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The present study explored the links between maternal insomnia symptoms, maternal depressive symptoms, and young children's sleep quality among two major cultural groups in Israel: Arab and Jewish. We also assessed the prevalence of maternal insomnia and depressive symptoms, in both cultural groups.Mothers of 497 healthy, typically developing infants and toddlers, ranging in age from 3-36 months, participated in the study: 253 of the mothers were Arab and 244 were Jewish. Mothers completed the Insomnia Severity Index (ISI), the Edinburgh Postnatal Depression Scale (EPDS), and the Brief Infant Sleep Questionnaire.For both cultural groups, there were significant positive associations between maternal ISI and EPDS, as well as between maternal ISI and child sleep variables (nighttime wakefulness and perceived child's sleep problems), after controlling for child age. Significant correlations were also found between maternal EPDS and child sleep, after controlling for child age, but these correlations were not significant once controlling for ISI. Cross-cultural differences in prevalence of insomnia and depressive symptoms were found based on the clinical cutoffs of the ISI and EPDS: Arab mothers, compared to Jewish mothers, reported higher levels of insomnia and depressive symptoms, and were more likely to have scores higher than the clinical cutoff on both measures.Maternal insomnia, depressive symptoms, and child sleep quality are significantly intertwined in both Arab and Jewish families in Israel. The findings highlight the importance of taking these three domains into consideration in research and in clinical assessments of families with young children.

Study objectives To examine the longitudinal links between maternal and infant nocturnal wakefulness by employing a trajectory-based approach, and to assess whether the strength of these links differs as a function of sleep assessment method (actigraphy vs. self-report) and sleeping arrangements. Methods Maternal and infant nocturnal wakefulness were assessed with actigraphy and sleep diaries at home for 5 nights, at 3 (N = 191), 6 (N = 178), 12 (N = 155), and 18 (N = 135) months postpartum. Outcome measures included the number of night-wakings (NW) and the length of nocturnal wakefulness (WASO). Results Strong associations between maternal and infant nocturnal wakefulness (controlling for nighttime breastfeeding) were found for NW and WASO. Trajectory analyses demonstrated that the strength of these relations decreased linearly from 3 to 18 months. Furthermore, the findings showed that the links between maternal and infant NW and WASO were stronger for maternal reports than for actigraphy. No consistent differences were found in the strength of the relations between maternal and infant NW and WASO as a function of sleeping arrangements (ie, room-sharing vs. solitary-sleeping families). Conclusions The results suggest that infant and maternal sleep are strongly intertwined, especially during the first 6 months. The decline in the synchronization between maternal and infant nocturnal wakefulness through infant development may be attributed to the growing ability of infants to self-soothe during the night. The findings emphasize the need to study sleep within a family context.

Study Objectives This study assessed and compared mothers’ and fathers’ sleep trajectories from pregnancy and throughout the first year of the infant’s life. We also examined associations between maternal, paternal, and infant sleep. Methods Two hundred and thirty-two couples were recruited for the study during pregnancy. Data were collected at pregnancy and at 4, 8, and 12 months postpartum. Maternal, paternal, and infant sleep were monitored at home for seven nights, using actigraphy, sleep diaries, and the Insomnia Severity Index (ISI). Results Mothers showed more impaired sleep quality than fathers, at all assessments, whereas fathers had shorter sleep duration. Based on the ISI, about 70% of mothers and 50% of fathers showed at least sub-clinical insomnia at the different assessments. Trajectory analyses (controlling for feeding method and sleeping arrangements) demonstrated a significant deterioration in diary-based and actigraphy sleep quality for both parents, from pregnancy to 4 months. Both parents and infants had an increase in sleep quality from 4 to 12 months, though some parental sleep variables showed a quadratic pattern with a decrease in sleep quality at 8 months. Statistically significant triadic associations at the different assessments were found between mothers’, fathers’, and infants’ sleep. Maternal and infant sleep measures were more strongly correlated than paternal and infant sleep. Conclusions The findings highlight the importance of considering the family context of sleep, by demonstrating similarities and differences in the changes that sleep undergoes in new mothers and fathers and by showing how sleep is interrelated between all family members.

Background: Parent reports suggest that 44-84% of children with ASD exhibit sleep disturbances that are of clinical concern. Previous studies have reported that, in children with ASD, the severity of sleep disturbances is associated with the severity of either sensory problems or aberrant behaviors, but none have performed combined analyses with measures of both sensory and aberrant behaviors symptom domains from the same children. Methods: we examined parent reports of 237 children with ASD, 1.4-8.7 years old, using the child sleep habits questionnaire (CSHQ), sensory profile (SP), and aberrant behaviors checklist (ABC). Results: The analyses revealed that sleep disturbances were most strongly associated with SP sensory sensitivity and ABC irritability scores. Together these scores explained 35% of the variance in total CSHQ scores. Moreover, sensory sensitivity scores moderated the association between irritability and sleep disturbances, indicating that sleep disturbances were significantly associated with irritability only in children with moderate to severe sensory sensitivities. Conclusion: We suggest that the three symptom domains may interact and exacerbate each other such that successful intervention in one symptom domain may have positive impact on the others. Further intervention studies testing this hypothesis are highly warranted. Trial registration: N/A

Objectives To examine differences in maternal sleep-related cognitions and to explore the associations between those cognitions and reported child sleep quality in a sample of mothers of young children, from two major cultural groups in Israel: Arab and Jewish. Method Mothers of 497 healthy, typically developing infants and toddler ranging in age from 3-36 months, participated in the study: 253 of the mothers were Arab and 244 were Jewish. Mothers completed the Maternal Cognitions about Infant Sleep Questionnaire, and the Brief Infant Sleep Questionnaire. Results Cross-cultural differences in maternal sleep-related cognitions were found between Arab and Jewish mothers. Arab mothers were more likely to hold sleep-related cognitions reflecting their difficulty in limiting their nighttime intervention in response to their child’s awakenings, compared to Jewish mothers who were more likely to report feelings of anger and higher levels of doubts in their parental competence in response to their child`s nocturnal awakenings. Moderation analyses demonstrated that, only for Arab mothers but not for Jewish mothers, cognitions reflecting difficulty in limiting nighttime intervention, and feelings of anger and doubts were positively associated with poorer perceived child sleep quality. Conclusion The results suggest that the links between maternal cognitions and child sleep are culturally-specific. Moreover, the discrepancies between Arab and Jewish mothers in sleep related cognitions may reflect differences between collectivistic and individualistic cultures. Maternal sleep-related cognitions seem to be an important parental aspect to consider in clinical sleep interventions of infants in the Arab society.

