Can a parental sleep intervention in an individual setting improve the maternal and paternal sense of competence and parent-child interaction in parents of young sleep-disturbed children? findings from a single-arm pilot intervention study.

BACKGROUND: In early childhood sleep and regulatory problems, parental factors are often impaired but essential to overcoming them. This study aims to examine, in parents of young sleep-disturbed children, whether mothers' and fathers' sense of parenting competence were increased and dysfunctional parent-child interactions reduced with a parental sleep intervention, whether these changes were sustained over a 12-month follow-up period and if children's symptomatic parameters could be related factors. METHODS: A total of 57 families with sleep-disturbed children aged 6 months to 4 years entered this single-arm pilot study. Each parent pair participated in six weekly individual face-to-face sessions of a multimodal cognitive-behavioral sleep intervention. The Parenting Sense of Competence Scale, Parental Stress Index Short Form, Child's Sleep Diary and Child's Questionnaire on Crying, Eating and Sleeping were obtained pre-, post-, 3, 6 and 12 months after the intervention. RESULTS: Maternal sense of competence and dysfunctional mother-child interaction improved significantly up to 6 months after the intervention. Factors related to lower maternal competence were the child's more frequent nightly food intake and more crying due to defiance; factors related to dysfunctional mother-child interaction were more frequent crying episodes, more crying due to defiance and more eating difficulties; factors related to increased maternal competence were less duration of child's night waking, less bed-sharing and lower frequency of crying episodes; factors related to increased paternal competence were less child's nightly food intake and fewer episodes of unexplained and unsoothable crying; and factors related to improved father-child interaction were less frequent child's night waking and fewer unexplained and unsoothable crying episodes. CONCLUSION: For parents of sleep-disturbed young children, an intervention that addresses the child's sleep could be promising to increase the parental sense of competence and reduce dysfunctional parent-child interactions, especially for mothers. Child symptomatic parameters may change, together with the parental sense of competence and parent-child interaction of both parents, after the intervention. Mothers with children with more severe symptomatology perceive their parenting competence as lower on average and their mother-child interaction as more dysfunctional. Future research with a larger sample and a randomized controlled design is needed. TRIAL REGISTRATION: The study was retrospectively registered at the German Clinical Trials Register (ID: DRKS00028578; registration date: 21.03.2022).

A single-arm pilot study: can a parental sleep intervention for sleep-disturbed young children in individual settings improve children's sleep, crying, eating, and parental distress in mothers and fathers?

BACKGROUND: Early sleep problems co-occur with crying, eating problems, and parental distress. This study investigates the impact of a parent-focused intervention to improve child sleep with the following aims: (1) To assess the impact on child sleep (sleep onset latency, frequency and duration of nighttime awakenings, frequency of bed-sharing, and nighttime food intake, total nighttime sleep duration, and sleep efficiency), child crying (frequency of crying episodes, of unexplained and unsoothable crying and of crying out of defiance), child eating difficulties, and parental distress of mothers and fathers. (2) To assess the maintenance of any changes in these areas longitudinally, at 3-month, 6-month, and 12-month follow-ups. (3) To explore at the within-subjects level, how children's sleep, crying, eating, and parental distress changed together across all study measurement points. METHODS: In this single-arm pilot study, the parents of 60 children participated in six individual sessions of a parent-focused multimodal age-adjusted cognitive-behavioral intervention to improve child sleep. Parents of 39 children (46% girls, age in months M = 22.41, SD = 12.43) completed pre- and at least one measure after the intervention. Sleep diary, questionnaire for crying, feeding, sleeping, and parental stress index (short-form) were assessed pre, post, three, six, and 12 months after the intervention. RESULTS: Significantly, sleep (decreased sleep onset latency, frequency, duration of nighttime awakenings, bed-sharing, nighttime food intake; increased total nighttime sleep duration, sleep efficiency), crying (reduced frequency of crying episodes, unexplained and unsoothable crying), and parental distress (reduced) changed, which remained partially stable over follow-up. The frequency of crying episodes decreased with fewer nighttime awakenings; morning crying with increased nighttime feeding; unexplained and unsoothable crying with higher sleep efficiency; crying due to defiance with more nighttime awakenings, sleep efficiency, and bed-sharing. Eating problems decreased with shorter night awakenings and time; maternal distress with fewer nighttime awakenings, paternal with less child's nighttime feeding, unexplained and unsoothable crying, and time. CONCLUSIONS: A parental sleep intervention for sleep-disturbed young children could be promising to reduce children's sleep problems, crying, eating problems and parental distress. Future studies should consider more personal contact during the follow-up to reduce the drop-out rate and a randomized-controlled design. TRIAL REGISTRATION: The study was retrospectively registered at the German Clinical Trials Register (ID: DRKS00028578, registration date: 21.03.2022).

