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The physiological processes governing sleep regulation show maturational changes during adolescent development. To date, data are available to specify when delays in circadian timing occur; however, no longitudinal data exist to characterize the maturation of the accumulation of sleep pressure across the evening. The aim of this longitudinal study was to test whether this change in evening sleep propensity can be identified during early adolescence. Twenty pre-pubescent boys' (Mage = 10.3, SD = 0.4 years) evening sleep homeostats were assessed using a series of sleep latency tests every hour (7:30 p.m. to 3:30 a.m.) at 6-month intervals across four waves. While results revealed shorter sleep onset latencies with increasing wakefulness (p < .001), this effect was not moderated by study wave (p = .79). Evening sleep propensity thus appears to remain stable in boys during early adolescence. Future studies should expand upon these findings by using larger samples of girls as well as boys across an extended age range during the teenage years., Competing Interests: Declaration of competing interest None, (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

This study tested the efficacy of a 5 × 1.5 h/session, group-based, parent-focused, behavioural intervention (BI) targeting sleep problems in preschool children. Parents were randomised to either the BI (N = 62) or care as usual (CAU; N = 66) conditions. Outcomes included sleep, anxiety, behavioural problems, internalising and externalising symptoms, transition to school and academic achievement. Assessments were conducted at pre- and post-BI intervention (in the year prior to formal schooling), and then at follow-ups 1 and 2 in the first year of formal schooling. Relative to the CAU, the BI condition demonstrated significantly greater improvements in sleep, anxiety, behaviour problems and internalising and externalising symptoms from pre-to post-intervention. Improvements in sleep, anxiety, and internalising symptoms were maintained, while behaviour and externalising symptoms were further improved upon at school follow-up 2. For the BI group, improvements in sleep at post-intervention were found to mediate improvements in anxiety, internalising, and externalising symptoms, but not behaviour problems, at school follow-ups 1 and 2. There were no significant effects of condition on school transition or academic outcome measures. The results suggest that the BI is effective for sleep, anxiety, behaviour, internalising and externalising symptoms, but not for school transition or academic outcomes. ANZCTR NUMBER: ACTRN12618001161213., Competing Interests: Declaration of competing interest There are no conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Study Objectives: Infant sleep problems are one of the most common complaints of new parents. Research to date has demonstrated a relationship between low parental cry tolerance and infant sleep problems. The aim of this study was to explore whether three emotion regulation strategies could increase parental cry tolerance., Methods: This study utilised a quasi-experimental design. We recruited 83 females (Mage= 32, SD= 5.26) comprising 3 groups: mothers of good sleeping infants aged 6-24 months, mothers of poor sleeping infants aged 6-24 months, and good sleeping women aged 23-40 years without children. Participants were instructed to listen to crying audio segments and indicate when they felt the child needed to be tended to (measured in seconds). This crying audio was paired with one of three emotion-regulation strategies (i.e., music, gaming, reappraisal). Each participant completed all 4 cry conditions which were counterbalanced to control for order effects., Results: We found that all three strategies yielded significantly longer reaction times (indicating higher cry tolerance) compared to the control condition (p <.001). We also found that mothers of poor sleepers and good sleeping women benefitted from all three emotion regulation strategies compared to control (p <.001 and p= <.05, respectively). The cry tolerance of mothers of good sleepers, on the other hand, did not differ between the control condition and any of the strategies (all ps >.05)., Conclusions: This demonstrates that cry tolerance can be increased using emotion regulation strategies, such as distraction via music or gaming, and reappraisal. This has clinical implications for families implementing behavioural sleep interventions., Competing Interests: Declaration of competing interest All authors declare no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or non-for-profit sectors., (Copyright © 2023 Elsevier B.V. All rights reserved.)

