screen media use was
24 positively correlated with time leaving home (Table 2).
25 Concerning the dependent variables, MSFsc was negatively correlated with time in
26 bed on schooldays and weekends, but social jetlag was not correlated with time in bed on
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1 weekends. Correlations of MSFsc and social jetlag, respectively, were stronger for the
2 subscales of the ASHS than for the ASWS, indicating that late sleep was rather a matter of
3 lacking sleep hygiene (ASHS) than of lacking sleep quality (ASWS). Time in bed on
4 schooldays and on weekends was negatively associated with all subscales of the ASWS and
5 the ASHS with higher correlation coefficients for time in bed on schooldays, except for
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6 problems in re-initiating sleep on schooldays. The subscales of the ASWS and the ASHS were
7 positively correlated with each other (r = 0.20−0.88) (Table 2).
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8 Inspection of the multilevel structure of the data showed that the intraclass correlations
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9 (ICCs) (Table 1) were highest for time in bed on schooldays (0.35), MSFsc (0.22), and
10 substances (0.24), indicating more differences between classes at mean levels for these
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11 variables than for the other sleep-related variables.
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12
13 3.2. Effects of morningness−eveningness on sleep time and sleep length

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14 The effects of morningness–eveningness on sleep time and time in bed (proxy for
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15 sleep length) were tested via multilevel analyses (Table 3). Morningness was negatively
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16 associated with late sleep time (MSFsc and social jetlag) and time in bed on weekends, but
17 was positively associated with time in bed on schooldays. These associations were more
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18 pronounced for sleep time than for time in bed.
19 Among the other covariates, notably (with β > 0.30), older age and school type
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20 (special needs and lower track) (Fig. 2) were positively associated with late sleep (MSFsc and
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21 social jetlag). Although age was negatively associated with time in bed (proxy for sleep
22 length) on schooldays (β = −0.38) and, to a lesser extent, with time in bed on weekends (β =
23 −0.20), on the class level there were few differences in time in bed on schooldays, and no
24 differences between classes for the weekend time in bed (Fig. 2).
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26 3.3. Effects of morningness−eveningness on sleep quality

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1 The effects of morningness−eveningness on sleep quality were also tested via
2 multilevel analyses (Table 4). Generally, morningness was positively associated with sleep
3 quality; that is, there were negative associations with all five subscales of problems in sleep
4 quality. There was a highly negative association between morningness–eveningness and
5 problems in returning to wakefulness. The associations of eveningness with problems in going
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6 to bed and problems in falling asleep were of medium strength, whereas problems in
7 maintaining sleep and problems in re-initiating sleep were weakly associated with
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8 eveningness. Girls reported lower sleep quality than boys on all five subscales.
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9
10 3.4. Effects of morningness−eveningness on sleep hygiene
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11 The effects of morningness–eveningness on sleep hygiene were also tested via
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12 multilevel analyses (Table 5). Morningness was positively associated with sleep hygiene;
13 thus, eveningness was related to problematic sleep hygiene behavior (the five subscales of the
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14 ASHS). The standardized coefficients were equally low (−0.21 to −0.26).

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15 Girls reported notably more emotional sleep hygiene problems than boys (β = 0.37).
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16 The special needs and lower track school types were associated with notably more
17 physiological problems and problematic sleep environment than the other school types (Fig.
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18 2).
19 Effect sizes (percentage of explained variance) were highest for MSFsc (42%), social
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20 jetlag (37%), time in bed on schooldays (44%), problems in going to bed (35%), problems in
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21 returning to wakefulness (56%), and substance use (32%). On the other hand, the multilevel
22 models did not explain that much variance in time in bed on weekends (11%), problems in
23 maintaining sleep (10%), problems in re-initiating sleep (8%), and in emotional sleep hygiene
24 problems (14%).
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26 4. Discussion
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1
2 The aim of this study was to investigate predictors of sleep problems in adolescence.
3 The impact of morningness–eveningness on sleep time (MSFsc and social jetlag), time in bed
4 (on schooldays and on weekends), sleep quality, and sleep hygiene of adolescents was tested
5 via multilevel analyses while controlling for covariates on the student level (age, sex, screen
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6 media use, and time leaving home) and on the class level (school type, grade level, and school
7 start time).
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8 Morningness–eveningness was a significant predictor of all dependent variables, and
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9 associations were highest (β > 0.40) for MSFsc, social jetlag, problems in going to bed,
10 problems in falling asleep, and problems in returning to wakefulness. Because the first lesson
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11 starts early in the morning, eveningness was related to shorter time in bed on school days,
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12 which is in line with findings by Arrona-Palacios et al. [40] and Carissimi et al. [41]. These
13 authors showed that lessons starting in the afternoon are best for optimal sleep duration of
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14 adolescents, regardless of their circadian preference [42]. Since another study also found
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15 longer sleep duration and lower sleepiness in afternoon schedule students but with distinct
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16 results for morning and evening types [43], the benefits of later schedules for academic
17 achievement are still unclear.