The interplay between personality and psychopathology in young adults’ insomnia is poorly understood. The authors examined the main-and-interactive role of self-criticism, anxiety, and depressive symptoms in young adults’ insomnia, as well as the potentially mediating role of sleep-related arousal and maladaptive cognitive styles. One hundred sixty-one undergraduate freshmen (Mage = 25.0 years) were assessed twice over 1.5 months, using measures of sleep quality, anxiety, depressive symptomatology, self-criticism, pre-sleep arousal, and mental control strategies. A structural equation modeling (SEM) analysis revealed that anxiety prospectively predicted insomnia, and this effect was mediated by sleep arousal and social avoidance. As well, self-criticism prospectively predicted insomnia under elevated levels of depressive symptoms. In young adults, insomnia treatment should include a routine assessment and intervention with anxiety, depression, and self-criticism.

Symptoms of insomnia are common during the perinatal periods and are linked to adverse parent/infant outcomes. Theories on insomnia development (e.g. 3P model) suggest that significant sleep disruption (e.g. nighttime infant care) can precipitate, while unhelpful sleep-related cognitions/behaviors can perpetuate parental insomnia symptoms. This study aims to examine how two interventions, one addressing infant sleep as the precipitator, the other targeting maternal sleep-related cognitions/behaviors as the perpetuator, might prevent postpartum insomnia. Participants are 114 nulliparous females 26 to 32 weeks gestation, with self-reported insomnia symptoms (Insomnia Severity Index scores ≥ 8). Participants are randomized to one of three conditions and receive: (1) a “responsive bassinet” used until 6 months postpartum, designed to boost/consolidate infant sleep and target infant sleep as a precipitator of insomnia, (2) therapist-assisted cognitive behavioral therapy for insomnia, addressing unhelpful sleep-related cognitions/behaviors as perpetuators of insomnia, or (3) a sleep hygiene booklet (control condition). The primary outcome is maternal insomnia symptoms. Secondary outcomes include maternal sleep duration/quality, mental health (e.g. depression, anxiety), and wellbeing-related variables (e.g. sleep-related impairment). Outcomes are assessed using validated instruments at 26–32 and 35–36 weeks’ gestation, and 2, 6, and 12 months postpartum. This study adopts an early-intervention approach and longitudinally compares two distinct approaches to prevent postpartum insomnia in an at-risk population. If interventions are efficacious, findings will demonstrate how interventions targeting different mechanisms mitigate insomnia symptoms in perinatal populations. This will provide empirical evidence for future development of multi-component sleep intervention to improve mother-infant wellbeing. Clinical Trial Registration: The Study for Mother-Infant Sleep (The SMILE Project): reducing postpartum insomnia using an infant sleep intervention and a maternal sleep intervention in first-time mothers. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377927, Australian New Zealand Clinical Trials Registry: ACTRN12619001166167.

Study Objectives This study explored the links between mothers’ objective and subjective sleep and their caregiving feelings toward their infant (i.e. patience for the infant, desire to be with the infant, and anger toward the infant), using a diary study design. We were particularly interested in examining whether nights of lower sleep quality within individual mothers predict more negative maternal caregiving feelings the following day. Methods The sample included 151 women, who were recruited during pregnancy. Data were collected at 4 and 8 months after delivery. Maternal sleep was monitored at home for seven nights using actigraphy and sleep diaries. Mothers rated their caregiving feelings each evening. Results Multilevel modeling (controlling for depressive symptoms, feeding method, and background variables) revealed that actigraphic and subjective sleep variables were associated with maternal caregiving feeling, both at the between- and within-person levels. For example, lower sleep percent predicted reduced levels of maternal patience for the infant at 4 and 8 months (between-person effect). Moreover, when a mother had a lower sleep percent on a given night (compared to her average), she reported lower levels of patience for her infant the following day (within-person prospective effect). Conclusions The findings demonstrate, for the first time, that maternal nightly variations in objective and subjective sleep quality predict daily changes in maternal feelings toward her infant at two different assessment points. Improving maternal sleep quality might be an important target for future interventions which may help mothers to feel more positively toward their infants.

This longitudinal study examined whether changes in maternal emotional distress (depressive, anxiety, and parenting-stress symptoms) predict changes over time in subjective and objective infant sleep. We recruited 226 Israeli expectant mothers (M age 28.8 ± 3.3), most representing the middle-upper socioeconomic class. Maternal depressive and anxiety symptoms were assessed in the third trimester of pregnancy. After delivery (3, 6, 12, and 18 months), infant sleep quality and duration were assessed for 5 nights using actigraphy and the Brief Infant Sleep Questionnaire. Maternal depressive and anxiety symptoms were reassessed, and maternal parenting-stress was measured at all postpartum assessments. The findings demonstrated significant correlations between maternal emotional distress and mothers' subjective ratings of infant sleep problems (rs >.16 and < .46). Latent trajectory analyses indicated no significant effects of changes in maternal emotional distress variables on changes in infant subjective or objective sleep. Post hoc power analyses demonstrated that we had enough statistical power to reject the null hypothesis. The results suggest that mothers with higher emotional distress symptoms-and especially those with parenting-stress symptoms-are more likely to experience their infant's sleep as problematic. However, our results challenge the assumption that maternal emotional distress symptoms contribute to infant sleep disturbances over time. The findings are relevant to mothers with mild to moderate emotional distress symptoms and must not be generalized to mothers who experience major clinical depression. Future studies should evaluate whether maternal emotional distress interacts with other risk factors, such as infant temperament, to predict infant sleep disturbances. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

'Hippocrates flagged the value of sleep for good health' was the first line of the Annual Research Review (ARR) by Gregory and Sadeh (2016) in this journal, titled Sleep problems in childhood psychiatric disorders - a review of the latest science. Where Hippocrates has been referred to as the 'Father of Medicine', Professor Avi Sadeh has been respected as a 'Father of Paediatric Sleep Medicine' by those who had the privilege to meet him or read his science. Sadly, Avi Sadeh passed away in the same year this ARR was published. What he left behind was a legacy - including his predecessors (Professor Mary Carskadon), successors and those he inspired, who could be guided by the key findings from his 2016 ARR. These include (a) greater attention to the assessment of sleep in children; (b) sleep research on a wider range of psychiatric disorders; (c) a greater focus on and examination of mechanisms underlying associations; (d) a clearer consideration of developmental questions; and (e) large-scale well-designed treatment studies.

