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Sleep patterns and insomnia among adolescents: A population-based study
Abstract
The aim of the current study was to examine sleep patterns and rates of insomnia in a population-based study of adolescents aged 16-19 years. Gender differences in sleep patterns and insomnia, as well as a comparison of insomnia rates according to DSM-IV, DSM-V and quantitative criteria for insomnia (Behav. Res. Ther., 41, 2003, 427), were explored. We used a large population-based study in Hordaland county in Norway, conducted in 2012. The sample included 10 220 adolescents aged 16-18 years (54% girls). Self-reported sleep measurements included bedtime, rise time, time in bed, sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset, rate and frequency and duration of difficulties initiating and maintaining sleep and rate and frequency of tiredness and sleepiness. The adolescents reported short sleep duration on weekdays (mean 6:25 hours), resulting in a sleep deficiency of about 2 h. A majority of the adolescents (65%) reported sleep onset latency exceeding 30 min. Girls reported longer sleep onset latency and a higher rate of insomnia than boys, while boys reported later bedtimes and a larger weekday-weekend discrepancy on several sleep parameters. Insomnia prevalence rates ranged from a total prevalence of 23.8 (DSM-IV criteria), 18.5 (DSM-V criteria) and 13.6% (quantitative criteria for insomnia). We conclude that short sleep duration, long sleep onset latency and insomnia were prevalent in adolescents. This warrants attention as a public health concern in this age group.
... Insomnia disorder is often described as a disorder of hyper-arousal (Dressle and Riemann 2023), and current recommendations point to cognitive-behavioral therapy for insomnia (CBT-I) as the treatment of choice for insomnia disorder ). Reported prevalence rates of insomnia in adolescent populations range between 24% and 37% (Hysing et al. 2013;Li et al. 2018). ...
... The prevalence rate of insomnia found in the present study was higher than what was reported in a previous Norwegian study, where Hysing and colleagues estimated a prevalence rate of insomnia of 13.6-23.8% (Hysing et al. 2013) among adolescents aged 16-19 y. Differences may be related to dissimilarities in methodology. ...
... A possible explanation could be that the CDinsomnia group is quite heterogenous, comprising both individuals primarily characterized by a delayed circadian rhythm and individuals with insomnia disorder alongside a circadian delay. Since insomnia is a common sleep disorder, also during adolescence (Hysing et al. 2013;Li et al. 2018), and since eveningness is a common trait during adolescence , it seems inevitable that many adolescents with insomnia will also exhibit an evening typology. In a study by Li et al. (2018), they found that 52.9% of evening types fulfilled the criteria for insomnia disorder based on the Insomnia Severity Index (ISI). ...
Epidemiological studies show a high prevalence of "insomnia" in adolescents. However, insomnia symptoms are not specific for insomnia disorder. Puberty is associated with circadian delay, which may cause insomnia symptoms such as problems falling asleep and daytime impairments, but also difficulties rising in the morning which is not a hallmark of insomnia disorder. The aim of this study was to investigate the extent to which adolescent insomnia symptoms may be attributed to circadian delay. The sample comprised 3,867 high-school-students. Survey instruments included the Bergen Insomnia Scale (BIS), the Munich ChronoType Questionnaire (MCTQ), the reduced Morningness-Eveningness Questionnaire (r-MEQ), and items on subjective sleep problems and sleep-related behaviors. Symptoms of circadian delay (CD) were defined as i) trouble waking on school days, ii) ability to sleep long into the day, iii) waking ≥10:00 on free days and/or iv) oversleeping for school. A total of 34.5% reported insomnia according to BIS. Among these, 88.4% reported ≥1 CD-symptom and 15.5% reported all CD-symptoms. Adolescents with insomnia and ≥1 CD-symptom were often evening-types (56.9%), had long social jetlag (2:55 h) and large school-/free day discrepancy in sleep duration (6:04 vs. 8:34 h). Results suggest circadian delay as a plausible explanation for insomnia symptoms in many adolescents.
... Insomnia is common in adolescence but may be underdiagnosed and under-treated [17,18]. Much research documents the biopsychosocial challenges to sleep experienced by adolescents in particular, with changes to the biological regulation of sleep -including a shift in the circadian timing system ("phase delay") and a slower accumulation of sleep pressure -contributing to a delayed sleep/wake cycle [19,20]. ...
... Insomnia is particularly evident in older adolescents and in females, with a female predominance emerging after puberty [17,24]. Furthermore, Sivertsen and colleagues demonstrated that sleep problems in 7-9-yearold children persisted into late adolescence (aged [16][17][18][19] for approximately one in three children [25]. Given that the majority of young people attend schools, being able to assess potential sleep problems in this environment could have widespread impact. ...
... All sleep profiles other than Good Sleepers, were predominantly female. The implication that females may be more vulnerable to sleep problems, given their over-representation in the Poor Sleeper and Poor Sleepy Sleeper profiles, is in line with previous findings that females are more predisposed to insomnia disorder and insomnia symptoms than males in adolescence [17,18,24]. Furthermore, females were more likely to be in the profiles categorised by high levels of daytime sleepiness. ...
Background
Sleep problems are common in young people. Yet brief screening measures to identify those most in need of an intervention are lacking. This study investigated the potential of the two-item Sleep Condition Indicator (SCI-02) for screening insomnia symptoms in children and adolescents. We sought to establish whether there are distinct subgroups with different sleep profiles and whether subgroup membership varied with gender and school year group.
Methods
Students (school years 5–13; typical age 9–18 years) in England completed the OxWell Student Survey in 2021. Sleep measures included: SCI-02, sleep onset latency (SOL), sleep duration, daytime sleepiness, and worry disrupting sleep. Latent profile analysis and multinomial logistic regression explored sleep profiles and predicted class membership.
Results
In total, 29,304 participants answered sleep items. Of these, 95% provided binary gender (n = 27,802, 55% female) for analyses. Five sleep profiles emerged. The profiles, labelled “good”, “moderate”, or “poor” sleepers, vary by sleep quality – which includes time taken to fall asleep (SOL), amount of sleep (sleep duration), and the disruption of sleep due to worry. The profiles are then further differentiated by high levels of daytime sleepiness – labelled “sleepy”. “Good Sleepers” (18,355, 66%), “Moderate Sleepers” (4825, 17.4%), “Moderate Sleepy Sleepers” (1250, 4.5%), “Poor Sleepers” (1037, 3.7%) and “Poor Sleepy Sleepers” (2335, 8.4%). Probable insomnia rates (SCI-02 ≤ 2) were high in both poor sleeper profiles (70–80%) compared with other profiles (0%) and the sample overall (9%). Compared with “Good Sleepers”, all other profiles were mostly female. Daytime sleepiness – the defining characteristic of the sleepy sleeper profiles – was more common in secondary school participants than primary school.
Conclusions
The SCI-02 is an efficient, two-question measure to screen for potential sleep problems in young people. Sleep disruption was high: one in ten were experiencing poor sleep. Females and adolescents appeared more vulnerable to poor sleep and daytime sleepiness. The SCI-02 has the potential for use in school and community contexts to identify children and adolescents who may benefit from support managing their sleep.
... Insomnia is common among adolescents in general, although the prevalence numbers vary in different studies as different criteria of insomnia are used [31]. People who are diagnosed with psychiatric diagnoses have more sleep problems than the general population, as several different diagnoses are associated with higher prevalences of sleep problems [32,33]. ...
... The need for sleep and sleep problems may differ at different developmental stages, so sleep problems among children or adults may be different from sleep problems among adolescents [26]. Adolescents in a Norwegian population study reported short sleep duration on weekdays, resulting in a sleep deficiency of approximately 2 h, and the majority of the adolescents reported sleep onset latency of more than 30 min [31]. Girls reported a higher rate of insomnia and longer sleep onset latency than boys [31]. ...
... Adolescents in a Norwegian population study reported short sleep duration on weekdays, resulting in a sleep deficiency of approximately 2 h, and the majority of the adolescents reported sleep onset latency of more than 30 min [31]. Girls reported a higher rate of insomnia and longer sleep onset latency than boys [31]. Since sleep problems may be different for different age groups, the relationship between sleep and OCD should be studied specifically within different developmental periods, such as childhood, adolescence and adulthood, as it may differ at different developmental stages [26]. ...
Background
Research suggests that individuals with obsessive-compulsive disorder (OCD) frequently experience insomnia. Some previous studies have suggested that insomnia may predict treatment outcomes, but the evidence is limited, especially for adolescents. This study examined the prevalence of insomnia in an adolescent OCD patient sample, explored the correlation between OCD and insomnia, and tested whether levels of insomnia at baseline predict outcomes for adolescent patients receiving the Bergen 4-Day Treatment (B4DT) for OCD.
Methods
Forty-three adolescent OCD patients who received B4DT were selected for this study. Treatment outcome was quantified as change in Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores across time from pre- to posttreatment and 3-month follow-up. Insomnia symptoms were measured by the Bergen Insomnia Scale (BIS). Linear mixed models were used to examine the relationship between the BIS and changes in CY-BOCS scores. We controlled for symptoms of general anxiety disorder measured by the GAD-7 and depression symptoms measured by the PHQ-9.
Results
In this sample, 68.4% of the patients scored above the cutoff for insomnia on the BIS. There was a moderate correlation between baseline CY-BOCS and BIS that did not reach statistical significance (r = .32, p = .051). High BIS scores before treatment were significantly associated with poorer treatment outcomes, as measured by changes in CY-BOCS over time (p = .002). The association between baseline insomnia and change in OCD symptoms remained significant (p = .033) while controlling for GAD-7 and PHQ-9.
Conclusion
Insomnia is common among adolescents with OCD, and these data suggest that these patients may be at increased risk for poor treatment outcomes. Future research to explore mechanisms and adjunctive treatments is warranted.
Trial registration
The study was approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (REK Nord: 2023/606482).
... However, ample evidence across the globe shows that adolescents sleep less than recommended on school nights (Galland et al., 2018;Hirshkowitz et al., 2015), and a substantial proportion experience daytime sleepiness (Liu et al., 2019). In Norway, two large-scale studies have consistently shown that highschool students average less than 7 hr of sleep on school nights (Hysing et al., 2013;Saxvig et al., 2021). This is concerning, as studies indicate that adolescents aged 14-17 years need approximately 8-10 hr of sleep per night for adequate daytime functioning (Hirshkowitz et al., 2015;Short et al., 2018). ...
... Furthermore, adolescence often marks the debut period of clinical sleep disorders, including insomnia (Johnson et al., 2006). Depending on the diagnostic criteria, insomnia may affect up to approximately a quarter of adolescents (Hysing et al., 2013), and tends to become chronic Johnson et al., 2006). The main criteria include difficulties initiating and/or maintaining sleep, and/or earlymorning awakening (EMA) despite adequate opportunities for sleep, combined with sleep-related worry and/or some form of daytime impairment. ...
This study explored the prospective associations between sleep patterns, mental health and registry‐based school grades among older adolescents. In the spring of 2019, 1st year high‐school students in Western Norway were invited to a survey assessing habitual sleep duration, insomnia, depression and anxiety. Sleep patterns, depression and anxiety were assessed using the Munich ChronoType Questionnaire, the Bergen Insomnia Scale, the Patient Health Questionnaire‐9, and the Generalized Anxiety Disorder‐7. Students consenting to data linkage with the county school authorities were re‐invited 2 years later. Registry‐based grade point averages for each of the included school years were accessed through the school authorities. The final longitudinal sample included 1092 students (65.1% girls; initial mean age 16.4 years). Data were analysed using linear mixed models. Longer school night sleep duration and less severe symptoms of insomnia, depression and anxiety were all associated with higher grade point averages at baseline in crude analyses. Shorter school night sleep duration, as well as more severe symptoms of insomnia and depression at baseline, all predicted worse grade point averages at 2‐year follow‐up when controlled for baseline grade point averages. [Correction added on 30 December 2024, after first online publication: In the preceding sentence, the word “better” has been corrected to “worse”.] By contrast, anxiety symptomatology at baseline was unrelated to changes in grade point averages over time. The longitudinal associations between school night sleep duration and insomnia symptoms on grade point averages were significant also when adjusted for sex and baseline symptoms of depression and anxiety. These findings indicate that shorter school night sleep duration and more severe insomnia symptoms predict lower grade point averages development over time, irrespective of co‐existing symptoms of depression and anxiety.
... The home environment and daily routines can significantly influence children's [22]sleep quality and patterns. Research by Mindell and Williamson (2018) highlighted the importance of creating a sleep-conducive environment, including a comfortable sleep environment (e.g., dark, quiet, and cool room), consistent bedtime routines, [23]and limiting stimulating activities before bedtime. Excessive screen time, especially close to bedtime, can disrupt sleep onset and reduce overall sleep duration in children, as shown in studies by Hysing et al. (2015) and . ...
