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Summary: This study investigated how changing or maintaining parent‐set bedtimes over time relates to adolescents' sleep timing, latency, and duration. Adolescents (n = 2509; Mage = 12.6 [0.5] years; 47% m) self‐reported their sleep patterns, and whether they had parent‐set bedtimes on two separate occasions in 2019 (T1; 12.6 years) and 2020 (T2; 13.7 years). We identified four groups based on parent‐set bedtimes: (1) bedtime rules at both T1 and T2 (46%, n = 1155), (2) no bedtime rules at T1 nor T2 (26%, n = 656), (3) bedtime rules at T1 but not T2 (19%, n = 472), (4) no bedtime rules at T1 but a parent‐set bedtime at T2 (9%, n = 226). As expected, the entire sample showed that bedtimes generally became later and sleep duration shorter across adolescence, but the change differed among the groups. Adolescents whose parents introduced bedtime rules at T2 reported earlier bedtimes and longer sleep duration (~20 min) compared with adolescents with no bedtime rules at T2. Importantly, they no longer differed from adolescents who consistently had bedtimes across T1 and T2. There was no significant interaction for sleep latency, which declined at a similar rate for all groups. These results are the first to suggest that maintaining or re‐introducing a parent‐set bedtime may be possible and beneficial for adolescents' sleep. [ABSTRACT FROM AUTHOR]

This study explored the prospective associations between sleep patterns, mental health and registry-based school grades among older adolescents. In the spring of 2019, 1st year high-school students in Western Norway were invited to a survey assessing habitual sleep duration, insomnia, depression and anxiety. Sleep patterns, depression and anxiety were assessed using the Munich ChronoType Questionnaire, the Bergen Insomnia Scale, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7. Students consenting to data linkage with the county school authorities were re-invited 2 years later. Registry-based grade point averages for each of the included school years were accessed through the school authorities. The final longitudinal sample included 1092 students (65.1% girls; initial mean age 16.4 years). Data were analysed using linear mixed models. Longer school night sleep duration and less severe symptoms of insomnia, depression and anxiety were all associated with higher grade point averages at baseline in crude analyses. Shorter school night sleep duration, as well as more severe symptoms of insomnia and depression at baseline, all predicted better grade point averages at 2-year follow-up when controlled for baseline grade point averages. By contrast, anxiety symptomatology at baseline was unrelated to changes in grade point averages over time. The longitudinal associations between school night sleep duration and insomnia symptoms on grade point averages were significant also when adjusted for sex and baseline symptoms of depression and anxiety. These findings indicate that shorter school night sleep duration and more severe insomnia symptoms predict lower grade point averages development over time, irrespective of co-existing symptoms of depression and anxiety., (© 2024 The Author(s). Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Infant sleep problems have been associated with a myriad of adverse child and parent outcomes, yet whether these problems may pose a risk for parents on the road has received little research attention. This study sought to test whether mothers of infants with insomnia are at an elevated risk for vehicular crashes, by comparing their objectively measured driving performance with that of mothers of well-sleeping infants and with that of women without children. Fifty-four women from these three groups completed a simulated driving task. Outcome measures included standard deviation of lateral position, number of lane crossings, standard deviation of speed, average speed and maximum speed. Women additionally reported on their driving behaviour using the Driving Behaviour Questionnaire, and on sleep, sleepiness and insomnia symptoms using 7-day sleep diaries and questionnaires. Mothers of infants with insomnia demonstrated greater lane deviation (Wald = 9.53, p = 0.009), higher maximum speed (Wald = 6.10, p = 0.04) and poorer self-rated driving behaviour (Wald = 7.44, p = 0.02) compared with control groups. Analyses also indicated that driving performance in mothers of infants with insomnia tended to be poorer relative to control groups with the progression of time on task. While further research is needed to assess the scope of these effects, our findings suggest that parents, healthcare providers and policymakers should be aware of the potential consequences of infant sleep problems on road safety, and collaborate to establish strategies to mitigate these risks., (© 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Sleep restriction therapies likely drive improvement in insomnia in middle childhood via increases in homeostatic sleep pressure (e.g., evening sleepiness). Increased evening sleepiness may also dampen comorbid anxiety symptoms; and reduced wakefulness in bed may reduce worry. However, sleep restriction therapies have never been evaluated as a standalone intervention in this population. The mechanism of action needs testing, as do effects on anxiety, and cognitive performance and parasomnias (possible contraindications). This randomised controlled trial evaluated the efficacy of two "doses" of sleep restriction therapy (sleep restriction therapy, bedtime restriction therapy), compared to a control condition (time in bed regularisation). A total of 61 children (mean [SD, range] age 9.1 [2.1, 6-14] years; 54% female) with chronic insomnia disorder received two weekly 60-min treatment sessions with a psychologist. Sleep, sleepiness, anxiety, worry, cognitive performance, and parasomnias were measured pre-treatment, across treatment, and at 4-weeks post-treatment. Both the sleep and bedtime restriction groups experienced reductions in total sleep time (d = 1.38-2.27) and increases in evening sleepiness (d = 1.01-1.47) during the 2-week treatment, and improvements in insomnia (i.e., sleep onset latency; d = 1.10-1.21), relative to the control group. All groups reported improved anxiety and worry, yet there were no differences between the control and restriction groups (all p > 0.658). Time in bed increased at the 1-month follow-up, and benefits to sleep and insomnia were maintained. There were no adverse effects on cognitive functioning (all p > 0.259), nor parasomnia occurrence (all p > 0.740). These results suggest that sleep restriction therapies are brief, yet effective, standalone interventions for insomnia in middle childhood, and improvements are likely due to increased sleepiness, not sleep regularisation., (© 2022 European Sleep Research Society.)