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18 Morningness–eveningness is less valuable in predicting problems of sleep hygiene and
19 sleep quality. The lesser interrelation of morningness–eveningness with aspects of sleep

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20 quality (maintaining and re-initiating sleep) and time in bed confirm that morningness–
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21 eveningness is rather a matter of sleep timing than of sleep quality or time in bed. Problems in
22 the sleep−wake rhythm become more severe with increasing age and, more crucially, with
23 increasing drift to eveningness. Morningness–eveningness was a strong predictor of problems
24 in returning to wakefulness: every student has to get up at the same time in the morning
25 because school starts early in the morning, regardless of whether the student prefers a later
26 waking time. This underlines that the early school start times are inappropriate [44]. In
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1 contrast, in the evening, adolescents are much more able to influence their own best time of
2 going to bed and, as a consequence, report fewer problems in the evening. The high
3 correlation of morningness–eveningness and problems in returning to wakefulness may partly
4 reflect that morning items play a greater role in the construction of the CSM: eight of 13 items
5 on the CSM are “morning items” (items 1, 3, 4, 5, 6, 10, 11, and 12) and two are “evening
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6 items” (items 2 and 7). On the other hand, the morning items on the CSM are verified as
7 being more suitable to measure morningness–eveningness [28], and researchers have
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8 advocated using only these as predictors of individual circadian preferences, referring to
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9 them as “morning affect factor” [45].
10 The consistently significant correlations of morningness–eveningness and sleep
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11 hygiene subscales indicate that good sleep hygiene practice could lessen the drift to
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12 eveningness in adolescence. Girls reported more sleep related problems than boys, in line with
13 findings by Lazaratou et al. [46]. Both sexes were evening oriented, and morningness–
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14 eveningness was unrelated to sex. In contrast to this, some research found that boys had a
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15 greater number of incorrect sleep beliefs than girls [47]. Although there is no consensus
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16 regarding sex differences in sleep parameters in adolescents, when sleep habits are
17 considered, girls generally reported better sleep hygiene than boys [48]. In the present study,
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18 girls reported more problems than boys; thus it is likely that girls with similar morningness–
19 eveningness experience more sleep problems.

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20 Regarding age differences, results corroborate previous study findings. As adolescents

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21 become older, they progressively delay their rise time and bedtime; time in bed decreases
22 [14], and sleep irregularity increases [49]. Thus, the present results strengthen the finding that
23 older adolescents exhibit more sleep problems than younger ones. Adolescents’ individual
24 rhythm desynchronizes more and more from socially acceptable waking times and bedtimes
25 as they shift to evening types [50]. In consequence, they accumulate an ever-increasing sleep
26 loss on schooldays, and returning to wakefulness becomes constantly more challenging,

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1 especially for evening types. This becomes even more severe because, on schooldays,
2 adolescent evening types can only partly recover from sleep debt by taking long naps in the
3 afternoon, which perpetuates their late bedtimes.
4 Electronic screen media are consumed during leisure time, that is, in the late afternoon
5 and evening hours before bedtime [27], when they are most harmful for the night sleep. The
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6 results confirmed that screen media hinder adolescents from going to bed in a timely manner
7 and are considered as a problematic sleep environment. Screen media emit blue light, which is
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8 harmful for an early sleep onset because it delays melatonin secretion [51].
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9 Concerning the class level variables, results have shown that the prevalence of sleep-
10 related problems was higher in the lower and intermediate tracks of secondary education and
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11 that the upper track copes best with the early school start times. This result suggests that the
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12 social and educational background plays a vital role, and that parents can effectively ensure
13 early and consistent bedtimes, give structure with mealtimes to reduce physiological
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14 problems, and give their child the opportunity for a quiet bedroom and adequate sleep
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15 environment.
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16
17 4.1. Study limitations