This study investigated the associations between adolescent evening use of technology devices and apps, night time sleep, and daytime sleepiness. Participants were 711 adolescents aged 12-18 years old (46% Female, M age  = 15.1, SD = 1.2). Time spent using technology devices and apps in the hour before bed, and in bed before sleep onset, was self-reported. Participants additionally completed a questionnaire about their sleep on school nights and next day sleepiness. In the hour before bed, 30 min of phone use was associated with a 9-min delay in bedtimes. Thirty minutes spent using laptops, gaming consoles, and watching YouTube was associated with later lights out times of 9 min, ∼16 min and ∼11 min respectively, while watching TV was associated with a 9 min earlier lights out times. Using gaming consoles and watching YouTube were associated with greater odds of receiving insufficient sleep (≤7 h TST). In bed before sleep onset, 30 min spent using laptops, phones, iPad/tablets, and watching YouTube were linked with later lights out times of ∼7 min for phones and laptops, 9 min for iPad/tablets, and ∼13 min for YouTube. Watching Netflix was associated with greater daytime sleepiness. YouTube at this time point was associated with increased odds of sleeping ≤7 h on school nights. Adolescents are engaging with a wide range of technology devices and apps in the evenings. However, certain devices and apps (e.g., phones, laptops, gaming and YouTube) might lead to more negative sleep outcomes for adolescents on school nights compared to others., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: The COVID-19 pandemic has profoundly impacted families, yet studies on its effects on infants and their parents have thus far been sparse and based mostly on retrospective parent reporting. This study aimed to prospectively evaluate the impact of COVID-19 living conditions on infant and parent sleep, as well as infant screen exposure, parent daytime sleepiness, and parent depression levels, using multi-method assessment., Methods: Infant and parent data collected in 2020 were compared with a matched cohort collected in 2019. The total sample included 1518 US infants aged 1-18 months (M = 8.5, SD = 4.6; 54% boys). Auto-videosomnography metrics were obtained from the 14-day period prior to survey completion (number of analyzed nights: M = 12.11 SD = 2.66 in the 2019 cohort; and M = 11.91 SD = 2.41 in the 2020 cohort). Parents completed online questionnaires regarding their infant's sleep and screen exposure, as well as their own sleep quality, daytime sleepiness, and depression levels., Results: Compared to 2019, infants in 2020 slept ∼40 min more per night on average, as indicated by auto-videosomnography. Infants additionally had earlier sleep timing, and increased parent-reported sleep-onset latency and nocturnal wakefulness. Infant screen time rose by 18.3 min per day for older infants, but remained stable for younger infants. Parents reported lower daytime sleepiness and higher depression symptomology during 2020, whereas no change was apparent in their sleep quality ratings., Conclusions: Restricted living conditions during COVID-19 in the USA led to increased infant screen exposure and parental depression, but also to increased infant sleep duration and reduced parent sleepiness. Future research is needed to examine the mechanistic pathways through which COVID-19 impacted on infant and parent well-being., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Behavioural sleep interventions (eg, extinction-based methods) are among the most efficacious evidence-based techniques in the treatment of infant sleep problems. However, behavioural sleep interventions can be challenging for families to successfully implement. This review aims to summarise current research surrounding the potential barriers that arise when clinicians attempt to implement extinction-based methods with parents of infants. We provide a model that summarises 3 types of contextual-barriers; socio-cultural barriers, parent barriers, and infant barriers. Based on the current evidence, we propose that adopting a stepped care approach, planning ahead, increasing support, motivational interviewing, and/or emotional regulation may serve as useful tools for parents when implementing extinction-based methods. By considering these techniques, more families may receive the benefits of improved infant sleep., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Study Objectives: To investigate circadian typology in a large, representative sample of Norwegian adolescents, and its implications for sleep health., Methods: The sample included 3920 1 st year high school students aged 16-17 years. Respondents completed a web-based survey, including the short version of the Horne-Ostberg Morningness-Eveningness Questionnaire (rMEQ), the Munich Chronotype Questionnaire (MCTQ) and items on sleep-related behaviors (eg electronic media usage in bed, consumption of caffeinated beverages), sleep beliefs and daytime sleepiness. Data were analyzed using one-way ANOVAs and Chi-squared tests., Results: In all, 7.8% were categorized as morning, 52.3% as intermediate and 39.9% as evening types, respectively. Evening types had later sleep timing, longer sleep latency, more social jetlag and shorter school day sleep duration than morning types, with intermediate types displaying a sleep pattern between these two extremes. None of the circadian types met the minimum recommended amount of sleep on school nights (ie 8+ hours), and only morning types had a mean sleep duration of 7+ hours (7:19 h, nearly 1 h more than evening types who slept 6:20 h, p < 0.001). Evening types reported more use of electronic media in bed, more consumption of caffeinated beverages and more daytime sleepiness than the other circadian types. They were also less satisfied with their school day sleep duration and perceived it more difficult to change their sleep pattern., Conclusions: Results from this study suggest that eveningness represents a sleep health challenge for older adolescents., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: This study aimed to provide the first estimate of sleep knowledge, practices, and attitudes regarding paediatric sleep in Australian health professionals., Methods: 263 Australian health professionals (medical practitioners, nurses, psychologists, social workers, occupational therapists, pharmacists, dentists and sleep coaches) completed an anonymous survey., Results: Clients with sleep disorders were commonly encountered by health professionals, yet professionals reported little time spent on clinical training in sleep medicine at the undergraduate (∼1-5 hrs) or postgraduate (∼0.5-3.5 hrs) level. Health professionals reported seeking continuing professional development (CPD) in sleep (∼6+ hrs), and CPD had the most influence on health professionals' practice, relative to other sources of information. Over half of health professionals (∼56-58%) reported that they were not trained in sleep measurement (i.e., sleep diaries and questionnaires), or how to take a sleep history. On average, professionals answered less than half (44.5%) of paediatric sleep knowledge questions correctly (M = 13.35, SD = 6.03). Approximately one third of health professionals reported not routinely screening for sleep disorders in paediatric patients and many did not routinely recommend evidence based treatments. The impact and importance of paediatric sleep was well recognised, but sleep was considered less important than a healthy diet and exercise., Conclusions: Results from the current study highlight key knowledge gaps regarding paediatric sleep across a wide range of Australian health professions, and may inform future efforts to reform clinical sleep medicine training in Australia., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Delayed sleep-wake phase disorder (DSWPD) during adolescence has been linked to impaired health and poor functioning. However there is a dearth of knowledge about DSWPD in young adulthood. We seek to contribute knowledge on the prevalence and correlates of DSWPD in this age group., Methods: Data were drawn from a 2018 national survey of students in higher education in Norway (the SHoT-study). All 162,512 fulltime students in Norway were invited to participate and 50,054 students (69.1% women) aged 18-35 years were included (response rate = 30.8%). DSWPD was assessed by self-report, and was operationalized according to the criteria for DSWPD in the most recent edition of the International Classification of Sleep Disorders. Correlates of DSWPD were examined by validated self-report instruments covering a wide range of demographic and health domains., Results: The overall prevalence of DSWPD was 3.3%, and significantly higher in male (4.7%) than female (2.7%) students. DSWPD was associated with being single, having financial difficulties, having divorced parents, being overweight/obese, and physical inactivity. Students with DSWPD had more sleep problems during weekdays, and higher levels of somatic and mental health problems. Students with DSWPD also had an elevated risk of self-harm-related thoughts and behaviors as well as suicidality., Conclusion: DSWPD remains a significant problem among young adults, and the high symptom load across health domains indicates that suggests a need for existing evidence-based approaches to be scaled for college students who present with DSWPD., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Co-occurring insomnia and symptoms of depression, anxiety, and stress pose difficult diagnostic and treatment decisions for clinicians. Cognitive Behavioural Therapy for Insomnia (CBTi) is the recommended first-line insomnia treatment, however symptoms of depression, anxiety and stress may reduce the effectiveness of CBTi. We examined the effect of low, moderate, and severe symptoms of depression, anxiety, and stress on insomnia improvements during CBTi., Methods: We undertook a chart-review of 455 patients (67% Female, Age M = 51.7, SD = 15.6) attending an outpatient CBTi program. Sleep diaries and questionnaire measures of insomnia, depression, anxiety, and stress symptoms were completed at pre-treatment, post-treatment and three-month follow up. We examined 1) the effect of low, moderate, and severe symptoms of depression, anxiety, and stress before treatment on changes in sleep diary and questionnaire measures of insomnia during CBTi, and 2) changes in symptoms of depression, anxiety, and stress during CBTi., Results: Sleep diary and questionnaire measures of insomnia severity showed moderate-to-large improvements during CBTi (d = 0.5-2.7, all p ≤ 0.001), and were not moderated by levels of depression, anxiety or stress before treatment (all interactions p > 0.05). Symptoms of depression, anxiety, and stress improved by three-month follow-up (M improvement = 41-43%; CI = 28-54, Cohen's d = 0.4-0.7)., Conclusions: Symptoms of depression, anxiety, and stress do not impair the effectiveness of CBTi. Instead, CBTi was associated with moderate-to-large improvement of depression, anxiety, and stress symptoms in patients with insomnia disorder. Clinicians should refer patients with insomnia for CBTi even in the presence of comorbid symptoms of depression, anxiety, and stress., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Development induces changes in sleep, and its duration has been reported to change as a function of aging. Additionally, sleep timing is a marker of pubertal maturation, where during adolescence, the circadian rhythm shifts later. Typically, this is manifested in a later sleep onset in the evening and later awakening in the morning. These changes across development seem to be universal around the world but are unlikely to persist into adulthood., Methods: This study utilized accelerometer data from 17,355 participants aged 16-30 years (56% female) measured by validated Polar wearables over a 14-day period. We compared sleep duration, chronotype (sleep midpoint) and weekend catch-up (ie, social jetlag) sleep across ages and regions over 242,948 nights., Results: The data indicate a decline in sleep duration as well as a dramatic shift in sleep onset times throughout adolescence. This continues well into early adulthood and stabilizes nearer age 30. Differences in sleep duration across ages were significant, and ranged from 7:53 h at age 16 to 7:29 h at age 30 in the sample. Additionally, there was a clear difference between females and males throughout adolescence and young adulthood: girls had longer sleep duration and earlier timed sleep in the current study. Differences in sleep were found between regions across the world, and across European areas., Conclusions: Both sleep duration and sleep timing go through a clear developmental pattern, particularly in early adulthood. Females had an earlier sleep midpoint and obtained more sleep. Regional differences in sleep occurred across the world., (Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.)