Circadian dysregulation and depressed mood commonly co-occur in young people, yet mechanisms linking Delayed Sleep-Wake Phase disorder (DSWPD) with depression are poorly understood. The present study aimed to examine the role of repetitive negative thinking (RNT), by comparing sleep, RNT and depressive symptomology between 40 'good' sleeping young people and 63 with DSWPD, with (n = 30) and without (n = 33) self-reported doctor-diagnosed depression. Secondary analysis from a randomised controlled trial was also undertaken to observe changes in depressive symptoms and RNT as a result of treatment for DSWPD. The 60 young people with DSWPD (mean [SD] age of 15.9 [2.2] years, 63% female) received either short (green) or long (red) wavelength bright light therapy (BLT) over 3 weeks. Cross-sectional baseline comparisons revealed an escalating pattern of worse sleep, more RNT and higher depressed mood scores in the DSWPD young people compared to good sleepers. Across all participants, RNT accounted for the associations between sleep-onset difficulties and depressed mood at baseline. Symptoms of depression, RNT and sleep onset difficulties in DSWPD individuals significantly improved after treatment (d = 0.47-0.65) and at the 1- (d = 0.43-1.00) and 3-month follow-up (d = 0.39-1.38), yet there were no differences between short- and long-wavelength BLT. Results provide preliminary evidence that RNT may link delayed sleep phase with depression. BLT conferred sleep benefits, but also improvements in depressed mood and RNT, and thus represents a potentially cost-effective strategy for young people experiencing delayed sleep phase and low mood., (© 2021 European Sleep Research Society.)

The aim of the present study was to describe sleep patterns in a large and representative sample of Norwegian adolescents. The sample included 4,010 first-year high school students, aged 16-17 years (54% female), who completed a web-based survey on sleep patterns. The process of going to sleep was addressed as a two-step sequence of (a) shuteye latency (interval from bedtime to shuteye time) and (b) sleep onset latency (interval from shuteye time to sleep onset). Results showed that 84.8% of the adolescents failed to obtain the recommended amount of sleep (8+ h) on schooldays, and 49.4% obtained less than 7 h. Mean bedtime on schooldays was 10:33 PM, with rise time 8:19 h later (time in bed). The adolescents reported long school-day shuteye latency (43 min), limiting sleep opportunity to 7:36 h. Sleep onset latency was 32 min and mean school-day sleep duration was only 6:43 h. On free days, 26.3% of the adolescents obtained less than 8 h of sleep, and 11.7% obtained less than 7 h. Mean bedtime was 00:33 AM, time in bed was 10:35 h, shuteye latency was 39 min and sleep onset latency was 24 min. Mean free-day sleep duration was 8:38 h. There were sex differences in several sleep parameters, including shuteye latency. The results indicate that the majority of Norwegian adolescents fail to obtain the recommended amount of sleep (8+ h) on schooldays. Long shuteye latency appears to be a main driver for short school-day sleep duration in adolescents., (© 2020 European Sleep Research Society.)