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18 A methodological limitation is the use of self-administered questionnaires. However,
19 we collected the data with reliable and valid measures. In addition, validation studies as well
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20 as Cronbach’s α values in our sample have shown that these measures are valid and reliable
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21 [52], and thus we assume no bias by our self-report data. Collection of objective data on sleep
22 variables (eg, via actigraphy) is expensive and was not feasible for such a large sample as
23 ours. Another limitation of the self-report nature of the data lies in voluntariness of
24 participation, and thus in an inevitable self-selection of schools, classes, and individuals.
25 However, every class in three administrative districts had an equal chance to participate.
26 Moreover, the correlative nature of the analyses could not determine causes and effects.
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1 Furthermore, in the questionnaire, we did not ask for sleep length, but used the time spent in
2 bed as an approximation, which calls for a cautious interpretation of the sleep measures
3 MSFsc and social jetlag, which are calculated from the time in bed measure and are not based
4 on real sleep data.
5 Furthermore, there are more correlates of sleep problems in adolescents that were not
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6 targeted by the present study. For example, increased stress perception in everyday life
7 [25,53], anxiety [54], and depression [55] lead to elevated arousal before falling asleep and
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8 give way to a vicious circle [56,57].
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9
10 4.2. Practical implications
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11 Later school start time had a positive effect on sleep length in a comparison of US and
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12 Australian adolescents [58]. Moreover, a 45-minute delay of class start times improved
13 tardiness, disciplinary issues, and sleep length half a year later, but not academic performance
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14 [59]. As sleep timing is more important than sleep length and quality for academic
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15 performance [60], and as morningness–eveningness has a biological underpinning, a later

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16 school start time would be beneficial for adolescent health and might lead to better academic
17 performance; however, but this is a hypothesis that still needs to be investigated further.
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18 Inappropriate sleep environment showed the highest correlations with problems in
19 going to bed. This issue could be mitigated to some extent if parents removed electronic
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20 devices from the adolescents’ bedroom and gave them the opportunity to sleep in an aired and
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21 dark room. However, this may be unrealistic, because adolescent development implies
22 increased autonomy with less interference from parents. Physiological problems could be
23 addressed by regular family dinner times not past 19:00, along with abstinence from later food
24 intake and no use of substances. Furthermore, parents could solve psychological problems
25 that hinder adolescents’ sleep onset by taking the time to talk with their children about their
26 day and encourage them to face the next day’s events. As adolescents report extreme
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1 difficulties in returning to wakefulness, adequate sleep hygiene behavior in the hour before
2 going to bed and an adequate sleep environment are the most important steps to promote early
3 bedtimes and to cushion adolescents’ drift to eveningness. Also, a program on sleep education
4 could promote healthy sleep beliefs [47]. Behavioral change, however, is very difficult to
5 achieve, especially because late sleep onset is caused by a daily endogenous rhythm of
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6 hormones [61].
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1 Conflict of interest
2 The authors have no conflicts of interest in regard to this work.
4 Acknowledgements
5 This study was supported by grants from the University of Education Heidelberg. The
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6 work of the second author was supported by a grant 2011/03/D/HS6/05760 from the National
7 Science Centre in Poland. The work was carried out at the University of Education
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8 Heidelberg. We would like to thank all principals, teachers, and parents who supported the
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9 study, and especially all students who participated; Farina Pötsch for visiting participating
10 schools; and Caroline Buhmann, Farina Pötsch, and Lena Saliger for feeding the computer.
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Table 1
Descriptive characteristics of the sample.
Covariates on the student level n Mean SD Range ICC

