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PubMed2001

Infant sleep problems and postnatal depression: a community-based study.

OBJECTIVES: To describe infant sleep patterns and investigate relationships between infant sleep problems and maternal well-being in the community setting. DESIGN: Cross-sectional community survey. Setting. Maternal and Child Health Centers in 3 middle-class local government areas in Melbourne, Australia. PARTICIPANTS: Mothers of infants 6 to 12 months of age. MAIN OUTCOME MEASURES: Maternal well-being (Edinburgh Postnatal Depression Scale) and infant sleep problems (standardized maternal questionnaire). RESULTS: The survey was completed by 738 mothers (94% response rate), of whom 46% reported their infant's sleep as a problem. In the univariate analyses, sleep patterns characterizing a sleep problem included the infant sleeping in the parent's bed, being nursed to sleep, taking longer to fall asleep, waking more often and for longer periods overnight, and taking shorter naps. The same sleep patterns were associated with high depression scores and tended to increase as depression scores increased. Because of positive skew, the Edinburgh Postnatal Depression Score was analyzed in 3 categories (<10, 10-12, and >12) using validated cutoff scores from community and clinical studies. Fifteen percent of mothers scored above 12 on the depression scale, indicating probable clinical depression, and 18% scored between 10 and 12, indicating possible clinical depression. After adjusting for potential confounders and factors significant in the univariate analyses, maternal report of an infant sleep problem remained a significant predictor of a depression score >12 (odds ratio: 2.13; 95% confidence interval: 1.27,3.56) and >10 (odds ratio: 2.88; 95% confidence interval: 1.93,4.31). However, mothers reporting good sleep quality, despite an infant sleep problem, were not more likely to suffer depression. CONCLUSIONS: Maternal report of infant sleep problems and depression symptoms are common in middle-class Australian communities. There is a strong association between the 2, even when known depression risk factors are taken into account. Maternal report of good sleep quality attenuates this relationship. Appropriate anticipatory guidance addressing infant sleep could potentially decrease maternal report of depressive symptoms.

Adult↗

PubMed2004

An epidemiologic study of self-reported sleep problems among Japanese adolescents.

STUDY OBJECTIVE: To examine the prevalence and correlates of sleep problems in Japanese adolescents. DESIGN AND SETTING: The survey was designed as a cross-sectional sampling. The targets of the survey were junior and senior high schools throughout Japan. Sample schools were selected by stratified cluster sampling. Self-reported anonymous questionnaires were sent to sample schools for all students to fill out. PARTICIPANTS: A total of 107,907 adolescents responded, and 106,297 questionnaires were subjected to analysis. MEASUREMENTS AND RESULTS: The overall prevalences of sleep problems in the month preceding the questionnaire were difficulty initiating sleep (boys: 15.3%, girls: 16.0%); nocturnal sleep duration less than 6 hours (boys: 28.7%, girls: 32.6%); excessive daytime sleepiness (boys: 33.3%, girls: 39.2%), and subjectively insufficient sleep (boys: 38.1%, girls: 39.0%). Multiple logistic regression analysis showed that female sex, being a senior high-school student, and having an unhealthy lifestyle (psychological stress, smoking, and drinking alcohol) were risk factors for sleep problems. CONCLUSION: Self-reported sleep problems in Japanese adolescents were common and were associated with multiple factors. There is a need for health education directed at solving sleep problems in Japanese adolescents.

Adolescent↗

PubMed2006

Sleep problems of children with pervasive developmental disorders: correlation with parental stress.

This study aimed to investigate the prevalence of sleep problems in Chinese children with pervasive developmental disorders (PDD) in Hong Kong and their relationship to parental stress. A cross-sectional survey was conducted in six child assessment centres. All parents of the children with PDD completed the Children's Sleep Habits Questionnaire, the Parenting Stress Index-Short Form, and questions on sleep practice. A total of 210 out of 250 questionnaires (response rate 84%) were returned. Mean age of the children was 3 years 6 months (SD 1 y 4 mo; range 2 y-7 y 7 mo; 168 males, 25 females). The prevalence of parent-defined sleep problems in various sleep domains ranged from 9.3 to 45.6%, with 67.9% of children having significant problems in at least one sleep domain. The most common problems reported were bedtime resistance and parasomnias. Similar sleep problems occurred in all the PDD subgroups. The factor most significantly associated with sleep problems was the occurrence of sleep problems before the age of 2 years. The parents of children with PDD with sleep problems experienced a higher level of stress than those whose children had no sleep problems. A high prevalence of significant sleep problems was reported in Chinese children in Hong Kong with PDD. A higher stress level among the parents of those children with PDD with sleep problems suggests the need for systematic early detection and management of sleep problems in children with PDD.