Objective: To determine whether the main reason for bedtime is associated with sleep and adaptive functioning in adolescents., Methods: Participants were 1374 adolescents (X age = 16.8 years, SD = 0.58; 33.6% male) from Helsinki, Finland. Adolescents completed a questionnaire battery including the Munich Chronotype Questionnaire, Strengths and Difficulties Questionnaire, Beck Depression Inventory, and items drawn from the School Sleep Habits Survey, and the Pittsburgh Sleep Quality Index., Results: On school nights, adolescents whose parents set their bedtime, and those who went to bed when they were tired went to bed earlier, obtained more sleep and had earlier midpoint of sleep than adolescents who went to bed when they have finished messaging/socializing or when their television show had finished. Adolescents who went to bed when they had finished their homework had sleep that fell in between these groups. On weekends, adolescents whose parents set their bedtime went to bed earlier and had an earlier midpoint of sleep. However, there were no differences between groups in terms of sleep duration once the need to rise for school in the morning was removed. Adolescents who went to bed on school nights when they were tired or once their homework was finished had better adaptive functioning., Conclusions: These results provide support for two very different approaches to help optimize the sleep of adolescents: either by implementing parental regulation of bedtimes across adolescence, or by encouraging adolescents to use their bodily cues to indicate when it is time for bed, rather than relying on an external cue., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: Recent evidence indicates that adolescents' motivation to change sleep-wake patterns is low, despite significant impact of adolescent sleep problems on many areas of daytime functioning. The aim of the present study is to evaluate components of adolescents' motivation, and subsequent changes in behaviour., Methods: Fifty-six adolescents, aged 13-23 (M = 15.8 ± 2.3 y; 38% m) diagnosed with Delayed Sleep-Wake Phase Disorder (DSWPD) underwent three therapy sessions involving bright light therapy to phase advance sleep patterns. Adolescents were instructed to advance wake-up times by 30-min daily. Motivation ratings of desire, ability, reason, need and commitment to change sleep patterns were taken at baseline. Sleep diaries were taken at the end of treatment session 1, with sequentially earlier wake-up times in 30-min intervals indicating compliance., Results: At the outset of therapy, adolescents indicated strong desire, reasons and need, yet moderate ability and commitment to advance their sleep-wake patterns. Following therapy, sleep-onset times were significantly advanced, total sleep time increased and sleep latency decreased (all p < 0.05). Therapy lasted 6-27 days (M = 13.9 ± 4.5) and clients complied for approximately half the time (between 3 and 15 days; M = 8.8 ± 2.7). Commitment was associated with ability (r = 0.66, p < 0.001) but not desire, reason or need (all p > 0.05). Adolescents' desire to change (r = 0.30, p = 0.03) and commitment (r = 0.30, p = 0.03) were positively correlated with behaviour change, but their need, ability and reasons were not. A mediation analysis showed that ability and desire were important in predicting behaviour change, by total effects through commitment (ie, indirectly and directly)., Conclusion: Our findings suggest that the total effects of ability (ie, confidence) and desire to change are the best predictors of behavioural changes, thus clinicians should focus on these components of the readiness to change model when undertaking treatments with sleep-disordered adolescents., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The tendency for adolescents to have restricted sleep has been examined in numerous studies; however, the impact of sleep restriction on adolescents' neural activity during sleep (measured by electroencephalography (EEG)) is less extensively researched, particularly regarding sleep spindles., Methods: In this experimental study, 34 adolescents attended a 10-day laboratory study where they received five consecutive nights of either 5 h, 7.5 h or 10 h of sleep opportunity, with one adaptation, one baseline and two recovery nights of 10 h of sleep opportunity before and after the experimental phase., Results: Both within- and between-subjects effects were observed for fast sleep spindle characteristics of density, duration and amplitude. Overall, when experiencing severe sleep restriction, fast spindles in adolescents were lower in amplitude and longer in duration. Sex differences were also seen for fast spindle amplitude., Conclusions: This investigation adds to the knowledge in this field by investigating specific sleep spindle characteristics in the context of experimentally manipulated sleep. Sleep restriction is highly prevalent among adolescents. These findings indicate that chronic sleep restriction has an impact on brain activity related to sleep spindles., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Study Objectives: To examine the relationship between pre-sleep cognitions and sleep-onset difficulties in an adolescent sample., Methods: Participants comprised 385 students (59% male) from grades 9 to 11, aged between 13 and 18 years (M = 15.6, SD = 1.0), from eight co-educational high schools of varied socio-economic status in metropolitan Adelaide, South Australia. The cross-sectional study used a questionnaire battery including the Sleep Anticipatory Anxiety Questionnaire -Adolescent Version (SAAQ-A), completed during school time, followed by eight days of sleep diary completion and wearing wrist actigraphy to obtain subjective and objective sleep onset latency (SOL)., Results: Significant relationships were found between somatic arousal (SAAQ-A subscale) and objective SOL and also between sleep-related cognitions (SAAQ-A subscale) and subjective SOL and SOL overestimation (sleep misperception). No relationships were found between subjective SOL and somatic or rehearsal and planning cognitions. Objective SOL was not related to rehearsal and planning and to sleep-related cognition scores, and sleep misperception had no relationship with somatic as well as rehearsal and planning cognition scores., Conclusions: These findings are not only similar to those in clinical adult populations but also notably different, for example, the lack of association between negative sleep-related pre-sleep cognitions and objective sleep difficulty. The results of this study provide a basis for a more detailed causal study on the existing relationships between negative pre-sleep cognitions and subjective and objective sleep difficulties in this population., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Study Objectives: To evaluate the efficacy of bedtime fading to reduce sleep disturbances in preschool aged children by using a group parent education format., Design: A repeated-measures design (pretreatment, treatment, post-treatment and two year follow-up)., Setting: Flinders University Child and Adolescent Sleep Clinic, Adelaide, South Australia., Participants: Participants comprised 21 children (M age = 3.0 ± 0.80 years, range = 1.5-4.0 years; 60% girls) identified as having difficulty initiating sleep, night waking, or a combination of both, and their mothers (M age = 36.1 ± 4.2 years)., Interventions: Mothers attended two group sessions that included basic sleep education (sleep needs, sleep architecture, and sleep homeostasis) and bedtime fading instruction., Measurements and Results: Primary outcome variables were sleep onset latency (SOL), wake after sleep onset (WASO), and bedtime tantrums, and these variables were measured using two week maternal report sleep diaries. Immediate improvements were observed over pretreatment to treatment in average SOL per night (M = 23.2 ± 11.3 min vs. M = 13.0 ± 7.3 min, d = 0.91), average WASO per night (M = 32.4 ± 23.1 min vs. M = 24.0 ± 18.3 min, d = 0.41), and number of bedtime tantrums per week (M = 1.7 ± 3.0 vs. M = 0.4 ± 0.7, d = 0.43). Treatment gains were maintained at two year follow-up. Mothers rated bedtime fading high in terms of usefulness and satisfaction, and they reported that could successfully reimplement the treatment when needed., Conclusions: Bedtime fading is a brief and promising intervention for pre-schoolers' sleep difficulties. This simple intervention can be easily implemented by parents at home with little instructions, resulting in improvements in sleep and bedtime tantrums., (Copyright © 2018 Elsevier B.V. All rights reserved.)