Difficult early morning awakening is one of the defining symptoms of delayed sleep-wake phase disorder. It is accompanied by low cognitive arousal and drowsiness resulting in difficulty concentrating and focusing attention upon awakening. We designed the current study to quantitate cognitive performance (i.e. omissions, commissions, reaction time [average and variability]) and cognitive domains (i.e. focused attention, sustained attention, impulsivity and vigilance) with Conners' Continuous Performance Test II during both habitual and conventional (00:00-07:00 hr) sleep-wake schedule in young adult patients with delayed sleep-wake phase disorder (n = 20, mean age = 24.8 years, SD = 3.0) and controls (n = 16, mean age = 24.4 years, SD = 3.4). Conners' Continuous Performance Test II was administered after awakening and in the afternoon during both habitual and conventional conditions. In-laboratory polysomnography was performed for 2 nights. We assessed sleep, tiredness, chronotype and depression using questionnaires. Saliva was sampled for dim light melatonin onset measurements. Repeated-measures ANOVAs were applied for the Conners' Continuous Performance Test II measures with group (patient/control), time (afternoon/morning) and condition (habitual/conventional schedule) as fixed factors. Patients with delayed sleep-wake phase disorder had reduced reaction times, especially in the morning, greater response speed variability, and made more omission and commission errors compared with controls. Patients with delayed sleep-wake phase disorder also had reduced focused attention, especially upon forced early awakening. The short total sleep time of patients with delayed sleep-wake phase disorder could not statistically explain this outcome. In conclusion, we observed a state-dependent reduced ability to focus attention upon early morning awakening in patients with delayed sleep-wake phase disorder. Patients also had more omissions, longer reaction time and increased RT variability after habitual sleep, suggesting a possible small cognitive trait dysfunction in delayed sleep-wake phase disorder., (© 2018 European Sleep Research Society.)

Evidence of night-to-night variation in adolescent sleep spindle characteristics is lacking. Twelve adolescents (M = 15.8 ± 0.8 years, eight males) participated in a laboratory study involving 9 nights with 10 hr sleep opportunity. Sleep electroencephalograph was analysed and intra-class coefficients calculated to determine the reliability of sleep spindles across multiple nights of recording. Slow spindle amplitude and fast spindle density, duration and amplitude characteristics all had acceptable reliability within a single night of sleep recording. Slow spindle density and duration measurements needed a minimum of 4 and 2 nights, respectively, for reliable estimation. Theoretical and methodological implications are discussed., (© 2018 European Sleep Research Society.)

Shuteye latency (SEL) refers to the time spent performing activities in bed before attempting sleep. This study investigates (a) the prevalence, duration and predictors of SEL, (b) its association with insomnia symptoms (sleep onset latency [SOL], sleep quality and fatigue), and (c) the activities engaged in during SEL. A representative sample of 584 adults (18-96 years old) participated in an online survey. Respondents reported their SEL on weekday nights (Sunday to Thursday) and weekend nights (Friday and Saturday), and activities during SEL. One in five adults tried to sleep immediately at bedtime. Around 16% of respondents were awake >30 min on both weekday and weekend nights. Younger people and those with an eveningness preference reported longer SEL. Longer SEL corresponded with a progressive decline in sleep quality, increased SOL and more fatigue. Those with an SEL >30 min reported using both passive (e.g. television) and interactive (e.g. smartphone) media more frequently than respondents with an SEL < 30 min, but there was no difference between the groups for non-screen-related activities. Implications of SEL for measurements commonly used in sleep research are discussed. Shuteye latency may be symptomatic of how a modern lifestyle puts increasing pressure on sleep, but may also reveal a previously undocumented behaviour associated with insomnia symptoms., (© 2018 European Sleep Research Society.)

