Sleep hygiene education involves promoting good sleep habits in all aspects of lifestyle and behavior. In this study, we evaluated the effects of a sleep hygiene education program for Japanese high school students who did not have insomnia symptoms.Tenth-grade students (N = 2815; intervention, n = 1347; control, n = 1468) from 16 high schools in a provincial city in Japan participated in this cluster-controlled trial. In this program, teachers conducted a 5-min class based on various catchphrases once per week using teaching materials developed for this study (“Healthy Living Sleep Guidelines for High School Students”). Twelve classes were conducted. The baseline and follow-up surveys were performed. The difference between the groups was examined using an intention-to-treat principle with the full analysis set. We selected the generalized estimating equation for this analysis. The intention-to-treat analysis revealed that the intervention group presented significantly greater prevention of insomnia symptoms and short sleep duration (< 6 h) compared to the control group (adjusted odds ratio: 0.72 [95% confidence interval: 0.54–0.96], adjusted odds ratio 0.79 [95% CI 0.67–0.94]). However, there were no significant differences in odds ratios between the two groups for poor subjective sleep quality, excessive daytime sleepiness, and late bedtime.This sleep hygiene education program may be useful as a low-cost, highly valid, and accessible primary prevention method for insomnia symptoms. However, the applicability of this program for children of other ages and regions needs to be verified.
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We extend our sincere gratitude to the high school teachers for their invaluable participation.
This study was supported by JSPS KAKENHI (Grant number JP26507009).
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflicts of interest.
All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of Oita University School of Medicine.
Informed consent was obtained from all study participants.
Gradisar M, Gardner G, Dohnt H. Recent worldwide sleep patterns and problems during adolescence: a review and meta-analysis of age, region, and sleep. Sleep Med. 2011;12(2):110–8.CrossRefPubMedGoogle Scholar
Blunden SL, Chapman J, Rigney GA. Are sleep education programs successful? The case for improved and consistent research efforts. Sleep Med Rev. 2012;16(4):355–70.CrossRefPubMedGoogle Scholar
Ohida T, Osaki Y, Doi Y, et al. An epidemiologic study of self-reported sleep problems among Japanese adolescents. Sleep. 2004;27(5):978–85.CrossRefPubMedGoogle Scholar
Kaneita Y, Ohida T, Osaki Y, et al. Association between mental health status and sleep status among adolescents in Japan: a nationwide cross-sectional survey. J Clin Psychiatry. 2007;68(9):1426–35.CrossRefPubMedGoogle Scholar
Armstrong JM, Ruttle PL, Klein MH, et al. Associations of child insomnia, sleep movement, and their persistence with mental health symptoms in childhood and adolescence. Sleep. 2014;37(5):901–9.CrossRefPubMedPubMedCentralGoogle Scholar
Zhang J, Lam SP, Li SX, et al. Longitudinal course and outcome of chronic insomnia in Hong Kong Chinese children: a 5-year follow-up study of a community-based cohort. Sleep. 2011;34(10):1395–402.CrossRefPubMedPubMedCentralGoogle Scholar
Chang PP, Ford DE, Mead LA, et al. Insomnia in young men and subsequent depression. The Johns Hopkins Precursors Study. Am J Epidemiol. 1997;146(2):105–14.CrossRefPubMedGoogle Scholar