A randomised controlled trial evaluated bright light therapy and morning activity for the treatment of Delayed Sleep-Wake Phase Disorder (DSWPD) in young people. 60 adolescents and young adults (range = 13-24 years, mean = 15.9 ± 2.2 y, 63% f) diagnosed with DSWPD were randomised to receive three weeks of post-awakening Green Bright Light Therapy (∼507 nm) and Sedentary Activity (sitting, watching TV), Green Bright Light Therapy and Morning Activity (standing, playing motion-sensing videogame), Red Light Therapy (∼643 nm) and Sedentary Activity or Red Light Therapy and Morning Activity. Sleep (ie sleep onset time, wake up time, sleep onset latency, total sleep time) and daytime functioning (ie morning alertness, daytime sleepiness, fatigue, functional impairment) were measured pre-treatment, post-treatment and at one and three month follow-up. Contrary to predictions, there were no significant differences in outcomes between treatment groups; and interaction effects between treatment group and time for all outcome variables were not statistically significant. However, adolescents and young adults in morning activity conditions did not meaningfully increase their objective activity (ie movement frequency). Overall, adolescents reported significantly improved sleep timing (d = 0.30-0.46), sleep onset latency (d = 0.32) and daytime functioning (d = 0.45-0.87) post-treatment. Improvements in sleep timing (d = 0.53-0.61), sleep onset latency (d = 0.57), total sleep time (d = 0.51), and daytime functioning (d = 0.52-1.02) were maintained, or improved upon, at the three month follow-up. However, relapse of symptomology was common and 38% of adolescents and young adults requested further treatment in addition to the three weeks of light therapy. Although there is convincing evidence for the short-term efficacy of chronobiological treatments for DSWPD, long-term treatment outcomes can be improved. To address this gap in our current knowledge, avenues for future research are discussed., Clinical Trial: Australian & New Zealand Clinical Trials Registry, https://www.anzctr.org.au, ACTRN12614000308695., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Sleep restriction therapy (SRT) is a largely untested single treatment component of cognitive-behaviour therapy for insomnia. To date, the evidence for contraindications for SRT is limited to very few studies. The present study investigated the objective and subjective daytime consequences during the acute phase of SRT for adults diagnosed with Chronic Insomnia Disorder., Methods: Sixteen adults (age = 36.3 ± 13.4 yrs, 12 females, 4 males) underwent SRT for their insomnia over a two week period based on recommendations by Miller and colleagues (2014) [6]. Participants completed sleep diaries, self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]), as well as objective measures of reaction time/inhibition (Go/NoGo task) and driving performance (AusEd driving simulator) at pre-, mid- (ie, after one week of SRT) and post-SRT (after two weeks of SRT)., Results: Sleep diary outcomes indicated participants complied with the restriction of time in bed, and that a similar amount of total sleep time (TST) was maintained from pre-to-post-treatment. There was no significant change in daytime sleepiness, and similarly no significant changes observed in objective performance on the Go/NoGo task and AusEd driving simulator., Conclusions: These preliminary results suggest SRT during the acute phase does not appear to place insomnia patients at risk of significant impairments in sleepiness and reaction times. We note these findings can only be translated into clinical practice when sleep duration remains relatively unchanged. Future studies using objective measures of sleep and a control group are recommended., (Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.)