Morningness–eveningness 3007 33.99 7.13 13–55
Age 3014 13.76 1.80 9.7–19.6
Sex 3035
Male 1576
Female 1459
Screen media use 2937 2.67 1.17 0–5
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Time leaving home 2951 07:11 23 min 05:40–08:05
Covariates on the class level
School type 3040
Special needs (Förderschule) 114
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Lower track (Hauptschule) 723
Intermediate track (Realschule) 1263
Upper track (Gymnasium) 940
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Grade level 3040
N, fifth: 451, sixth: 498, seventh: 558, eighth: 589, ninth: 494,
tenth: 450
School start time 3040 07:47 12 min 07:30–8:10
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Sleep variables
MSFsc 2962 04:22 1 h 28 min 01:07–10:17 0.22
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Social jetlag 2962 2 h 42 min 1 h 14 min 0 h 0 min–8 h 37 min 0.16
Time in bed on schooldays 3005 8 h 35 min 1 h 10 min 2h 0 min - 12 h 0 min 0.35
0 h 0 min–14 h 45
Time in bed on weekends 2974 9 h 55 min 1 h 37 min 0.04
min
ASWS
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Problems in going to bed 2885 2.50 0.72 1–5 0.05

Problems in falling asleep 2885 2.35 0.74 1–5 0.03
Problems in maintaining sleep 2709 2.26 0.79 1–5 0.03
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Problems in re-initiating sleep 2874 1.92 0.70 1–5 0.03

Problems in returning to
2880 2.97 0.96 1–5 0.06
wakefulness
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ASHS
Physiological problems 2923 2.28 0.62 1–5 0.12
Cognitive problems 3028 2.96 0.83 1–5 0.09
Emotional problems 2907 2.23 0.87 1–5 0.05
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Problematic sleep environment 3026 1.86 0.77 1–5 0.11

Substances 2898 1.35 0.76 1–5 0.24
ASHS, Adolescent Sleep Hygiene Scale (1 = never to 5 = always); ASWS, Adolescent Sleep−Wake Scale (1 =
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never to 5 = always); ICC, intraclass correlation (with larger values indicating greater differences between
classes); MSFsc,
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Table 2
Correlations.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Morningness–eveningness
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– **
2 Age
.31 *
– ** **
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3 Screen media use .25
.36 * *
– ** **
4 Time leaving home .02 .07
.14 * *
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Sleep variables
– ** ** ** **
5 MSFsc .39 .38 .17
.53 * * * *
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– ** ** ** – **
6 Social jetlag .33 .30 ** .86
.53 * * * .06 *
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** – ** – ** ** – ** – **
7 Time in bed on schooldays .39 .13
* .57 * .33 * * .46 * .39 *
– – ** – ** – ** – **
8 Time in bed on weekends * .02 .30
.05 .17 * .17 * .42 * .02 *
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Adolescent Sleep−Wake Scale
– ** ** ** ** ** – ** – **
9 Problems in going to bed .13 .30 .05 ** .32 .28
.57 * * * * * .28 * .11 *
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1 – ** ** ** ** – ** – **
.8 **
Problems in falling asleep .06 ** .19 .04 * .21 .17
0 .40 * * * * .20 * .11 8* *
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1 – ** ** ** ** ** – ** – **
.5 ** .7 **
Problems in maintaining sleep .08 .09 .03 .16 .12
1 .28 * * * * * .14 * .10 8* * 7 *
1 – ** – – – .5 ** .7 ** .6 **
Problems in re-initiating sleep ** .06 ** .05 ** .05 * .02 † **
2 .19 * .05 .03 .06 2 * 4 * 4 *
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1 Problems in returning to – ** ** ** ** ** – ** ** .6 ** .5 ** .3 ** .3 **
.19 .22 .05 ** .27 .30 .08
3 wakefulness .73 * * * * * .21 * * 8 * 3 * 9 * 3 *
Adolescent Sleep Hygiene Scale
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1 – ** ** ** ** ** – ** – ** .5 ** .5 ** .4 ** .3 ** .3 **
Physiological problems .31 .33 .05 ** .40 .34
4 .40 * * * * * .39 * .18 * 1 * 1 * 6 * 8 * 8 *
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1 – ** ** ** ** ** – ** – ** .5 ** .5 ** .4 ** .3 ** .3 ** .8 **
Cognitive problems .28 .29 .01 .33 .29
5 .37 * * * * * .35 * .14 * 2 * 1 * 6 * 5 * 8 * 3 *
1 – ** ** ** ** ** – ** – ** .4 ** .5 ** .4 ** .4 ** .3 ** .8 ** .8 **
Emotional problems .22 .16 .02 .20 .18
6 .30 * * * * * .24 * .08 * 5 * 0 * 7 * 1 * 7 * 1 * 1 *
1 – ** ** ** ** ** – ** – ** .4 ** .4 ** .3 ** .3 ** .3 ** .8 ** .7 ** .5 **
Problematic sleep environment .25 .36 .06 ** .40 .33
7 .35 * * * * * .36 * .20 * 6 * 4 * 9 * 2 * 1 * 8 * 2 * 9 *
1 – ** ** ** ** ** – ** – ** .3 ** .3 ** .2 ** .2 ** .3 ** .7 ** .5 ** .5 ** .6 **
Substances .48 .31 .02 .48 .42
8 .39 * * * * * .46 * .22 * 5 * 2 * 9 * 0 * 0 * 6 * 4 * 0 * 8 *
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Pearson’s correlation coefficient was used. MSFsc, .