Stress reactivity in salivary cortisol and electrocardiogram in adolescents: Investigating sleep disturbances and insomnia.

This study examined the role of sleep disturbances and insomnia in the context of stress reactivity in adolescence. One-hundred and thirty-five 11-18 year olds (Mage  = 14.2 years, SD = 1.9, 52% female) completed the Trier Social Stress Test for Children. Salivary cortisol and subjective stress ratings were collected at six time points, and heart rate as well as heart rate variability were measured pre-, during and post-stress induction. Additionally, sleep disturbances and insomnia diagnosis were assessed by a self-report questionnaire and a sleep interview. Robust mixed models investigated if adolescents with compared with adolescents without (a) sleep disturbances and (b) insomnia differ regarding cortisol, heart rate, heart rate variability and psychological stress reactivity considering gender effects. The results indicated that boys with high sleep disturbances showed higher cortisol activity compared with boys with low sleep disturbances, B = 0.88, p < 0.05. Moreover, in boys with insomnia, heart rate and alpha 1 significantly differ less than in boys without insomnia. These findings support the notion of sex differences regarding the association between poor sleep and increased activity of the hypothalamic-pituitary-adrenal axis, and a less adaptable autonomic nervous system in boys in response to an experimental social stress task.

Child Sleep Problems Affect Mothers and Fathers Differently: How Infant and Young Child Sleep Affects Paternal and Maternal Sleep Quality, Emotion Regulation, and Sleep-Related Cognitions.

PURPOSE: Problems in infant and young child sleep can represent a serious challenge to parental behavior of mother and father. However, most research about the effect of infant and young child sleep on parenting has focused on mothers. Therefore, the present study aimed to explore the perception and consequences of infant and young child sleep problems of both parents. PARTICIPANTS AND METHODS: Participants were recruited via random sampling at, eg, kindergartens in North Rhine Westphalia. The sample includes data of heterosexual German-speaking couples with children without any medical or psychopathological problems. For this study, parents were asked to complete the test battery with regard to their youngest child. As sampling was via the kindergarten, the range of child age was 4-68 months. A survey assessed data of parents (N=196, 46% female). The test battery contained the following questionnaires: Children Sleep Habits Questionnaire (CSHQ), Pittsburgh Sleep Quality Index (PSQI), Self-Report Measure for the Assessment of Emotion Regulation Skills (SEK-27), and a German version of the Infant Sleep Vignettes Interpretation Scale (ISVIS). For the outcome variables of parental sleep as well as for parental emotional competence, the statistical tests of ANOVA were used, and for parental sleep-related cognitions with the grouping variables of infant and young child sleep as well as parental gender, a MANOVA was used. According to the analysis of group differences, the age of the child was also included additional to the grouping variable of parental gender and children's sleep. RESULTS: Mothers and fathers in this sample were equally aware of their children's sleep problems and reported similar sleep quality and emotion regulation themselves (all p > 0.05). Mothers as well as fathers of children with sleep problems had lower parental sleep quality (F(1, 183) = 110.01, p < 0.001) and emotion regulation (F(1, 184) = 143.16, p < 0.001) compared to parents of children without sleep problems. In children under 26 months of age, the child's age seemed to have less negative impact on the father's sleep quality (F(1, 183) = 5.01, p < 0.001) and emotion regulation (F(1, 184) = 0.72, p < 0.05) than on the outcomes of the mother. With regard to sleep-related cognition, there were statistically significant effects of parental gender (F(2, 185) = 44.39, p < 0.001) and interaction effects of parental gender × child sleep problems observed (F(2, 185) = 31.91, p < 0.001). CONCLUSION: The conclusion from this survey refers to the role of the father. According to the results, an association between paternal emotional competence, sleep quality as well as their sleep-related cognitions and infants and toddlers sleep behavior could be assumed in addition to and independent of the results of mothers. We would highlight the urgent need of inclusion of fathers in infant and developmental sleep research. In the context of sleep intervention, both parents should be provided with ongoing support to improve their sleep quality and competence in emotion regulation.