Aims: Comorbid insomnia and obstructive sleep apnea (OSA) represents a highly prevalent and debilitating condition; however, physicians and researchers are still uncertain about the most effective treatment approach. Several research groups have suggested that these patients should initially receive treatment for their insomnia before the sleep apnea is targeted. The current study aims to determine whether Cognitive and Behavioral Therapy for Insomnia (CBT-i) can effectively treat insomnia in patients with comorbid OSA and whether its effectiveness is impaired by the presence of OSA., Methods: A retrospective chart review was conducted to examine 455 insomnia patients entering a CBT-i treatment program in a hospital out-patient setting. Three hundred and fourteen patients were diagnosed with insomnia alone and 141 with insomnia and comorbid OSA. Improvements in average sleep diary parameters, global insomnia severity, and several daytime functioning questionnaires from baseline, to post-treatment, to 3-month follow-up were compared between insomnia patients with and without comorbid OSA., Results: Insomnia patients with comorbid OSA experienced significant improvements in insomnia symptoms, global insomnia severity, and other daytime functioning measures during and following treatment. Furthermore, improvements were no different between patients with or without comorbid OSA. Sleep apnea presence and severity were not related to rates of insomnia-remission or treatment-resistance following treatment., Conclusions: CBT-i is an effective treatment in the presence of comorbid OSA. This information offers support for the suggestion that patients with comorbid insomnia and OSA should be treated with CBT-i prior to the treatment of the OSA., (Copyright © 2017 Elsevier B.V. All rights reserved.)

A relationship between evening technology use and sleep has been established, and models suggest various mechanisms to explain this relationship. Recent updates to these models also suggest the influence of individual difference factors, such that the relationship between technology and sleep varies between young people. Flow is an experience of immersion and time distortion that could vary between adolescents when using technology. The aim of the present study was to investigate the effects of flow on the self-selected bedtimes of adolescents when videogaming. Seventeen older adolescent, experienced videogamers (age = 15.9 ± 0.83 years), played a new videogame on two school-night evenings in a sleep laboratory. Game difficulty was set to "hard" one evening (flow condition) and "easy" on the other evening (disrupted flow). Trait and state flow were measured, along with heart rate during videogaming, and bedtime measured objectively with real-time cameras. An interaction effect for heart rate indicated an elevated heart rate in the easy condition after 150 min of gaming (p < 0.02). No significant differences were found in bedtimes between the easy and hard conditions (p = 0.77). Adolescents high on trait flow played for longer and selected significantly later bedtimes than their low trait flow peers but only for the hard (flow) condition (12:22 AM vs. 10:53 PM, p = 0.004). Similarly, adolescents with high state flow went to bed significantly later than those low on state flow (12:24 PM vs. 10:52 PM, p = 0.001), again only in the hard condition. These findings suggest that individual and situational characteristics may amplify the effects of technology use on the "sleep" of adolescents and provides support for the displacement of bedtime hypothesis., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Study Objectives: Variation in day length is proposed to impact sleep, yet it is unknown whether this is above the influence of behavioural factors. Day length, sleep hygiene, and parent-set bedtime were simultaneously explored, to investigate the relative importance of each on adolescents' sleep., Methods: An online survey was distributed in four countries at varying latitudes/longitudes (Australia, The Netherlands, Canada, Norway)., Results: Overall, 711 (242 male; age M = 15.7 ± 1.6, range = 12-19 yrs) adolescents contributed data. Hierarchical regression analyses showed good sleep hygiene was associated with earlier bedtime, shorter sleep latency, and longer sleep (β = -0.34; -0.30; 0.32, p < 0.05, respectively). Shorter day length predicted later bedtime (β = 0.11, p = 0.009), decreased sleep latency (β = -0.21, p < 0.001), and total sleep (β = -0.14, p = 0.001). Longer day length predicted earlier bedtimes (β = -0.11, p = 0.004), and longer sleep (β = 0.10, p = 0.011)., Conclusions: Sleep hygiene had the most clinical relevance for improving sleep, thus should be considered when implementing adolescent sleep interventions, particularly as small negative effects of shorter day length may be minimised through sleep hygiene techniques., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Study Objectives: To clinically validate the Flinders Fatigue Scale (FFS) as a brief measure of daytime fatigue, and to derive cut-off scores to classify fatigue severity., Method: The FFS was administered to 439 adult volunteers from the general population, 292 adults with insomnia, 132 adults with Obstructive Sleep Apnoea (OSA) and 66 adults with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), together with the Fatigue Severity Scale (FSS) and the Epworth Sleepiness Scale (ESS)., Results: A factor analysis revealed a single factor solution for the seven-item scale (67% of total variance), although a better fit was obtained for a modified six-item version (75% of total variance). Group FFS scores varied in accordance with theorised fatigue levels, with CFS/ME and insomnia samples reporting significantly higher fatigue than OSA and volunteer samples. Good convergent validity was established with the FSS for volunteer (r = 0.67) and CFS/ME samples (r = 0.61). Excellent discriminant validity with the ESS was observed for the insomnia (r = -0.08) and CFS/ME groups (r = 0.03), while a small-to-moderate correlation was found within the volunteer sample (r = 0.29). Cut-off scores were identified to categorise borderline (13-15), moderate (16-20) and severe (≥21) fatigue., Conclusions: The FFS is a reliable and valid instrument to quantify subjective daytime fatigue. Sensitivity and specificity analyses indicate scores that best discriminate insomniacs and CFS/ME populations from a non-clinical population. However, it is proposed that the data can also be used to indicate the severity of fatigue by reference to these first two groups., (Copyright © 2016. Published by Elsevier B.V.)