Introduction Insomnia symptoms are common during the perinatal period and are linked to adverse parent/infant outcomes. This single-blind 3-arm randomised controlled trial examined how two interventions targeting different mechanisms prevent postpartum insomnia compared to sleep hygiene control. Trial registration: ACTRN12619001166167. Methods Participants were nulliparous females 26-32 weeks gestation with self-reported insomnia symptoms (Insomnia Severity Index [ISI] scores ≥ 8). Participants were randomized 1:1:1 to: (a) a responsive bassinet designed to support infant sleep until 6 months postpartum (RB), (b) therapist-assisted cognitive behavioural therapy for insomnia (CBT-I) delivered during pregnancy and postpartum, or (c) a sleep hygiene booklet (control condition; CTRL). Outcomes were assessed at baseline (T1), 35-36 weeks gestation (T2), and 2, 6, and 12 months postpartum (T3-T5). The primary outcome is ISI scores averaged T3-T5. Secondary outcomes are PROMIS Sleep Disturbance (SDI), Sleep-Related Impairment (SRI), and self-report total sleep time (TST). We report preliminary results on T1-T4 as T5 is ongoing. Multiple regression analyses controlling for baseline outcomes examined group differences at post-baseline timepoints. Results 127 participants were randomised (age M±SD=32.62±3.49; RB = 44, CBT-I = 42, CTRL = 41), and 118 (92.9%) completed T4. Compared to CTRL, CBT-I had lower ISI, SDI, and SRI at T2, T3, and T4 (all p.25). The RB condition had significantly longer TST at T4 (40.10 min longer, p=.008, d=.63) compared to CTRL, but these two conditions did not differ significantly on any other measures across all timepoints (p>.22). Conclusion Preliminary findings suggest CBT-I was efficacious in preventing insomnia symptoms and reducing sleep disturbance and sleep-related impairment, but did not increase maternal sleep duration postpartum. Conversely, a responsive bassinet designed to support infant sleep meaningfully increased maternal sleep duration at 6 months postpartum but did not prevent insomnia symptoms. These initial findings suggest that perinatal sleep complaints are a multifactorial problem that likely require multi-component interventions targeting different causes and mechanisms. Support (If Any) National Health and Medical Research Council, Department of Education and Training.

Postpartum emotional distress is very common, with 10%-20% of postpartum women reporting depressive or anxiety disorders. Sleep is a modifiable risk factor for emotional distress that has a pivotal role in postpartum adjustment. The present study aimed to examine whether sleep duration and quality during pregnancy predict trajectories of emotional distress in the postpartum period. Participants were 215 women that were assessed from the third trimester of pregnancy to 18-months postpartum. At all five time points (third trimester, 3-, 6-, 12-, and 18-months postpartum), measures of sleep duration and quality (measured by wake time after sleep onset; WASO) were derived from both actiography and diary-based measures. Repeated measures of depression and anxiety symptoms were collected using self-report measures. Results indicated four bivariate postpartum depression and anxiety growth trajectories, including (a) high comorbidity (5.4%); (b) moderate comorbidity (19.4%); (c) low anxiety and decreasing depression symptomology (18.6%); and (d) low symptomology (56.6%). Multinomial logistic regression analyses showed that mothers with shorter sleep durations during pregnancy were more likely to belong to the high comorbidity or moderate symptoms classes compared to the low symptomology class. In addition, mothers with higher WASO (i.e. lower sleep quality) at 3-months postpartum were more likely to belong to the moderate class compared to the low symptomology class. Given the potential negative implications of disrupted sleep in the perinatal period, the present study may inform future intervention studies that target sleep problems during pregnancy.

Despite the marked impact of the coronavirus disease 2019 (COVID‐19) pandemic on the life of families and its possible negative implications for sleep, little is known about how sleep among parents and children has been impacted by this current crisis. In the present study, we addressed, for the first time, possible consequences of the COVID‐19 crisis and home confinement on maternal anxiety, maternal insomnia, and maternal reports of sleep problems among children aged 6–72 months in Israel (N = 264). Our results revealed a high frequency of maternal clinical insomnia during the COVID‐19 pandemic: 23% during the pandemic, compared to only 11% before the pandemic (retrospective reports about 1–2 months before the pandemic). About 80% of mothers reported mild‐to‐high levels of current COVID‐19 anxiety. The majority of mothers reported no change in their child’s sleep quality, duration, and sleeping arrangement. However, about 30% reported a negative change in child’s sleep quality and a decrease in sleep duration, and there were also mothers who reported a positive change. These findings suggest that the changes in sleep patterns during the COVID‐19 pandemic are varied and that no unified change for the worse should be expected. Further consideration of changes in sleep within the family context during this ongoing crisis is needed.

STUDY OBJECTIVES: This study tested whether parental cry tolerance (PCT) and distress-attribution cognitions predict outcomes of behavioral interventions for infant sleep problems. It additionally examined intervention effects on these parental factors. METHODS: Participants were 91 infants aged 9–18 months (61% boys) with sleep-related problems and their parents. Families were randomized to 1 of 2 behavioral interventions for infant sleep problems: Checking-in or Camping-out. Assessments were completed at baseline and 1-month post-treatment. Infant sleep was assessed using actigraphy and parent reports on the Brief Infant Sleep Questionnaire. PCT was measured using the Intervention Delay to Infant Crying Video laboratory paradigm, and parental distress-attribution cognitions were assessed via the Infant Sleep Vignettes Interpretation Scale. RESULTS: Higher PCT and lower parental distress-attribution cognitions at baseline predicted greater improvement in parent-reported sleep problems post-treatment, and higher PCT additionally predicted larger reductions in the number of reported nighttime awakenings. Moreover, PCT increased, and distress-attribution decreased, following the interventions. CONCLUSIONS: Parent factors both predict and are predicted by behavioral interventions for infant sleep problems. This study’s findings suggest that parents with low cry tolerance and high distress-attribution cognitions derive less benefit from these interventions and may thus require augmented care. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Interventions for sleep problems in early childhood; URL: https://clinicaltrials.gov/ct2/show/NCT01489215;Identifier: NCT01489215. CITATION: Kahn M, Livne-Karp E, Juda-Hanael M, et al. Behavioral interventions for infant sleep problems: the role of parental cry tolerance and sleep-related cognitions. J Clin Sleep Med. 2020;16(8):1275–1283.