... Research by Mindell and Williamson (2018) highlighted the importance of creating a sleep-conducive environment, including a comfortable sleep environment (e.g., dark, quiet, and cool room), consistent bedtime routines, [23]and limiting stimulating activities before bedtime. Excessive screen time, especially close to bedtime, can disrupt sleep onset and reduce overall sleep duration in children, as shown in studies by Hysing et al. (2015) and . [24] Furthermore, inconsistent sleep schedules, irregular bedtimes, and disruptions in bedtime routines can lead to sleep difficulties and contribute to behavioral sleep problems. ...
Behavioral sleep problems in children are a significant concern with implications for their cognitive, emotional, and physical well-being. This review explores key aspects of behavioral sleep problems, including types, impact, risk factors, assessment, treatment, and future directions in research. Insomnia, delayed sleep phase disorder (DSPD), parasomnias, and sleep-related breathing disorders are among the common types discussed, each presenting unique challenges and considerations in diagnosis and management. The impact of behavioral sleep problems on cognitive development, emotional regulation, behavioral functioning, and physical health is highlighted, emphasizing the need for early identification and intervention.Assessment methods such as parent and child reports, sleep diaries, actigraphy, and polysomnography are essential for evaluating sleep problems objectively and tailoring interventions to individual needs. Behavioral interventions, cognitive-behavioral therapy for insomnia (CBT-I), pharmacological options, and alternative therapies are discussed as effective strategies for addressing sleep disturbances in children. The importance of multidisciplinary collaboration among healthcare providers, educators, parents, and researchers is emphasized to promote healthy sleep habits and improve outcomes for children.Emerging research areas, including genetics, technology use, and societal changes, offer new insights into the complexities of sleep disorders in children. Longitudinal studies and intervention trials are recommended to evaluate the long-term effects of sleep disturbances and develop evidence-based interventions. Healthcare providers are encouraged to prioritize screening, education, and referral for sleep disorders, while educators and parents are advised to promote consistent sleep schedules, limit screen time, and create sleep-conducive environments. In conclusion, addressing behavioral sleep problems in children requires a comprehensive approach involving early identification, evidence-based interventions, interdisciplinary collaboration, and ongoing research efforts. By prioritizing sleep health and implementing effective strategies, stakeholders can support optimal development and well-being in children.
... Insomnia refers to significant and persistent difficulties with sleep initiation, maintenance, or early morning awakening. [48][49][50] These sleep complaints are accompanied by impaired daytime functioning, which can manifest as irritability, difficulty concentrating, behavioral disturbances, mood changes, and academic performance issues. Insomnia can be categorized as short-term or transient, typically related to acute stressful events, or long-term and chronic, persisting for at least three nights per week over a period of 3 months or more. ...
... 48,52 The diagnosis of insomnia is made based on the presence of sleep complaints, impairment in functioning, and distress related to poor sleep, without necessarily attributing it to a specific comorbid condition. 50,53 Sleep diaries and actigraphy are useful to characterize sleep timing and duration, assisting in the diagnosis of insomnia and circadian rhythm disorders. ...
Sleep‐related disorders in children can significantly impact children's physical, emotional, and cognitive development and constitute a major source of parental concern. This comprehensive review aims to describe sleep‐related disorders commonly encountered in pediatric practice, their etiology, diagnosis, and management strategies. The review explores various disorders prevalent in different age groups, including insomnia, sleep apnea, parasomnias, and circadian rhythm disorders, highlighting the importance of early identification and intervention for optimal child health and well‐being.
... Sleep duration less than 7 hours was considered as insufficient for adolescents in age group 11-15 years. Sleep duration of less than 7 hours previously has been associated with poorer self-reported health in young adults (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) years) compared to sleep duration of 7-8 hours [22]. The results showed that almost 3% of adolescents reported poor health, which is slightly more than reported in other studies on European countries [23]. ...
... This is more than reported in other populations with the same cut-off point used [25]. However, results reporting one to three fifths of adolescents not reaching seven hours of daily sleep can also be found [26,27]. In line with other studies on European and North American countries [20], this study also found a significantly lower proportion of adolescents not reaching the sleep duration at least seven hours on weekends compared to schooldays. ...
Insufficient sleep and recurrent health complaints may increase the risk of poorer self-reported health in adolescence, yet the relationships between these factors are not well understood. This study aims to explore the association between poor self-reported health and insufficient sleep duration among 11, 13, and 15 years old adolescents in Latvia by assessing the moderation effects of age and gender and by considering the mediating effect of health complaints. Methods: Data from the Health Behaviour in School-aged Children Study on 2017/2018 of Latvia ( n = 4412) were used for statistical analysis. Results: On average, 19.3% reported insufficient sleep duration on schooldays and 4.4% on non-school days. Of those with insufficient sleep duration, 5.8% reported poor self-reported health while this proportion was 2% among those with sufficient sleep. Poor self- reported health was associated insufficient sleep duration on school days (OR = 3.02; 95%CI 2.02-4.49), but not on non-schooldays. The association between insufficient sleep and poor self-reported health changed considerably after adjustment with health complaints (OR = 1.58;95%CI 1.03-2.43), however, it still remained significant. Conclusions: There is significant association between insufficient sleep and poor self-reported health regardless of total burden of health complaints.
... Our results do not match the results from some studies, which found that boys sleep less and go to bed later than girls [30][31][32]. On the other hand, our results comply with other studies, which found that boys sleep more in comparison to girls [33,34]. After comparing the average sleep time with data from countries monitored by Gariepy et al. [28], our measured value (8 h 44 min) was closest to the data recorded in Canada (8 h 41 min) and furthest from the data from Poland (7 h 47 min). ...
Background: This study aims to explore the association between sleep patterns in
children and their exposure to phthalates to assess potential health implications. Methods: Participants (n = 60) completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Consumerbehavior scores (CBS) were calculated. The Tanner scale was used to monitor the stages of puberty. First-morning urine samples were analyzed by high-performance liquid chromatography–tandem mass spectrometry. Results: The average sleep duration was 8 h and 44 min, withboyssleeping significantly longer (p = 0.01). Notably, 51.7% of participants reported sleeping less than 9 h. The nonlinear effects of phthalate metabolite in association with PSQI were observed for hydroxy-mono-isononyl phthalate (OH-MiNP, p = 0.003) and MnOP(p<0.001), indicating that the relationship does not follow a simple linear pattern. Simple linear regression revealed a significant positive association between the Mono-n-octyl phthalate (MnOP) and PSQI scores (p = 0.016). After adjustment for place of residence, BMI, CBS, sex, and age, the significance of associations between phthalate metabolites and sleep quality diminished, necessitating cautious interpretation. No statistically significant associations between pubertal changes and the value of PSQI as well as phthalates were observed. Conclusion: Our results provide preliminary evidence of potential nonlinear associations that require validation in a larger cohort. The findings highlight the importance of monitoring phthalate exposure in children, as it may influence sleep patterns and overall health.
... Therefore, insomnia in children can take many forms, from difficulty initiating sleep to frequent night-time awakenings and unrefreshing sleep. Insomnia prevalence ranges from 20 to 30% in infants and toddlers [5,6] and up to one-third of adolescents [7,8]. Multiple severe consequences can occur, affecting, e.g., learning, behavior, and overall quality of life for the child and their family. ...
Background: Insomnia disorder in childhood and adolescence has severe implications on overall well-being and development. Age-specific treatments for insomnia disorder with cognitive behavioral interventions (CBT-I) are available and effective. Nightmare disorder also has severe consequences in children and adolescents. However, less is known about children with insomnia (I) and comorbid nightmare disorder (I + N). Methods: In this retrospective study, data from 499 children and adolescents with insomnia disorder were included. The prevalence of a comorbid nightmare disorder (I + N) was calculated within three subsamples (toddlers and preschoolers 0.5–4 years, elementary school children 5–10 years, and adolescents 11–18 years). Differences between children with insomnia (I) and those with additional nightmare disorder (I + N) regarding age, sex, family background, sleep quality (SOL, WASO, TST, and SE) based on sleep logs, behavior sleep problems (based on interviews), and behavioral problems (CBCL and YSR) were calculated within each age group. Results: The overall prevalence of additional nightmares or nightmare disorder in children or adolescents with insomnia was 15–24%. We found various clinically relevant differences between I and I + N for each age group; for example, there were more sleep onset association problems in I + N elementary school children, prolonged SOL of 56 min, and about 50 min less TST and SE of 76.8% in I + N adolescents. However, most statistical tests were not significant. Especially sleep parameters but also emotional burden were more pronounced in I + N groups than in the I groups. Toddlers and preschoolers with I + N were significantly older than those with only I, had another family situation (e.g., divorced parents) significantly more often, and I + N adolescents were statistically more often anxious and depressed. Discussion: Descriptively, I + N children and adolescents seemed to be more impaired than those with insomnia only. However, a comorbid nightmare disorder cannot be recognized by insomnia-specific sleep parameters. Therefore, diagnostic procedures for insomnia should always screen for nightmares but also other sleep disorders. If necessary, CBT-I should be supplemented with nightmare-specific interventions.
... Insomnia has been identified as the most prevalent sleep disorder among adolescents. It is estimated that up to 18.5% of older adolescents (aged 16-18 years) meet the diagnostic criteria for insomnia as outlined in the DSM-5 [6]. Insomnia is often comorbid with psychological and behavioral abnormalities, including depression and nonsuicidal self-injury [7-9]. ...
Objective: The objective of this study was to investigate the current state of insomnia among secondary vocational school students, identify its influencing factors, and explore potential mechanisms of action. Methods: The study population consisted of 2150 students (968 male and 1182 female) enrolled in a secondary vocational school in Wuhan, China. A cross-sectional research design was employed to analyze the data using descriptive statistics, correlation analysis, structural equation modeling, and bootstrapping. Results: Adolescents with poorer family functioning, higher levels of paranoid personality traits, and higher levels of anxiety are more likely to experience insomnia. There was a significant direct association between family functioning and insomnia ( β = −0.153, p < 0.001). Paranoid personality traits and anxiety were not only significant independent mediators in the relationship between family functioning and insomnia (paranoid personality traits: β = 0.021, 95% CI: [−0.035, −0.008]; anxiety: β = 0.173, 95% CI: [−0.204, −0.114]) but also chain mediators ( β = 0.059, 95% CI: [−0.073, −0.048]). Conclusions: Managing insomnia in secondary vocational school students requires familial and individual strategies, including reducing family conflict, improving family functioning, and addressing cognitive biases and anxiety.
... Clinical insomnia symptoms, or insomnia disorder [62] evaluated with ISI was 21.5%, similar as has been reported previously 18.5% (23.6% female and 12.5% male) in adolescents 16-18-years of age [63]. Multiple factors increase the risk for developing insomnia, including being a late-chronotype during the adolescent period [64], social stressors including school stress, screen-and social-media use, irregular sleep behavior, caffeine usage and being a female [62]. ...
Objectives
Sleep is often compromised in adolescents, affecting their health and quality of life. This pilot-study was conducted to evaluate if implementing brief-behavioral and sleep-hygiene education with mindfulness intervention may positively affect sleep-health in adolescents.
Method
Participants in this community-based non-randomized cohort-study volunteered for intervention (IG)- or control-group (CG). Sleep was recorded during regular school-schedule for 3-school-nights and 2-non-school-nights with an FDA-cleared/EU-Medical Device Regulation (CE-2862) compliant home sleep test, and Questionnaires were utilized to evaluate chronotype, sleepiness, insomnia-, anxiety- and depression-symptoms. The four-week intervention included sleep-hygiene education, mindfulness- and breathing-practices for one-hour, twice weekly. Data was collected during the last-week of February and first two-weeks of March 2023 and repeated after intervention.
Results
Fifty-five participants completed the study, IG (86%) and CG (77%). Average age was 17.3-years and prevalence of severe social-jetlag (SJL) 72%.
Participants who quit participation (n = 10) after baseline data-collection all females (3-IG/7-CG) in comparison to participants who completed the study were sleepier than the IG and CG (+ 2.6-p = 0.04; + 3.8-p = 0.001), with more symptoms of insomnia- (+ 3.8-p = 0.002; + 4.7-p < 0.0001), and depression (+ 16.7-p < 0.0001; + 19.6-p < 0.0001), and report being later-chronotypes, (-18.2, p < 0.0001;-13.1, p < 0.0001).
On average the IG advanced sleep-onset (32-min; p = 0.030), decreased SJL (37-min; p = 0.011) and increased total sleep time (TST, 29-min; p = 0.088) compared to the CG. Average sleep duration did not differ significantly comparing IG and CG after intervention.
