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Maternal, environmental, and temperamental characteristics of toddlers with and toddlers without sleep problems.

Sleep problems of young children are a common behavioral concern of parents. Thirty parents of toddlers with sleep problems (SP) and 30 parents of toddlers without sleep problems (WSP) were studied to ascertain differences in maternal, environmental, and temperamental characteristics. The Sleep Behavior Inventory and The Toddler Temperament Scale provided data identifying certain environmental and temperamental characteristics that may influence the development and/or maintenance of sleep problems. Implications of these findings for anticipatory guidance and counseling are discussed.

Child Behavior Disorders

Sleep problems and sleep medication involvement of psychiatric patients.

Psychiatric patients received a computer interview that assessed 27 life problem areas. Within the sleep area, difficulty falling asleep was compared to awakening problems and appeared to be a more severe patient problem in terms of the large number of associated nonsleep problems. The patient's intensity of physical tension and degree of excessive solitary behavior were related to the problem of falling asleep. The major variables associated with awakening problems were pain and physical complications interfering with sleep. Patients with a strong sleep medication involvement were found to use multiple classes of drugs, to use a greater overall quantity of drugs, and to express various drug problems. A combination of physical tension, anxiety, and depression were predictive of patients' sleep medication involvement, whereas no one particular group of sleep problems indicated a significantly greater involvement than another group.

Adult

Are groups for parents of children with sleep problems effective?

Sleep groups are increasingly being used to support parents who have children with sleep problems. JANINA SZYNDLER and GEORGINA BELL present a model of sleep groups developed by clinical psychologists in Kingston and Esher and examine the effectiveness of this approach.

Child Behavior Disorders

Management of sleep problems in cancer patients.

Sleep disturbances are common in cancer patients, but there are few specific data on their prevalence. Among other things, sleep problems may be a symptom of the cancer itself, part of a stress reaction to having cancer, a sequela to some other cancer symptom such as pain, or a side effect of cancer treatment. Insomnia is the more common sleep problem, although hypersomnia also occurs. Most insomnias are related either to pain or to psychophysiologic factors. Treatment should start with identification of a specific cause of sleeplessness; after that, behavioral interventions, medication, or psychotherapy may be helpful. When using medications, keep in mind possible complications, such as daytime sedation, tolerance, and rebound insomnia.

Analgesics

Sleep problems in children with mental handicap.

This paper reports on a longitudinal study of sleep problems in 200 children with severe mental handicap. Sleep problems were extremely common: 51% of children had settling problems, 67% of children had waking problems, and 32% of parents said they rarely got enough sleep. Sleep problems were also very persistent: between a half and two-thirds of children who exhibited sleep problems at Time 1 still had them 3 years later. Sleep problems were associated with a number of child characteristics: poor communication skills, poor academic skills, poor self-help skills, incontinence, daytime behaviour problems and epilepsy. There were no relationships with family variables such as social class, income, family composition or housing tenure. However, maternal stress, maternal irritability and perceived impact on the family were related to sleep problems. A Sleep Index was constructed, and path analysis was used to trace the main causal pathways of the child, family and social characteristics. Ten variables explained 50% of the variance in the Sleep Problems Index. Communication skills played a pivotal role. The implications of the findings for intervention strategies are discussed.

Activities of Daily Living

Sleep problems in adolescence.

A sample of 943 adolescents from the general population were questioned about sleep problems. A quarter of the sample reported needing a lot more sleep than they previously had, and 10% of the sample complained of difficulty falling asleep. Adolescents reporting sleep problems showed more anxious, depressed, inattentive, and conduct disorder behaviors than those who had no (or only occasional) sleep problems. Sleep problems, particularly multiple problems, were associated with DSM-III disorder. There were no significant differences between male and female adolescents on any of the above measures. Finally, sleep problems were relatively persistent over time from ages 13 to 15.

Adolescent

Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis.

This research evaluated the relationship between pain and sleep problems, and the role of pain and sleep problems in depression, in a sample of 242 patients who had been diagnosed with definite or classical rheumatoid arthritis (RA). Patients completed the Pain scale of the Arthritis Impact Measurement Scales, the Center for Epidemiological Studies Depression Scale, and self-reports of sleep disturbance at two data waves over a 2-year interval. Cross-sectional multiple regression analysis revealed that the sleep problems variable was independently associated with depression at Time 1. Longitudinal multiple regression analyses demonstrated that prior pain predicted subsequent adverse changes in sleep problems, whereas sleep problems did not affect pain over time, and prior pain and the interaction of high pain and high sleep problems were independently associated with depression from Time 1 to Time 2. These data suggest that pain may exacerbate sleeping difficulty in RA patients, and that both factors may contribute to depression over time.