Objective Infants' sleeping patterns can influence parents' sleep and their well-being. Infants' sleeping problems can evoke negative emotions from their parents because of the influence the problems have on parents' lives. However, little is known regarding the associations between infants' night sleep patterns and parents' overall negativity toward their children. The objective of this study was to study this association. Methods In a longitudinal design, we followed infants and their parents from 9 to 18 months. Overall, 392 families participated in the study. Parents' negativity and children's sleeping patterns were assessed with questionnaires. Results Parents' negativity and children's sleeping problems showed moderate continuity through the study's 9-month period. Children's sleeping problems at 9 months predicted an increase in mothers' (but not fathers') negativity at 18 months. Parents' negativity was not associated with infants' sleep problems. Conclusion The results of this study suggest that already in infancy, children's tendencies, in this case sleep, can evoke negative emotions in their mothers and highlight infants' roles in the intricate parent-child relationship.

Objective The purpose of this study was to examine differences in reported sleep patterns (eg, sleep onset, nocturnal sleep duration, nocturnal wakefulness) and aspects of sleep ecology (eg, sleeping arrangements), in a sample of young children, between two cultural groups in Israel: Arab and Jewish. Method Mothers of 497 healthy, typically developing infants and toddlers, ranging in age from 3 to 36 months, participated in the study: 253 of the mothers were Arab and 244 were Jewish. The mothers were asked to complete the Brief Infant Sleep Questionnaire – a well-validated questionnaire of early childhood sleep patterns. Mothers also completed a demographic questionnaire. Results Substantial cross-cultural differences in reported sleep patterns were found between Arab and Jewish children. Arab children, compared to Jewish children, had later bedtimes, shorter overall night duration, and longer periods of nocturnal wakefulness. Furthermore, Arab mothers perceived their children's sleep as more problematic than did Jewish mothers. Arab families were more likely to room-share, with higher rates of maternal involvement at bedtime. Sleep onset played an important role in predicting nighttime sleep in Arab children; in the Jewish group, nighttime sleep was linked to parental proximity and assistance at bedtime. Conclusion The findings emphasize the importance of deepening the understanding regarding the role of culture in infants sleep patterns. This will enable health care professionals to attune their interventions to the specific cultural context. Further studies are needed to understand the basis and impacts of these cultural differences.

Inadequate sleep and excessive exposure to media screens have both been linked to poorer mental health in youth. However, the ways in which these interact to predict behaviour problems have yet to be examined using objective sleep measurement. The lack of objective evidence for these relationships in young children has recently been defined by the World Health Organization (2019) as a gap in the field. We thus aimed to test the interacting effects of screen exposure and objectively measured sleep on behaviour problems in the preschool age. A total of 145 children aged 3-to-6-years participated in this cross-sectional study. Sleep was assessed objectively using actigraphy for 1-week, and subjectively using parent-reported daily sleep diaries. Parents reported the child’s daily duration of screen exposure, and completed the Strengths and Difficulties Questionnaire. Results showed that actigraphic sleep duration, timing and efficiency were associated with screen exposure. The link between screen time and behaviour problems was moderated by sleep duration, as it was significant only for children with sleep duration of 9.88 h or less per night. Sleep duration also moderated the relation between screen time and externalizing—but not internalizing—problems. Hence, the combination of increased screen exposure and decreased sleep duration may be particularly adverse for child mental health. While these key relationships should be further examined in longitudinal and experimental investigations, our findings shed light on their complexity, underscoring the importance of the moderating role of sleep.

The development of sleep is influenced by complex interactions between biologically driven forces and diverse socio-environmental factors. Among those factors, parents have a critical role. The present review focuses on new studies regarding the links between parenting and the development of sleep in early childhood in the context of a transactional model. Recent findings from longitudinal studies and large cohort studies highlight the contribution of various parenting factors, such as parental bedtime behaviors, parental cognitions, cry tolerance, maternal mood, stress, and the parents' couple relationship, to the development of child sleep. Recent research also demonstrates the effectiveness of behavioral sleep interventions in which parents are the main agents of change in the behavioral aspects of child sleep.

Study Objectives Behavioral interventions for pediatric insomnia are cost-effective and benefit most families, but there is no evidence indicating which treatments are most suitable for specific patient populations. This randomized controlled trial evaluated the moderating role of infant separation anxiety in two brief interventions for infant sleep problems. Methods Ninety-one infants aged 9–18 months (61% boys) with pediatric insomnia were randomized to either Checking-in, a Graduated extinction protocol which involves gradual separation from parents, or to the Camping-out intervention, in which parental presence is maintained. Sleep was measured using actigraphy and parent reports. Infant separation anxiety was observed in the laboratory. Assessments were completed at baseline, post-treatment and 6-month follow-up. Results Improvement in sleep was demonstrated following both interventions and maintained at follow-up. Separation anxiety did not change significantly following treatment. Infant separation anxiety moderated treatment efficacy, with greater benefit for infants with high separation anxiety in the Camping-out compared to the Checking-in intervention. Conclusions This study provides support for considering infant separation anxiety in the effort to personalize treatment for pediatric insomnia. Pediatricians should incorporate evaluation of infant separation anxiety to assessment processes, and favor more gentle treatment approaches, such as Camping-out, over Graduated extinction for highly anxious infants. Clinical Trial Registration NCT01489215.

