The Zurich 3-step concept for the management of behavioral sleep disorders in children: a before-and-after study.

OBJECTIVES: Several strategies have been found to be effective for the treatment of childhood behavioral sleep disorders. One which has yet to be evaluated is the Zurich 3-step concept, which combines basic notions of the two-process model of sleep regulation (introducing a regular rhythm and adjusting bedtime to sleep need) with behavioral strategies. This uncontrolled before-and-after study describes our concept and its step-wise approach, assesses changes in sleep-wake variables and behavior problems, and also examines associations between changes in sleep-wake variables and behavior problems. METHODS: A total of 79 children with sleep problems (age range 6-47 months, 42% females) were included. Sleep problems were assessed by the Infant Sleep Questionnaire, sleep-wake variables by diary and actigraphy, and behavior problems of children ≥ 18 months by the Child Behavior Checklist. RESULTS: A significant decrease in nocturnal wake duration (Cohen's d = -0.34) and a significant increase in the duration of the longest continuous nocturnal sleep period (Cohen's d = 0.19) were found from before to after intervention (on average 2.7 months, SD 1.5). The variability for sleep onset and end time decreased, and actigraphically measured circadian rest-activity cycle measures improved. Parent-reported internalizing and total behavior problems also decreased (Cohen's d = 0.66). CONCLUSIONS: The findings of both objective and subjective assessment techniques suggest that the Zurich 3-step concept is effective. Thus, the intervention concept may be useful in clinical practice with sleep-disordered children.

[Sleep physiology and its relevance for the management of behavioral sleep disorders in children]. / Schlafphysiologie bei Kindern und deren Bedeutung für die Behandlung von nicht-organischen Schlafstörungen.

Sleep problems are among the most frequent behavioural issues during childhood. This article highlights some of the most important aspects of children's sleep physiology and presents a clinical approach for the management of behavioural sleep disorders in children. Our concept is based on developmental aspects of sleep physiology and also uses behavioural strategies for the parents and their child to handle maladaptive sleep behaviour.