Consequences of child maltreatment: A glimpse at stress and sleep.

The present study goal was to provide further information on the association of maltreatment experiences in childhood (CM) and impaired sleep taking the hyperarousal theory of insomnia and stress reaction into account. In all, 62 participants took part in the study. CM history (Childhood Trauma Questionnaire) and subjective sleep quality (Pittsburgh Sleep Quality Index) were assessed before study commencement. In addition, participants wore an actigraph for 6-7 consecutive nights and completed a sleep log during this time. After 3-4 days, the participants took part in a laboratory stress paradigm (Maastricht Acute Stress Test) with 29 participants in the experimental and 31 in the control condition. Saliva cortisol samples were taken before and after the experiment and heart rate variability was assessed. CM was positively correlated with impaired subjectively assessed sleep in adulthood. The stress manipulation led to heightened subjective and physiological stress. Although lower cortisol changes after and lower mean heart rate values during the stress induction were found in the CM group, the differences were not statistically significant. There was no observable sleep reactivity on the stress induction. Stress and CM appear to have long-term effects on subjective sleep. Acute social stress does not directly worsen sleep quality, neither in participants with nor without a history of CM. However, the association underlines the importance of prevention and intervention. When treating sleep impairments, potential CM experiences should be taken into account.

Sleep and stress in times of the COVID-19 pandemic: The role of personal resources.

There is still little research on the association between COVID-19-related stress and insufficient sleep. As distress is assumed to be high in these times, the role of personal resources becomes more important. The current study aimed to investigate the predictive role of COVID-19-related stress, positive affect, and self-care behavior for subjective sleep quality and sleep change measures since the outbreak of COVID-19 in Germany. A sample of 991 adults (M = 34.11 years; SD = 12.99) answered questionnaires during the first lockdown period in Germany and afterward (between April 1 and June 5, 2020). A higher stress level predicted lower sleep quality and more negative changes in overall sleep and pre-sleep arousal. Higher levels of positive affect and self-care predicted higher sleep quality and more positive changes in sleep. Analyses showed a moderation of positive affect on the association between stress and change in pre-sleep arousal. The improvement in personal resources, especially positive affect, in times of high stress seems relevant to overcome sleep problems. Future research should include objective measurements of sleep and longitudinal designs to uncover causal directions of effects.

How the Sleep of Couples Changes from Pregnancy to Three Months Postpartum.

BACKGROUND: Sleep disturbances are frequent during pregnancy and postpartum. However, detailed research of sleep in couples during pregnancy and postpartum is lacking. OBJECTIVE: Changes of sleep for primi- and multiparous pregnant women and their partners from late pregnancy to three months postpartum. The particular focus of this study is on sex differences in sleep, sleep problems, mutual sleep influence of couples, and the influences of parity and feeding methods on couples' sleep. MATERIALS AND METHODS: The sample included 69 pregnant couples in the last trimester of pregnancy (t1) and three months after birth (t2). Sleep was measured with sleep diary for both times of measurement. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep disturbances. Other variables as parity and infant feeding type were determined by questionnaire. Besides results for woman and men, also dyadic data are calculated. RESULTS: Over the time women had a worse sleep quality than men. They had a prolonged sleep onset latency, higher frequency and longer duration of night wakings than men. Sleep efficiency for women was prepartal 83.32% and postpartal 83.6% below the clinically cut-off value of 85%. For 56.52% of women at t1 and for 55.07% at t2 PSQI scores exceeded the clinically cut-off of 5. However, men suffered from a sleep loss after birth of their child, too. In pregnancy and postpartum men reported lower total sleep time at both times of measurement in comparison to women. For 30.43% of men at T1 and for 24.64% at T2 PSQI score exceeded the clinically cut-off of 5. Sleep efficiency for men was prepartal 90.96% and postpartal 90.69%. Results indicate predictive links between prepartal PSQI of couples to postpartal PSQI. Neither parity nor feeding method could explain variance in postpartal PSQI-score. CONCLUSION: This is one of the very rare studies incorporating dyadic data. Results show the need of diagnosing and treating existing sleep problems in pregnancy to prevent future sleep problems postpartum.