Adult

Sleep problems in healthy preadolescents.

Few data currently exist concerning the sleep problems of preadolescents. A parent report questionnaire concerning sleep habits and problems was developed. The questionnaires were completed by the parents of 1000 unscreened elementary school children attending the third, fourth, and fifth grades. The schools were randomly selected from an urban area. Of the 1000 questionnaires, 972 were completed and could be used for statistical analysis. Among the parents, 24% reported sleeping poorly and 12% regularly relied on sedatives to induce sleep. Sleep difficulties lasting more than 6 months were present in 43% of the children. In 14% (132 of 972), sleep latency was longer than 30 minutes, and more than one complete arousal occurred during the night at least two nights per week. The following variables were seen among the poor sleepers: lower parental educational and professional status, parents who were more likely to be divorced or separated, and more noise or light in the rooms were they slept. They also presented a higher incidence of somnambulism, somniloquia, and night fears (nightmares and night terrors) than the children who slept well. Boys who slept poorly were significantly more likely to have insomniac fathers (P less than .010). Regular use of sedatives was described in 4% (5 of 132) of the children who slept poorly. Among the "poor sleepers," 21% (33 of 132) had failed 1 or more years at school. School achievement difficulties were encountered significantly more often among the poor sleepers than among the children without sleep problems (P = .001). Of the families with children suffering from sleep problems, 28% expressed a desire for counseling.(ABSTRACT TRUNCATED AT 250 WORDS)

Belgium

[Sleep problems of the aging (author's transl)].

Sleep problems of the aging differ from adolescents clinicaly as well as in their EEG-pattern. They can be purely functional (exogenous or reactiv) however are frequently influenced by changes in the aging organism. Most common are cardio-vascular and pulmonary problems. The treatment of sleep disorders has to emphasize the improvement of these problems so that functional sleep difficulties can be treated successfully. It has to be recognized that elderly people can react paradoxically or overreact to all psychotropic agents including hypnotics.

Aged

Sleep problems and institutionalization of the elderly.

This study examined the role of sleep problems in the decisions of families to institutionalize elderly relatives. Previous work on institutionalization of the elderly has given little attention to the contribution of nocturnal, sleep-related problems. Seventy-three primary caregivers of elders recently admitted to a nursing home or psychiatric hospital were asked to identify the problems the elder was having during the night and day and rate the degree to which these influenced their decision to institutionalize the elder. Seventy percent of the caregivers in each sample cited nocturnal problems in their decision to institutionalize, often because their own sleep was disrupted. The most frequent disruptive nocturnal events were micturition, pain, and complaints of sleeplessness. Sleep problems of the elderly contribute heavily to the decision to institutionalize an elder and thus to the social and economic cost of institutional care. They appear to do this largely by interfering with the sleep of caregivers. The nature, prevalence, and treatability of the sleeping problems of both elders and their caregivers need further study.

Activities of Daily Living

The incidence of sleep problems among type A and type B college students: changes over a ten-year period (1982-1992).

Ten years ago we reported that Type A scoring students were twice as likely as their Type B peers to report sleep problems. In an exact 1992 replication of that study, no Type A-B differences in the frequency of self-reported sleep problems were observed; however, the over-all incidence of sleep problems among the 753 college students had increased substantially.

Humans

[Sleep problems and use of hypnotics in a nursing home. An inventory].

An inventory has been made on sleeping problems and the use of hypnotics in a nursing home. Contrary to general opinion, the results show that admission to a nursing home does not have to lead to an increase of hypnotics and neuroleptics used. One third of the total patient population revealed severe subjective sleeping problems, for which, however, a therapeutic intervention was not always necessary. In particular somatic revalidation patients showed high percentages of sleeping complaints and medical treatment. A communication hypothesis is presented as a possible explanation: somatic patients are able to ask for medication contrary to psychogeriatric patients, for whom the caregiving network often initiates therapeutic intervention. Attention is focussed on a few sleep disturbing stimuli that often occur in the setting of a nursing home. Prevention of these stimuli implicates changes in the nursing care organization.

Aged

Sleep patterns and sleep problems amongst people with mental handicap.

This paper is in two parts. The first part reviews the available literature describing sleep patterns of people with mental handicap and the nature and prevalence of sleep disorders amongst this client group. Both electroencephalographic studies and informant-based reports are included. The literature is small, particularly in terms of the latter reports, and most of the information from both E.E.G. and informant sources describes populations of children with mental handicap. The need for further investigation of sleep and sleep problems, particularly amongst adults with mental handicap, therefore, becomes evident. The second part presents the results of a detailed sleep survey of 120 adults with mental handicap, approximately half of whom were resident in hospital and half in the community. A descriptive summary of the total sample is provided. Fifteen per cent of the sample presented significant sleep problems, particularly in the form of intermittent wakenings. The results of comparisons between (1) good and poor sleepers (2) hospital and community residents and (3) people with mental handicap and 'normal' adults (using data from another study) are then presented. The relationships between sleep and daytime functioning and the potential usefulness of behavioural approaches to management of sleep pattern are discussed.