Background/Objective Infancy is a period of rapid development when the quality of caregiving behavior may be particularly consequential for children's long-term functioning. During this critical period for caregiving behavior, parents experience changes in their sleep that may affect their ability to provide sensitive care. The current study investigated the association of mothers' sleep disturbance with both levels and trajectories of maternal sensitivity during interactions with their infants. Methods At 18 weeks postpartum, mothers and their infants were observed during a home-based 10-minute “free play” interaction. Mothers' nighttime sleep was objectively measured using actigraphy and subjectively measured using sleep diaries. Maternal sensitivity was coded in two-minute intervals in order to characterize changes in sensitivity across the free play interaction. We used exploratory factor analysis to reduce the dimensionality of the objective and subjective measures of mothers' sleep, identifying a subjective sleep disturbance and an objective sleep continuity factor. Results Using multi-level modeling, we found that mothers with poorer objective sleep continuity evidenced decreasing sensitivity toward their infants across the interaction. Mothers' self-reports of sleep disturbance were not associated with maternal sensitivity. Conclusions Although future research is necessary to identify the mechanisms that may explain the observed association between poor sleep continuity and the inability to sustain sensitivity toward infants, mothers' postpartum sleep continuity may be one factor to consider when designing interventions to improve the quality of caregiving. Clinical trial registration Clinicaltrials.gov , NCT01846585.

ObjectiveThis study examined for the first time mother–infant sleep and emotional distress in solo mother families compared with two-parent families and explored whether the links between mother–infant sleep and maternal emotional distress differ as a function of family structure.MethodsThirty-nine solo-mother families and 39 two-parent families, with an infant within the age range of 6–18 months participated in the study. Actigraphy and sleep diaries were used to assess maternal and infant sleep at home. Mothers completed questionnaires to assess maternal depressive and anxiety symptoms, social support, sleeping arrangements, breastfeeding, and demographics.ResultsSolo mothers were older and more likely to breastfeed and share a bed with their infants than married mothers. There were no significant differences between the groups in mother–infant sleep and maternal emotional distress, while controlling for maternal age, breastfeeding, and sleeping arrangements. Family structure had a moderating effect on the associations between maternal emotional distress and mother–infant sleep. Only in solo-mother families, higher maternal emotional distress was associated with lower maternal and infant sleep quality.Conclusions Our findings suggest that, although there are no significant differences in maternal and infant sleep between solo-mother families and two-parent families, the strength of the associations between maternal emotional distress and both infant and maternal sleep quality are stronger in solo-mother families, compared with two-parent families. Hopefully, understanding which aspects of parenting may contribute to the development of sleep problems in solo-mother families could be helpful in tailoring interventions to this growing population.

Parenting behaviours play a major role in the evolution of infant sleep. Sleep problems in infancy have been associated with excessive parental involvement at night-time, and with shorter delays in response to infant night wakings and signalling. Infant crying and sleep problems are linked, yet little is known about the impact of parental responses to crying on infant sleep patterns. This study examined the hypothesis that lower parental tolerance for crying is associated with infant sleep problems. We studied 144 married couples divided into three groups: parents of infants suffering from night-waking problems (i.e. the clinical group), parents of infants without sleep problems and childless couples. Crying tolerance was assessed using questionnaires, audio recordings of crying infants and using a novel paradigm, in which participants were shown a video of a crying infant and asked when they would intervene. Parents in the clinical group demonstrated shorter intervention delays in the crying infant clip (group effect: P

Study objectives To examine the convergence between actigraphy, sleep diaries, and the Brief Infant Sleep Questionnaire (BISQ) in the assessment of infant nocturnal wakefulness (i.e. minutes awake after sleep onset [WASO] and number of night-wakings [NW]) in the context of a longitudinal study. Methods The sample included 226 families, who were recruited during pregnancy. Data were collected at 3, 6, 12, and 18 months postpartum. Infants' sleep was monitored at home for five nights using actigraphy, sleep diaries, and the BISQ. Outcome measures included WASO and NW, as well as sleep latency, sleep duration, and sleep onset. Results Trajectory analyses demonstrated that all three methods showed declines in NW and WASO from 3 to 18 months. Statistically significant correlations were found between the three methods at all assessment points for all sleep variables. However, agreement rates (using Krippendorff's α and Bland-Altman analyses) between actigraphy and parental reports were poor. For NW, agreement between actigraphy and parental reports at 18 months was lower than that at 3 and 6 months. Diaries and BISQ showed satisfactory agreement for sleep latency. Conclusions Although the three methods' measures of infant nocturnal wakefulness are significantly correlated during infancy, absolute agreement between these methods is poor overall. The growing disagreement between actigraphy and parental reports (in NW) across development probably suggests that parents become less aware of infants' awakenings, due to the increasing ability of infants to self-soothe. Using both objective and subjective assessment methods seems especially important after the age of 6 months.

Background Low parental tolerance for crying has been associated with infant sleep problems, yet the directionality of this link remained unclear. This longitudinal study aimed to assess the synchronous and prospective bidirectional links between parental cry-tolerance, soothing, and infant sleep from pregnancy through six months postpartum. Methods Sixty-five couples were recruited during pregnancy and assessed for cry-tolerance using a paradigm in which participants were shown a videotape of a crying infant and were asked to stop the video when they feel it is necessary to intervene. Infant sleep was assessed objectively using actigraphy for five nights at three and six months postpartum. Parental soothing techniques were reported by parents at both assessment points, and cry-tolerance was reassessed at six months. Results Concomitant associations were found between maternal cry-tolerance and infant sleep at six months, indicating that lower maternal cry-tolerance was correlated with poorer actigraphic sleep quality. Furthermore, Structural Equation Modeling analyses yielded significant prospective associations, showing that lower cry-tolerance at pregnancy predicted better infant sleep at three months, whereas more disrupted sleep at three months predicted lower cry-tolerance at six months. Moreover, fathers showed higher cry-tolerance compared to mothers, and parents became more similar to each other across time in their reactivity to infant crying. Conclusion Consistent with the transactional model of infant sleep, the findings of this study highlight the role of parental cry-tolerance in infant sleep development, and demonstrate bidirectional links between this construct and infant sleep throughout the first six months of life.

