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Early to Bed, Early to Rise?: An Exploration of Adolescent Sleep Hygiene Practices

Susan Kohl Malone
The Journal of School Nursing 2011 27: 348 originally published online 23 May 2011
DOI: 10.1177/1059840511410434

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Integrative Review

The Journal of School Nursing

27(5) 348-354
Early to Bed, Early to Rise?: ª The Author(s) 2011
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DOI: 10.1177/1059840511410434
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Sleep Hygiene Practices

Susan Kohl Malone, MSN, RN NCSN1

Cognition, memory, safety, mental health, and weight are all affected by inadequate sleep. Biological studies indicate significant
changes in sleep architecture during adolescence, such as changes in melatonin secretion, and a need for greater total sleep
time. Yet, social contexts and cultural values impinge on these changing biological sleep needs making adolescents vulnerable
to the dangers of insufficient sleep. Sleep hygiene practices are purported as potential mediating factors between biological
sleep needs and the sociocultural context of sleep. The purpose of this literature review is to highlight biological and social
factors contributing to insufficient sleep in adolescents, to explore the evidence of several recommended sleep hygiene
practices, and to stimulate further research about how adolescents negotiate their shifting biological sleep needs amid
increasing social demands.

Keywords
health/wellness, screening/risk identification, high school, integrative reviews

Introduction patterns contributing to insufficient sleep and restricted

Adolescent sleep hygiene has received scant attention from
the existing literature, despite the prevalence and persistence
of insufficient sleep (less than 8 hr/night) and restricted
sleep (less than or equal to 6 hr/night) during this develop-
mental period (National Sleep Foundation, 2006; Noland,
Price, Dake, & Telljohann, 2009; Roberts, Roberts, & Xing,
2011). Reasons for this dearth of literature include slowly
changing perceptions of adolescent sleep needs (Stearns,
Rowland, & Giarnelli, 1996), and society’s normalization
of adolescent sleepiness (Carskadon, 1990; Spruyt, O’Brien,
Cluydts, Verleye, & Ferri, 2005). This nonchalance, how-
ever, belies the impact of insufficient and restricted sleep
on significant public health issues. For example, insufficient
sleep contributes to many leading causes of death for 15- to
24-year-olds, such as, motor vehicle crashes (Center for
Disease Control and Prevention [CDC], 2010; Pizza et al.,
2010) and suicide (CDC, 2010; Choquet & Kovess, 1993;
Liu, 2004). Insufficient sleep is associated with overweight
and obesity, an ongoing national epidemic in youth (Chaput,
Brunet, & Tremblay, 2006; Ogden, Carroll, Curtin, Lamb, &
Flegal, 2010). And finally, insufficient sleep impairs working
memory and the ability for abstract, complex tasks (Kopasz
et al., 2010), contributing to poor academic performance
(Wolfson & Carskadon, 2003). In essence, the associations
between insufficient and/or restricted sleep and significant
public health concerns indicate that this is not a benign phe-
nomenon that should be readily accepted as normal. This
review of the literature highlights biological and social
sleep in adolescents; explores the evidence of several
recommended sleep hygiene practices; and stimulates
further research about how adolescents negotiate their shifting
biological sleep needs amid increasing social demands.
Method
The search questions that guided this review were as
follows: What biological and social factors contribute to
insufficient sleep/restricted sleep during adolescence?
What sleep hygiene practices recommended for adoles-
cents promote healthy sleep habits (9 hr of sleep/night)?
A systematic search of the literature was performed
primarily using CINAHL and PubMed databases. The
search terms used included: adolescence; sleep hygiene;
sleep habits; insufficient sleep; restricted sleep; sleep
duration; sleep debt and sleep deprivation in varying
combinations. Subsequently, the ancestry method of
review using reference lists of articles identified initially
was performed. Limits for peer reviewed and research
articles were placed.
1
School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
Corresponding Author:
Susan Kohl Malone, School of Nursing, University of Pennsylvania,
Philadelphia, PA, USA
Email: malones@nursing.upenn.edu