Stratifying participants with severe SJL (> 2-h) at baseline; 1) responders (61%) advanced sleep-onset on non-school-nights (96-min) and decreased SJL (103-min; p < 0.001) 2) non-responders (39%) increased sleep-duration on school-nights (36-min) and non-school-nights (63-min) but maintained severe-SJL.
Conclusion
Teacher-lead sleep-education and mindfulness program can improve TST and SJL in adolescence.
... Adolescence, typically defined as ages 10 to 19, is a period of rapid and profound changes in biology, personality, and social relationships, often accompanied by sleep problems like irregular patterns, insufficient duration, and insomnia (Carskadon et al., 2004;Chung et al., 2011). Insomnia, characterized by persistent difficulties in falling or staying asleep despite adequate sleep opportunity, is one of the most serious sleep problems in adolescents, particularly prevalent among older adolescents and girls (De Zambotti et al., 2018;Hysing et al., 2013;Johnson et al., 2006). In the US, 9.4% of adolescents aged 13-16 were diagnosed with insomnia based on DSM-IV criteria (Chung et al., 2011). ...
Insomnia is a prevalent concern among adolescents, but accurately measuring its severity remains challenging. The Insomnia Severity Index (ISI) is widely used to assess insomnia symptoms, yet its psychometric properties have not been thoroughly evaluated in Chinese adolescents. This study addresses this gap by applying bifactor modeling and item-response theory (IRT) analysis to a large sample of 570,295 Chinese adolescents. Confirmatory factor analysis (CFA) identified a three-factor structure with correlated factors as the best-fitting model (CFI = 0.996, TLI = 0.991, RMSEA = 0.035, SRMR = 0.010). Further bifactor CFA revealed that a two-factor model (excluding item 4) provided a superior fit (CFI = 0.999, TLI = 0.997, RMSEA = 0.021, SRMR = 0.004), with the general insomnia severity factor explaining 69% of the common variance. The general factor captured variances related to nighttime sleep difficulties (e.g., trouble falling asleep or staying asleep) and daytime impairments (e.g., fatigue, irritability). IRT analysis demonstrated that the ISI exhibited high reliability and discrimination across moderate to high levels of insomnia severity, although reduced reliability was observed at the extreme ends of the scale. Gender differences showed that females had higher insomnia scores than males (Cohen's d = 0.12), while boarding students exhibited significantly higher insomnia severity compared to day students (Cohen's d = 0.30). These findings underscore the ISI's reliability and validity for measuring insomnia severity among Chinese adolescents, highlighting its utility as a valuable assessment tool for both research and clinical practice. The results provide important insights into adolescent sleep health and suggest potential applications for targeted interventions aimed at mitigating insomnia symptoms in this population.
... This is similar to the study by Murphy et al. [37], where females had more sleep disturbances. Similarly, general population-based studies have also found that older adolescent girls consistently reported significantly shorter sleep duration and decreased sleep efficiency than boys of the same age [53]. Younger youth in our study were also three times more likely to suffer from sleep-related impairment and two times more likely to suffer from anxiety compared to older youth. ...
Background
There is a bidirectional relationship between sleep and pain disturbances. Sleep disturbances increase the risk for chronic pain, while chronic pain can interfere with sleep. Hence, we assessed the subjective sleep characteristics of youth with functional abdominal pain disorders (FAPDs) compared to healthy youth and examined associations with gastrointestinal symptoms.
Methods
We included youth ages 10–18 years without a sleep or organic GI disorder diagnosis from a large private school. Participants completed demographics, sleep history, and validated questionnaires: sleep quality (ASWS‐SF), insomnia (PISI), daytime sleepiness (ESS), sleep disturbance (PROMIS SD), sleep‐related impairment (PROMIS SRI), and Rome 4 diagnostic questionnaire. Cases (FAPDs) completed abdominal pain index (API), nausea severity (NSS), anxiety, depression (PROMIS), and functional disability (FDI). Parents filled sleep hygiene metrics (SHIP). Cases were matched 1:1 with controls based on age and gender.
Results
Of 120 youth (60 cases and 60 controls), the mean age was 13.5 ± 1.9 years and 50% were females. Youth with FAPDs had higher insomnia, sleep disturbance, sleep‐related impairment, daytime sleepiness, sleep hygiene, gasping, and nightmares than healthy youth (p < 0.05). Higher insomnia severity was associated with worse abdominal pain (r = 0.41, p < 0.01), higher daytime sleepiness with a family history of disorders of gut‐brain interaction (DGBIs, OR = 14.7, p = 0.002), and higher sleep‐related impairment (OR = 5.6, p = 0.02) and depression (OR = 6.1, p = 0.01) with black race.
Conclusion
Youth with FAPDs have worse sleep than healthy youth and multiple sleep parameters are associated with abdominal pain. Future studies could focus on determining mechanisms by which sleep disturbances affect abdominal pain and vice versa.
... 2. Hysing et al., (2015) The point of the current thing was to assess slumber designs and fees of a sleeping ailment in a population-based think of young people between the ages of sixteen to nineteen. Sex differences and pictograms of rest designs and a sleeping disorder, the comparison of the sleeping disorder rate according to DSM-IV, DSM-V, and the quantitative rate of a sleeping disorder (Behav. ...
... 41 Sex-specific differences emerge, with adolescent girls experiencing longer sleep onset latencies and more insomnia symptoms, while boys exhibit less regular sleep patterns and later bedtimes. 42 Delayed sleep phase disorder (DSPD) is common in adolescence, characterized by a delayed sleep schedule and daytime impairment. 43 DSPD desynchronizes patients from societal schedules, leading to sleep loss and daytime sleepiness. ...
Objective
To investigate the impact of circadian rhythm disruptions on mental health among college students and explore effective interventions for maintaining stable circadian rhythms.
Methods
A comprehensive review of literature was conducted, focusing on sleep patterns, circadian rhythms, and their effects on mental health. Studies were analyzed to identify common factors contributing to circadian misalignment in college students and effective treatments. Data from large-scale studies and specific clinical trials were utilized to understand the relationship between circadian rhythms and psychiatric disorders.
Results
Disruptions in circadian rhythms were linked to increased prevalence of psychiatric disorders such as depression, anxiety, and bipolar disorder. Biological changes during adolescence, academic pressures, and extensive use of electronic devices were major contributing factors. Effective interventions included light therapy, chronotherapy, melatonin supplementation, and cognitive behavioral therapy for insomnia.
Conclusion
Stable circadian rhythms are crucial for mental health, particularly in college students who are vulnerable to disruptions due to lifestyle factors. Implementing interventions such as regular sleep schedules, light exposure management, and behavioral therapies can significantly improve mental health outcomes. Further research and targeted mental health programs are essential to address circadian misalignment and its associated psychiatric disorders in this population.
... Adolescence is a developmental period characterized by a wide range of physical, psychological, and social changes [16], including significant changes in sleep [17]. Epidemiological studies estimates that around 7.8-23.8% of adolescents is affected by insomnia [18][19][20]. While these existing studies provide a foundation for investigating insomnia and suicide in adolescents, few studies have attempted to determine the association between specific insomnia symptoms and suicide risk. ...
Objective
This study aimed to investigate a range of insomnia-related factors, including difficulty with sleep induction, nocturnal awakenings, early awakenings, total sleep time, overall sleep quality, well-being, functioning, and daytime drowsiness, to determine which variables were significantly associated with subsequent adolescent suicide attempts.
Method
A total of 782 students aged 11–16 years old from one middle school in Changsha, China completed the survey at baseline and 6 months follow-up with a prospective cohort design. The binary logistic regression models were used to analyze the associations between insomnia variables and suicide attempts during the 6 months follow-up.
Results
The new incidence rate of suicide attempts was 4.60% (36/782) at 6-month follow-up. Insomnia was a significant predictor of incident suicide attempts (OR = 6.00; 95%CI, 2.47–14.60). After adjusting for age, gender, nationality, stress, anxiety and depression, insomnia was found to predict suicide attempts only among female (OR = 4.28; 95%CI, 1.41–12.98) and only nocturnal sleep disruption was significantly associated with an increased risk of suicide attempts (OR = 2.74; 95%CI, 1.32–5.71).
Conclusions
Nocturnal sleep disruption are independently associated with increased risk of suicide attempts. Intervention for nocturnal sleep disruption may be important for early identification as well as prevention of adolescent suicide, especially among adolescent girls.
... Our physical activity findings align with existing research, emphasizing the prevalence of sedentary lifestyle among adolescents [45,46]. Notably, we observed a delayed sleep onsite time and longer sleep duration on weekends, similar to previous studies [47,48]. For our future studies, we plan to examine associations of sleep and physical activity behaviors with cardiometabolic health data already collected at the midadolescence visit, such as weight, body composition, blood pressure, and blood biomarkers of cardiovascular health. ...
Background
The increasing prevalence of physical inactivity and insufficient sleep in adolescents likely contribute to worsening cardiometabolic and mental health. However, obtaining accurate behavioral measures is a challenge. Consumer wearable devices offer a user-friendly method to assess physical activity and sleep.
Objective
This study aimed to describe the process and the preliminary results of physical activity and sleep collected using a consumer wearable Fitbit device in an adolescent cohort.
Methods
We provided Fitbit Charge 2 or Charge 3 wrist-worn activity monitors to adolescent participants in Project Viva, a Boston, Massachusetts area cohort, from 2017 to 2022. We invited participants to wear the devices for ≥7 days for 24 hours a day to measure their physical activity, heart rate, and sleep, and allowed them to keep the device as a participation incentive.
Results
We collected over 7 million minutes of physical activity, heart rate, and sleep data from 677 participants, female. The mean (SD) age of participants was 17.7 (0.7) years. Among the 677 participants, were non-Hispanic White, non-Hispanic Black, were Hispanic, non-Hispanic Asian, and belonged to other races. Participants demonstrated a high adherence to the research protocol, with the mean (SD) wear duration of 7.5 (1.1) days, and 90% of participants (612/677) had 5 or more days wearing the device for >600 minutes/day. The mean (SD) number of steps was 8883 (3455) steps/day and the mean (SD) awake sedentary time was 564 (138) minutes/day. Male participants were more often engaged in very active (27 minutes/day) and moderately active physical activity (29 minutes/day) compared with female participants (15 and 17 minutes/day, respectively). Over 87% (588/677) of participants had sleep data available for 5 or more days, among whom the average nightly sleep duration was 7.9 (SD 0.9) hours.
Conclusions
This study demonstrated the feasibility of using consumer wearable devices to measure physical activity and sleep in a cohort of US adolescents. The high compliance rates provide valuable insights into adolescent behavior patterns and their influence on chronic disease development and mental health outcomes.
... Interestingly, girls in lower secondary school were more likely than boys to fall short of the 8-h sleep recommendation. This contrasts with other studies of younger and older adolescents, which often report similar sleep durations across sexes, with boys sometimes showing slightly shorter sleep durations (6,7,43,44). For instance, findings among Australian adolescents indicated no significant sex differences in objectively measured sleep parameters (45). ...
Background
Failure to adhere to sleep and physical activity recommendations among adolescents constitutes a public health problem. However, the associations between sleep duration and adolescents’ physical activity levels remain less explored. The aims of this paper were twofold: (1) to describe sleep and physical activity levels among Norwegian school-based adolescents, stratified by school level and sex and (2) to explore the association between sleep and physical activity levels.
Methods
Data were derived from the 2022 Norwegian Ungdata Survey, totaling 63,113 adolescents from lower (aged 13 to 16 years) and upper (aged 16 to 19 years) secondary schools. Study variables were measured using single-item questions from the Ungdata survey and collected through an electronic questionnaire administered during school hours. Logistic regressions were performed using crude analysis and adjusted for Socioeconomic status (SES) and grade level (age).
Results
In lower secondary school, 57.0% of girls and 44.7% of boys reported sleeping less than the recommended 8 h, whereas in upper secondary school, the rate was 74.9% among girls and 74.3% among boys. Girls consistently reported more sleep problems, feeling more tired at school or during activities, and less physical activity than boys across school levels. Sleep duration was a significant predictor for all levels of weekly physical activity among girls across school levels, with the highest odds revealed in upper secondary school among those being active 5 times a week (B = 1.32; 95% CI [1.24 to 1.40]). Sleep duration was a predictor for being active 5 times a week for boys across school levels (B = 1.22; 95% CI [1.17 to 1.27]).
Conclusion
About half of younger adolescents and three-quarters of older adolescents do not adhere to the sleep recommendation. Lower levels of physical activity were consistently reported by girls than boys. Sleep duration consistently predicted a 20 to 30% higher likelihood of being active at least 5 days a week across sex and school levels. These findings underscore the critical role of sleep duration relations to higher physical activity levels among Norwegian adolescents. Government and policymakers should encourage healthy sleep and PA habits by explicitly incorporating guidelines into the curriculum.