† p < .10. * p < .05, ** p < .01, *** p < .001.
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Table 3
Effects on sleep time and sleep length.

Time in bed Time in bed
MSFsc Social jetlag
on schooldays on weekends
β (SE) p β (SE) p β (SE) p β (SE) p
Within classes
Morningness–eveningness –0.40 (0.02) *** –0.48 (0.02) *** 0.21 (0.02) *** –0.16 (0.02) ***
Age 0.39 (0.05) *** 0.35 (0.05) *** –0.38 (0.04) *** –0.20 (0.06) **
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Sex (female) –0.12 (0.03) *** 0.06 (0.03) † –0.11 (0.03) *** 0.22 (0.04) ***
Screen media use 0.13 (0.02) *** 0.07 (0.02) *** –0.15 (0.02) *** –0.15 (0.02) ***
Time leaving home 0.05 (0.02) * –0.18 (0.02) *** 0.23 (0.02) *** 0.03 (0.02)
Between classes
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Special needs 0.44 (0.09) *** 0.49 (0.09) *** –0.18 (0.11) † 0.11 (0.13)
Lower track 0.36 (0.05) *** 0.33 (0.06) *** –0.10 (0.05) † –0.09 (0.06)
Intermediate track 0.14 (0.04) ** 0.12 (0.05) ** –0.08 (0.04) * –0.06 (0.05)
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Grade level –0.10 (0.03) ** –0.12 (0.03) *** –0.07 (0.03) * 0.01 (0.04)
School start time 0.02 (0.02) 0.01 (0.03) –0.06 (0.02) ** –0.03 (0.03)
Effect size R2 R2 R2 R2
Within classes 0.26 0.28 0.17 0.06
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Between classes 0.94 0.83 0.95 0.61
Sniders and Bosker 0.42 0.37 0.44 0.11
N 2761 2761 2794 2769
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Note: Multilevel regression analysis calculated in Mplus 7. All continuous variables were z standardized beforehand
(morningness–eveningness with higher values indicating morningness, age, screen media use with higher values indicating
more screen time, time leaving home, and school start time are clock times. Grade levels are from fifth grade to tenth grade
of secondary school. Dummy variables (coded 0, 1) are sex, special needs, lower track, and intermediate track. The reference
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group among the school types is the upper track (gymnasium). β are standardized regression coefficients. MSFsc,; SE,
standard error; Snijders and Bosker: explained variance (R2) following Snijders and Bosker [62].
† p < .10. * p < .05, ** p < .01, *** p < .001.
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Table 4
Effects on Sleep Quality (ASWS).