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Malone
Results
Biological and Sociocultural Factors
The seminal work of Carskadon, Wolfson, Acebo,
Tzischinsky, and Seifer (1980) provided physiological
evidence of changing sleep needs and sleep architecture in
older adolescents (Tanner stages 3 – 5). This evidence has
been corroborated by several studies in subsequent decades
(Jenni, van Reen, & Carskadon, 2005; Taylor, Jenni, Acebo,
& Carskadon, 2005; Walderhauser & Steger, 1986) and has
led to a general consensus that adolescents need 9 hr of sleep
per night (National Sleep Foundation, 2006). Yet, adoles-
cents are biologically wired to fall asleep later than in
childhood and numerous sociocultural factors leave adoles-
cents vulnerable to insufficient sleep and restricted sleep.
Two salient biological reasons for delayed sleep onset
during adolescence are the delay in melatonin secretion and
increased sleep latency. Melatonin, the sleep-inducing
hormone, is secreted about 1 hr before sleep onset. During
Tanner stage 1, melatonin secretion occurs 1 hr earlier
(i.e., approximately 8:30 p.m.) than during Tanner stage
5 (i.e., approximately 9:30 p.m.; Taylor et al., 2005). Addi-
tionally, older adolescents take longer to fall asleep
(increased sleep latency) even after periods of extended
wakefulness (Jenni et al., 2005; Taylor et al., 2005). These
two biological facts contribute to the later bedtimes for
adolescents typically observed as progressing from
9:30 p.m. in 6th-grade students to 11 p.m. in 12th-grade stu-
dents (National Sleep Foundation, 2006).
Despite these changes, total sleep time needs do not
change as adolescents journey toward adulthood, but getting
9 hr of sleep per night becomes an increasing challenge. In
fact, the trend for insufficient sleep during adolescence has
accelerated over the past century. In 1913, Terman and
Hocking reported that the majority of 15-year-olds obtained
9–10 hr of sleep/night. In 2009, Noland et al. found that
91.9% of adolescents surveyed (N ¼ 384) obtained less than
9 hr with 10% getting as little as 6 hr of sleep on most school
nights. And in 2011, Roberts et al. reported that restricted
sleep in 11- to 17-year-olds has a prevalence rate of 20%,
an incidence rate of 17%, and a persistence rate of 54%
(Wave 1—prevalence: N ¼ 4,175; Wave 2—incidence:
N ¼ 3,134; Wave 1–Wave 2—persistence: N ¼ 3,134).
These studies underscore the reality that more and more
adolescents are suffering from insufficient sleep, as the
decades unfold.
Sociocultural factors are identified as significant forces
contributing to the worsening sleep status of our youth
(Carskadon, 1990; Carskadon, Wolfson, Acebo, Tzischinsky,
& Seifer, 1998; LeBourgeois, Giannotti, Cortesi, Wolfson, &
Harsh, 2005). Early high school start times, changing
academic demands, expanding social opportunities, and
decreasing parental influence are a few of these factors.
The landmark study of Carskadon et al. (1980) prompted
a flurry of studies that compared delayed high school start
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349
times to outcomes such as improved attendance, fewer trips
to the school nurse, fewer peer relationship problems, longer
sleep duration on school nights (Center for Applied
Research & Educational Improvement, 2001), and fewer
automobile crashes for 16- to 18-year-olds (Danner &
Phillips, 2008). Indeed, a 30-min delay in high school start
times reduces the percentage of students getting less than
7 hr of sleep per night and improves measure of alertness,
mood, and health (Owens, Belon, & Moss, 2010). In
response to the mounting evidence of the benefits of delayed
high school start times for adolescent health, the CDC is
considering recommending later high school start times to
school administrators (Wahlstrom, 2009).
Changing academic demands during the high school years
increase the vulnerability for insufficient sleep for many
students. Jin and Shi (2008) compared sleep duration between
students enrolled in advanced placement (AP)/college
courses (N ¼ 352) and students not enrolled in AP/college
courses (N ¼ 1,708). Their results revealed that students
enrolled in AP/college courses slept 40 min to 1 hr less than
students not enrolled in AP/college courses. Furthermore,
only 2.9% of students enrolled in two or more AP/college
courses reported 9 hr of sleep per night. Therefore, AP/college
course loads increase adolescent vulnerability to insufficient
and restricted sleep.
It is often thought that expanding social opportunities
further impinge on adolescent sleep time. Expanding tech-
nology use in the last decade has enhanced the ability to stay
connected 24/7. Ultimately, these social opportunities for
adolescents translate into insufficient sleep and daytime
sleepiness.
Finally, adolescence is characterized as a ‘‘transition
from parent-managed health care to personal responsibility
for health behavior’’ (Srof & Velsor-Friedrich, 2006,
p. 366), yet little is known about how adolescents negotiate
their shifting biological sleep needs amid these sociocultural
factors. Parent/guardian involvement frequently shifts from
enforcing bedtime in the evening to waking up sleepy teens
on school day mornings. However, LeBourgeois et al.
(2005) propose that extended parental involvement in
adolescent sleep regimes contributes to better sleep quality
in Italian adolescents compared to American adolescents.
In sum, the convergence of these issues—social apathy
toward adolescent sleepiness, biological changes in sleep
architecture, increasing social demands during adolescence,
and the challenges of increased independence for health
behaviors—leaves adolescents particularly vulnerable to
insufficient sleep/restricted sleep. Policy changes for high
school start times provide compelling evidence for improv-
ing adolescent sleep and the consequences of insufficient
sleep on health, but policy change is a slow process. Thus,
sleep hygiene practices are purported as mediating factors
between biological sleep needs and the sociocultural context