Objective/background: Delayed sleep-wake phase disorder (DSWPD) is associated with a delayed timing of circadian rhythms, and this delay is suggested to be the basis of the disorder. However, this has been questioned due to frequent relapses following treatment based on this aetiology. Recent studies have emerged suggesting personality factors may contribute to sleep patterns in DSWPD. The aim of this study was to further investigate circadian and personality factors in DSWPD patients as well as patients with non-24-h sleep-wake rhythm disorder (N24SWD) relative to control sleepers., Patients/methods: This sample consisted of 16 DSWPD (age = 21.1 ± 2.8, 10 m, 7 f), and three N24SWD patients (age = 24.0 ± 4.4, 2 m, 1 f). Controls were seven males and seven females (age = 23.4 ± 5.9). Before starting an 80-h modified constant routine, eligible participants' sleep patterns were monitored for a week and they completed a personality questionnaire (NEO PI-R). An ultradian routine with alternating 20-min sleep opportunities and 40 min of enforced wakefulness was used to measure the timing of endogenous circadian temperature and melatonin rhythms., Results: As compared with controls, DSWPD patients reported higher neuroticism, significantly lower extraversion, conscientiousness and agreeableness. Similarly, N24SWD patients' patterns of personality traits were similar to that of DSWPD. Conscientiousness, in particular, was associated with phase timings of circadian rhythms as well as sleep measures and lifestyle factors within the DSWPD group., Conclusions: These findings suggest that circadian rhythm sleep-wake disorders (CRSWDs) may not only stem from circadian abnormalities but personality factors may also drive lifestyle choices, including sleep timing., (Copyright © 2016 Elsevier B.V. All rights reserved.)

How computer games affect the time at which adolescents go to bed is of growing research interest; however, the intrinsic individual and extrinsic sociocultural factors mediating the relationship between gaming and sleep have received minimal attention. This paper investigates how gaming duration mediates the relationship between intrinsic factors (perception of risky events and flow) and extrinsic factors (parental regulation and media accessibility) and adolescent bedtime. Adolescents (N = 422; age = 16.3 ± 2.02 years, 41% M) from six metropolitan schools and the Flinders University completed a questionnaire battery. More flow states (r = .34, p < .01) and increased accessibility (r= .21, p < .01) significantly predicted longer gaming duration, whereas greater parental regulation (r = - .15, p < .01) predicted fewer hours spent playing video games. In addition, higher perception of the negative consequences of risk-taking (r = .14, p < .01) significantly predicted later bedtimes in adolescence. The relationship between flow and bedtime during adolescence was fully mediated by gaming duration (b = .142, p < .001), whereas the association between parental regulation and bedtime was independent of gaming duration. Flow and parental regulation of media were identified as the key points for clinical intervention to decrease the duration of gaming of adolescents, thus promoting earlier bedtimes., (Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.)

Background: Sleep is vital for adolescent functioning. Those with optimal sleep duration have shown improved capacity to learn and decreased rate of motor vehicle accidents. This study explored the influence of numerous protective and risk factors on adolescents' school night sleep (bedtime, sleep latency, total sleep time) simultaneously to assess the importance of each one and compare within three countries., Method: Online survey data were collected from Australia, Canada, and The Netherlands. Overall, 325 (137 male), 193 (28 male), and 150 (55 male) contributed to data from Australia, Canada, and The Netherlands, respectively (age range 12-19 years)., Results: Regression analyses showed mixed results, when comparing protective and risk factors for sleep parameters within different countries, with combined behavioural factors contributing to small to large shared portions of variance in each regression (9-50%). One consistent finding between countries was found, with increased pre-sleep cognitive emotional sleep hygiene related to decreased sleep latency (beta = -0.25 to -0.33, p < 0.05). Technology use (mobile phone/Internet stop time) was associated with later bedtime, or less total sleep, with the strength of association varying between device and country., Conclusion: Results indicate that when designing interventions for adolescent sleep, multiple lifestyle factors need to be considered, whereas country of residence may play a lesser role., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Internet gaming disorder (IGD) is currently positioned in the appendix of the DSM-5 as a condition requiring further study. The aim of this review was to examine the state of current knowledge of gaming withdrawal symptomatology, given the importance of withdrawal in positioning the disorder as a behavioral addiction. A total of 34 studies, including 10 qualitative studies, 17 research reports on psychometric instruments, and 7 treatment studies, were evaluated. The results indicated that the available evidence on Internet gaming withdrawal is very underdeveloped. Internet gaming withdrawal is most consistently referred to as 'irritability' and 'restlessness' following cessation of the activity. There exists a concerning paucity of qualitative studies that provide detailed clinical descriptions of symptoms arising from cessation of internet gaming. This has arguably compromised efforts to quantify withdrawal symptoms in empirical studies of gaming populations. Treatment studies have not reported on the natural course of withdrawal and/or withdrawal symptom trajectory following intervention. It is concluded that many more qualitative clinical studies are needed, and should be prioritised, to develop our understanding of gaming withdrawal. This should improve clinical descriptions of problematic internet gaming and in turn improve the quantification of IGD withdrawal and thus treatments for harmful internet gaming., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objectives: Sleep disturbance and psychopathology are common during adolescence and are highly prevalent in individuals diagnosed with autism spectrum disorder (ASD). The aim of this study was to investigate relationships between sleep disturbance, psychopathology symptoms, and daytime functioning in adolescents with high-functioning autism spectrum disorder (HFASD) compared to typically developing (TD) adolescents., Methods: Twenty-seven adolescents with HFASD and 27 age- and sex-matched TD adolescents completed questionnaires related to sleep, psychopathology and daytime functioning. Participants also completed a 7-day sleep/wake diary. A subsample of HFASD adolescents (55%) and all the TD adolescents wore an actigraphy monitor concurrently with the sleep diary., Results: Adolescents with HFASD had significantly higher scores for depressed mood, anxiety and pre-sleep arousal compared with TD adolescents and poorer daytime functioning. There were more significant correlations between sleep variables and psychopathology variables, and sleep variables and daytime functioning, in the HFASD group than in the TD group. Standard regression found that sleep variables significantly accounted for 57% of the variance in daytime functioning symptoms of insufficient sleep in the HFASD group, while psychopathology variables accounted for 63% of the variance in daytime functioning., Conclusions: Both sleep disturbance and psychopathology are more prevalent in adolescents with HFASD and are major contributors to poor daytime functioning in these individuals., (Copyright © 2014. Published by Elsevier B.V.)