Problems
Problems in Problems in Problems in Problems in
in returning
going to bed falling asleep maintaining sleep Re-initiating sleep
to wakefulness
β (SE) p β (SE) p β (SE) p β (SE) p β (SE) p
Within classes
Morningness–eveningness –0.55 (0.02) *** –0.41 (0.02) *** –0.27 (0.02) *** –0.22 (0.02) *** –0.76 (0.02) ***
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Age –0.03 (0.05) 0.02 (0.05) 0.05 (0.05) –0.02 (0.05) –0.10 (0.04) *
Sex (female) 0.09 (0.03) ** 0.21 (0.04) *** 0.31 (0.04) *** 0.27 (0.04) *** 0.14 (0.03) ***
Screen media use 0.13 (0.02) *** 0.07 (0.02) *** 0.02 (0.02) 0.02 (0.02) –0.02 (0.02)
Time leaving home –0.03 (0.02) –0.01 (0.03) –0.03 (0.03) 0.01 (0.03) –0.02 (0.02)
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Between classes
Special needs 0.07 (0.13) –0.03 (0.10) –0.05 (0.09) –0.15 (0.10) –0.06 (0.12)
Lower track –0.04 (0.06) –0.10 (0.06) † –0.08 (0.06) –0.13 (0.06) * –0.07 (0.04)
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Intermediate track –0.03 (0.04) –0.05 (0.04) –0.03 (0.05) –0.06 (0.05) –0.06 (0.04) †
Grade level –0.03 (0.03) –0.07 (0.03) † –0.04 (0.03) –0.07 (0.03) * 0.03 (0.03)
School start time –0.01 (0.03) 0.00 (0.03) 0.04 (0.03) 0.03 (0.03) –0.04 (0.02) †
Effect size R2 R2 R2 R2 R2
Within classes 0.32 0.18 0.09 0.06 0.53
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Between classes 0.73 0.50 0.36 0.35 0.85
Sniders and Bosker 0.35 0.19 0.10 0.08 0.56
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N 2809 2809 2809 2809 2809
Note: See footnote to Table 2. ASWS, Adolescent Sleep Wake Scale; SE, standard error.
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Table 5
Effects on Sleep Hygiene (ASHS).

Physiological Cognitive Emotional Problematic sleep
Substances
problems Problems Problems environment
β (SE) p β (SE) p β (SE) p β (SE) p β (SE) p
Within classes
Morningness–eveningness –0.26 (0.02) *** –0.26 (0.02) *** –0.23 (0.02) *** –0.21 (0.02) *** –0.22 (0.02) ***
Age 0.23 (0.05) *** 0.12 (0.05) ** 0.14 (0.05) ** 0.20 (0.06) *** 0.40 (0.05) ***
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Sex (female) 0.20 (0.04) *** 0.29 (0.03) *** 0.37 (0.04) *** 0.13 (0.04) *** 0.05 (0.04)
Screen media use 0.18 (0.02) *** 0.18 (0.02) *** 0.07 (0.02) *** 0.23 (0.02) *** 0.12 (0.02) ***
Time leaving home –0.05 (0.02) * –0.07 (0.02) ** –0.03 (0.02) –0.07 (0.02) ** –0.07 (0.02) **
Between classes
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Special needs 0.26 (0.08) ** 0.23 (0.12) † –0.02 (0.10) 0.39 (0.08) *** 0.08 (0.09)
Lower track 0.21 (0.05) *** –0.02 (0.05) –0.06 (0.06) 0.37 (0.05) *** 0.22 (0.05) ***
Intermediate track 0.08 (0.04) * –0.06 (0.04) –0.09 (0.05) † 0.15 (0.04) *** 0.13 (0.05) **
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Grade level –0.02 (0.03) 0.02 (0.03) 0.00 (0.03) –0.05 (0.03) –0.01 (0.03)
School start time 0.03 (0.02) 0.01 (0.02) 0.01 (0.03) 0.06 (0.02) ** 0.04 (0.03)
Effect size R2 R2 R2 R2 R2
Within classes 0.14 0.14 0.09 0.13 0.12
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Between classes 0.98 0.90 0.81 0.98 0.94
Sniders and Bosker 0.25 0.22 0.14 0.24 0.32
N 2809 2809 2809 2809 2809
AN
Note: See footnote to Table 2. ASHS = Adolescent Sleep Hygiene Scale; SE, standard error.
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Fig. 1. Distribution of morningness–eveningness scores. CSM, Composite Scale of Morningness.
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Fig. 2. Differences in sleep time, sleep length, sleep quality, and sleep hygiene by school type.
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Note: Four school types are shown: special needs, lower, intermediate, and higher track, which refer to the cognitive abilities of the pupils. The words above and below the respective scales illustrate
the coding of the scales (eg, in MSFsc, it refers to late MSFsc and early MSFsc). Error bars are 95% confidence intervals. MSFsc,
Significant differences (* p < .05, ** p < .01, *** p < .001) were tested via multilevel analyses while controlling for all covariates (see Tables 3─5).
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Highlights
• Multilevel analyses of morningness−eveningness and sleep-related habits of students

from secondary education were conducted.
• Morningness was a significant predictor of sleep time, quality, and hygiene.
• School type explained variance in sleep time and hygiene, but not sleep quality.
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Accepted Manuscript: 10.1016/j.sleep.2016.09.022