of sleep (LeBourgeois et al., 2005). However, evidence for
their effectiveness is scant and inconsistent. In addition,
350
their applicability to adolescents, and their appropriateness
for various cultural groups (Jenni & O’Connor, 2005), raises
concern.
Sleep Hygiene Practices
Sleep hygiene has been defined as ‘‘those practices of daily
living that promote good sleep and daytime functioning’’
(Spielman & Glovinsky, 1993, p. 550). Thus, the goal of
sleep hygiene practice recommendations is to improve sleep.
However, the evidence for many of these recommendations
is scant, in part, because sleep hygiene describes ‘‘a diverse
set of rules, rather than a uniform treatment approach as use
of a common term would imply’’ (Stepanski & Wyatt, 2003,
p. 223). As such, the evidence for several commonly recom-
mended practices are considered independently. These
include avoiding daytime napping; establishing regular
sleep/wake times; avoiding bedtime technology use; and
avoiding late afternoon/evening physical, cognitive, and
social stimulation. School nurses are encouraged to consider
the evidence supporting these recommendations prior to
recommending them to students and their families as well
as to consider potential research questions for further inves-
tigation of adolescent sleep habits.
Daytime napping. Avoiding daytime naps is a common
sleep hygiene recommendation (LeBourgeois et al., 2005;
Noland et al., 2009; Stepanski & Wyatt, 2003), however,
to date, no studies on the effects of daytime napping on
nocturnal sleep in adolescents were found. The return of nap
tendencies in the mid-teen years is supported by robust
evidence that human sleep is biphasic as opposed to mono-
phasic (Worthman & Melby, 2002) and by the seminal work
of Carskadon et al. (1980) indicating a consistent early
afternoon/mid-afternoon increase in sleepiness emerging at
Tanner stage 2 and persisting throughout Tanner stage 5 and
into adulthood. This mid-afternoon dip in wakefulness
reflects the 12-hr biphasic rhythm of slow wave sleep
(Dinges & Broughton, 1989; Hayashi, Morikawa & Hori,
2002). Indeed, daytime naps, lasting greater than 1 hr for
young adults with irregular sleep/wake patterns and sleep
debt, does not affect sleep onset or the quality nighttime
sleep (Vela-Bueno et al., 2008). Hence, evidence supporting
the recommendation to avoid daytime naps is lacking.
Furthermore, the presence of daytime napping has varied
across time and between cultures. Extensive data regarding
the sleep habits (including daytime napping) of 1,700
cultures from around the world at various historical times
exist as part of the Cross Cultural Survey of the Human
Relations Area File (Webb & Dinges, 1989). A few contem-
porary studies report that daytime napping is quite prevalent
in older African American children (Crosby, LeBourgeois, &
Harsh, 2005), Chinese adolescents (Liu, Liu, Owens, &
Kaplan, 2005), and young adults in Spain (Vela-Bueno
et al., 2008). Interestingly, in cultures where napping is
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The Journal of School Nursing 27(5)
accepted, the timing of daytime naps is consistently reported
during early to mid-afternoon. As a result of the evidence sup-
porting a biological tendency for mid-afternoon naps and cul-
tural differences regarding the acceptability of naps,
recommending the avoidance of daytime naps to students is
of questionable value. More research is needed about the
effect of including or excluding daytime naps on adolescent
sleep and overall well-being.
Establishing regular sleep/wake times. Establishing regular
bedtimes (LeBourgeois et al., 2005; Noland et al., 2009;
Spielman & Glovinsky, 1993) is another commonly recom-
mended sleep hygiene practice. However, a hallmark of
adolescent sleep patterns is irregularity—early awakenings
on school mornings and sleeping in on weekends. Dahl and
Lewin (2002) contend that this irregularity is problematic
because the adolescent circadian timing system is slow to
change. Several days may be needed to shift the timing
system back to an earlier sleep wake cycle after one week-
end of late nights. Still others report that an irregular sleep
wake pattern is a risk factor for short sleep duration
(Li et al., 2010; Manni et al., 1997) and daytime sleepiness
(Wolfson & Carskadon, 2003)
On the contrary, weekend sleep compensation (defined as
less than 8 hr of sleep during the school week, followed by
greater than 8 hr of sleep on the weekend) reduces the like-
lihood of overweight/obese in high school students (Wing,
Li, Li, Zhang, & Kong, 2009). And with melatonin elevation
onset beginning at 9:30 or 10 p.m. (Taylor et al., 2005) an
earlier bedtime of 9 p.m. to accommodate early school start
times and 9 hr of sleep may be biologically challenging. In
sum, evidence supporting the practice of establishing regular
sleep patterns for adolescent health is inconsistent and the
potential to establish regularity is challenged by delayed
melatonin secretion.
Avoiding bedtime technology use. Limiting technology use
before bedtime is also recommended. Nonetheless, use of
cell phones, listening to electronic music devices, surfing the
internet, watching television and playing video games
almost every night before bed are common (National Sleep
Foundation, 2011). Distinguishing what types of technology
use may help sleep and what types of technology may hinder
sleep is important.
Evidence supports limiting the use of technology that
emits light just prior to sleep because of the significant role
that light plays in setting the circadian rhythm. This process
begins when the retina detects light and sends a message
through the suprachiasmatic nuclei to the pineal gland to
inhibit melatonin secretion. Brainard, Rollag, and Hanifin
(1997) demonstrated that even low levels of illumination
(similar to twilight) are capable of significantly reducing
melatonin levels. Empirical studies support this association
and television viewing is associated with delayed sleep onset
in school-age children (Li et al., 2007; Smaldone, Honig, &