Objective: Daylight is an important zeitgeber for entraining the circadian rhythm to a 24 h clock cycle, especially within the Polar circle, which has long Polar nights several months each year. Phase delays in sleep timing may occur, but the mean shift is normally small. However, the individual variation in phase shifts is large, implicating moderating factors. Here we examined the role of several self-regulatory variables (mood and fatigue, behavioral habits, and psychological self-regulation) as moderators of seasonality in sleep timing and chronotype., Methods: A sample of 162 young adults (76% females; mean age: females 23.4 years, males 24.3 years) participated in a prospective study across three seasons (September, December, March) in Tromsø/Norway at 69°39′N Sleep diary and sleep/health-related questionnaire data were collected at each time-point., Results: Sleep timing and chronotype were delayed during the dark period (December) compared with brighter photoperiods (September and March). Comparable effects were observed for insomnia, fatigue, mood (depression and anxiety), subjective health complaints, physical activity, and school-related stress. Most importantly, depression and fatigue moderated the degree of seasonal shifting in sleep timing, whereas the other self-regulation indicators did not (ie eating habits, physical activity, and psychological self-regulation)., Conclusion: Seasonality in sleep timing and chronotype was confirmed, and it seems that depressive symptoms during the dark period exacerbate phase-shifting problems for people living in sub-Arctic regions.

Objective: Catastrophising is a repetitive cognitive process related to sleep disturbance in adult insomnia patients. More recently catastrophising has been associated with increased sleep disturbances in community samples of children and adolescents, with this association mediated by anxiety and depression. However, there currently is no evidence of these processes outside of community samples; impeding our ability to draw clinical conclusions. Knowledge on such dysfunctional cognitive processes in adolescents experiencing sleep disturbance would be clinically beneficial in aetiology and intervention. Our research examined the link between catastrophising, anxiety, depression and sleep latency in a sample of sleep-disordered adolescents. We also explored specific catastrophising themes which may impact the sleep latency of these adolescents., Method: Forty adolescents (age=15.1±1.5 years, 53% boys) diagnosed with delayed sleep phase disorder completed a 7-day sleep diary, along with measures of anxiety and depression and a catastrophising interview with a trained sleep therapist., Results: Several catastrophisation themes were generated, the most common concerning interpersonal and performance aspects of school. Bootstrapping analyses showed depression did not mediate the relationship between catastrophising and sleep; however, an indirect relationship was found between catastrophising, anticipatory anxiety, and sleep latency., Conclusion: These findings have implications for the role of dysfunctional thinking in prolonging sleep onset for adolescents and providing a clinical framework for health professionals when assessing and treating adolescents with delayed sleep timing., (Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.)

Pathological video-gaming, or its proposed DSM-V classification of "Internet Use Disorder", is of increasing interest to scholars and practitioners in allied health disciplines. This systematic review was designed to evaluate the standards in pathological video-gaming instrumentation, according to Cicchetti (1994) and Groth-Marnat's (2009) criteria and guidelines for sound psychometric assessment. A total of 63 quantitative studies, including eighteen instruments and representing 58,415 participants, were evaluated. Results indicated that reviewed instrumentation may be broadly characterized as inconsistent. Strengths of available measures include: (i) short length and ease of scoring, (ii) excellent internal consistency and convergent validity, and (iii) potentially adequate data for development of standardized norms for adolescent populations. However, key limitations included: (a) inconsistent coverage of core addiction indicators, (b) varying cut-off scores to indicate clinical status, (c) a lack of a temporal dimension, (d) untested or inconsistent dimensionality, and (e) inadequate data on predictive validity and inter-rater reliability. An emerging consensus suggests that pathological video-gaming is commonly defined by (1) withdrawal, (2) loss of control, and (3) conflict. It is concluded that a unified approach to assessment of pathological video-gaming is needed. A synthesis of extant research efforts by meta-analysis may be difficult in the context of several divergent approaches to assessment., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