Modularized iCBT­I self-learn training for university staff-prevention and early intervention in the SARS-CoV-2 crisis: A pilot study.

Background: Insomnia is a widespread disease in adults and has a high prevalence rate. As sleep disturbances are a risk factor concerning mental and physical health, prevention and early intervention are necessary. Thus, the aim of this study was to implement a self-learning prevention and early intervention training for university staff members. We adapted an established cognitive behavioral therapy for insomnia (CBT-I) intervention as an online version for use during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) crisis. Methods: Development and adaptation procedure of the internet-based CBT­I (iCBT-I) prevention and early intervention training is described. Sessions and topics are shown in detail. The Online Sleep Prevention and Treatment Acceptance questionnaire (OSTA) and the Online Sleep Prevention and Treatment Feedback questionnaire (OSTF) were used to assess acceptance. Sleep problems of university staff members were assessed using the Pittsburgh Sleep Questionnaire (PSQI). Results: The online-adapted version consisted of seven modules. Contents of sessions and topics were implemented based on video clips. Drawings were added to information regarding sleep and sleep hygiene as well as addressing stress and cognitions. In all, 15 individuals participated in this pilot study. The new iCBT­I self-learning prevention training was well accepted. In addition, participants scored the online version as helpful based on the OSTA. Prior to online training, 89% of the participants reported impaired sleep quality or insomnia symptoms, and 56% had a PSQI score over 10. After training 78% of participants showed reduced sleep problems according to PSQI and 56% reached clinically significant enhancement. In addition, after training 44% were healthy sleepers. Discussion: This is the first iCBT­I prevention and early intervention training for university staff members. The training by participants was very well accepted and they scored the videos as very helpful. Sleep problems decreased after online training. However, further studies with larger samples and more sleep-related assessment strategies, e.g., actigraphy and sleep log, are necessary.

Online cognitive behavioral group therapy (iCBT-I) for insomnia for school children and their parents: Adaptation of an established treatment (KiSS training).

BACKGROUND: Due to the SARS-CoV­2 crisis, online adaptation of sleep trainings is necessary. As sleep disturbances in school children are common, prevention of chronification is essential. The aim of this study was to adapt an established age-oriented cognitive behavioral therapy for insomnia (CBT-I) group training for 5-10-year-old children with insomnia and their parents to an online version (group iCBT-I). METHODS: The adaptation procedure and structure of the iCBT­I are described. To assess acceptance the Online Sleep Treatment Acceptance questionnaire (OSTA) and the Online Sleep Treatment Feedback questionnaire (OSTF) were implemented. In addition, trainers filled in the Adherence and Feasibility Questionnaire for Online Sleep Treatment (AFOST). Sleep problems were assessed using a structured interview for sleep disorders in children and clinical interview, and the Children's Sleep Habit Questionnaire (CSHQ-DE). Emotional problems were evaluated with the Child Behavior Checklist (CBCL 4-18). RESULTS: This pilot study included 12 parents and 6 children fulfilling insomnia criteria prior to online training. The adapted online version consisted of three parental sessions, whereas child-oriented sessions were transferred into videoclips. The new group iCBT­I was well accepted by parents. Parents scored the online version as helpful and time saving based on the OSTA and trainers estimated the adapted version to be feasible and effective. According to AFOST, adherence was given. After training, 67% of children showed reduced sleep problems according to parental rating. CONCLUSION: Parental acceptance of a group iCBT­I for school children and their parents was very good and parents scored the videos for their children as very helpful. Trainers declared the adapted version to be feasible. A further study with a larger sample is necessary.