Study objectives To examine longitudinally differences in (1) objective and subjective sleep patterns and (2) parenting functioning (i.e. maternal emotional distress, maternal separation anxiety, and parental involvement in infant care) between room-sharing and solitary-sleeping mother-infant dyads. Methods Maternal and infant sleep, sleeping arrangements, and parental functioning were assessed at 3 (N = 146), 6 (N = 141), 12 (N = 135), and 18 (N = 130) months postpartum. Maternal and infant sleep were assessed with actigraphy and sleep diaries for five nights. Questionnaires were used to assess sleeping arrangements, nighttime breastfeeding, and parental functioning. Results Persistent room-sharing mothers (i.e. sharing a room with the infant on at least three assessment points) had significantly lower actigraphy-based sleep percent, lower longest sleep periods, and more night-wakings than persistent solitary-sleeping mothers. For infants, differences in actigraphic sleep were found only in longest sleep period, although mothers of persistent room-sharing infants reported more infant night-wakings than mothers of persistent solitary-sleeping infants. The trajectories of maternal and infant sleep in both room-sharing and solitary-sleeping groups demonstrated that sleep became more consolidated with time. Group differences indicated higher maternal separation anxiety and lower paternal overall and nighttime involvement in infant caregiving in room-sharing families compared with solitary-sleeping families. Conclusions The findings are discussed in light of the latest American Academy of Pediatrics recommendation to share a room until 12 months postpartum. Although no causal effects can be inferred from this study, maternal sleep quality and certain parenting characteristics seem to be important factors to consider when parents consult about sleeping arrangements.

The aims of this paper are to study the associations between objective and subjective sleep in pregnant women, to examine which specific aspects of women's sleep are associated with depressive and anxiety symptoms and to test the moderating role of depressive and anxiety symptoms in the relations between objective and subjective sleep. The sample included 148 pregnant women. Objective sleep was measured by actigraphy for five nights at the participants' home, and subjective sleep was measured with the Pittsburgh sleep quality index. Depressive symptoms were assessed with the Edinburgh postnatal depression scale and anxiety symptoms with the Beck anxiety inventory. Significant associations were found between the subjective sleep measures and the depressive and anxiety scores, but there were no significant associations between actigraphic sleep measures and the depressive and anxiety scores. Depressive and anxiety scores emerged as significant moderators of the links between objective and subjective sleep. The findings suggest that emotional distress (i.e., depressive and anxiety symptoms severity) during pregnancy is associated with subjective sleep disturbances but not with objective sleep disturbances. Importantly, only among women with higher levels of emotional distress was subjective sleep quality associated with objective sleep quality. These findings may suggest that women with higher levels of emotional distress are not necessarily biased in their perception of sleep quality. However, they may perceive fragmented sleep as more detrimental to their wellbeing.

The aims of this longitudinal study were to examine (a) development of infant sleep and maternal sleep from 3 to 6 months postpartum; (b) concomitant and prospective links between maternal sleep and infant sleep; and (c) triadic links between paternal involvement in infant caregiving and maternal and infant sleep. The study included 57 families that were recruited during pregnancy. Maternal and infant sleep was assessed using actigraphy and sleep diaries for 5 nights. Both fathers and mothers completed a questionnaire assessing the involvement of fathers relative to mothers in infant caregiving. The results demonstrated moderate improvement in infant and maternal sleep percent between 3 and 6 months. Maternal sleep percent at 3 months significantly predicted infant sleep percent at 6 months. Greater paternal involvement in infant daytime and nighttime caregiving at 3 months significantly predicted more consolidated maternal and infant sleep at 6 months. These findings suggest that maternal sleep is an important predictor of infant sleep and that increased involvement of fathers in infant caregiving responsibilities may contribute to improvements in both maternal and infant sleep during the first 6 months postpartum.

PURPOSE OF REVIEW: Extensive scientific efforts have been made in an attempt to identify early markers of behavioral and emotional problems. In this context, sleep has received considerable research attention, as it appears to be closely linked to developmental psychopathology. The present review synthesizes some of the most recent findings regarding the concurrent and longitudinal associations between psychopathology and behavioral manifestations of sleep in childhood and adolescence. RECENT FINDINGS: Recent evidence suggests that compromised sleep is associated with both internalizing and externalizing problems in childhood and adolescence. Moreover, sleep problems have been shown to predict the development of various emotional and behavioral problems, including depression, anxiety, attention-deficit hyperactivity disorder, risk-taking and aggression. Yet, inconsistencies are apparent, particularly among findings that are based on objective sleep measurement. SUMMARY: Taken together, most recent findings suggest that poor sleep in childhood and adolescence constitutes a risk factor for psychopathological symptoms. Accordingly, the importance of early detection and intervention should be a primary goal in clinical settings. In the research domain, the underlying mechanism of these associations should receive future research attention, in an attempt to broaden the understanding of the relationship between sleep and psychopathology. Language: en

Professor Avi Sadeh, a pioneer in the field of pediatric sleep and actigraphy, died on September 19, 2016. Dr. Sadeh earned his BA in psychology and MA in clinical psychology at Haifa University (I...

Circadian clocks are temporal interfaces that organize biological systems and behavior to dynamic external environments. Components of the molecular clock are expressed throughout the brain and are centrally poised to play an important role in brain function. This paper focuses on key issues concerning the relationship among circadian clocks, brain function, and development, and discusses three topic areas: (1) sleep and its relationship to the circadian system; (2) systems development and psychopathology (spanning the prenatal period through late life); and (3) circadian factors and their application to neuropsychiatric disorders. We also explore circadian genetics and psychopathology and the selective pressures on the evolution of clocks. Last, a lively debate is presented on whether circadian factors are central to mood disorders. Emerging from research on circadian rhythms is a model of the interaction among genes, sleep, and the environment that converges on the circadian clock to influence susceptibility to developing psychopathology. This model may lend insight into effective treatments for mood disorders and inform development of new interventions.

This study assessed the links between maternal sleep and mothers’ perceptions of their attachment relationship with their infant among women at risk for postpartum depression by virtue of having been depressed during pregnancy. Sixty-two mothers completed sleep diaries and questionnaires at 3 and 6 months postpartum. Regression analyses, controlling for depression severity and infant temperament, revealed significant prospective correlation between maternal shorter total sleep time at 3 months and lower scores on a mother–infant attachment questionnaire at 6 months. At 6 months, the longer time mothers were awake tending to their infants the lower were their attachment scores. The findings suggest that improving sleep of mothers who suffered from prenatal depression may have a positive effect on mothers’ self-reported relationship with their infants.

The current study explored the relationship between maternal subjective sleep quality and two factors that have been independently linked to maternal sleep: infant caretaking at night and maternal depressive symptom severity. Participants were a follow‐up cohort of 94 women (mean age 33.3, SD=4.4), who were depressed during pregnancy and part of a larger randomised controlled trial. Participants were evaluated 10 weeks after delivery, using the Edinburgh Postnatal Depression Scale and daily sleep logs for one week. On average, women woke to attend to the infant 2.2 times (SD=1.1) and spent 47.3 min (SD=33.0) awake to attend to the infant. Regression analysis revealed that the number of times a woman’s sleep was disrupted by attending to her infant was a significant predictor of her perceived subjective sleep quality; however, the total amount of time she spent attending to her infant and her depressive symptom severity were not predictors. The findings of this study suggest that during the third postpartu...