Malone
Byrne, 2007). Ironically, many adolescents watch television
as a way to promote sleep (Noland et al., 2009).
Cell phone use, particularly texting, and electronic music
devices exceed all other forms of technology use by 13- to
17-year-olds just prior to bedtime (National Sleep Founda-
tion, 2011). Van den Bulck’s (2007) startling findings on
cell phone use after bedtime report that 51% of teens send
or receive calls after bedtime. Of this 51%, 20.3% used their
cell phone for text messages and 17.3% used their cell
phones for calls between 12 a.m. and 3 a.m. Adolescents
who used their cell phones in this manner once a month or
more were more likely to be tired during the day than those
who did not.
On the contrary, listening to 45 min of classical music at
bedtime effectively reduced sleep problems in young adults
(Harmat, Takacs, & Bodizs, 2008). Studies on the use of
music to enhance sleep in adolescents were not found. Given
that 64% of 13- to 17-year-olds report listening to music 1 hr
prior to bedtime (National Sleep Foundation, 2011), further
investigation on music and sleep in adolescents is warranted.
In summary, the sleep hygiene practice recommendation to
avoid technology use before bedtime is at odds with the life-
style of the vast majority of adolescents. Additionally, this rec-
ommendation needs to distinguish between technologies that
do interfere with sleep from those that enhance sleep.
Avoiding late afternoon/evening physical, cognitive, and social
stimulation. Avoiding late afternoon/evening exercise and
cognitively or emotionally stimulating activities prior to
bedtime (LeBourgeois et al., 2005; Li et al., 2010; Stepanski
& Wyatt, 2003) may pose particular challenges for adoles-
cents who may be negotiating athletic practices, athletic
games, academic demands, and social interaction. A meta-
analysis of the effects of exercise on sleep does not support
the proposition that late afternoon or evening exercise
impairs sleep (Youngstedt, O’Connor, & Dishman, 1997).
Yet, Li et al. (2010) found that excitement before bedtime
was one of many risk factors associated with shorter sleep
duration. Recent research suggests that extraverts are more
vulnerable to sleep insufficiency after socially stimulating
experiences (Rupp, Killgore, & Balkin, 2010). Therefore,
vulnerability for insufficient sleep based on waking soci-
alizing opportunities may depend on individual characteris-
tics (i.e., introversion/extraversion). This urges future
researchers to consider introverted and extroverted personal-
ities as a potential mediating factor.
Discussion
Physiological evidence behind late bedtimes during adoles-
cence continues to build. Increasing awareness of early high
school start times on adolescent health is spreading. Sleep
hygiene practice recommendations thought to promote
sleep, such as avoiding daytime naps, establishing regular
sleep/wake times, and avoiding late afternoon/evening
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351
stimulating activities, are of questionable value in promoting
adolescent sleep. Distinguishing between the various forms
of technology used prior to bedtime should be considered. The
potential use of music to promote sleep is intriguing. However,
our understanding of these sleep hygiene practice is limited by
the dearth of research on adolescent sleep habits.
In summary, while the intuitive appeal of sleep hygiene
may be strong, evidence for the applicability of these prac-
tices for adolescents is questionable (LeBourgeois et al.,
2005; Moseley & Gradisir, 2009). Strategies that work for
one cultural group may be inappropriate for others. In fact,
acculturated Latino adolescents have been found less likely
to engage in health promoting strategies (including sleeping
9 hr) than their less acculturated peers (Ebin et al., 2001).
Similarly, strategies that may work for adults cannot simply
be assumed to be strategies that will work for adolescents.
Indeed, even adolescents desiring more sleep stated that they
would be unwilling to incorporate some sleep hygiene prac-
tice recommendations (Moseley & Gradisir, 2009). Thus,
understanding sleep hygiene from the broader sociocultural
perspective and from the adolescent perspective is critical if
developmentally and culturally appropriate recommenda-
tions for enhancing sleep are to be realized.
This literature review highlighted four common sleep
hygiene recommendations including avoiding daytime
napping; establishing regular sleep/wake times; avoiding
bedtime technology use; and avoiding late afternoon/
evening physical, cognitive, and social stimulation. See
Table 1 for a summary of the findings.
Implications for School Nursing Practice
The public often seeks the expertise of health care profes-
sionals for advice on many aspects of child rearing, includ-
ing sleep. Policy makers solicit input on evidence for
delaying high school start times to better meet the needs
of adolescents. Conceptually, nursing has long recognized
the significance of maintaining a balance between rest
and activity for optimal functioning (Orem, 1980). Yet,
adolescents are not typically screened for sleep problems
(Mindell & Owens, 2002) and sleep hygiene recommendations
are frequently guided by practitioner’s beliefs and values.
School nurses are uniquely poised to screen adolescents
for sleep disorders and insufficient/restricted sleep. While
many screening tools for pediatrics exist, the Sleep Disor-
ders Inventory for Students–Adolescent Form is designed
specifically for adolescents (Luginbuehl, Bradley-Klug,
Ferron, Andreson, & Benbadis, 2008) and has met the cri-
teria for rigorous tool development (Spruyt & Gozal,
2011). This tool screens adolescents for obstructive sleep
apnea, periodic limb movement disorder/restless leg syn-
drome, excessive daytime sleepiness, delayed sleep phase
syndrome, and narcolepsy. It is available from Child Uplift,
Inc. (http://www.sleepdisorderhelp.com) and is recommended
for use by school counselors and school nurses.
352 The Journal of School Nursing 27(5)

