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Open Access Highly Accessed Research article

"Sleepiness" is serious in adolescence: Two surveys of 3235 Canadian students

Edward S Gibson1*, AC Peter Powles2, Lehana Thabane13, Susan O'Brien4, Danielle Sirriani Molnar5, Nik Trajanovic6, Robert Ogilvie5, Colin Shapiro7, Mi Yan8 and Lisa Chilcott-Tanser9

Author Affiliations

1 Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada

2 Faculty of Medicine, McMaster University, St. Joseph's Healthcare, 50 Charlton Street, Hamilton, Ontario, L8N 4A6, Canada

3 Centre for Evaluation of Medicines, St. Joseph's Healthcare, 105 Main Street East, Level P1, Hamilton Ontario, L8N 1G6, Canada

4 Ancaster High School, Hamilton Wentworth District School Board, 374 Jerseyville Road West, Hamilton, Ontario, L9G 3K8, Canada

5 Department of Psychology, Brock University, 500 Glenridge Avenue, St. Catharines, Ontario, L2S 3A1, Canada

6 Sleep and Alertness Clinic, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada

7 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto Western Division, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada

8 Department of Statistics and Actuarial Sciences, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada

9 Central-West Sleep Laboratories, 139 Grand River Street North, Paris, Ontario, N3L 2M4, Canada

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BMC Public Health 2006, 6:116  doi:10.1186/1471-2458-6-116

Published: 2 May 2006



Evidence is growing that sleep problems in adolescents are significant impediments to learning and negatively affect behaviour, attainment of social competence and quality of life. The objectives of the study were to determine the level of sleepiness among students in high school, to identify factors to explain it, and to determine the association between sleepiness and performance in both academic and extracurricular activities


A cross-sectional survey of 2201 high school students in the Hamilton Wentworth District School Board and the Near North District School Board in Ontario was conducted in 1998/9. A similar survey was done three years later involving 1034 students in the Grand Erie District School Board in the same Province. The Epworth Sleepiness Scale (ESS) was used to measure sleepiness and we also assessed the reliability of this tool for this population. Descriptive analysis of the cohort and information on various measures of performance and demographic data were included. Regression analysis, using the generalised estimating equation (GEE), was utilized to investigate factors associated with risk of sleepiness (ESS>10).


Seventy per cent of the students had less than 8.5 hours weeknight sleep. Bedtime habits such as a consistent bedtime routine, staying up late or drinking caffeinated beverages before bed were statistically significantly associated with ESS, as were weeknight sleep quantity and gender. As ESS increased there was an increase in the proportion of students who felt their grades had dropped because of sleepiness, were late for school, were often extremely sleepy at school, and were involved in fewer extracurricular activities. These performance measures were statistically significantly associated with ESS. Twenty-three percent of the students felt their grades had dropped because of sleepiness. Most students (58–68%) reported that they were "really sleepy" between 8 and 10 A.M.


Sleep deprivation and excessive daytime sleepiness were common in two samples of Ontario high school students and were associated with a decrease in academic achievement and extracurricular activity. There is a need to increase awareness of this problem in the education and health communities and to translate knowledge already available to strategies to address it.