A Conversation with Dr. Geneviève Forest

Biography

Dr. Geneviève Forest earned a Ph.D. in Neuropsychology from Université de Montréal in 2001 and completed postdoctoral studies in sleep and chronobiology at the University of Ottawa, both in Canada.

Dr. Forest has been a full professor in the Department of Psychoeducation and Psychology at the Université du Québec in Outaouais since 2004.

Her main research interests focus on the role of sleep in psychological, emotional, and cognitive functions, as well as the impact of sleep deprivation on these functions.

Interview

Sleep Foundation (SF): Thank you for participating, Dr. Forest.

Last year SleepFoundation.org released sleep guidelines at the beginning of the pandemic. As time has worn on, however, we’re in a different state. We’re now 11 months in, broaching on a year for the U.S. Many of the things we wrote about didn’t anticipate the length and consequences of social isolation, as well as the school closures, job loss, and this anxiety.

So, let’s start with this: now that we’re 11 months into this pandemic, what has surprised you as you look back?

Genevieve Forest (GF): Well, my thoughts are tied to the results of the research that I did, which came from the first wave and the beginning of the pandemic. We found really big changes in the sleep of young adolescents and young adults, but it was at the beginning when most schools and universities were shutting down or there was a transition to remote teaching.

The school’s schedules were reorganizing everything, and adolescent and young adults didn’t have to wake up early in the morning. So, they gained control of their schedules, and that was a major factor. We found there was a major shift in sleep. For example, the youngest adolescents, those from 12 to 14 years old, woke up 2.5 hours later during weekdays.

It’s a big change, but since most schools started again in the fall of 2020 with regular school schedules, if we were doing the same research right now, we wouldn’t have the same results. And, if we’re looking at the accumulating stress for over a year of social isolation, now those young adolescents will not benefit from a good night of sleep that they had in the beginning.

So, I think that’s one of the major problems. At the beginning [of the pandemic], young people had an opportunity to sleep more and to have sleep that was more aligned with their natural rhythm. But, now with the pandemic still going, and the pressure and constraint of the school’s structure, and the social isolation that is still going on… I think the stress and this psychological distress will give us a completely different portrait.

SF: So, you found that at the very beginning of the pandemic, kids were left to set their own schedules and found a wake time that was closer to a weekend schedule?

GF: It was both present for the teenagers and the young adults. So, everyone shifted their sleep patterns to later bedtimes and wake times, and we found an increase in sleep duration. Overall, everyone got about an hour of sleep more per night.

But, the thing is that for the younger teenagers, they all reported an improvement in sleep quality and in daytime sleepiness. The young adults did not; they reported more sleep difficulties, no improvement in daytime sleepiness and no improvement in sleep onset latency. In fact, they reported more nightmares, plus more evening, early morning, and evening awakenings.

So, even though they shifted their sleep patterns and they slept more, young adults reported more sleep difficulties. But, the younger teens reported much better sleep, and they benefited more from that.

SF: Sleep opportunity has been one of the main educational awareness focuses of sleep in the last 15 years. We know that societal pressures — artificial societal, policy-caused pressures — have, unfortunately, resulted in volitional voluntary sleep deprivation. Your study seems to suggest that students took advantage of this increased sleep opportunity.

Have you seen anything else that is promising? Do you think people have become more in-touch with how valuable sleep is as a result of increased opportunity?

GF: What we found with our adolescent and young adults is that they shift their sleep patterns, and it gives them more free time to do other things in the evening. What we also found is that the participants that shifted their sleep were those who presented as the more evening type. So, the “night owls” were those who shifted more their sleep, but our results also showed that some of the bad lifestyle habits that they developed during the pandemic also contributed to the sleep patterns that they have during the pandemic.

One of those habits was screen time. The increase in electronic device use during the pandemic was directly associated with a more pronounced shift to later bedtimes and wake times in the young teenagers. So, even beyond the effect of chronotype, the usage of electronic devices contribute to shift sleep patterns during the pandemic.

It was also the case with employment in young adults. In young adults, what we found was that those who increased the numbers of hours that they worked during the pandemic, woke up earlier during the pandemic. They had to cut back on their sleep during weekends and weekdays. So, because you probably have more work to do during the pandemic, or maybe because they were working at home and their office was right there, they just woke up earlier and did the work at home.

We also found that young adolescents who increased their caffeine consumption during the pandemic also woke up later during the pandemic. They were at home, probably caffeine was more accessible for them. So, those who were shifting their wake times later in the morning were probably those who also struggled more with sleepiness and those who increased their caffeine consumption during the pandemic.

There was also an increase in cannabis consumption with young adults who shifted their bedtimes to later, probably because during weekends, they have more opportunity to use cannabis before bedtime. All those lifestyle habits also had an impact on sleep patterns, beyond the effect of chronotype.

SF: Forced school closures means that many school-related extracurricular and social activities are cancelled. What effect do you think that has on kids and families?

GF: I don’t know if it’s the fact that they filled out their times before with something else. But, my thought is that teenagers were so sleep-deprived that when the pandemic arrived, they took the opportunity to compensate for that. It outweighed anything else that the pandemic could bring on them. They just slept all they could, and they just aligned their sleep with their needs. They filled the rest of the time with things that they could do.