Table 1. Summary of Sleep Hygiene Practices With Supporting Evidence and Nonsupporting Evidence

Sleep Hygiene Practice Evidence Supporting this Practice Evidence not Supporting This Practice

Avoiding daytime naps
Establishing regular sleep/wake
times
Limiting technology use at bedtime Low levels of illumination significantly reduce
Avoiding late afternoon/evening
physical, cognitive, and social
stimulation.
No evidence exists for adolescence
Several days may be needed to shift the
timing system back to an earlier sleep wake
cycle after one weekend of late nights (Dahl &
Lewin, 2002)
An irregular sleep wake pattern is a risk factor
for short sleep duration and daytime sleepiness
(Li et al., 2010; Manni et al., 1997; Wolfson &
Carskadon, 1998)
melatonin levels (Brainard et al., 1997)
Television viewing is associated with delayed
sleep onset in school-age children (Li et al.,
2007; Smaldone et al., 2007)
Cell phone use for text messages and calls
between 12 a.m. and 3 a.m. once a month or
more increases daytime sleepiness (Van den
Bulck, 2007)
Excitement before bedtime is associated with
shorter sleep duration (Li et al., 2010)
Afternoon naps reflect the biphasic
homeostatic pattern of human sleep that
emerges at Tanner stage 5 and persists
through adulthood (Carskadon et al., 1980;
Hayashi et al., 2002; Worthman &
Melby, 2002)
One hour naps for young adults with irregular
sleep/wake patterns and sleep debt does not
affect sleep onset or the quality nighttime
sleep (Vela-Bueno et al., 2008)
Differences exist between cultures regarding
acceptance of napping behavior (Crosby
et al., 2005; Liu et al., 2005; Vela-Bueno
et al., 2008)
Sleeping in on the weekend reduces the
likelihood of overweight/obese in high
school students (Wing et al., 2009)
Forty-five minutes of classical music at bedtime
effectively reduced sleep problems in young
adults (Harmat et al., 2008)
Late afternoon or evening exercise does not
impair sleep (Youngstedt et al., 1997)