Javaheri S, Storfer-Isser A, Rosen CL, et al. Association of short and long sleep durations with insulin sensitivity in adolescents. J Pediatr. 2011;158(4):617–23.CrossRefPubMedGoogle Scholar
Gupta NK, Mueller WH, Chan W, et al. Is obesity associated with poor sleep quality in adolescents? Am J Hum Biol. 2002;14(6):762–8.CrossRefPubMedGoogle Scholar
Kaneita Y, Ohida T, Uchiyama M, et al. Excessive daytime sleepiness among the Japanese general population. J Epidemiol. 2005;15(1):1–8.CrossRefPubMedGoogle Scholar
Dewald JF, Meijer AM, Oort FJ, et al. The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review. Sleep Med Rev. 2010;14(3):179–89.CrossRefPubMedGoogle Scholar
Kaneita Y, Ohida T, Osaki Y, et al. Insomnia among Japanese adolescents: a nationwide representative survey. Sleep. 2006;29(12):1543–50.CrossRefPubMedGoogle Scholar
Kaneita Y, Ohida T, Uchiyama M, et al. The relationship between depression and sleep disturbances: a Japanese nationwide general population survey. J Clin Psychiatry. 2006;67(2):196–203.CrossRefPubMedGoogle Scholar
Cassoff J, Knauper B, Michaelsen S, et al. School-based sleep promotion programs: effectiveness, feasibility and insights for future research. Sleep Med Rev. 2013;17(3):207–14.CrossRefPubMedGoogle Scholar
Irish LA, Kline CE, Gunn HE, et al. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev. 2015;22:23–36.CrossRefPubMedGoogle Scholar
Kor K, Mullan BA. Sleep hygiene behaviours: an application of the theory of planned behaviour and the investigation of perceived autonomy support, past behaviour and response inhibition. Psychol Health. 2011;26(9):1208–24.CrossRefPubMedGoogle Scholar
Cain N, Gradisar M, Moseley L. A motivational school-based intervention for adolescent sleep problems. Sleep Med. 2011;12(3):246–51.CrossRefPubMedGoogle Scholar
Sousa D, Cortez I, AraÚJo JF, et al. The effect of a sleep hygiene education program on the sleep–wake cycle of Brazilian adolescent students. Sleep Biol Rhythms. 2007;5(4):251–8.CrossRefGoogle Scholar
Cortesi F, Giannotti F, Sebastiani T, et al. Knowledge of sleep in Italian high school students: pilot-test of a school-based sleep educational program. J Adolesc Health. 2004;34(4):344–51.CrossRefPubMedGoogle Scholar
Kira G, Maddison R, Hull M, et al. Sleep education improves the sleep duration of adolescents: a randomized controlled pilot study. J Clin Sleep Med. 2014;10(7):787–92.PubMedPubMedCentralGoogle Scholar
Arora T, Taheri S. Is sleep education an effective tool for sleep improvement and minimizing metabolic disturbance and obesity in adolescents? Sleep Med Rev. 2017;36:3–12.CrossRefPubMedGoogle Scholar
Gruber R. School-based sleep education programs: a knowledge-to-action perspective regarding barriers, proposed solutions, and future directions. Sleep Med Rev. 2017;36:13–28.CrossRefPubMedGoogle Scholar
Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675–700.CrossRefPubMedGoogle Scholar
Weiss MD, Wasdell MB, Bomben MM, et al. Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia. J Am Acad Child Adolesc Psychiatry. 2006;45(5):512–9.CrossRefPubMedGoogle Scholar
Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry. 1994;151(8):1172–80.CrossRefPubMedGoogle Scholar
Munezawa T, Kaneita Y, Osaki Y, et al. The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey. Sleep. 2011;34(8):1013–20.CrossRefPubMedPubMedCentralGoogle Scholar
Kim K, Uchiyama M, Okawa M, et al. An epidemiological study of insomnia among the Japanese general population. Sleep. 2000;23(1):41–7.CrossRefPubMedGoogle Scholar
Hasler G, Buysse DJ, Klaghofer R, et al. The association between short sleep duration and obesity in young adults: a 13-year prospective study. Sleep. 2004;27(4):661–6.CrossRefPubMedGoogle Scholar