[Learning how to Sleep: Principles and Guidelines for Diagnostics and Treatment for Insomnia and Nightmares in Childhood and Adolescence]. / Schlafen kann man lernen: Leitlinienbasierte Diagnostik und Behandlung von Insomnien und Alpträumen im Kindes- und Jugendalter.

Learning how to Sleep: Principles and Guidelines for Diagnostics and Treatment for Insomnia and Nightmares in Childhood and Adolescence Impaired sleep, short sleep duration and sleep disorders appears also in early life. The most frequent sleep disorders are insomnia and nightmares. Risk of chronification is high and daytime impairments are extensively from emotion regulation problems, impaired performance, and aggression up to suicidality. Therefore, early diagnostic and treatment is necessary. As symptoms vary according to age, treatment should be strictly age-dependent. Various guideline-oriented and age-dependent treatments will be presented. Beyond, parents often have daytime impairments due to the child's sleep problem and therefore report an improvement of their own sleep after treatment. However, more studies are necessary and randomized controlled and age-oriented studies are necessary with inclusion of comorbid disorders or address sleep disorders in the context of mental disorders. In addition, efficacy of sleep treatment in mental disorders should be studied.

Aetiology and treatment of nightmare disorder: State of the art and future perspectives.

This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non-traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep-disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence-based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.

[Therapy of insomnia and nightmares in childhood and adolescence]. / Therapie von Insomnien und Albträumen im Kindes- und Jugendalter.

Therapy of insomnia and nightmares in childhood and adolescence Abstract. Sleep problems and sleep disorders have a high prevalence in childhood and adolescence. Normally, such conditions persist and often become chronic. Daytime impairments are widespread with concentration deficits, mental problems, and also a higher suicide risk. Therefore, early and effective interventions are necessary. As symptoms change with age, therapy should be adjusted accordingly. Various strategies for infants and toddlers, schoolchildren, and adolescents will be named. In addition, evidence of these therapy strategies will be shown. All in all, more randomized controlled studies addressing children and adolescents are needed. Furthermore, studies with children and adolescents suffering from comorbid disorders or mental disorders and sleep problems should be conducted.

Sleep better, feel better? Effects of a CBT-I and HT-I sleep training on mental health, quality of life and stress coping in university students: a randomized pilot controlled trial.

BACKGROUND: The SWIS sleep training for university students showed promising results regarding subjective and objective sleep parameters. As sleep disorders and impaired sleep quality are closely related to various aspects of mental health, the current study examines the effects of the SWIS sleep training on mental health in university students. METHODS: Fifty six university students (M = 25.84, SD = 5.06) participated in the study, 68% were women. Forty one were randomly assigned to the SWIS treatment (pre-post-follow-up), 15 to a Waiting List Control condition (WLC, pre-post). Besides sleep-related measures, the students completed four online questionnaires measuring mental health, quality of life and stress coping strategies. Effect sizes for the pre-post data were compared between the conditions, long-term effects were calculated with repeated measures ANOVA or Friedman ANOVA. Long-term clinical changes were analyzed with the Reliable Change Index (RCI). RESULTS: The pre-post comparisons between SWIS and WLC revealed lower depression scores in both conditions, a better physical state in the SWIS condition and less maladaptive stress coping strategies in the WLC students. The long-term results of SWIS provided significant improvements regarding the students' somatic complaints, reduced anxiety, an improved physical state and a better quality of life with moderate to large effect sizes. Most of the significant improvements occurred between pre- and follow-up measurement. These statistically significant results were also reflected in clinically significant changes from pre- to follow-up-test. CONCLUSIONS: SWIS and WLC condition both improved in two mental health variables immediately after the training. These findings may be explained by unspecific treatment expectation effects in the WLC. Interestingly, most mental health outcomes showed significant improvements after 3 months, but not immediately after the training. These positive long-term effects of the SWIS training on mental health indicate that the transfer of strategies might simply need more time to affect the students' mental health. TRIAL REGISTRATION: The current study was retrospectively registered at German Clinical Trials Register (ID: DRKS00014338 , registration date: 20.04.2018, enrolment of first participant: 14.04.2015).