Adult

Cosleeping and sleep problems in Hispanic-American urban young children.

To assess whether the traditional pediatric prohibition against cosleeping in the parental bed requires reconsideration for urban ethnic minorities, cosleeping and sleep problems were studied in a sample of Hispanic-American, east Harlem, New York City, children 6 to 48 months of age. The incidence of frequent all-night cosleeping was found to be 21%, significantly higher than the documented rate of 6% found in a representative sample of white middle-American urban children of the same age and sex. For occasional cosleeping, however, there were no significant ethnic differences, and frequent part-night cosleeping was significantly less common than noted in the white sample. There were greater ethnic differences for sharing the parental bedroom compared with cosleeping in the parental bed, approximately 80% for Hispanic-Americans vs 10% for the white population. Within the Hispanic-American group, frequent all-night cosleeping was significantly more common among single parents and those living in multiple households and less common among infants and later-born children in the family. Frequent all-night cosleeping was also significantly associated with sleep problems.

Child, Preschool

A faded bedtime with response cost protocol for treatment of multiple sleep problems in children.

The sleep-wake cycles of 4 developmentally delayed individuals with longstanding severe sleep disturbances were regulated using a faded bedtime procedure with response cost. Bedtimes were systematically delayed for each individual, thus increasing the probability of short latency to sleep onset. The response cost component, consisting of removing the individual from bed for 1 hour, was implemented when an individual did not experience short latency to sleep onset. A fading procedure was then applied successfully to advance the bedtimes and to gradually increase durations of sleep. Specifically, all 4 individuals had decreased amounts of nighttime sleep that increased following treatment. Two of the 4 individuals showed excessive daytime sleep that decreased following treatment. Three of the 4 individuals experienced decreases in night wakings following treatment. Both environmental and biological manipulations of the sleep-wake cycle are hypothesized as mechanisms of treatment. The relative advantages of this procedure over other procedures for the treatment of pediatric sleep disorders are discussed, as are directions for future research.

Adolescent

Prevalent sleep problems in the aged.

Quality of sleep influences the level of daytime functioning, including stress levels, psychosomatic complaints, general health, and overall well-being. As people age, they complain more about disturbed sleep, insomnia, increased time in bed, and sleep fragmentation. These complaints can be related to circadian rhythm desynchronization, hypnotic or other medication use, chronic bedrest, napping, dementia, or to sleep apnea, a disorder of respiratory cessation which is quite prevalent in the elderly. We review here the results of 12 years of research on sleep in the elderly. In studies of three populations of elderly, it was found that between 24% and 42% had five or more apneas per hour of sleep and 4%-14% had 20 or more apneas per hour of sleep. Since apnea is related to dementia and even to mortality, this high prevalence of apnea is of extreme importance.

Aged

A different approach to sleep problems of infancy: swaddling above the waist.

Daytime sleep and wake periods of ten swaddled infants were periodically recorded by their mothers. The babies were swaddled above the waist for the first four days of the second, third and fourth months of life. During the next four days of the same months, the same infants were monitored with no swaddling. Comparison of the two sleep situations (swaddled and unswaddled) demonstrated that the increase in the total daytime sleep was statistically significant when the baby was loosely swaddled above the waist.

Circadian Rhythm

[Sleep problems and their treatment in psychosis (author's transl)].

Sleep disturbances in psychoses can mean hypo- as well as hypersomnia. In 90% of endogenous depressed patients sleep disturbances were seen, mostly as hyposomnia. In the group of schizophrenic psychotic patients only 30% had sleep disturbances. With polygraphical investigations in endogenous depressed patients a shortening of REM-latency and a disturbed sleep profile, in schizophrenic psychoses a shortened REM-rebound and a reduced amount of stages 3 and 4 were found. The treatment of choice for depressions are antidepressive drugs and sleep deprivation, for schizophrenic psychoses neuroleptic drugs. This treatments improved subjective and objective sleep disturbances with psychopathological remission at the same time. So far, only hypothetical considerations do exist about the relationship between psychopathology and sleep disturbances. It is suspected that etiological relations exist between depression and desynchronization of central sleep mechanisms and between schizophrenia and special disturbances of REM-sleep and stage 3 and 4.

Antidepressive Agents