... Insomnia refers to a sleep disorder caused by physical, psychological and social stressors, usually accompanied by non-adaptive behaviors and hyperarousal, leading to the subjective experience of disturbed sleep (1). Worldwide, insomnia is the most common sleep disorder among adolescents, with a prevalence rate ranging from 7.8% to 23.8% (2)(3)(4)(5). In addition, according to the White Paper on Sleep Health of Chinese Residents 2024, more than half of adolescents used to fall asleep after midnight, and accompanied by difficulties in falling asleep, restless sleep and nocturia, with insomnia being a major concern. ...
Objective
The objective of this systematic review and meta-analysis was to evaluate the overall efficacy of cognitive behavioral therapy for insomnia (CBT-I) in treating insomnia in adolescents, and to examine the efficacy of CBT-I on different sleep-related outcomes in this population.
Methods
Randomized controlled trials (RCTs) of CBT-I on insomnia in adolescents were identified using electronic databases and manual searches. The Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess risk of bias in RCTs. A standardized mean difference (SMD) with a 95% confidence interval (CI) was used to combine effect sizes. A sensitivity analysis was performed for each outcome using a stepwise elimination method to assess whether the pooled results were significantly affected by individual studies.
Results
The analysis included 8 RCTs involving a total of 599 participants. The meta-analysis indicated that marked and statistically significant improvements in insomnia (SMD = −1.06; 95% CI -1.65 to −0.47; p < 0.01), sleep onset latency (SMD = −0.99; 95% CI -1.65 to −0.32; p < 0.01), total sleep time (SMD = 0.50; 95% CI 0.10 to 0.90; p = 0.01), and sleep efficiency (SMD = 0.57; 95% CI 0.26 to 0.87; p < 0.01) were observed at post-treatment time point following CBT-I. At follow-up time point, a statistically significant improvement in insomnia (SMD = −0.79; 95% CI -1.42 to −0.17; p = 0.01) was observed following CBT-I.
Conclusion
CBT-I was effective in improving insomnia in adolescents and some sleep-related outcomes, including sleep onset latency, total sleep time, and sleep efficiency. CBT-I was characterized by low risk and high therapeutic benefits and could serve as alternative or adjuvant approaches to medication for the treatment of insomnia. Considering the advantages in terms of safety and efficacy, CBT-I should be the preferred intervention for the treatment of insomnia in adolescents.
Systematic Review Registration
https://www.crd.york.ac.uk/prospero/, CRD42024526102.
... However, the prevalence of inadequate sleep duration and poor sleep quality among elementary school children has remained prevalent. Excessive screen time, irregular bedtime routines, and environmental stressors contribute to disrupted sleep patterns [11,12]. ...
Objectives: Sleep patterns significantly influence the physical, psychological, and social health of children, with irregularities correlating with behavioral issues like aggression. Studies highlight the association between disrupted sleep pattern and increased aggression in elementary school children, emphasizing the need for interventions promoting healthy sleep habits. This study aims to detect the relationship between sleep pattern habits and disruptive behaviors among children of elementary schools. Methods: A correlational study was conducted in Al-Najaf elementary schools, focusing on disruptive behaviors among 198 children. The study data were collected through a refined Arabic questionnaire and sleep habits scale, revealing severity of disruptive behaviors and personal information variables. Tools’ validity was confirmed by experts, showing high reliability (Cronbach α=0.91). Results: The study examined elementary school children diagnosed with disruptive behaviors in Al-Najaf Province, Iraq. Most participants were male (60.6%), aged 8-10 years (43.9%), and primarily in the first education grade (24.2%). Sleep patterns during weekends and holidays exceeded the normal range (47%), with disruptions reported by over half of the samples (56.1%). No significant correlation was found between disruptive behavior and personal traits, except with variable age, which had a significant correlation (P=0.003). Sleep patterns did not significantly correlate with disruptive behavior, although a weak negative correlation was found between age and education grade. Discussion: Disruptive behaviors are prevalent among elementary school children in Al-Najaf Province, albeit mildly impactful and diminishing with increasing age. According to the current result, these behaviors are not primarily linked to personal traits and show no or little significant correlation with sleep patterns.
... Insomnia has been identi ed as the most prevalent sleep disorder among adolescents. It is estimated that up to 18.5% of older adolescents (aged 16-18 years) meet the diagnostic criteria for insomnia as outlined in the DSM-5 (Hysing, 2013). Insomnia is often comorbid with psychological and behavioral abnormalities, including depression and non-suicidal self-injury (Sivertsen, 2014;Latina, 2021;de Zambotti, 2018). ...
Objective Investigate the current state of insomnia among secondary vocational school students, identify its influencing factors, and explore potential mechanisms of action. Methods The study population consisted of 2150 students (968 male, 1182 female) enrolled in a secondary vocational school in Wuhan, China. A cross-sectional research design was employed for the purpose of analyzing the data using descriptive statistics, correlation analysis, structural equation modeling, and bootstrap. Results Adolescents with poorer family functioning, higher levels of paranoid personality traits, and higher levels of anxiety are more likely to experience insomnia. There was a significant direct association between family functioning and insomnia ( β = -0.153, p < 0.001 ). Paranoid personality traits and anxiety were not only significant independent mediators in the relationship between family functioning and insomnia (paranoid personality traits: β = 0.021, 95% CI: [-0.035, -0.008]; anxiety: β = 0.173, 95% CI: [-0.204,-0.114]), but also chain mediators ( β = 0.059, 95% CI: [-0. 073,-0.048]). Conclusion Managing insomnia in secondary vocational school students requires familial and individual strategies, including reducing family conflict, improving family functioning, and addressing cognitive biases and anxiety.
... Bedtimes get later with each passing year during adolescence, partially due to biological factors, such as adjustments to the homeostatic sleep regulating system that give greater tolerance for sleep deprivation, and sociocultural factors as the newly acquired autonomy (8). The average sleep duration during the weekend for the youngest adolescents is about 8.4 hours and about 6.9 hours for the high school seniors (9). Adolescents' hours of sleep are significantly less than those recommended by the National Sleep Foundation (10). ...
Introduction
Adolescents’ health and well-being are seriously threatened by suicidal behaviors, which have become a severe social issue worldwide. Suicide is one of the leading causes of mortality for adolescents in low and middle-income countries, with approximately 67,000 teenagers committing suicide yearly. Although an association between sleep disturbances (SDs) and suicidal behaviors has been suggested, data are still scattered and inconclusive. Therefore, to further investigate this association, we conducted a meta-analysis to verify if there is a link between SDs and suicidal behaviors in adolescents without diagnosed psychiatric disorders.
Methods
PubMed, CENTRAL, EMBASE, and PsycINFO were searched from inception to August 30th, 2024. We included studies reporting the estimation of suicidal behaviors in adolescents from 12 to 21 years of age, with SDs and healthy controls. The meta-analysis was based on odds ratio (OR, with a 95% confidence interval ([CI]), estimates through inverse variance models with random-effects.
Results
The final selection consisted of 19 eligible studies from 9 countries, corresponding to 628,525 adolescents with SDs and 567,746 controls. We found that adolescents with SDs are more likely to attempt suicide (OR: 3.10; [95% CI: 2.43; 3.95]) and experience suicidal ideation (OR: 2.28; [95% CI 1.76; 2.94]) than controls.
Conclusion
This meta-analysis suggests that SDs are an important risk factor for suicidal ideation and suicide attempts in healthy adolescents. The findings highlight the importance of early identification of SDs to prevent suicidal behaviors in this population.
Systematic review registration
PROSPERO, identifier CRD42023415526.
... Studies on sleep in adolescents show that, on average, for every hour that an adolescent goes to bed later, sleep onset latency is prolonged, and a shorter duration of sleep is generated (by approximately six and a half hours) on sleep days per week. The above brings about a deficit of approximately two hours of sleep per week [11][12][13][14]. Thus, increased technology use and frequency of being awakened by a smartphone during the night were significantly associated with waking up too early, not feeling refreshed upon waking, and having daytime sleepiness [7]. ...
Background: Smartphones, internet access, and social media represent a new form of problematic behavior and can affect how teens sleep. Methods: A cross-sectional design was employed to examine the prevalence and association of problematic internet use and problematic smartphone use with sleep quality in a non-probability sample of 190 high school students in Mexico. The internet-related experiences questionnaire (IREQ), the mobile-related experiences questionnaire (MREQ), and the Pittsburgh Sleep Quality Index (PSQI) were used. Results: The study revealed that 66% of participants exhibited some form of problematic internet use, primarily in the form of social media use; 68% had some form of problematic smartphone use, and 84% reported poor sleep quality. The PSQI score was most accurately predicted by problematic smartphone use (MREQ), followed by enrollment in the morning school shift, participation in sports, the father’s education level, and knowledge that “smartphone use disturbs sleep”, which together explained 23% of the variation in sleep quality. Conclusions: Excessive smartphone use may negatively affect sleep quality in adolescents. We recommended that interventions be implemented to educate adolescents about appropriate and healthy use of technology, in parallel with the promotion of preventive sleep habits.
... The onset of puberty is associated with a delay in the release of melatonin in parallel with a slower building of homeostatic sleep pressure, leading to a natural inclination for later bedtimes and waketimes (Crowley et al. 2018, Karan et al. 2021a). Social and environmental factors such as increases in autonomy, evening activities (e.g., homework, sports, other extracurriculars), heightened saliency of social interactions, and increasing access to devices such as phones and tablets push bedtimes later and later over middle and high school (Tarokh et al. 2016), and adolescents frequently report difficulty falling asleep and extended sleep onset latency (Hysing et al. 2013, Khan et al. 2023. Despite later sleep times, school start times remain relatively constant, contributing to chronic patterns of insufficient sleep and accumulating sleep debt for adolescents across the globe. ...
Sleep is fundamental to human existence—especially during periods of extensive neurodevelopment such as adolescence. Importantly, poor sleep health in the transition into puberty can impact developing neural systems, contributing to the onset and maintenance of emotional disorders such as anxiety and depression. This review explores the complex interplay between sleep and neuroaffective development in adolescence, when changes in sleep architecture, circadian rhythms, and hormonal fluctuations interact with ongoing brain maturation to impact cognitive and emotional functioning. By synthesizing extant literature and charting future directions for research and intervention, this review elucidates the bidirectional associations between sleep and neuroaffective processes during puberty and highlights how sleep architecture and neurophysiology can inform our understanding of adolescent brain development. Ultimately, this article argues that promoting sleep health and addressing sleep-related challenges, especially in early adolescence, are promising strategies for enhancing well-being and fostering positive neurodevelopmental outcomes across both healthy and clinical populations.
... 22 It is estimated that almost one-quarter of adolescents experience insomnia. 23 Insomnia is more common in females and older adolescents, with a prevalence comparable to other major psychiatric disorders (eg depressive disorders). 22 Diagnosing insomnia in adolescence is particularly challenging because diagnosis requires an 'adequate opportunity to sleep', 22 which, in many adolescents, does not occur due to external factors already described. ...
Background:
Adolescence is a stage of significant transition as children develop into young adults. Optimal sleep is crucial during this period to ensure physical, emotional and mental wellbeing. However, it is well recognised that insufficient quality and quantity of sleep is common among adolescents worldwide.
Objective:
This article aims to provide general practitioners with an overview of the key issues encountered in adolescent patients relating to sleep and summarises approaches to assessment and evidence-based management of sleep problems in this population.
Discussion:
This review highlights the physiological changes that affect sleep during adolescence and how other factors, including unhealthy sleep behaviours, influence these. It discusses the importance of healthy sleep and the consequences of sleep disturbance in adolescents. Management strategies are outlined, focusing on the key common issues that affect sleep in the teenage years, and guidance on when to consider co-management with specialist care is provided.
... However, by mid-to-late puberty, girls have much higher rates of insomnia, and more severe symptoms than boys. [80][81][82] There is evidence that sleep patterns change across the menstrual cycle. Adult females have reported poorer nighttime sleep quality, reduced sleep efficiency, shorter sleep duration, and daytime sleepiness during the premenses (late luteal) and menses (early follicular) phases compared with the late follicular and early luteal phases. ...
Prior research has established that insomnia is predictive of pain in adolescents and that psychological mechanisms have a crucial role in this relationship. Adolescent girls report more insomnia and pain than boys, yet little is known of gender differences in how insomnia influences pain. This study assessed gender differences in levels and trajectories of insomnia and pain during adolescence, and whether rumination and negative mood mediated the effect of insomnia on pain. Longitudinal survey data measured on 5 annual occasions (Nbaseline = 2,767) were analyzed in a multigroup longitudinal serial mediation model. A final model was generated with insomnia as the predictor, rumination and depressed mood as mediators, pain as the outcome, and gender as the grouping variable. The results showed that insomnia predicted pain in adolescents, with an effect 3.5 times larger in girls than boys. Depressed mood was the main mediator in boys. In girls, rumination was the only significant mediator. There were significant gender differences in the effects of insomnia on rumination and pain, and in the effects of rumination on depressed mood and pain, with stronger effects in girls. These results highlight that girls and boys should be considered separately when studying the relationship between insomnia and pain.