This paper reviews 15 adolescent (10-19 yrs) studies that have directly investigated the effects of shortened sleep duration on overweight and obesity. The research studies included in this review inconsistently found significant effects between shortened sleep duration and weight status. This heterogeneity in study findings largely resulted from variability in study design, gender, and the method used to measure sleep duration. Consequently, due to the conflicting research findings, it remains inconclusive as to whether shortened sleep is a risk factor for overweight or obesity during adolescence. This review also identified methodological limitations within the literature and presented alternative methodologies for future research. First, sleep duration measures were identified that had questionable reliability and were possibly less accurate than other recommended sleep measurements. Second, 92% of cross-sectional studies found a significant relationship, yet 0% of prospective studies did. Third, the vast majority of studies neglected to statistically adjust for co-contributions from depression, and approximately half of the studies considered the role of physical activity. Recommendations for future research directions are presented which may help to clarify the conflicting findings and address the methodological concerns identified within this topical area., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: To explore the discrepancy between sleep diary and actigraphic measures of sleep in adolescents and to ascertain whether these discrepancies may vary according to characteristics of the participant., Methods: Participants were 385 adolescents aged 13-18years (X=15.6, standard deviation [SD]=0.95; 60% male) from eight high schools in South Australia. Adolescents completed the School Sleep Habits Survey and Pediatric Daytime Sleepiness Scale during class time, followed by an 8-day sleep diary and wrist actigraphy. The Flinders Fatigue Scale was completed on the final day of the study. Parents completed a sleep, medical, education, and family history survey., Results: Actigraphic estimates of wake after sleep onset (WASO) were substantially greater than sleep diary estimates (74min actigraphy vs. 7min sleep diary) and actigraphic estimates of total sleep time were substantially less than sleep diary and parent report (6h 51min actigraphy vs. 8h 16min sleep diary vs. 8h 51 parent report). Actigraphy displayed no significant relationship with daytime functioning and weak relationships with concomitantly recorded sleep diary variables. Sex and puberty-related differences in actigraphic scoring were found, with more WASO and less sleep scored in boys compared to girls and more WASO scored amongst pubertally-mature boys than boys of less advanced pubertal development., Conclusions: There may be differences in the sleep of adolescents that result in less actigraphic total sleep scored than perceived, particularly in boys, possibly because of increased sleep motor activity in adolescents that actigraphic algorithms score as wake. This is a significant concern that requires further examination with polysomnography., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Although there is ongoing debate concerning the clinical status of Internet addiction, and the quality of the extant literature in this emerging field is not optimal, several clinical trials of both pharmacological and psychological treatments for Internet addiction have been published in recent years. A systematic review investigating the reporting quality of eight treatment studies is presented. Reporting quality was defined according to the 2010 Consolidating Standards of Reporting Trials (CONSORT) statement. An evaluation of the reviewed studies highlighted several key limitations, including (a) inconsistencies in the definition and diagnosis of Internet addiction, (b) a lack of randomization and blinding techniques, (c) a lack of adequate controls or other comparison groups, and (d) insufficient information concerning recruitment dates, sample characteristics, and treatment effect sizes. It is concluded that improvements in future studies' design and reporting would be of significant benefit to both researchers and clinicians, and to the overall positioning of Internet addiction in the behavioral addiction field., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Chronic sleep problems can lead to the development of Behavioural Insomnia of Childhood - a sleep disorder involving problematic sleep-onset associations (i.e., parental presence), and resulting in impairments for children and family members. The aim of the present paper was to perform a controlled evaluation of cognitive-behaviour therapy (CBT) for Behavioural Insomnia. 42 children (M = 9.3 ± 1.9 yrs, range 7-13 yrs, 18f, 24 m) were randomised to CBT (N = 21) or waitlist control (N = 21). CBT consisted of 6 sessions, and combined behavioural sleep medicine techniques (e.g., sleep restriction) with anxiety treatment techniques (e.g., cognitive restructuring). Compared to waitlist controls, children receiving CBT showed significant improvements in sleep latency, wake after sleep onset, and sleep efficiency (all p ≤ .003), but not total sleep time (p > .05). CBT was also associated with a reduction in problematic sleep associations (p ≤ .001), child-reported total and separation anxiety (both p ≤ .01), with all gains being maintained 6 months post-treatment. This is the first controlled study to demonstrate that multi-component CBT can be effective for the sleep, insomnia, and anxiety symptoms of Behavioural Insomnia of Childhood in school-aged children. Future research is needed to ascertain active treatment components., (Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.)

Objective: The current study aimed to develop and evaluate a motivational school-based intervention for adolescent sleep problems., Methods: The intervention was implemented in three co-educational secondary schools in Adelaide, South Australia. Two year-11 Psychology classes from each school participated, with one as the intervention class (N=53) and one as the control class (N=51). Students in the intervention classes attended four 50-min sleep education classes, held once per week. The lessons were modified from those of Moseley and Gradisar [23] to incorporate a motivational interviewing framework. Students completed an online questionnaire battery measuring school day and weekend sleep parameters, daytime sleepiness, and depression at pre- and post-program and follow-up, and completed motivation to change questionnaires during the program., Results: Students in the intervention group significantly increased their knowledge about sleep relative to the control group (p=0.001). During the intervention, students' motivation to regularize their out-of-bed times improved (p=0.03), and there was a trend towards improved motivation to increase average total sleep time (p=0.11). But despite improvements in sleep and daytime functioning for adolescents in the program group (p<0.05), these changes were not significantly different from the control group (all p>0.05)., Conclusions: School-based interventions are promising for educating adolescents about sleep. Future programs should translate increased motivation into long-term behavioral change. The identification of barriers and support to assist this change is recommended., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Adolescent sleep health is becoming increasingly recognized internationally as a significant concern, with many countries reporting high incidences of sleep disturbance in our youth. Notwithstanding the value of findings obtained from each large-scale survey of adolescent sleep performed within individual countries, the field lacks synthesis and analysis of adolescent sleep studies into a single review. This review presents findings from a meta-analysis of 41 surveys of worldwide adolescent sleep patterns and problems published in the last decade (1999-2010). Sleep patterns tended to delay with increasing age, restricting school-night sleep. Notably, Asian adolescents' bedtimes were later than peers from North America and Europe, resulting in less total sleep time on school nights and a tendency for higher rates of daytime sleepiness. Weekend sleep data were generally consistent worldwide, with bedtimes 2+ hours later and more total sleep time obtained. We note a worldwide delayed sleep-wake behavior pattern exists consistent with symptoms of Delayed Sleep Phase Disorder, which may be exacerbated by cultural factors. Recommendations for future surveys of adolescent sleep patterns are discussed and provided in light of current methodological limitations and gaps in the literature., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Electronic media have often been considered to have a negative impact on the sleep of children and adolescents, but there are no comprehensive reviews of research in this area. The present study identified 36 papers that have investigated the relationship between sleep and electronic media in school-aged children and adolescents, including television viewing, use of computers, electronic gaming, and/or the internet, mobile telephones, and music. Many variables have been investigated across these studies, although delayed bedtime and shorter total sleep time have been found to be most consistently related to media use. A model of the mechanisms by which media use may affect sleep is presented and discussed as a vehicle for future research., (Copyright 2010 Elsevier B.V. All rights reserved.)

Childhood sleep problems have been associated with a range of adverse cognitive and academic outcomes, as well as increased impulsivity and emotional disorders such as anxiety and depression. The aim of the study was to examine subjective reports of sleep-related problems in children with anxiety disorders during school and weekend nights. Thirty-seven children with clinically-diagnosed anxiety disorders and 26 non-clinical children aged 7-12 years completed an on-line sleep diary to track sleep patterns across school nights and weekend nights. Anxious children reported going to bed significantly later (p=0.03) and had significantly less sleep (p=0.006) on school nights compared to non-anxious children. No significant differences in sleep onset latency, number of awakenings or time awake during the night, daytime sleepiness, or fatigue were found between the two groups. On the weekends, anxious children fell asleep quicker and were less awake during the night than on weeknights. School-aged anxiety disordered children showed a sleep pattern that differs from their non-anxious peers. Although the mean 30 min less sleep experienced by anxious children may initially seem small, the potential consequences on daytime performance from an accumulation of such a sleep deficit may be significant, and further investigation is warranted.