But, as we know, the blue lights will impact their sleep, so night owls, like the evening types, went to bed later. If they used electronic devices during the night, well, it could interact with the fact that they shifted their bedtimes to later. The takeaway here is that even though we should start school later, we should also properly frame free time in adolescents because they need to know more about sleep hygiene and the impact of electronic-device use on their sleep. Those with free time have to use it properly, because if they’re just using electronic devices and smoking pot, they will not experience great sleep.

SF: Let’s talk about parents with school age kids. Without social interaction, kids are now dependent upon their parents to provide that interaction. Are you concerned that this is producing adolescent depression?

GF: I have a colleague here at the university who did a study during the pandemic that showed that parents of children have difficulty maintaining their response to the needs of their children during the pandemic. So, it’s a fact.

One of the other things is that we’re starting to dig in a little bit more into our data, and we looked at just the young adults, and it seems that the resilience, the psychological resilience of young adults could be a factor that modulates the impact of the pandemic on sleep. One of the things that we found was that in less-resilient young adults, negative emotion is linked to the increase in nightmares, but in resilient young adults that’s not the case.

So, it seems that resilience could be a protective factor. When you’re resilient, you seem to be more able to deal with the increasing negative emotion, but only in men. If you’re a woman and you’re resilient, our results suggest that negative emotions will be associated with an increase in nightmares.

SF: And how do you define “resilience” in this context?

GF: Well, it’s a broad concept. Resilience is a concept used to explain how someone will be able to cope with everything that comes along with stress or something that you have to deal [with]. It could be a situation like the pandemic or, I don’t know, a situation that will bring anxiety. Some people are really good with that. They will just think and take action, and they will recover quickly. So, we say that they are “resilient”. And, some people will just feel really anxious, they are not able to think straight, and they will have to really analyze everything.

SF: Are there any beneficial recommendations that we could implement as a result of new learnings?

GF: Well, the original question you asked about sleep routines… the main point is the fact that adolescents are sleep deprived. With the pandemic, it all brings back the debate about school start time. And, I think it’s the main thing that I will always come back to, because in the U.S., there’s been lobbying about changing school start times. And I think it’s working through some of the states that are changing school start time to later times.

It’s showing really great improvement in teenagers’ well-being, academic performance, academic motivation, and dropouts. But, in Canada, nobody wants to talk about that. And every school starts very early, and sometimes it’s 7:30 in the morning or 8:00. And, we have much difficulty with how to change that.

And, probably one of the main arguments is about transportation. Or parents that don’t want to change those hours, or staff because those are the one that will teach, and they have children of their own. But, it’s not doing students much good.

SF: COVID has impacted all of us in so many different ways. If you had to give one sleep recommendation, what would it be?

GF: It’s important to address anxiety and depression issues for those who have them, and for people to follow their natural rhythm if they can, with a structure for free time.

SF: So, after COVID, what comes out of this? Any crystal ball thoughts on what happens?

GF: For adolescents and young adults, we’re still looking far ahead, but for the next year, well, in Canada, we’re still talking about remote teaching. In the U.S. there is maybe a little bit of teaching face to face also, but it’s difficult to predict anything, but because the situation is evolving very rapidly.

In terms of sleep, like I said at the very beginning of this roundtable, the situation was very different at the very beginning because of the almost complete shutdown of school. Now, the adolescents don’t benefit from the free schedules that they had at the beginning.

They still have to get up in the morning to go to school, but they have the accumulating effects of the pandemic for over a year, with all of this stress and the social isolation. We don’t know what it will do to them. I have three adolescents at home — three boys — and I know first hand that it’s very difficult for them. One of them was 16 at the beginning. Now, he’s going to turn 18. It’s been almost a year without any contact with anyone.

SF: This has been such a rich conversation. One final question: How have you personally seen your sleep impacted? Do you find that it’s different from some of the presenting issues in your clinics? Just as an expert in the field who is experiencing all of this, how have you tried to guard against many of the disruptions that you’ve spoken about?

GF: Well, for my part, I’ve been doing the same thing as my teenagers. I’ve always been a good sleeper, so I just shifted my sleep. Because I’m working at home I also save time on transport.

I also realized that I don’t need an alarm clock. I can wake up at the time that I want. So, yes, that’s the way I’m leaning with my sleep, and I’m sleeping much, much better since the pandemic. I have less dealing with calls and other interruptions during my day. So, my days are longer but much more productive. The anxiety is less for me, so my sleep is better.

More Interviews:

• Dr. Brian Abaluck, MD
• Dr. Helene A. Emsellem, MD
• Dr. Geneviève Forest, Ph.D
• Dr. Michael Thorpy, MD

Learn More:

• https://www.sleepfoundation.org/sleep-hygiene
• https://www.sleepfoundation.org/narcolepsy
• https://www.sleepfoundation.org/sleep-apnea
• https://www.sleepfoundation.org/excessive-sleepiness
• https://www.sleepfoundation.org/circadian-rhythm