... Insomnia is the most common sleep complaint in youths, with a prevalence rate of 7.8-23.8% for insomnia disorder [1][2][3][4][5][6] and up to 40% for insomnia symptoms [2]. Youth insomnia tends to run a chronic course and persist into adulthood [7,8]. ...
Background
Insomnia and eveningness are common and often comorbid conditions in youths. While cognitive behavioural therapy for insomnia (CBT-I) has been suggested as a promising intervention, it remains unclear whether it is sufficient to also address circadian issues in youths. In addition, despite that light has been shown to be effective in phase-shifting one’s circadian rhythm, there has been limited data on the effects of bright light therapy and its combination with CBT-I on sleep and circadian outcomes in youths. The current protocol outlines a randomised controlled trial that examines the efficacy of CBT-I and CBT-I plus bright light therapy (BLT) in reducing insomnia severity, improving mood symptoms and daytime functioning (e.g. sleepiness, fatigue, cognitive function), and improving subjective and objective sleep and circadian measures compared to a waitlist control group.
Methods
We will carry out a randomised controlled trial (RCT) with 150 youths aged 12–24 who meet the criteria of insomnia and eveningness. Participants will be randomised into one of three groups: CBT-I with bright light therapy, CBT-I with placebo light, and waitlist control. Six sessions of CBT-I will be delivered in a group format, while participants will be currently asked to use a portable light device for 30 min daily immediately after awakening throughout the intervention period for bright light therapy. The CBT-I with light therapy group will receive bright constant green light (506 lx) while the CBT-I with placebo light group will receive the modified light device with the LEDs emitting less than 10 lx. All participants will be assessed at baseline and post-treatment, while the two active treatment groups will be additionally followed up at 1 month and 6 months post-intervention. The primary outcome will be insomnia severity, as measured by the Insomnia Severity Index. Secondary outcomes include self-reported mood, circadian, daytime functioning, and quality of life measures, as well as sleep parameters derived from actigraphy and sleep diary and neurocognitive assessments. Objective measures of the circadian phase using dim-light melatonin onset assessment and sleep parameters using polysomnography will also be included as the secondary outcomes.
Discussion
This study will be the first RCT to directly compare the effects of CBT-I and BLT in youths with insomnia and eveningness. Findings from the study will provide evidence to inform the clinical management of insomnia problems and eveningness in youths.
Trial registration
ClinicalTrials.gov NCT04256915. Registered on 5 February 2020.
... Nevertheless, there is a growing trend of adolescents, especially in Asian populations like Chinese adolescents, grappling with sleep-related issues [2]. Sleep disturbance typically encompasses symptoms of insomnia (such as difficulty initiating or maintaining sleep and early morning awakeness) and poor sleep quality, which is prevalent among adolescents [3,4] and prospectively associated with internalizing disorders in adolescence [5]. Therefore, it is crucial to identify the factors influencing sleep disturbance in adolescents, which holds the promise of facilitating timely intervention and early prevention. ...
Insomnia is common in adolescents with associated negative health consequences. This systematic review and meta‐analysis assessed the effect of cognitive behavioural therapy for insomnia interventions on insomnia symptoms and subjective sleep quality in adolescents aged 10–19 years. Key electronic databases, including CINAHL, Embase, MEDLINE, PsycINFO and Scopus, were systematically searched from inception to October 2024, and five randomised controlled trials met inclusion criteria for qualitative synthesis. Four randomised controlled trials, examining a total of 527 participants, were included in the meta‐analysis. One randomised controlled trial employing a hybrid cluster design was excluded in quantitative analyses due to the number of clusters and sizes not reported. Cognitive behavioural therapy for insomnia delivered to adolescents with insomnia improved subjective sleep quality and insomnia symptoms, with effect sizes (Hedge's g ) of 0.4 and 1.04, respectively. Our findings provide support for the efficacy of cognitive behavioural therapy for insomnia in the treatment of adolescents with insomnia regardless of delivery modality. Further high‐quality randomised controlled trials are required to strengthen our findings and understand how best to deliver cognitive behavioural therapy for insomnia to adolescents.
Background . Menstrual irregularities occupy a leading place among gynecological diseases in girls. It is assumed that there is a connection between reproductive system disorders and sleep in adolescent girls, but to date this issue remains poorly understood. The aim . To study the subjective sleep quality of adolescent girls with irregular and regular menstrual cycles. Materials and methods . A survey of 461 teenage girls living in the city of Irkutsk and the Irkutsk region was conducted in the period from January 2023 to May 2024. Two groups were formed: group 1 – teenage girls with an irregular menstrual cycle (n = 121), group 2 – teenage girls without menstrual disorders (n = 340). Results . Adolescent girls with irregular menstrual cycles had sleep disturbances more often and longer, falling asleep later and taking longer, waking up later, poor sleep and daytime sleepiness. The average duration of sleep on weekdays, regardless of the nature of the menstrual cycle, was below the normal values for this age, which indicates a sleep deficit in adolescent girls. Conclusions . Poor sleep hygiene in adolescent girls, poor quality and short sleep cause disruption of the circadian rhythm that regulates the menstrual cycle. Increasing the duration and improving the quality of sleep are an important component of the formation and maintenance of reproductive health in adolescent girls. Further research is needed to better understand the complex relationships between circadian sleep-wake rhythms and the reproductive system in adolescent girls.
Study objectives:
To examine the feasibility, acceptability, and impact of a Sleep Promotion Program (SPP).
Methods:
This pilot trial randomized adolescents (13-15y) with insufficient sleep duration and irregular sleep timing to SPP-continuation (n=24; SPP in month 1, continuation treatment in month 2) or monitoring-SPP (n=20; monitoring in month 1, SPP in month 2). SPP included one clinician session and at-home delivery of web-based reports of each youth's sleep diary data with accompanying intervention questions that prompt youth to engage in sleep behavior change. Attrition rate primarily measured feasibility. Program satisfaction measured acceptability. Total sleep time (TST), sleep timing, and sleep timing regularity were measured via sleep diary at baseline, follow-up 1, and follow-up 2 (each ∼1 month apart). Linear mixed effects models compared treatment arms on changes in sleep from baseline to follow-up 1 (month 1). We also compared changes in sleep during month 1 to changes in sleep during month 2 among SPP-continuation participants.
Results:
Attrition rate was 8.5%. 96.5% participants rated the quality of care received as good or excellent. In month 1, SPP-continuation youth showed a significantly greater increase in mean TST than monitoring-SPP youth (0.57 vs. -0.38 hours; contrast=0.95; CI=0.14, 1.76, p=0.024). SPP-continuation participants showed an increase in TST during month 1 (0.51h) but a decrease during month 2 (-0.74 h; contrast=-1.24, CI=-2.06, -0.42, p=0.005). No other significant effects were observed.
Conclusions:
SPP is highly feasible, acceptable, and associated with a significant increase in TST early in treatment.
Clinical trial registration:
Registry: ClinicalTrials.gov; Name: Targeted Intervention for Insufficient Sleep among Typically-Developing Adolescents; Identifier: NCT04163003; URL: https://clinicaltrials.gov/ct2/show/NCT04163003.
Study Objectives
To investigate the association between maternal early pregnancy body mass index (BMI) and risk of offspring insomnia.
Methods
We conducted a nationwide cohort study among 3,281,803 singleton live births in Sweden born 1983-2015. Using national registries with prospectively recorded information, we followed participants for an insomnia diagnosis from 2 to up to 35 years of age. We compared insomnia risks by early pregnancy BMI categories using hazard ratios (HR) with 95% confidence intervals (CI) from adjusted Cox models. To assess unmeasured shared familial confounding, we conducted sibling-controlled analyses among 1,724,473 full siblings and studied the relation of maternal full sisters’ BMI and insomnia risk in 1,185,998 offspring.
Results
There were 7,154 insomnia diagnoses over a median follow-up age of 17.9 years. Compared with women with normal BMI, adjusted HR (95% CI) of offspring insomnia for early pregnancy BMI categories overweight, obesity class I, and obesity classes II or III were, respectively, 1.22 (1.14, 1.30), 1.60 (1.45, 1.77), and 2.11 (1.83, 2.45). Corresponding adjusted HR (95% CI) in sibling comparisons were, respectively, 1.32 (1.05, 1.65), 1.48 (1.03, 2.14), and 1.56 (0.91, 2.65). Associations with maternal sisters’ BMI were attenuated, suggesting a weak role for unmeasured shared factors. Other pregnancy, birth, and neonatal complications were associated with risk of insomnia in offspring but did not substantially mediate the association.
Conclusions
The dose-response relation between maternal overweight and obesity severity with offspring insomnia risk is not fully explained by shared familial factors.
Objective: This study was conducted to explore the sex differences in the direct and indirect associations among mental health/suicidality, sleep, and screen time. Methods: Using the 2021 Youth Risk Behavior Survey (YRBS) data, 9408 participants were included in the analyses. The associations of endogenous variables (mental health and suicidality), exogenous variable (screen time), mediator (sleep), and covariates (demographic features and risky behaviors) were analyzed using the Structural Equation Model and “medsem” package, as well as logistic regression and bootstrapping methods. To explore the sex differences in the mediation effect, the Likelihood Ratio Test was used for the multiple-group analysis to compare the unconstrained model with the mediation path-constrained model. Results: Screen time had a significant negative association with sleep duration (female: β = −.09, p < .001; male: β = −.04, p < .001), positive relations to mental health problems (female: β = .10, p < .001; male: β = .12; p < .001), and suicidality (female: OR: 1.07, 95% CI: 1.02–1.13; male: OR: 1.06, 95% CI: 1.01–1.23). Sleep duration is negatively associated with mental health problems (female: β = −.16, p < .001; male: β = −.14; p < .001) and negatively associated with the likelihood of suicidality (female: .89, 95% CI: .85–.94; male: OR: .84, 95% CI: .79–.90). Furthermore, female adolescents had higher frequencies in mental health problems, higher odds ratio in suicidality, shorter sleep duration, and bigger mediation effects of sleep, compared to their male counterparts. Conclusion: Mental health and suicidality were affected differently by screen time and sleep between female and male adolescents. Future research may continue to explore sex differences and their underlying reasons.
Chronic reduction of sleep time in children and adolescents has been related to increased incidence of anxiety and depression. In rats, protocols of protracted sleep deprivation or chronic sleep restriction (CSR) are considered a stressor. In previous studies we showed that post-weaning CSR in male rats induces anxiety-like behaviour and changes in neurotransmission in emotion-related brain areas. In the present study we examined whether the effects of this adversity are sex-dependent. Twenty-two litters, containing four males and four females were distributed into control (CTL) and CSR groups. CSR began on postnatal day (PND) 21 and lasted for 21 days; each day the animals were placed onto small platforms immersed in water for 18 h and were allowed to sleep freely in their home-cages for the remaining 6 h. Throughout the CSR, all animals underwent the sucrose splash test once/week to assess their self-care and hedonic behaviours. Body weight was measured on PNDs 21 and 42. At the end of CSR period, the adolescents were allowed to sleep freely for 2 days, after which, behavioural tests began. Within each litter, one male and one female (pair) were not tested and provided blood and brain for determination of basal corticosterone (CORT) levels and hippocampal BDNF. One pair was tested in the sucrose preference test (SPT), one pair on the elevated plus maze (EPM) and one pair in the forced swim test (FST). CORT was measured after all conditions. CSR impaired self-care behaviour and body weight gain in males and females and increased relative adrenal weight only in males. There were no changes in sucrose intake in the SPT; CSR females displayed less immobility in the FST and CSR males displayed more anxiety-like behaviour in the EPM. CORT levels were similar between CTL and CSR males, whilst lower in CSR females than CTL ones in all experimental conditions. No changes in BDNF levels were detected in the dorsal hippocampus of CSR rats. The results indicate that CSR impaired self-care behaviour in both sexes, but only males displayed anxiety-like behaviour, whilst sleep recovery in females appeared to normalise their behaviour.
Sleep is important for our survival. Research suggests that getting ‘good’ sleep is a problem for a proportion of adolescents. The paper advocates for holistic treatment of sleep disorders incorporating expertise from a multidisciplinary team. Much of the assessment and treatment of sleep disorders in adolescents comes from research within adult populations, therefore, there is a need for further research to be completed within the adolescent population to ensure there is a robust evidence base for assessment and treatment of sleep disorders.