Behavioral insomnia is a very common problem throughout childhood. It has negative impact on children and their families and can persist for many years if not treated. Interventions based on cognitive-behavioral therapy (CBT) principles have mainly focused on withdrawing excessive parental bedtime involvement and helping children develop self-soothing strategies for falling asleep and resuming sleep during the night. With young children, these interventions are mostly based on training and modifying parental behaviors. Changing parental sleep-related expectations, beliefs and perceptions is an important component in these interventions. With older children and adolescents, more versatile interventions exist and they include additional components of CBT including relaxation and stress reduction techniques, modifying cognitive processes related to worrying and anxiety, positive imagery training and others. Extensive research has established the efficacy of behavioral interventions in early childhood. However, research on interventions for older children has been very limited and has failed to provide sufficient information on the efficacy of specific CBT techniques for childhood insomnia.

Objectives The goals of this study were to assess: (a) the involvement of fathers and mothers in overall and nighttime infant caregiving; (b) the links between paternal involvement in infant care and infant sleep patterns during the first 6 months. Methods Fifty-six couples recruited during their first pregnancy, participated in the study. After delivery (1 and 6 months), both parents completed a questionnaire assessing the involvement of fathers relative to mothers in infant caregiving. Infant sleep was assessed using actigraphy and sleep diaries. Results Mothers were significantly more involved than fathers in daytime and nighttime caregiving. A higher involvement of fathers in overall infant care predicted and was associated with fewer infant night-wakings and with shorter total sleep time after controlling for breastfeeding. Conclusions The findings highlight the importance of including fathers in developmental sleep research. Future studies should explore mechanisms underlying the relations between paternal involvement and infant sleep.

In an experiment of nature, a normal cohort of parents who were raised under communal sleeping arrangements (CSA) in Israeli kibbutzim are raising their infants at home under home-based family sleeping arrangements. The present study focused on exploring the links between the early sleep experiences of CSA parents and their present sleep-related beliefs and behaviors. In particular, the study assessed whether the cognitions of CSA parents regarding infant sleep differ from cognitions of parents who were raised under home-based family sleeping arrangements. Furthermore, parental soothing methods and infant sleep patterns were compared. One hundred forty-one families participated in this study. The children's ages ranged between 4.5 to 30 months. Parental cognitions were evaluated by two questionnaires. Infant sleep was assessed by a questionnaire and by daily parental reports. As expected, CSA parents were more likely than were control parents to: (a) interpret infant night wakings as a sign of distress and (b) actively soothe their infants at bedtime, co-sleep with them, and report more night wakings of their infants. These findings support the hypothesis that early childhood sleep-related experiences of parents ("Ghosts in the Nursery") influence their parental sleep-related cognitions that in turn affect infant sleep patterns.

Infant sleep undergoes dramatic evolution during the first year of life. This process is driven by underlying biological forces but is highly dependent on environmental cues including parental influences. In this review the links between infant sleep and parental behaviors, cognitions, emotions and relationships as well as psychopathology are examined within the context of a transactional model. Parental behaviors, particularly those related to bedtime interactions and soothing routines, are closely related to infant sleep. Increased parental involvement is associated with more fragmented sleep. Intervention based on modifying parental behaviors and cognitions have direct effect on infant sleep. It appears that parental personality, psychopathology and related cognitions and emotions contribute to parental sleep-related behaviors and ultimately influence infant sleep. However, the links are bidirectional and dynamic so that poor infant sleep may influence parental behaviors and poor infant sleep appears to be a family stressor and a risk factor for maternal depression.

The aim of this study was to explore the relationships between infant sleep patterns and infant physical growth (weight for length ratio) using both objective and subjective sleep measures. Ninety-six first-born, healthy 6-month-old infants and their parents participated in the study. Infant sleep was assessed by actigraphy for four consecutive nights and by the Brief Infant Sleep Questionnaire (BISQ). In addition, parents were asked to complete background and developmental questionnaires. Questions about feeding methods were included in the developmental questionnaire. Infants' weight and length were assessed during a standard checkup at the infant-care clinic when the infants were 6 months old. Significant correlations were found between infant sleep and growth after controlling for potential infant and family confounding factors. Actigraphic sleep percentage and reported sleep duration were correlated negatively with the weight-to-length ratio measures. Sex-related differences in the associations between sleep and physical growth were found. Breast feeding at night was correlated with a more fragmented sleep, but not with physical growth. These findings suggest that sleep is related significantly to physical growth as early as in the first months of life. The study supports increasing evidence from recent studies demonstrating a link between short sleep duration and weight gain and obesity in young children.

Infant sleep is a major source of concern for many parents. The aims of this longitudinal study were to assess: (a) the development of sleep patterns among infants, (b) the development of maternal cognitions regarding infant sleep, and (c) the relations between these domains during the 1st year of life. Eighty-five mothers were recruited during pregnancy and completed a questionnaire aimed at assessing maternal sleep-related cognitions. After delivery (at 1, 6, and 12 months) sleep was assessed using actigraphy and sleep logs, and maternal cognitions were reassessed. The findings demonstrated significant predictive and concomitant links between maternal cognitions and infant sleep. Maternal soothing behaviors mediated the relations between these domains.

OBJECTIVE. The goal was to assess stress reactions in young children during and after war and the effects of a new brief intervention. METHODS. Two separate studies were conducted. In study I, we assessed war exposure and stress reactions of 74 children (2–7 years of age) in a sheltered camp during the second Israel-Lebanon war (July to August 2006). Their exposure to war experiences and their stress reactions were assessed through parental reports during the last week of the war. In addition to standard care, 35 children received a brief intervention (Huggy-Puppy intervention) aimed at encouraging them to care for a needy Huggy-Puppy doll that was given to them as a gift. The effects of the Huggy-Puppy intervention were assessed in a follow-up interview 3 weeks after the war. Study II assessed the efficacy of group administration of the Huggy-Puppy intervention to 191 young children, compared with 101 control subjects. The effects of the intervention on stress-related symptoms after the war were assessed in telephone interviews with the parents. RESULTS. Study I indicated that, during the war, most children had significant exposure to war-related experiences and had severe stress reactions. The Huggy-Puppy intervention was associated with significant reductions in stress reactions in the postwar assessment. A higher level of attachment and involvement with the doll was associated with better outcomes. The results of study II indicated that group administration of the Huggy-Puppy intervention was associated with significant reductions in stress reactions. CONCLUSION. These studies suggest that the Huggy-Puppy intervention may offer pediatricians and other child health care professionals a promising, cost-effective intervention for children during stressful times.