Child↗

PubMed2001

How do early parenting centres support women with an infant who has a sleep problem?

Some women who have an infant experiencing sleep problems arc so sleep deprived themselves that admission to an early parenting centre is needed to help them better manage the situation. This paper reports on a qualitative sttudy that used focus group methods to interview families who were admitted to an early parenting centre for persistent infant sleep problems. Results showed that parents needed a variety of strategies such as instructional, emotional and physical supports to develop confidence to manage infant's sleep disturbance at home.

Female↗

PubMed2001

Sleep problems and substance use in adolescence.

Longitudinal studies of adults have reported finding insomnia to significantly predict onset of substance abuse. This study estimated the association between sleep problems and substance use among adolescents in the context of psychiatric problems. Data come from the US National Household Survey on Drug Abuse 1994-1996 that included 13,831 adolescents. Use of cigarettes, alcohol and any illicit drug were each associated with adolescents' reports of having frequent sleep problems, adjusting for age, sex, race and family income (odds ratios ranging from 1.5 to 3.8). Adjusting for internalizing (e.g. depression and anxiety) and externalizing (e.g. deviance and aggression) problems reduced the associations between sleep problems and use of these substances, suggesting that part of the association is attributable to psychiatric problems. The part of the association not attributable to psychiatric problems was limited to the associations between sleep problems and use of illicit drugs. These results suggest that the relationship between sleep problems and drug use/abuse must be viewed in the context of psychiatric problems. Longitudinal research that employs more specific measures of sleep problems is indicated. Such research may provide information on the relationship of sleep problems to the immediate health and well being of adolescents, as well as their trajectories into adulthood.

Adolescent↗

PubMed1999

Sleep problems and daytime challenging behaviour in a community-based sample of adults with intellectual disability.

The present study aimed to explore associations between sleep problems and daytime challenging behaviour in a community sample of adults with intellectual disability. Sleep and behaviour questionnaires were completed for 205 people aged 18 years or over living in health- or social-services-managed community housing. This sample represented an 86% return rate. The informants were carers and the individuals themselves where possible. Seventy-nine people with sleep problems were compared with 121 individuals without this difficulty; five people were excluded from the analysis. Individuals with sleep problems displayed significantly more daytime irritability, stereotypy and hyperactivity than those without sleep problems. Individuals displaying clinically significant aggression/temper, self-injury and screaming were significantly more likely to have a concurrent sleep problem, and these forms of challenging behaviour were significantly more severe in the sleep problem group. Associations between sleep problems and daytime challenging behaviour exist in this population, although the nature of any links remains unclear and should be the attention of future research.

Adult↗

PubMed2003

[An epidemiological study on sleep problems in children aged 1 to 23 months in Shanghai].

OBJECTIVE: To understand prevalence of sleep problems and presence of improper sleep habit of children aged one to 23 months in Shanghai, and to identify their related factors. METHODS: Totally, 1 252 normal children, without severe illness and abnormal delivery history, aged one to 23 months were randomly selected from five districts of Shanghai. Under strict quality control system, their parents were interviewed with questionnaire to look into their familial and social environment, as well as sleep-related factors. RESULTS: Fully-completed information was obtained in 1 129 of 1 252 children, with a response rate of 90.18%. Prevalence of sleep problems in children was 65.90% in Shanghai, remarkably higher than in the other areas. Prevalence of nightmare, level of fright at night, snore and sleep apnea in boys were significantly higher than those in girls. Prevalence of improper sleep habit in children was also higher, including sleeping with their parents, parental presence at sleep onset and irregular sleep time. Main risk factors related to children's sleep problems were maternal anxiety, children's irregular sleep time, parental presence at sleep onset, difficulty-type temperament and maternal poor sleep during pregnancy. CONCLUSIONS: In Shanghai, prevalence of sleep problems in children aged one to 23 months was relatively higher and main risk factors for them were social, cultural and familial environment, especially negligence of cultivating proper sleep habit and parental improper response to children's poor sleep behavior.