Difficulties falling asleep are common among adolescents, especially during times of stress. Adolescents may thus benefit from brief techniques (15 min) that decrease pre-sleep cognitive-emotional arousal and sleep-onset latency. The present study used a 3 (intervention: mindfulness bodyscan mp3, constructive worry, control) by 3 (time: baseline, week 1, week 2) mixed-model design on a school-based sample of adolescents (N = 232; M age  = 15.9 ± 0.8 years, range = 14-18 years; 19% male), and a sub-sample of adolescents with prolonged sleep-onset latency (i.e. ≥30 min; N = 119; M age  = 16.9 ± 0.9 years; 21% male). It was expected that the 15-min pre-recorded breath-based mindfulness bodyscan, and constructive worry, would decrease sleep-onset latency and pre-sleep arousal similarly over time, relative to the control condition. A significant interaction was observed among adolescents with prolonged sleep-onset latency, who completed ≥3 days for at least 1 week (p = .001), where mindfulness decreased sleep-onset latency relative to constructive worry and the control. Neither technique changed pre-sleep worry or cognitive-emotional arousal, or associated daytime functioning (both the whole sample and sub-sample). A pre-recorded mp3 breath-based mindfulness bodyscan technique is a promising means by which adolescents with prolonged sleep-onset latency can decrease sleep-onset latency. This simple tool has potential for scalable dissemination by stakeholders (e.g. teachers), unqualified to treat adolescent sleep difficulties. Future studies are needed to determine whether benefits may extend to academic performance and mental health, if performed for a longer time period with increased compliance., (© 2018 European Sleep Research Society.)

The currently assumed aetiology for delayed sleep phase disorder (DSPD) is a delay of the circadian system. Clinicians have sought to use bright light therapy, exogenous melatonin or chronotherapy to correct the disorder. However, these treatments have achieved unreliable outcomes for DSPD patients and, as such, one suggestion has been that the disorder may be caused by a longer than normal circadian rhythm period length (i.e. tau). The present study investigated this premise using a 78-h ultradian, ultra-short sleep-wake cycle. This constant bedrest routine was used to simulate a series of 1-h long 'days' by alternating 20-min sleep opportunities and 40 min of enforced wakefulness. Thirteen participants were recruited for the study including, six people diagnosed with DSPD according to the International Classification of Sleep Disorders-2 [mean age = 22.0, standard deviation (SD) = 3.3] and seven good sleepers (mean age = 23.1, SD = 3.9) with normal sleep timing. The DSPD participants' core temperature rhythm tau (mean = 24 h 54 min, SD = 23 min) was significantly longer (t = -2.33, P = 0.04, Cohen's d = 1.91) than the good sleepers' (mean 24 h 29 min, SD = 16 min). The temperature rhythm of the DSPD participants delayed more rapidly (i.e. >25 min day(-1) ) than the good sleepers'. These findings provide an explanation for the difficulty that DSPD patients have in phase advancing to a more conventional sleep time and their frequent relapse following treatment. The outcomes of this study support a vigorous and continued application of chronobiological and behavioural therapies to entrain DSPD patients to their desired earlier sleep times., (© 2013 European Sleep Research Society.)

Video-gaming is an increasingly prevalent activity among children and adolescents that is known to influence several areas of emotional, cognitive and behavioural functioning. Currently there is insufficient experimental evidence about how extended video-game play may affect adolescents' sleep. The aim of this study was to investigate the short-term impact of adolescents' prolonged exposure to violent video-gaming on sleep. Seventeen male adolescents (mean age = 16 ± 1 years) with no current sleep difficulties played a novel, fast-paced, violent video-game (50 or 150 min) before their usual bedtime on two different testing nights in a sleep laboratory. Objective (polysomnography-measured sleep and heart rate) and subjective (single-night sleep diary) measures were obtained to assess the arousing effects of prolonged gaming. Compared with regular gaming, prolonged gaming produced decreases in objective sleep efficiency (by 7 ± 2%, falling below 85%) and total sleep time (by 27 ± 12 min) that was contributed by a near-moderate reduction in rapid eye movement sleep (Cohen's d = 0.48). Subjective sleep-onset latency significantly increased by 17 ± 8 min, and there was a moderate reduction in self-reported sleep quality after prolonged gaming (Cohen's d = 0.53). Heart rate did not differ significantly between video-gaming conditions during pre-sleep game-play or the sleep-onset phase. Results provide evidence that prolonged video-gaming may cause clinically significant disruption to adolescent sleep, even when sleep after video-gaming is initiated at normal bedtime. However, physiological arousal may not necessarily be the mechanism by which technology use affects sleep., (© 2012 European Sleep Research Society.)