This longitudinal study assessed the role of early sleep patterns in predicting attention regulation and behavior problems. Sleep of 43 infants was assessed using actigraphy at 12 months of age and then reassessed when the children were 3–4 years old. During this follow-up, their attention regulation and behavior problems were also assessed using a computerized test and parental reports. Lower quality of sleep in infancy significantly predicted compromised attention regulation and behavior problems. These findings underscore the need to identify and treat early sleep problems.

Objective Controversies exist regarding the impact of co-sleeping on infant sleep quality. In this context, the current study examined: (a) the differences in objective and subjective sleep patterns between co-sleeping (mostly room-sharing) and solitary sleeping mother–infant dyads; (b) the predictive links between maternal sleep during pregnancy and postnatal sleeping arrangement; (c) the bi-directional prospective associations between sleeping arrangement and infant/maternal sleep quality at three and six months postpartum. Methods The sample included 153 families recruited during pregnancy. Data were obtained in home settings during the third trimester of pregnancy and at three and six months postpartum. Mothers were asked to monitor their own sleep and their infants' sleep for five nights using actigraphy and sleep diaries. Questionnaires were used to assess sleeping arrangements, feeding methods, socio-demographic characteristics, and maternal depressive and anxiety symptoms. Results Mothers of co-sleeping infants reported more infant night-wakings than mothers of solitary sleeping infants. However, none of the objective sleep measures was significantly different between co-sleeping and solitary sleeping infants, after controlling for feeding techniques. Co-sleeping mothers had significantly more objective and subjective sleep disturbances than mothers in the solitary sleeping group. Moreover, poorer maternal sleep during pregnancy and at three months postpartum predicted higher levels of co-sleeping at six months. Conclusion Mothers of co-sleeping infants report more infant night-wakings, and experience poorer sleep than mothers of solitary sleeping infants. The quality of maternal sleep should be taken into clinical consideration when parents consult about co-sleeping.

The aims of this longitudinal study were to examine (a) development of infant sleep and maternal sleep from 3 to 6 months postpartum; (b) concomitant and prospective links between maternal sleep and infant sleep; and (c) triadic links between paternal involvement in infant caregiving and maternal and infant sleep. The study included 57 families that were recruited during pregnancy. Maternal and infant sleep was assessed using actigraphy and sleep diaries for 5 nights. Both fathers and mothers completed a questionnaire assessing the involvement of fathers relative to mothers in infant caregiving. The results demonstrated moderate improvement in infant and maternal sleep percent between 3 and 6 months. Maternal sleep percent at 3 months significantly predicted infant sleep percent at 6 months. Greater paternal involvement in infant daytime and nighttime caregiving at 3 months significantly predicted more consolidated maternal and infant sleep at 6 months. These findings suggest that maternal sleep is an important predictor of infant sleep and that increased involvement of fathers in infant caregiving responsibilities may contribute to improvements in both maternal and infant sleep during the first 6 months postpartum.

The purpose of this study was to characterize the sleep patterns of children with intrauterine growth retardation, known to be at risk for neurodevelopmental disorders, and seek a possible correlation with behavior, concentration, and attention problems. The sleep patterns of 26 children with intrauterine growth retardation aged 4 to 7 years were compared with those of 47 control children using activity monitors (actigraphs). In addition, data were collected from the parents regarding sleep habits, behavior, concentration, and attention. Children with intrauterine growth retardation aged 4 to 7 years were found to have a tendency toward poorer quality of sleep than their matched controls. This inclination was statistically significant only for one sleep measure, the true sleep time. A tendency toward increased fragmentation of sleep, prolonged waking, and decreased sleep efficiency, although not statistically significant in this study, was demonstrated. Our results showed that 58% of the children with intrauterine growth retardation, compared with 40% of the children in the control group, could be defined as “poor sleepers” (sleep efficiency lower than 90% or three or more waking episodes per night). This disturbed sleep profile is probably an integral part of the neurodevelopmental profile typical of these at-risk children. No significant correlations were found between sleep quality and behavior, concentration, and attention problems. ( J Child Neurol 2002;17:872—876).

This study examined the links between maternal sleep, maternal depressive symptoms, and mothers' perceptions of their emotional relationship with their infant in a self-recruited sample of mothers. Eighty mothers of infants 3-18 months old completed sleep diaries for 5 consecutive nights, and questionnaires assessing sleep (Insomnia Severity Index [ISI]), depressive symptom severity (Edinburgh Postnatal Depression Scale [EPDS]), and perceived mother-infant relationship (Postpartum Bonding Questionnaire [PBQ] and Maternal Postnatal Attachment Questionnaire [MPAQ]). Significant correlations, controlling for depression severity, were found between more disturbed maternal sleep and more negative maternal perceptions of the mother-infant relationship. Regression analyses revealed that EPDS showed the strongest association with PBQ, whereas ISI demonstrated the strongest association with MPAQ. The present study highlights the importance of deepening and expanding our understanding of the negative implications of maternal sleep problems.

The purpose of the present study was to investigate the links between infants' sleep and their parents' sleep and to assess the links between infant/parent sleep and parenting stress. Furthermore, we explored whether the links between sleep and parenting stress are moderated by maternal leave status. Participants were 50 families with an infant between the ages of 4-5 months. Half of the mothers were on maternity leave while the others returned to work. Parents completed daily sleep logs about infants' and their own sleep for 4 consecutive nights. Each parent also completed the Parenting Stress Index. Infant sleep was associated with sleep of both mothers and fathers, but the correlations with maternal sleep were stronger. Parental perceptions of their infant's sleep as problematic were associated with higher parenting stress. Poorer infant and maternal sleep patterns were associated with parenting stress only in families with mothers on maternity leave, probably because these mothers need to provide intensive caregiving "around the clock" without sufficient opportunities to rest.