Adaptation, Psychological↗

PubMed1994

Sleep problems in the elderly.

Sleep problems in older adults are so common that nearly half of all hypnotic prescriptions written are for persons over 65 years old. Although normal aging affects sleep, the practitioner should evaluate the many factors that cause insomnia: medical illness, psychiatric illness, dementia, alcohol and/or polypharmacy, restless legs syndrome, periodic leg movements, and sleep apnea syndrome. Nonpharmacologic treatment of sleep disorders is preferred. The nurse practitioner can assess and manage elderly patients with sleep disorders, but they need to refer those who can benefit from evaluation to a sleep disorder center.

Aged↗

PubMed2005

Brief report: parental descriptions of sleep problems in children with autism, Down syndrome, and Prader-Willi syndrome.

Children with an intellectual disability (ID) are at high risk of developing sleep problems. The extent to which the prevalence and nature of sleep problems in these children is dependent on the disorder underlying their intellectual impairments remains unclear. This study examined and compared parental descriptions of sleep problems in children with autism (n = 37), Down syndrome (DS; n = 15), Prader-Willi syndrome (PWS; n = 29), presumed familial intellectual disability (FID; n = 29), and typically developing children (TD; n = 55) in order to determine any influences of disorder on sleep patterns. The prevalence of sleep problems in the disability groups was at least four times higher than for TD children. Sleep problems were more prevalent in autism than the other disorders. Settling difficulties and co-sleeping were more common in the children with autism, whereas sleep maintenance problems were common in autism, DS, and FID, and daytime napping and excessive daytime sleepiness differentiated the children with PWS. These findings are discussed in light of the specific disorders, and with respect to the impact that sleep problems can have on the child and his/her family.

Adolescent↗

PubMed2001

Economic evaluation of strategies for managing crying and sleeping problems.

AIMS: To estimate the financial cost to the NHS of infant crying and sleeping problems in the first 12 weeks of age and to assess the cost effectiveness of behavioural and educational interventions aimed at reducing infant crying and sleeping problems relative to usual services. METHODS: A cost burden analysis and cost effectiveness analysis were conducted using data from the Crying Or Sleeping Infants (COSI) Study, a three armed prospective randomised controlled trial that randomly allocated 610 mothers to a behavioural intervention (n = 205), an educational intervention (n = 202), or existing services (control, n = 203). Main outcome measures were annual total cost to the NHS of infant crying and sleeping problems in the first 12 weeks, and incremental cost per interruption free night gained for behavioural and educational interventions relative to control. RESULTS: The annual total cost to the NHS of infant crying and sleeping problems in the first 12 weeks was 65 pound sterling million (US$104 million). Incremental costs per interruption free night gained for the behavioural intervention relative to control were 0.56 pound sterling (US$0.92). For the educational intervention relative to control they were 4.13 pound sterling (US$6.80). CONCLUSIONS: The annual total cost to the NHS of infant crying and sleeping problems is substantial. In the cost effectiveness analysis, the behavioural intervention incurred a small additional cost and produced a small significant benefit at 11 and 12 weeks of age. The educational intervention incurred a small additional cost without producing a significant benefit.

Behavior Therapy↗

PubMed1994

Managing sleep problems in children with special needs.

Sleep problems are common among all children, and have been shown to respond to behaviour modification techniques. Anne Reeve and Sheila Miers describe a group for mothers of children with special needs which took the same approach to solving the children's sleep problems.

Behavior Therapy↗

PubMed2002

Self-reported organic and nonorganic sleep problems in schoolchildren aged 11 to 15 years in Vienna.