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Morningness−eveningness correlates with sleep time, quality, and hygiene in

Christian Vollmer, Konrad S. Jankowski, Juan F. Díaz-Morales, Heike Itzek-Greulich,

To appear in: Sleep Medicine

Received Date: 1 July 2016

2 school students: A multilevel analysis

5 Peter Wüst-Ackermann e, Christoph Randler d,e

18 Received in revised form

4 School start time

7 self-report questionnaire containing measures of morningness–eveningness, sleep time

14 start time). Morningness–eveningness was a significant predictor of all dependent variables

19 circadian rhythms to daily educational and social demands.

2 1.1. Sleep problems in adolescence

17 1.2. Predictors of sleep problems in adolescence

19 Morningness–eveningness, circadian preference, or chronotype is an individual’s preference

25 arises in this developmental stage.

17 1.2.4. School type

22 1.3. Present study

24 limiting their ability to detect or overestimating effects of morningness–eveningness on sleep-

2 differential effects of morningness–eveningness on several sleep-related variables in

4 levels and school types with diverging school start times.

5 Although most previous studies have indicated negative effects of morningness–

16 intermediate track, and upper track) was operationalized.

21 variables also contribute to the variance in the sleep-related outcome variables.

26 schools of secondary education in three adjacent German administrative districts (Heidelberg,

3 completed the self-administered questionnaire in normal classroom settings in the presence of

5 (Regierungspräsidium Karlsruhe), school principals, parents, and students. Written consent

7 principles and standards of human research proclaimed by the University of Education

10 2.2. Measurement instruments

2 2.2.2. Electronic screen media use

10 2.2.3. Sleep time and sleep length

19 considered as the absolute difference between mid-sleep on schooldays and mid-sleep on

22 2.2.4. Sleep quality

26 the students in the special needs track.

2 2.2.5. Sleep hygiene

4 onset in five subscales (physiological problems, cognitive problems, emotional problems,

15 After the investigation of descriptive statistics and bivariate correlations in SPSS 22

23 lesson) were used as predictors at the class level.

25 2.4. Missing data

19 the cognitive subscale (mean = 2.96).

20 Concerning the predictors, morningness–eveningness did not differ by sex (boys,

24 positively correlated with time leaving home (Table 2).

7 positively correlated with each other (r = 0.20−0.88) (Table 2).

13 3.2. Effects of morningness−eveningness on sleep time and sleep length

18 pronounced for sleep time than for time in bed.

26 3.3. Effects of morningness−eveningness on sleep quality

4 quality. There was a highly negative association between morningness–eveningness and

5 problems in returning to wakefulness. The associations of eveningness with problems in going

10 3.4. Effects of morningness−eveningness on sleep hygiene

14 ASHS). The standardized coefficients were equally low (−0.21 to −0.26).

17 achievement are still unclear.

18 Morningness–eveningness is less valuable in predicting problems of sleep hygiene and

19 sleep quality. The lesser interrelation of morningness–eveningness with aspects of sleep

23 increasing drift to eveningness. Morningness–eveningness was a strong predictor of problems

3 correlation of morningness–eveningness and problems in returning to wakefulness may partly

7 being more suitable to measure morningness–eveningness [28], and researchers have

10 The consistently significant correlations of morningness–eveningness and sleep

19 eveningness experience more sleep problems.

20 Regarding age differences, results corroborate previous study findings. As adolescents

26 loss on schooldays, and returning to wakefulness becomes constantly more challenging,

3 afternoon, which perpetuates their late bedtimes.

17 4.1. Study limitations

10 parental and selfrelated problems and morningness–eveningness in adolescents. Stress