Suzuki H, Kaneita Y, Osaki Y, et al. Clarification of the factor structure of the 12-item General Health Questionnaire among Japanese adolescents and associated sleep status. Psychiatry Res. 2011;188(1):138–46.CrossRefPubMedGoogle Scholar
Otsuka Y, Kaneita Y, Itani O, et al. Association between unhealthy dietary behaviors and sleep disturbances among Japanese adolescents: a nationwide representative survey. Sleep Biol Rhythms. 2019;17(1):93–102.CrossRefGoogle Scholar
Takegami M, Suzukamo Y, Wakita T, et al. Development of a Japanese version of the Epworth Sleepiness Scale (JESS) based on item response theory. Sleep Med. 2009;10(5):556–65.CrossRefPubMedGoogle Scholar
Munezawa T, Kaneita Y, Osaki Y, et al. Nightmare and sleep paralysis among Japanese adolescents: a nationwide representative survey. Sleep Med. 2011;12(1):56–64.CrossRefPubMedGoogle Scholar
Goldberg DP, Rickels K, Downing R, et al. A comparison of two psychiatric screening tests. Br J Psychiatry. 1976;129:61–7.CrossRefPubMedGoogle Scholar
Doi Y, Minowa M. Factor structure of the 12-item General Health Questionnaire in the Japanese general adult population. Psychiatry Clin Neurosci. 2003;57(4):379–83.CrossRefPubMedGoogle Scholar
Biddle L, Gunnell D, Sharp D, et al. Factors influencing help seeking in mentally distressed young adults: a cross-sectional survey. Br J Gen Pract. 2004;54(501):248–53.PubMedPubMedCentralGoogle Scholar
Young KS. Internet addiction: the emergence of a new clinical disorder. Cyberpsychol Behav. 1998;1(3):237–44.CrossRefGoogle Scholar
Adedokun OA, Burgess WD. Analysis of paired dichotomous data: a gentle introduction to the McNemar Test in SPSS. J MultiDiscip Eval. 2011;8(17):125–31.Google Scholar
Gortmaker SL, Cheung LWY, Peterson KE, et al. Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children—eat well and keep moving. Arch Pediatr Adolesc Med. 1999;153(9):975–83.CrossRefPubMedGoogle Scholar
Chung KF, Lee CT, Yeung WF, et al. Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis. Fam Pract. 2018;35(4):365–75.CrossRefPubMedGoogle Scholar
Tagaya H, Uchiyama M, Ohida T, et al. Sleep habits and factors associated with short sleep duration among Japanese high-school students: a community study. Sleep Biol Rhythms. 2004;2(1):57–64.CrossRefGoogle Scholar
Chung KF, Chan MS, Lam YY, et al. School-based sleep education programs for short sleep duration in adolescents: a systematic review and meta-analysis. J Sch Health. 2017;87(6):401–8.CrossRefPubMedGoogle Scholar
Wing YK, Li SX, Li AM, et al. The effect of weekend and holiday sleep compensation on childhood overweight and obesity. Pediatrics. 2009;124(5):e994–1000.CrossRefPubMedGoogle Scholar
Azevedo CVM, Sousa I, Paul K, et al. Teaching chronobiology and sleep habits in School and University. Mind Brain Educ. 2008;2(1):34–47.CrossRefGoogle Scholar
Lin CY, Strong C, Scott AJ, et al. A cluster randomized controlled trial of a theory-based sleep hygiene intervention for adolescents. Sleep. 2018;41(11):zsy170-zsy.CrossRefGoogle Scholar
Bakotic M, Radosevic-Vidacek B, Koscec A. Educating adolescents about healthy sleep: experimental study of effectiveness of educational leaflet. Croat Med J. 2009;50(2):174–81.CrossRefPubMedPubMedCentralGoogle Scholar
Kallenbach WW, Gall MD. Microteaching versus conventional methods in training elementary intern teachers. J Educ Res. 1969;63(3):136–41.CrossRefGoogle Scholar
Des Jarlais DC, Lyles C, Crepaz N, et al. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health. 2004;94(3):361–6.CrossRefPubMedPubMedCentralGoogle Scholar