PURPOSE: To estimate the prevalence of self-reported sleep problems, to examine associations among demographic characteristics, familial factors, and sleep problems, and to investigate the association between the symptoms of obstructive sleep apnea (OSA) and nonorganic sleep disorders. METHODS: An anonymous questionnaire with 22 questions was designed. 332 schoolchildren (aged 11-15 years, mean age 12 years and 9 months; median, 12 years; 56% female, 44% male) from two high schools in Vienna were investigated with regard to self-reported symptoms characteristic for obstructive sleep apnea and for parasomnia/insomnia. Data were analyzed by definition of three groups (problem, occasional problem, and nonproblem sleepers, and by calculation of an insomnia/parasomnia sum score). Statistical analysis included nonparametric tests (Mann Whitney-U and Kruskal), Pearson correlation test, and multiple regression analysis. RESULTS: Twelve percent reported at least one sleep problem every night, 76% reported occasional sleep problems, and 12% had no sleep problems. Girls were affected more frequently than boys (p <.01). Children with sleep problems suffered more often from concentration difficulties (p <.05), daytime fatigue (p <.001), and daytime naps (p <.05). Children who snored had nightmares (10% vs. 2%, p <.01), night terrors (4% vs. 1.5%, p <.001), sleepwalking (1.4% vs. 1%, p <.05), and nocturnal awakening (16% vs. 5%, p <.01) more frequently. On multiple regression analysis, 23% of the variability of a defined parasomnia/insomnia sum score had the characteristic OSA symptoms of nocturnal sweating, dryness of the mouth, snoring, hyperactivity, and daytime fatigue. CONCLUSION: 12% of schoolchildren aged 11-15 years reported sleep problems almost every night. The children suffer from daytime fatigue, naps, and concentration difficulties. Nearly one-fourth of the symptoms of parasomnia/insomnia were associated with characteristic signs of OSA, suggesting the importance of a routine clinical investigation in children with so-called nonorganic sleep disorders.

Adolescent↗

PubMed2006

Association between childhood sleep problems and perinatal factors, parental mental distress and behavioral problems.

The aim of this study was to examine the effect of age, gender and perinatal risk factors on the risks for sleep problems, and investigate the relation between childhood sleep problems and children's behavioral syndromes and parental mental distress in early and middle childhood. We recruited a representative sample of 1391 children, ages 4-9, from nine kindergartens and three elementary schools by using a multistage sampling method. Parents of child participants completed a questionnaire including perinatal risk factors, sleep habits and problems, the Child Behavior Checklist (CBCL) and the Chinese Health Questionnaire (CHQ). A mixed model was used for data analysis to address cluster effect from the same classes and schools. Results showed that boys suffered from more sleep problems than girls. Early insomnia, sleep terrors and enuresis decreased with ages, but sleepwalking increased with ages. Perinatal exposure to alcohol, coffee and non-prescribed medication, vaginal bleeding, artificial delivery, first-born order and higher parental CHQ score (> or =4) were significantly associated with several childhood sleep problems. In addition, children with sleep problems had higher T-scores of the eight behavioral syndromes derived from the CBCL. Our findings indicated that the childhood sleep problems were associated with perinatal risk factors, parental psychopathology and children's behavioral problems.

Child↗

PubMed1999

Management of sleeping problems in Wolf-Hirschhorn syndrome: a case study.

Sleeping problems are common among children with Wolf-Hirschhorn syndrome. Extinction may be effective if sleeping problems have been shaped and are positively reinforced by parental attention. The present study shows that extinction was effective in the treatment of severe sleeping problems in a six-year old girl with Wolf-Hirschhorn syndrome. Effects were maintained during follow-up.

Abnormalities, Multiple↗

PubMed2002

Bright light therapy for sleep problems in adults aged 60+.

BACKGROUND: The prevalence of sleep problems in adulthood increases with age. While not all sleep changes are pathological in later life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life, significant stresses for carers and increased healthcare costs. The most common treatment for sleep disorders (particularly insomnia) is pharmacological. The efficacy of non-drug interventions has been suggested to be slower than pharmacological methods, but with no risk of drug-related tolerance or dependency. Bright light treatment involves participants sitting in front of a "light box" which emits very high (typically 10,000 lux) fluorescent light for periods of around two hours daily. The timing of this light treatment will depend on the irregular timing of the participant's sleep pattern. OBJECTIVES: To assess the efficacy of bright light therapy in improving sleep quality (sleep timing in particular) amongst adults aged 60 and above. SEARCH STRATEGY: The following databases were searched: MEDLINE (1966 - January 2001); EMBASE (1980 - January 2001), CINAHL ( 1982 - January 2001; PsychINFO 1970 to 2001; The Cochrane Library (Issue 1, 2001); National Research Register (NRR [2001]). Bibliographies of existing reviews in the area, as well as of all trial reports obtained, were searched. Experts in the field were consulted. SELECTION CRITERIA: Randomised controlled trials of bright light therapy for primary sleep problems where 80% or more of participants were over 60. Participants must have been screened to exclude those with dementia and/or depression. DATA COLLECTION AND ANALYSIS: Abstracts of studies identified in searches of electronic databases were read and assessed to determine whether they might meet the inclusion criteria. MAIN RESULTS: Reviewers found no trials on which to base conclusions for the effectiveness of this treatment. REVIEWER'S CONCLUSIONS: When the possible side-effects of standard treatment (hypnotics) are considered, there is a reasonable argument to be made for clinical use of non-pharmacological treatments. In view of the promising results of bright light therapy in other populations with problems of sleep timing, further research into their effectiveness with older adults would seem justifiable.