Objective:
To investigate the relationship between symptoms of trait anxiety, state anxiety and symptoms of insomnia and the degree of their influence on daytime functioning disorders in adolescent girls.
Material and methods:
The study included 50 healthy adolescent girls, senior school students, aged 15-17 years, selected as simple random sample. Insomnia symptoms and their impact on daytime functioning were assessed using the SLEEP-50 (S-50) questionnaire. Trait and state anxiety were assessed using the Spielberger questionnaire. The method of path analysis was used to identify significant associations.
Results:
There was a positive association of the severity of daytime functioning disorders with the severity of insomnia symptoms (β=0.45; p<0.001) and the level of trait anxiety (β=0.34; p=0.004). Trait anxiety was also a significant predictor of state anxiety (p<0.001), with a direct relationship between these parameters (β=0.62). Positive covariation of insomnia symptoms severity and state anxiety was found (β=0.53; p<0.001).
Conclusion:
Improving sleep quality and daytime functioning in adolescents with insomnia symptoms should take into account personality characteristics. High levels of trait anxiety increase the negative effects of insomnia on the impaired daytime functioning.
Aims
Poor sleep is highly prevalent in young people and increases risk of mental health difficulties, yet access to sleep interventions remains limited. This paper evaluates the use of a sleep intervention delivered by non‐expert practitioners in a secondary care youth mental health service.
Method
Assistant psychologists were trained to deliver a six‐session 1:1 cognitive‐behavioural sleep intervention adapted for use with young people with mental health difficulties. A within‐subject design assessed clinical outcomes relating to sleep (Insomnia Severity Index), psychological distress and personal goals (Goal Based Outcome Measures) at four time points.
Results
High referral, intervention take‐up (82.82%) and completion (70%) rates were reported, together with high baseline levels of insomnia (Insomnia Severity Index mean 20.47, SD 3.68) and poor sleep efficiency (56.36%, SD 17.23). Fifty‐six young people (average age 19.2 years, SD 3.25) were included in the outcome analysis. Statistically and clinically significant improvements were seen across all outcome measures, with 68% no longer meeting clinical threshold (ISI ≥15) for insomnia at endpoint.
Conclusions
This study demonstrates exceptionally high levels of clinical need and engagement with a sleep intervention adapted specifically for young people with mental health difficulties. Whilst limited by the uncontrolled design, large improvements in insomnia and psychological distress support its effectiveness and utility in clinical settings. More robust implementation and evaluation is warranted in broader youth mental health services to promote earlier access.
High school students suffer from mental health challenges and poorer academic performance resulting from sleep disturbances. Unfortunately, approaches to this problem sometimes focus on increasing sleep duration by going to bed early; a strategy with limited success because teens experience a phase delay in bedtimes. There is a need for approaches that leverage behavioural sleep science and are accessible, scalable, and easily disseminated to students. DOZE (Delivering Online Zzz's with Empirical Support) is a self‐management app that is grounded in sleep and circadian basic science. Although initial testing supports it as a feasible and acceptable app in a research context, it has not been tested as a strategy to use in schools. The present study tested DOZE in private high schools in Canada. Two‐hundred and twenty‐three students downloaded the app and completed daily sleep diaries over 4 weeks. Students reported a more regularised routine for bedtime, M diff = −0.43 h, p < 0.001, 95% CI [−0.65, −0.21], and rise time, M diff = −0.61 h, p < 0.001, 95% CI [−0.84, −0.38], in addition to a higher total sleep time, M diff = 0.18 h, p < 0.008, 95% CI [0.05, 0.31]. Students also rated DOZE to be highly acceptable. The evidence suggests that students find DOZE to be acceptable and engagement in this nonclinical population was reasonably high under minimal researcher supervision. This makes DOZE an attractive option and a step towards broad‐based sleep health services. High powered replications with control groups are needed to increase empirical rigour.
Objective:
The study objective was to inform patient-centered care for adolescent insomnia by describing adolescents' perspectives on insomnia. Specific constructs of interest included: 1) factors that contributed to insomnia development or maintenance, 2) impact of insomnia on day-to-day life, 3) recommended research priorities, and 4) overall experience living with insomnia.
Method:
A convenience sample of adolescents (ages 13-18 years) self-identifying with insomnia symptoms was recruited through social media. Respondents (n = 3,014) completed an online survey. Responses to an open-ended item assessing patient experience were coded using thematic analysis.
Results:
Participants identified as 70.8% White non-Hispanic, 77.0% female, and lived in one of five English-speaking countries (United States, United Kingdom, Canada, Australia, or New Zealand). Most (87.5%) met DSM-V diagnostic criteria for insomnia. The most common contributory factors to insomnia endorsed were stress (72.1%) and depressed mood (63.6%), while common impact areas were mood (72.2%), focus (61.0%), and pain (49.7%). Patient-centered research priorities were identifying insomnia causes (66.4%) and early detection (66.1%). Common adolescent experiences included high distress levels, feelings of invalidation, and helplessness about their insomnia.
Conclusions:
Adolescents with insomnia offer a unique perspective that should inform patient-centered research and care. There is a need for heightened screening and awareness about insomnia as a condition that causes significant distress and impairment for adolescents. To provide validating care, providers should recognize the multifaceted causes of insomnia.
The authors have integrated the major findings on the sleep–wake cycle and its performance correlates in adolescents. Basic research shows that lack of synchronicity between early school start times and the circadian rhythm of adolescents (and the sleep debt accumulated as a result) involves several cognitive correlates that may harm the academic performance of adolescent students. The authors therefore examined findings from pilot interventions in which schools delayed their start times; specifically, they examined the effects on students, including potential pitfalls and strategies to consider for effective scheduling change. There is sufficient evidence that adolescent students would benefit from delaying school start times and that this change can be implemented with tolerable consequences if adequately strategized by school districts and communities.
Depression is a common and debilitating disorder in adolescence. Sleep disturbances and depression often co-occur with sleep disturbances frequently preceding depression. The current study investigated whether catastrophic worry, a potential cognitive vulnerability, mediates the relationship between adolescent sleep disturbances and depressive symptoms, as well as whether there are gender differences in this relationship. High school students, ages 16-18, n = 1,760, 49 % girls, completed annual health surveys including reports of sleep disturbance, catastrophic worry, and depressive symptoms. Sleep disturbances predicted depressive symptoms 1-year later. Catastrophic worry partially mediated the relationship. Girls reported more sleep disturbances, depressive symptoms, and catastrophic worry relative to boys. The results, however, were similar regardless of gender. Sleep disturbances and catastrophic worry may provide school nurses, psychologists, teachers, and parents with non-gender specific early indicators of risk for depression. Several potentially important practical implications, including suggestions for intervention and prevention programs, are highlighted.
This study examines relationships between affect and sleep in youth with affective disorders using ecological momentary assessment (EMA).
Participants included 94 youth, ages 8-16 (M = 11.73, 53% female) years with an anxiety disorder only (n = 23), primary major depressive disorder (with and without a secondary anxiety diagnoses; n = 42), and healthy controls (n = 29). A cell phone EMA protocol assessed affect and actigraphy measured sleep.
The patterns of bidirectional relationships between affect and sleep differed across diagnostic groups. Higher daytime positive affect and positive to negative affect ratios were associated with more time in bed during the subsequent night for youth with primary depression and less time in bed for youth with anxiety only. More time asleep was associated with more positive affect for both diagnostic groups the following day.
This relationship may be important to consider in the treatment of youth affective disorders.
A reduction in sleep amount from late childhood through the second decade has long been known; however, the weight of current evidence holds that sleep need does not decline across this span. This article will describe how the loss of sleep through adolescence is not driven by lower need for sleep but arises from a convergence of biologic, psychological, and socio-cultural influences.
To assess the effects of delayed high-school start times on sleep and motor vehicle crashes.
The sleep habits and motor vehicle crash rates of adolescents from a single, large, county-wide, school district were assessed by questionnaire before and after a 1-hour delay in school start times.
Average hours of nightly sleep increased and catch-up sleep on weekends decreased. Average crash rates for teen drivers in the study county in the 2 years after the change in school start time dropped 16.5%, compared with the 2 years prior to the change, whereas teen crash rates for the rest of the state increased 7.8% over the same time period.
Later school start times may both increase the sleep of adolescents and decrease their risk of motor vehicle crashes.
To evaluate the association between adolescent insomnia and mental health during adolescence and young adulthood.
Cross-sectional and prospective study.
School and in home.
Nationally based population sample of 4494 adolescents, 12 to 18 years old at baseline (mean = 15.83 years), with 3582 young adults, 18 to 25 years old (mean = 21.25 years) at 6- to 7-year follow-up.
Self-report measures of mental health.
Insomnia symptoms were reported by 9.4% of the adolescents. Cross-sectionally, adolescent insomnia symptoms were associated with use of alcohol, cannabis, and drugs other than cannabis; depression; suicide ideation; and suicide attempts (all P values < 0.01) after controlling for sex. Prospectively, insomnia symptoms during adolescence were a significant risk factor for depression diagnosis (odds ratio = 2.3) in young adulthood after controlling for sex and baseline depression.
This study is the first to longitudinally evaluate insomnia symptoms during adolescence as a risk factor for mental health problems in young adulthood. The findings indicate that insomnia is a prevalent problem for adolescents and argue for future treatment-outcome studies to evaluate the efficacy and effectiveness of various insomnia interventions in this age group.
Sleep tendency (latency to sleep onset) was examined during extended waking in prepubertal and mature adolescents to determine whether sleep pressure is lower near bedtime in the latter group. Participants were nine prepubertal (pubertal stage Tanner 1, mean age 11.1 years, SD+/-1.3 years, five males) and 11 pubertally mature adolescents (Tanner 5, 13.9+/-1.2 years, three males). They spent 10 nights at home on an identical fixed 10-h sleep schedule followed by a 36-h constant routine with sleep latency tests at 2-h intervals using standard polysomnography. Saliva was collected to assess dim-light melatonin onset (DLMO) phase. DLMO was earlier in the Tanner 1 (mean clock time=20:33 hours, SD=49 min) than Tanner 5 group (21:29 hours+/-42 min). Sleep latency compared at a 'critical period' spanning 12.5 (20:30 hours clock time) to 18.5 h (02:30 hours) after waking did not differ at 20:30 hours, but was shorter for the Tanner 1 group at 22:30 hours (Tanner 1=9.2+/-6.3 min; Tanner 5=15.7+/-5.8 min), 00:30 hours (Tanner 1=3.6+/-1.7 min; Tanner 5=9.0+/-6.4 min), and 02:30 hours (Tanner 1=2.0+/-1.7 min; Tanner 5=4.3+/-3.2 min; trend). These differences were apparent controlling for circadian phase by partial correlation. Sleep tendency after 14.5, 16.5, and 18.5 h awake was lower in mature versus prepubertal adolescents, supporting our hypothesis that a developmental change of intrinsic sleep-wake regulation may provide physiologically mediated 'permission' for later bedtimes in older adolescents.
To examine the effects of total sleep deprivation on adolescent sleep and the sleep electroencephalogram (EEG) and to study aspects of sleep homeostasis.
Subjects were studied during baseline and recovery sleep after 36 hours of wakefulness.
Four-bed sleep research laboratory.
Seven prepubertal or early pubertal children (pubertal stage Tanner 1 or 2 = Tanner 1/2; mean age 11.9 years, SD +/- 0.8, 2 boys) and 6 mature adolescents (Tanner 5; 14.2 years, +/- 1.4, 2 boys).
Thirty-six hours of sleep deprivation.
All-night polysomnography was performed. EEG power spectra (C3/A2) were calculated using a Fast Fourier transform routine.
In both groups, sleep latency was shorter, sleep efficiency was higher, non-rapid eye movement (NREM) sleep stage 4 was increased, and waking after sleep onset was reduced in recovery relative to baseline sleep. Spectral power of the NREM sleep EEG was enhanced after sleep deprivation in the low-frequency range (1.6-3.6 Hz in Tanner 1/2; 0.8-6.0 Hz in Tanner 5) and reduced in the sigma range (11-15 Hz). Sleep deprivation resulted in a stronger increase of slow-wave activity (EEG power 0.6-4.6 Hz, marker for sleep homeostatic pressure) in Tanner 5 (39% above baseline) than in Tanner 1/2 adolescents (18% above baseline). Sleep homeostasis was modeled according to the two-process model of sleep regulation. The build-up of homeostatic sleep pressure during wakefulness was slower in Tanner 5 adolescents (time constant of exponential saturating function 15.4 +/- 2.5 hours) compared with Tanner 1/2 children (8.9 +/- 1.2 hours). In contrast, the decline of the homeostatic process was similar in both groups.
Maturational changes of homeostatic sleep regulation are permissive of the sleep phase delay in the course of adolescence.