Media consumption and sleep quality in early childhood: results from the Ulm SPATZ Health Study.

BACKGROUND: Media use is increasingly becoming common in preschoolers and starting before the age of three years. While several studies have documented the effects of screen time on sleep duration in this age group, investigations including sleep quality are scarce and mainly cross-sectional. Moreover, they are limited by investigating sleep across broader age ranges or in older preschoolers, which may blur early effects and the ideal time for intervention. METHODS: The current study analyzed data from the Ulm SPATZ Health Study, a birth cohort study in which 1006 live newborns were recruited from the general population shortly after delivery at the University Medical Center Ulm, Southern Germany, from April 2012 to May 2013. Longitudinal data on child sleep were parent reported on the Children's Sleep Habits Questionnaire (CSHQ) at ages two and three years. Child media consumption was assessed at three years of age with different questions on electronic media and books. Statistical analyses included Kruskal-Wallis tests and multivariable linear and logistic regression models. RESULTS: Electronic media consumption had a moderate prevalence and dose, and prevalence of never using books appeared to be high (39%). The preliminary results indicated strong statistically significant inverse cross-sectional associations between electronic media consumption and overall sleep quality and, using longitudinal data, with worsening indicators of bedtime resistance, sleep anxiety, and daytime sleepiness. CONCLUSIONS: This was the first larger-scale study to comprehensively investigate the effects of electronic media consumption and book reading on all CSHQ items in three-year-olds. Considering the risk of chronification, preventive efforts (eg, by effective sleep-oriented training programs) already seem necessary in early life.

Let's talk about sleep: a systematic review of psychological interventions to improve sleep in college students.

Sleep problems are a common occurrence in college students. Insomnia, nightmares and impaired sleep quality lead to several mental health issues, as well as impaired academic performance. Although different sleep programmes exist, a systematic overview comparing their effectiveness is still missing. This systematic review aims to provide an overview of psychological interventions to improve sleep in college students. Seven databases were searched from November to December 2016 (MEDLINE, EMBASE, PsycINFO, Cinahl, Cochrane Library, PubMed, OpenSigle). The search string included search terms from three different topics: sleep, intervention and college students. Outcome measures included subjective as well as objective measures and focused on sleep, sleep-related and mental health variables. Twenty-seven studies met the inclusion criteria. They were assigned to four intervention categories: (1) sleep hygiene, (2) cognitive-behavioural therapy (CBT), (3) relaxation, mindfulness and hypnotherapy and (4) other psychotherapeutic interventions. Fifteen studies were randomized controlled trials. While sleep hygiene interventions provided small to medium effects, the CBTs showed large effects. The variability of the effect sizes was especially large in the relaxation category, ranging from very small to very large effect sizes. Other psychotherapeutic interventions showed medium effects. CBT approaches provided the best effects for the improvement of different sleep variables in college students. Five studies included insomnia patients. The other three intervention categories also showed promising results with overall medium effects. In the future, CBT should be combined with relaxation techniques, mindfulness and hypnotherapy. Furthermore, the interventions should broaden their target group and include more sleep disorders.

Short- and Long-Term Effects of CBT-I in Groups for School-Age Children Suffering From Chronic Insomnia: The KiSS-Program.

OBJECTIVE/BACKGROUND: This intervention study evaluates the short- and long-term effects of cognitive behavior therapy for insomnia (CBT-I) in groups for school-age children and their parents, named the KiSS-program. CBT-I was implemented in three sessions for children and three sessions for parents. PARTICIPANTS AND METHODS: All in all, 112 children with chronic childhood insomnia were randomly assigned to a wait-list (WL) control or treatment condition. RESULTS: According to subjective measures as well as objective wrist actigraphy, children in the CBT-I condition reported greater improvements in sleep behavior immediately after the treatment compared to the WL group. Improvements in sleep behavior after CBT-I persisted over the 3-, 6-, and 12-month follow-up assessments. CONCLUSIONS: The present study is the first randomized controlled trial that provides evidence for the long-term effectiveness of CBT-I in treating school-age children with chronic insomnia.