Aged↗

PubMedDate not supplied

Sleep problems in pre-school children: a review of the literature.

This paper reviews the literature on sleep problems in pre-school children, aiming to raise awareness of the current knowledge in this field. The article begins with a discussion of the prevalence of sleep problems in young children. Disorders of initiating and maintaining sleep are by far the most common type of sleep problem in this age group, and are therefore the focus of this review. The effects of sleep disturbance are examined, focusing on how parents often feel desperate and in need of support outside the family. The causes of sleep problems are considered and the complexity in identifying causal factors is highlighted. The article continues with an exploration of the treatment of sleep problems, suggesting that much of the advice given to parents is contradictory. The literature demonstrates that the use of medication is common, but it appears that this method of treatment is of limited benefit. It seems that behaviour modification or a psychodynamic approach may be much more successful, and the use of self-help manuals/booklets has been shown to be useful by some authors. Finally, preventative strategies are discussed highlighting the need for further research in this area.

Behavior Therapy↗

PubMed2005

Subjective wellbeing and sleep problems: a bivariate twin study.

The relationship between subjective wellbeing (SWB) and self-reported sleep problems was investigated in a cohort of Norwegian twins aged 18 to 31 years. Questionnaire data from 8045 same- and opposite-sex twins were analyzed using structural equation modeling to explore the relative effects of genetic and environmental influences on phenotypic variance and covariance. Special attention was paid to sex-specific effects. The correlation between the phenotypes was estimated to be -.43. Univariate analyses indicated considerable genetic influences for both SWB and sleep problems, for male and female twins alike. The best fitting bivariate model specified additive genetic and individual environmental factors for both phenotypes, and nonadditive genetic effects for sleep problems, with no sex-specific effects. Genetic and environmental effects accounted for 60% and 40% of the phenotypic correlation, respectively. Additive genetic factors affecting the two phenotypes were correlated (-.85), suggesting that part of the genetic effects that positively influence SWB also protect against sleep problems. In conclusion, the results indicate considerable overlap in genetic etiology for SWB and sleep problems, for males and females alike.

Adolescent↗

PubMed1999

Sleep problems in children with attention-deficit/hyperactivity disorder: impact of subtype, comorbidity, and stimulant medication.

OBJECTIVE: To determine the relationship of sleep problems to attention-deficit/hyperactivity disorder (ADHD), diagnostic subtype, comorbid disorders, and the effects of stimulant treatment. METHOD: On the basis of clinical diagnostic interviews, children aged 6 to 12 years were assigned to 4 groups: unmedicated ADHD (n = 79), medicated ADHD (n = 22), clinical comparison (n = 35), and healthy nonclinical comparison (n = 36). These groups were compared on 2 sleep questionnaires completed by the parents that assessed current sleep problems and factors associated with sleep difficulties (i.e., sleep routines, sleep practices, child and family sleep history). RESULTS: Factor analysis revealed 3 sleep problem categories: dyssomnias, parasomnias, and sleep-related involuntary movements. Linear regression analyses showed that (1) dyssomnias were related to confounding factors (i.e., comorbid oppositional defiant disorder and stimulant medication) rather than ADHD; (2) parasomnias were similar in clinical and nonclinical children; and (3) the DSM-IV combined subtype of ADHD was associated with sleep-related involuntary movements. However, sleep-related involuntary movements were more highly associated with separation anxiety. CONCLUSIONS: The results suggest that the relationship between sleep problems and ADHD is complex and depends on the type of sleep problem assessed as well as confounding factors such as comorbid clinical disorders and treatment with stimulant medication.

Attention Deficit Disorder with Hyperactivity↗