The impact of nonresponse on estimates of mental health problems was examined in a prospective teacher screen in a community survey of 9,155 7-9 year olds. For 6,611 of the children, parents consented to participation in the actual study (Responders), while for 2,544 children parental consent was not obtained (Nonresponders). The teacher screen involved assessment of a broad set of symptoms of mental health problems and functional impairment. Calculations of non-response coefficients, a function of effect sizes and non-response proportion, revealed only ignorable nonresponse bias for both mean scores and correlations. However, the results from binary logistic regressions revealed that children ascribed signs of mental health problems by their teachers were less likely to participate. This was most frequent among children with only moderate symptoms. However, it also involved children with high symptom scores related to inattention, hyperactivity, emotions and peer relationship problems. These findings suggest that measures based on effect size can underestimate the magnitude of non-response bias and that a logistic regression approach may be more appropriate for studies geared at estimating prevalence of mental health problems in children.
Study Objectives
The present study investigated the effectiveness of a school-based intervention in increasing sleep knowledge and improving adolescent sleep problems.
Design
A randomized, controlled trial using 2 groups (program class, classes-as-usual: [CAU]) assessed over 3 time points (pre-program, post-program, 6-week follow-up).
Participants/Setting
Eighty-one students (mean age = 15.6 ± 0.6 y; 33% male) from 2 schools in South Australia. Schools provided one class to participate in the sleep intervention program (N = 41) and a second class to act as a control class (N = 40).
Intervention
Four 50-minute classes across a 4-week period. Classes consisted of educating adolescents on promoting and maintaining a healthy lifestyle based on a cognitive-behavior therapy framework.
Measurements and Results
Data were collected pre-program, post-program, and at 6-week follow-up using an online questionnaire. Qualitative student and teacher data were collected at post-program. Baseline data indicated sleep problems were prevalent (53.1% insufficient sleep on school nights [ < 8 h] and 77.8% discrepant school/weekend rise times [ > 2 h]). These 2 criteria identified 36 adolescents with a delayed sleep timing (DST; Program, N = 21; CAU, N = 15). The program increased sleep knowledge (P = 0.001); however, analyses revealed no significant effects on target sleep variables as compared with the CAU class for the entire group (all P > 0.05). For DST adolescents, there was a significant interaction for reducing the discrepancy between school and weekend out of bed times (P = 0.002). There was no impact on other sleep parameters or depressed mood.
Conclusions
School-based sleep interventions for adolescents are a novel method for addressing a prevalent problem. Future programs should develop ways to motivate adolescents to change sleep practices.
The confluence of sleep/wake cycle and circadian rhythm changes that accompany pubertal development and the social and emotional developmental tasks of adolescence may create a period of substantial risk for development of insomnia. Although poor sleep affects cognitive performance and is associated with poor emotional and physical health, epidemiologic studies among adolescents have been limited. In this first epidemiologic study of insomnia defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria in a US sample of adolescents, we estimated lifetime prevalence of insomnia, examined chronicity and onset, and explored the role of pubertal development.
Data come from a random sample of 1014 adolescents who were 13 to 16 years of age, selected from households in a 400000-member health maintenance organization encompassing metropolitan Detroit. Response rate was 71.2%. The main outcome measured was DSM-IV-defined insomnia.
Lifetime prevalence of insomnia was 10.7%. A total of 88% of adolescents with a history of insomnia reported current insomnia. The median age of onset of insomnia was 11. Of those with insomnia, 52.8% had a comorbid psychiatric disorder. In exploratory analyses of insomnia and pubertal development, onset of menses was associated with a 2.75-fold increased risk for insomnia. There was no difference in risk for insomnia among girls before menses onset relative to boys, but a difference emerged after menses onset. In contrast, maturational development was not associated with insomnia in boys.
Insomnia seems to be common and chronic among adolescents. The often found gender difference in risk for insomnia seems to emerge in association with onset of menses.
The study's aim was to investigate how school start time affects sleepiness and functioning in Norwegian 10th grade students (N = 106). The intervention school started at 0930 hours on Mondays and 0830 hours the rest of the week. A control school started at 0830 hours all schooldays. The students were assessed on a reaction time test as well as with self-report measures of sleepiness, mood and sleep. The intervention school obtained one hour longer total sleep time on Sunday nights compared to the control school and performed better on the reaction time test on Mondays than on Fridays, relative to the control school. Later school start times may both lengthen nocturnal sleep and increase students' alertness in early morning classes.
Objective:
The objective of the present study was to investigate the relationship between sleep insufficiency and sleep duration, particularly regarding negative cardiometabolic health outcomes already considered to be affected by reduced sleep time.
Methods:
A total of N=30,934 participants from the 2009 Behavioural Risk Factor Surveillance System (BRFSS) answered questions about their sleep duration as well as subjective feelings of sleep insufficiency. Outcomes included body mass index (BMI), obesity (BMI ≥ 30kgm(-2)) and history of hypertension, diabetes, hypercholesterolaemia, heart attack and stroke. Linear and logistic regression models examined whether cardiometabolic outcomes were associated with (1) sleep duration alone, (2) sleep insufficiency alone and (3) the combined effect of sleep duration and sleep insufficiency.
Results:
Results indicated that, when examined alone, sleep duration <5h (versus 7h) was related to BMI (B=2.716, p<0.01), obesity (B=2.080, p<0.000001), diabetes (B=3.162, p<0.000001), hypertension (B=2.703, p<0.000001), hypercholesterolaemia (B=1.922, p<0.00001), heart attack (B=4.704, p<0.000001) and stroke (B=4.558, p<0.000001), and sleep insufficiency (days per week, continuous) was related to BMI (B=0.181, p<0.01), obesity (B=1.061, p<0.000001) and hypercholesterolaemia (B=1.025, p<0.01). All of these relationships remained significant after adjustment for covariates, except for diabetes and sleep duration. Also, after adjustment, a significant relationship between insufficient sleep and hypertension emerged (B=1.039, p<0.001). When evaluated together, after adjustment for covariates, significant relationships remained between sleep duration <5h (versus 7h) and BMI (B=1.266, p<0.05), obesity (B=1.389, p<0.05), hypertension (B=1.555, p<0.01), heart attack (B=2.513, p<0.01) and stroke (B=1.807, p<0.05). It should be noted that relationships between sleep duration >9h (versus 7h) were seen for heart attack (B=1.863, p<0.001) and stroke (B=1.816, p<0.01). In these models, sleep insufficiency was associated with hypercholesterolaemia (B=1.031, p<0.01) and hypertension (B=1.027, p<0.05).
Conclusions:
These analyses show that both sleep duration and insufficiency are related to cardiometabolic health outcomes, and that when evaluated together, both variables demonstrate unique effects.
Abstract The term ‘sleep debt’ is widely used to describe the effects of sleep loss. The construct of sleep debt, however, is poorly defined in the scientific literature. Cumulative build-up of sleep pressure appears to be a key feature of sleep debt. The concepts of ‘core sleep’ and ‘basal sleep need’ have been proposed to provide a theoretical framework, albeit without strong empirical basis. It has been hypothesized that adaptation to sleep debt may be possible over time, but experimental evidence for this hypothesis is ambiguous. Recent experiments using chronic sleep restriction have revealed significant effects of sleep debt on daytime sleep latency and behavioral alertness. In a series of strictly controlled laboratory studies, we found that sleep debt can lead to fundamentally different daytime responses, depending on whether homeostatic sleep pressure (as measured in the waking electroencephalogram (EEG)) or behavioral alertness (as measured with psychomotor vigilance lapses) is considered. This suggests the existence of an as yet unidentified regulatory mechanism of waking neurobehavioral function. To study the nature of this regulatory process under chronic sleep restriction, advantage can be taken of the natural variability in sleep need frequently cited in the literature. We also obtained evidence for interindividual differences in vulnerability to sleep loss regardless of sleep need. Statistical modeling of the effects of chronic sleep restriction on behavioral alertness, taking into account these interindividual differences, provided a reference for defining sleep debt. The results suggested that sleep debt may be defined as the cumulative hours of sleep loss with respect to a subject-specific daily need for sleep.
Recent sleep research finds that many adolescents are sleep-deprived because of both early school start times and changing sleep patterns during the teen years. This study identifies the causal effect of school start time on academic achievement by using two policy changes in the daily schedule at the US Air Force Academy along with the randomized placement of freshman students to courses and instructors. Results show that starting the school day 50 minutes later has a significant positive effect on student achievement, which is roughly equivalent to raising teacher quality by one standard deviation. (JEL I23, J13)
To evaluate cognitive-behavior therapy plus bright light therapy (CBT plus BLT) for adolescents diagnosed with delayed sleep phase disorder (DSPD).
Randomized controlled trial of CBT plus BLT vs. waitlist (WL) control with comparisons at pre- and post-treatment. There was 6-month follow-up for the CBT plus BLT group only.
Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia.
49 adolescents (mean age 14.6 ± 1.0 y, 53% males) diagnosed with DSPD; mean chronicity 4 y 8 months; 16% not attending school. Eighteen percent of adolescents dropped out of the study (CBT plus BLT: N = 23 vs. WL: N = 17).
CBT plus BLT consisted of 6 individual sessions, including morning bright light therapy to advance adolescents' circadian rhythms, and cognitive restructuring and sleep education to target associated insomnia and sleep hygiene.
DSPD diagnosis was performed via a clinical interview and 7-day sleep diary. Measurements at each time-point included online sleep diaries and scales measuring sleepiness, fatigue, and depression symptoms. Compared to WL, moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue. At 6-month follow-up (N = 15), small-to-large improvements (d = 0.24-1.53) continued for CBT plus BLT adolescents, with effects found for all measures. Significantly fewer adolescents receiving CBT plus BLT met DPSD criteria at post-treatment (WL = 82% vs. CBT plus BLT = 13%, P < 0.0001), yet 13% still met DSPD criteria at the 6-month follow-up.
CBT plus BLT for adolescent DSPD is effective for improving multiple sleep and daytime impairments in the immediate and long-term. Studies evaluating the treatment effectiveness of each treatment component are needed.
Australia-New Zealand Trials Registry Number: ACTRN12610001041044.
To determine the proportion of adolescents whose bedtime is set by their parents and to evaluate whether parent-set bedtimes are associated with earlier bedtimes, more sleep, and better daytime functioning.
385 adolescents aged 13-18 years (mean = 15.6, SD = 0.95; 60% male) from 8 socioeconomically diverse schools in South Australia.
Adolescents completed the School Sleep Habits Survey during class time and then completed an 8-day Sleep Diary. The Flinders Fatigue Scale was completed on the final day of the study.
17.5% of adolescents reported a parent-set bedtime as the main factor determining their bedtime on school nights. Compared to adolescents without parent-set bedtimes, those with parent-set bedtimes had earlier bedtimes, obtained more sleep, and experienced improved daytime wakefulness and less fatigue. They did not differ significantly in terms of time taken to fall asleep. When parent-set bedtimes were removed on weekends, sleep patterns did not significantly differ between groups.
Significant personal and public health issues, such as depression and accidental injury and mortality, are associated with insufficient sleep. Converging biological and psychosocial factors mean that adolescence is a period of heightened risk. Parent-set bedtimes offer promise as a simple and easily translatable means for parents to improve the sleep and daytime functioning of their teens.
Most studies on seasonal variability in sleep have asked participants if they think their sleep quality varies with the seasons, which reveals the research hypothesis to the participants. To date, the hypothesis of seasonal variation in sleep has not been tested in a large population-based fully blinded study. The aim of the current study was to investigate monthly variations in sleep problems in a geographic region of Norway with large seasonal differences in daytime light. Using data from a general health survey, the authors had access to information on sleep in the general population, collected across the seasons over 2 years without linking sleep to seasonal variation. In all, 43,045 participants (mean age, 44.6 years) of the Nord-Trøndelag Health Study, 1995-1997 (referred to as "HUNT-2"), provided reports of insomnia symptoms and time in bed in all months except July. The mean prevalence of insomnia symptoms was 12.4%. No evidence of a seasonal variation on reports of insomnia symptoms or time in bed was found. These null findings are in marked contrast to previous seasonality studies of sleep. Previous studies reporting seasonal variations in sleep and insomnia might have been subject to publication biases and lack of blinding to the research hypothesis.
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.
The aim of the present study was to investigate the prevalence of "behaviorally induced insufficient sleep syndrome (BIISS)" which is a newly defined hypersomnia, among adolescents. BIISS is characterized by excessive daytime sleepiness, short habitual sleep duration and sleeping considerably longer than usual during weekend/vacations. The study was conducted in the Hordaland County, Norway using a cluster sampling procedure. In all, 1285 high school students (aged 16-19 years) participated by completing self-report questionnaires on a computer. The estimated prevalence of BIISS was 10.4%. The results from logistic regression analyses showed that use of alcohol and living in an urban area were positively related to BIISS, whereas a high level of education in mothers was negatively related to BIISS. BIISS was associated with poor grades and symptoms of anxiety and depression.