Although adolescents often experience insufficient and/or poor sleep, sleep variables such as total sleep time do not account for individuals' sleep need and sleep debt and may therefore be an inadequate representation of adolescents' sleep problems and its daytime consequences. This problem can be overcome by using the Chronic Sleep Reduction Questionnaire (CSRQ), an assessment tool that measures symptoms of chronic sleep reduction and therefore accounting for sleep need and sleep debt. The present study aims at developing an English version of the CSRQ and assesses the reliability and validity of the Dutch and the English CSRQ version. The CSRQ was administered in large Dutch (n = 166, age = 15.2 ± 0.57 years, 28% male) and Australian (n = 236, age = 15.5 ± 0.99 years, 65% males) samples. Subjective sleep variables were measured with surveys and sleep diaries of five school nights. Additionally, sleep of the same five nights was monitored with actigraphy. Both CSRQ versions showed good psychometric properties concerning their reliability (Dutch: α = 0.85; English: α = 0.87) and validity as the same overall structure of the two CSRQ versions and significant correlations with subjective and objective sleep variables were found. School grades were related to chronic sleep reduction, whereas the relationship between grades and other sleep variables was weak or absent. These results highlight the idea that chronic sleep reduction may be a better indicator of adolescents' insufficient and/or poor sleep than other sleep variables such as total sleep time., (© 2012 European Sleep Research Society.)

The aim of this study was to assess the effectiveness of Intensive Sleep Retraining, a novel, short duration behavioural therapy in treating chronic primary insomnia. Seventeen consecutive volunteers from the general public (mean age = 39.1 years), meeting selection criteria for chronic primary insomnia participated in the treatment study. The study was performed as a case replication series. Assessment involved sleep diary, actigraph and questionnaire measures of sleep and daytime functioning for a period of 2 weeks prior to, immediately after, and 6 weeks following the treatment. Treatment involved a single night of sleep deprivation, facilitating short sleep latencies (mean: 6.9 min) to a series of 50 brief nap opportunities. Following treatment, Sleep Onset Latency significantly decreased by a mean of 30.5 min (SD = 28.3), Wake Time after Sleep Onset significantly decreased by a mean of 28 min (SD = 34.0), and Total Sleep Time significantly increased by 64.6 min (SD = 45.5). Significant improvements were also seen in the daytime functioning and psychological measures of fatigue and vigour, cognitive sleep anticipatory anxiety and self-efficacy for sleep. This brief therapy was effective in improving sleep and some daytime functioning and psychological questionnaire measures. These improvements were maintained up to 2 months following the treatment weekend. Further exploration of this brief therapy is needed, with larger, randomized, placebo-controlled trials over longer follow-up periods, and in comparison to other traditional therapies for insomnia.

A resurgence in the field of sleep initiation and thermoregulation has seen a number of investigators reporting relatively gradual increases in distal skin temperatures of the hands and feet prior to sleep onset at typical bedtimes. The present study extends upon prior knowledge by investigating whether: (1) this is a change of distal skin temperature triggered specifically by the attempt to fall asleep and (2) whether this relationship holds for various phases of the circadian rhythm whenever sleep is attempted. Fourteen healthy good sleepers participated in a modified 45-h constant routine (CR) with multiple sleep onset latency tests (MSLT) conducted every half hour. After a brief decrease of finger temperature associated with small postural adjustments at the beginning of each sleep latency test, finger temperature showed rapid (0.8 degrees C min-1) increases of 1-3 degrees C leading up to the onset of sleep. This rapid increase of finger temperature was relatively consistent across the 45-h CR, despite very significant circadian variation of the pre-MSLT baseline finger temperature and homeostatic decrease of sleep latency.