School mornings are generally quiet in the Gorham household. Anna Gorham, 17, can barely muster a response to her parents’ inquires as she tries to shake off the sleepiness before heading to school.

“They try to talk to me, but I usually don’t say anything,” the Mountain View High School junior said between yawns at her kitchen counter on Friday. Despite the blackout curtains in her room, Gorham says she can rarely fall asleep before 11 p.m. on a school night. And even without a first period class, getting up each morning requires more than a little prodding from her parents.

“It’s always been challenging to get my kids up in the morning, and on the weekends, they sleep late. They’re trying to catch up,” her mother, Page Gorham, said. “My daughter talks a lot about being tired during the day because she doesn’t get enough sleep.”

Bend-La Pine Schools is considering having middle and high school students start later in the morning. Unlike in previous debates, the school board now has access to a growing volume of research and is hearing from the local medical community that early mornings could be hazardous to a high schooler’s health.

“We’re not doing our best as a community to support our teens’ optimal health, both mentally and physically,” said Dr. Suzanne Mendez, a pediatric hospitalist at St. Charles Bend. “The research shows that teens need more sleep than they’re getting, and they will get more sleep with later start times.”

Mendez, who spoke during the public comment period of the Bend-La Pine School Board meeting Tuesday, delivered a letter signed by 33 local doctors and other health providers supporting later start times. Middle schools and high schools in the district generally start classes at 7:45 a.m., while elementary schools start at 9 a.m. A number of medical groups, including the American Academy of Pediatrics and the American Academy of Sleep Medicine, recommend teens get 8 to 10 hours of sleep per night and support start times no earlier than 8:30 a.m. Those groups maintain that the average American adolescent is “sleep deprived and pathologically sleepy,” due, in part, to changes that occur after puberty.

“They have what we call a delayed circadian phase. Their body clock is set late,” said Dr. Meghna Mansukhani, a sleep specialist with the Mayo Clinic in Rochester, Minnesota. “It’s just their biology is different.”

Research has documented that adolescent body clocks tend to shift about two hours later after puberty, turning early birds into night owls. Their bodies delay the secretion of melatonin, a hormone that regulates sleep patterns, meaning teens have trouble falling asleep.

The pediatric group wrote in a 2014 position statement, the average teen has difficulty falling asleep before 11 p.m. and is best suited to wake up at 8 a.m. or later. They often try to sleep in on weekends to catch up but that can make getting up early on weekdays even more difficult.

Bend-La Pine Schools convened a committee in 2016 to examine the research on start times. They relied mainly on a 2014 University of Minnesota study that found that in high schools with start times no later than 8:05, 33 percent to 50 percent of students averaged eight hours of sleep per school night. In the schools with start times after 8:35, 57 percent to 66 percent hit the eight-hour mark. Teens getting less than eight hours of sleep were more likely to report symptoms of depression, had more problems with substance use and had lower academic achievement than their more-rested peers.

The committee presented a report to the superintendent in March 2017 that outlined three options: moving start times ahead for all grades, flipping elementary and secondary start times or keeping the current schedule.

The district would have to solve a series of logistical challenges if start times are altered. Delaying start times for all grades would pose challenges for after-school activities, and secondary students would miss more school if they had to travel for sports. Elementary students might struggle with the long afternoon, and their parents may have to leave for work before their kids leave for school. Swapping start times, on the other hand, could leave younger kids waiting for the school bus in the dark for much of the year. A single start time of 8:30 a.m. for all grades could mean kindergartners riding the same bus with high school seniors.

The school board will get an update on the issue at its March 13 meeting and could make a decision sometime by this summer.

“If we move toward a schedule that is a significant change, and we don’t yet know that, then we will be doing a very broad listening effort,” Jay Mathisen, deputy superintendent for Bend-La Pine Schools, said. A major change likely wouldn’t take effect before the 2019-20 school year. “We haven’t rule out starting something that’s a minor change next fall.”

The start time committee’s work came at the same time that a national work group of medical experts conducted a review of the scientific evidence on school start times. The group published their review in December 2016, finding that “the natural biological rhythms of adolescents and teens are a poor fit with early school start times.”

The review determined that when the start times were up to 60 minutes later, students got an extra 19 minutes of sleep on school nights. When start times were more than an hour later, students got an extra 53 minutes of sleep.

The review found mixed evidence that later start times translated to better grades or test scores, although it was associated with less tardiness and truancy.

The most compelling research in the review might be the studies on car crashes. One study looked at accident rates over two years among groups of students with start times that differed by 75 to 80 minutes. The students with earlier start times had a much higher car-crash rate — an additional 19 accidents per 1,000 drivers — and the difference in crash rates was highest during school commuting times.

Another study found a similar increase in crash rates, including an increase in accidents where cars ran off the right side of the road, a scenario that is closely linked to driver fatigue and inattention.

Since the 2016 review, more studies have supported the findings that later start times improve academic performance and behavioral health measures. But Mansukhani, the Mayo Clinic sleep specialist, said research has been mixed on whether younger kids do fine with earlier start times, and if flipping elementary and secondary schedules could do more harm than good.

“I don’t know if we’re doing it at the cost of elementary school kids, but the gains are potentially so high in the older age group just because of their biology,” she said.

While most research has been inconclusive or supportive of later start times, a mathematical model published by Harvard Medical School and the University of Surrey in March 2017 cast doubt that later start times would help. The researchers concluded that just as kids’ body clocks adjust to the time change every fall, their body clocks would drift later in response to the later start time. In a matter of weeks, they would find it just as hard to get out of bed.

The modeling also suggested that limiting light exposure late at night would be as effective in getting students more sleep as changing their alarm from 7 to 8 a.m.

“When we put our committee together, people were saying, ‘By golly, if you don’t do this you’re ignoring the research that is currently out there,’” Mathisen said. “Maybe this is the front end of some pushback, but it’s just the one study.”

That debate also persists among the sleep medicine community.

“No one functions well when they’re sleep deprived,” said Dr. Raj Dasgupta, an assistant professor at the University of Southern California’s Keck School of Medicine. “But if I were to pick one side of the field, I would side more on keeping things the way they are.”

Dasgupta, who is also a spokesman for the American Academy of Sleep Medicine, says while adolescents gravitate toward later sleep times, that might have more to do with evening screen time than biology.

He says teens would get more sleep by keeping consistent sleep and wake times, even on the weekends, exercising more, keeping a stringent food schedule and limiting late-night texting.

— Reporter: 541-633-2162, mhawryluk@bendbulletin.com