School nurse researchers are well situated to gather rich,
descriptive data from adolescents about their sleep hygiene
practices and thereby contribute to this body of knowledge.
Descriptive information from adolescents will provide an
understanding of perceptions about adequate sleep and sleep
hygiene practices; their willingness to implement various
sleep hygiene practices; or information on other strategies
that may have been tried. Without understanding what sleep
hygiene practices mean to adolescents and what place sleep
has in their lives, interventions and recommendations may
yield little results.
School nurses may share recent findings about adolescent
sleep needs and patterns with parent groups. Enhanced
knowledge of adolescent sleep patterns may contribute to
improved parent–adolescent relationships. For example, one
common misunderstanding is delayed wake times on week-
ends for adolescents. Hansen, Janssen, Schiff, Zee, and
Dubocovich (2005) note, ‘‘Knowledge of the unusual week-
day/weekend sleep phenomenon among adolescents could
promote better family relationships if parents understood
that sleeping late on weekends is part of their children’s
inborn cycle and not lazy or antisocial behavior’’ (p. 1560).
Finally, many local school board policies such as standar-
dized testing times and high school start time fail to base their
policies on scientific evidence. Standardized testing often
occurs in the early morning hours—a time when adolescents
are least likely to perform well (Hansen et al., 2005) and
delayed high school start times continue to meet resistance
from numerous parties (Wahlstrom, 2010). School nurses can
play a critical role in informing policy makers on these issues.
Future Research
While empirical evidence on how various sleep hygiene
practices affect sleep biology is needed, these studies alone
will miss the dynamic interplay between biology and culture
that guides the sleep practices of individuals. Existing
quantitative evidence from large mailed and school-based
surveys have failed to elicit the voice of the adolescent
toward whom many sleep hygiene recommendations may

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Malone
be directed. Qualitative descriptive studies are needed to fill
the gaps in our understanding of adolescent sleep hygiene.
Thus, future studies directed toward describing adolescents’
understandings, perceptions, and implementation of sleep
hygiene practices and identifying factors that facilitate
adolescents’ adoption of healthy behaviors, such as adequate
sleep, are needed. Results of these studies may guide recom-
mendations for fitting adolescent sleep needs within a
broader sociocultural context and contribute to the theoreti-
cal basis for understanding the adoption of healthy sleep
habits by adolescents.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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Bio
Susan Kohl Malone, MSN, RN NCSN, is a PhD student at the
University of Pennsylvania School of Nursing. Susan works with
Dr. Terri Lipman in the Center for Health Equity Research at the
University of Pennsylvania School of Nursing. Her research focus
is abdominal obesity and chronic partial sleep debt in high school
students.