To examine the relationship between sleep duration and body mass index (BMI) in Norwegian children (aged 10-12).
Children and parents of a population of primary school children (N=9 430) were invited to complete a questionnaire containing questions about usual bedtimes, wake-up times, self and parent evaluations of pubertal maturation, parental education and economic status, and parent-reported height and weight of the child. Sixty per cent of parents and children participated. BMI was available for 4 158 children, 44% of the original sample.
A U-shaped relationship was found between sleep duration and age- and gender-adjusted BMI. Shorter and longer sleep durations were significantly related to high BMI. The percentage of obesity and overweight was higher in the shortest sleep duration group compared with intermediate sleep durations. Crude logistic regression analyses showed a significant association between early pubertal maturation and both obesity and overweight. Socio-economic status was significantly related to overweight. Short sleep duration showed a significant association with obesity but not with overweight. In an adjusted logistic regression model, short sleep duration was still significantly associated with obesity when controlling for physical maturation and socio-economic status.
High BMI was associated with short and long self and parent-reported duration of sleep. The percentage of obesity/overweight was higher in the shortest sleep duration group than for intermediate sleep durations. Short sleep duration was significantly associated with obesity but not with overweight. Adjusting for physical maturation and socio-economic status, short sleep duration still showed a significant association with obesity.
Insufficient sleep, poor sleep quality and sleepiness are common problems in children and adolescents being related to learning, memory and school performance. The associations between sleep quality (k=16 studies, N=13,631), sleep duration (k=17 studies, N=15,199), sleepiness (k=17, N=19,530) and school performance were examined in three separate meta-analyses including influential factors (e.g., gender, age, parameter assessment) as moderators. All three sleep variables were significantly but modestly related to school performance. Sleepiness showed the strongest relation to school performance (r=-0.133), followed by sleep quality (r=0.096) and sleep duration (r=0.069). Effect sizes were larger for studies including younger participants which can be explained by dramatic prefrontal cortex changes during (early) adolescence. Concerning the relationship between sleep duration and school performance age effects were even larger in studies that included more boys than in studies that included more girls, demonstrating the importance of differential pubertal development of boys and girls. Longitudinal and experimental studies are recommended in order to gain more insight into the different relationships and to develop programs that can improve school performance by changing individuals' sleep patterns.
The present study investigated the effectiveness of a school-based intervention in increasing sleep knowledge and improving adolescent sleep problems.
A randomized, controlled trial using 2 groups (program class, classes-as-usual: [CAU]) assessed over 3 time points (pre-program, post-program, 6-week follow-up).
Eighty-one students (mean age = 15.6 +/- 0.6 y; 33% male) from 2 schools in South Australia. Schools provided one class to participate in the sleep intervention program (N = 41) and a second class to act as a control class (N = 40).
Four 50-minute classes across a 4-week period. Classes consisted of educating adolescents on promoting and maintaining a healthy lifestyle based on a cognitive-behavior therapy framework.
Data were collected pre-program, post-program, and at 6-week follow-up using an online questionnaire. Qualitative student and teacher data were collected at post-program. Baseline data indicated sleep problems were prevalent (53.1% insufficient sleep on school nights [< 8 h] and 77.8% discrepant school/weekend rise times [> 2 h]). These 2 criteria identified 36 adolescents with a delayed sleep timing (DST; Program, N = 21; CAU, N = 15). The program increased sleep knowledge (P = 0.001); however, analyses revealed no significant effects on target sleep variables as compared with the CAU class for the entire group (all P > 0.05). For DST adolescents, there was a significant interaction for reducing the discrepancy between school and weekend out of bed times (P = 0.002). There was no impact on other sleep parameters or depressed mood.
School-based sleep interventions for adolescents are a novel method for addressing a prevalent problem. Future programs should develop ways to motivate adolescents to change sleep practices.
To investigate trend data in the prevalence of sleep-onset difficulties among Norwegian adolescents covering the age groups 11, 13 and 15 years.
Data were based on the Health Behaviour in School-aged Children - A WHO Cross-National Survey (HBSC) - and were collected on six occasions between 1983 and 2005. At each point in time data were obtained from representative samples comprising between 3402 and 5026 adolescents.
The prevalence of sleep-onset difficulties was higher among 11-year-old students compared to the 13- and 15-year-olds. Girls reported a higher prevalence than boys. A logistic regression analysis showed that the prevalence of sleep-onset difficulties overall had increased significantly since 1983, which constituted the reference year. When the analysis was broken down by age and gender, the same tendency was found in all groups.
The prevalence of sleep-onset difficulties among adolescents has increased during the last decades. This development gives reason for concern and should receive more attention from teachers, parents and health professionals.
Following a series of baseline nights, four adult subjects slept a series of nights in which the time allowed for sleep was reduced by approximately 2.5–3 h. The amount of time during which a stage 4 EEG was present showed a substantial elevation although the procedure resulted in no prior reduction of the total nightly amount of stage 4. This was most apparent on the final (“recovery”) night in the series which could be treated as a “short sleep” night by simply not considering the final hours of recording.
Nineteen children (8 girls, 11 boys) were evaluated in a total of 47 three-day sessions across three summers. Children were ranked according to Tanner's stages of secondary sexual characteristics. Nocturnal sleep was recorded from 2200 to 0800 hr each night. Multiple sleep latency tests were given at 2 hr intervals from 0930 each day. Nocturnal sleep time and REM sleep time remained constant across Tanner stages. Slow wave sleep time declined progressively across Tanner stages, with a 40% reduction from prepuberty to maturity. Daytime sleepiness was significantly greater in subjects at Tanner stages 3 and 4 than at Tanner stages 1 and 2. Subjects at Tanner stage 5 tended to be as sleepy as Tanner stage 3 and 4 subjects but did not differ significantly from the less mature subjects. No gender differences were found in daytime sleepiness for children at similar Tanner stages. More mature children were significantly sleepier at 1330 and 1530 than in the late afternoon and evening.
Increased lifestyle demands and reduced sleep are reported to result in daytime sleepiness and impaired functioning for teenagers. A sample of 612 freshman urban high school students completed a questionnaire describing their sleep patterns and problems, along with sociodemographic information, daily activities, pubertal development, depressive mood, and morning-evening preference. About 63% of the respondents felt they needed more sleep on weeknights (MS group), experienced sleepiness that interfered with their schoolwork, and had problems with sleeping. The other group reported they got sufficient sleep on weeknights (SS group) and did not experience sleepiness problems to the same degree. However, both had similar weeknight sleep and daily activity patterns. The MS group reported an ideal sleep time of 9.2 h, about 2 h more than they were getting and 1 h more than the SS group ideal, and had a higher preference for later bed and waking times. In our sample, individual differences in biologic sleep need and quality of sleep may be emerging as early as 14 years of age.
Despite many constraints on time schedules among teenagers, epidemiological data on sleep complaints in adolescence remain limited and are nonexistent for sleep disorders. This study provides additional data on sleep habits and DSM-IV sleep disorders in late adolescence.
A representative sample of 1,125 adolescents aged 15 to 18 years was interviewed by telephone using the Sleep-EVAL system. These adolescents came from 4 European countries: France, Great Britain, Germany, and Italy. Information was collected about sociodemographic characteristics, sleep/wake schedule, sleep habits, and sleep disorders and was compared with information from 2,169 young adults (19-24 years of age).
Compared with young adults, adolescents presented with a distinct sleep/wake schedule: they went to sleep earlier, they woke up later, and they slept longer than young adults did. On weekends and days off, they also slept more than young adults did. However, the prevalence rates of sleep symptoms and sleep disorders were comparable in both groups. Approximately 25% reported insomnia symptoms and approximately 4% had a DSM-IV insomnia disorder. Fewer than 0.5% had a circadian rhythm disorder.
Prevalence of insomnia disorders is lower in the adolescent population than in middle-aged or elderly adults. However, a rate of 4% in this young population is important given their young age and the consequences for daytime functioning.
Insufficient sleep (sleep deprivation) is a common problem of considerable health, social, and economical impact. We assessed its prevalence and associations, and the role of genetic influences.
Panel study based on questionnaires administered in 1981 and 1990.
12.423 subjects aged 33-60 years included in the Finnish Twin Cohort, representative of the Finnish population.
N/A.
A difference of 1 hour between the self-reports of the sleep need and the sleep length was considered insufficient sleep. Associations with education, life style, work, psychological characteristics and sleep-wake variables were assessed. Structural equation modelling techniques were used to compare genetic models among monozygotic and dizygotic twin pairs.
In 1990, the prevalence of insufficient sleep was 20.4% (16.2% in men and 23.9% in women). 44% of those with insufficient sleep in 1981 also had it 9 years later (Spearman correlation for persistence 0.334). In multivariate analyses, the strongest positively associated factors were daytime sleepiness (women: odds ratio 3.87, 95% confidence limits 3.24-4.63/men: 3.77, 2.98-4.75), insomnia (2.48, 1.92-3.19/2.91, 2.17-3.90), not able to sleep without disturbance (1.95, 1.47-2.60/2.54, 1.66-3.89), and evening type (2.10, 1.65-2.69/1.73, 1.25-2.41). Among men, also weekly working hours > or =75 was strongly associated (3.23, 1.54-6.78). "Not working" was negatively associated in both genders (0.68, 0.51-0.89/0.59, 0.42-0.83). Two thirds of the interindividual variability in the liability to insufficient sleep was attributed to non-genetic factors.
Insufficient sleep is a common and long-standing condition, most strongly associated with sleep/wake variables. One third of the liability to it is attributed to genetic influences. Sleep sufficiency should be assesssed in health examinations of working adults.
The aim of this epidemiological study was to utilise a cross-sectional as well as a longitudinal approach to examine sleep habits and how they develop in young people in Iceland. The 668 subjects (1-20 years) who responded to a postal survey in 1985 were followed up 5 and 10 years later. The majority of the variance in bedtime and sleep duration was explained by age, but also to a considerable degree by other factors such as residence, season, and year of survey or interaction of these factors. Natural phenomena, such as the diminution of total sleep duration in the first years of life and the tendency for longer sleep on weekends compared to weekdays were confirmed. The lengthening of sleep on weekends was first significant at the age of 9 and was greater among adolescents than young adults. The incidence of daytime sleepiness increased in adolescence, as did napping, at which time their nocturnal sleep time significantly decreased. Over a period of 10 years, a significant shift to earlier wake-up times occurred in children up to 15 years of age, which resulted in a shortened total sleep time. The idea that individual sleep duration is an inherent parameter is supported by the high positive correlation of total sleep time across a 10-year period (r=.73). The present data confirm that Icelandic adolescents (aged 11, 13, and 15) have delayed bedtimes and shorter nocturnal sleep compared to European peers.
Over the past decade, excessive sleepiness among children and adolescents has been identified as a major societal concern. Professionals working with pediatric groups must increasingly factor sleepiness into assessments of waking function. We define and discuss excessive sleepiness in children and adolescents and review available evidence regarding effects on behavior, mood, and performance. Findings for daytime sleepiness and subsequent impairment in these domains are classified as robust to unknown. Empirical evidence clearly indicates that children and adolescents experience significant daytime sleepiness as a result of inadequate or disturbed sleep. The specific effect of sleepiness on functional domains in pediatric groups are less well-studied, but existing data suggests that children are likely to experience impairment in behavioral, mood, and performance domains. However, such variables as developmental differences in the type and degree of impairment, the degree of sleep disturbance required to produce impairments, and potential risk and protective factors for the effects of sleepiness in children have yet to be described. Further research is clearly warranted, and we discuss important questions and methodological concerns to encourage inquiry in both clinical and experimental settings. Advice is offered with regard to screening for sleep problems and associated sleepiness with children and adolescents.
Formal diagnostic systems (DSM-IV, ICSD, and ICD-10) do not provide adequate quantitative criteria to diagnose insomnia. This may not present a serious problem in clinical settings where extensive interviews determine the need for clinical management. However, lack of standard criteria introduce disruptive variability into the insomnia research domain. The present study reviewed two decades of psychology clinical trials for insomnia to determine common practice with regard to frequency, severity, and duration criteria for insomnia. Modal patterns established frequency (> or =3 nights a week) and duration (> or =6 months) standard criteria. We then applied four versions of severity criteria to a random sample and used sensitivity-specificity analyses to identify the most valid criterion. We found that severity of sleep onset latency or wake time after sleep onset of: (a) > or =31 min; (b) occurring > or =3 nights a week; (c) for > or =6 months are the most defensible quantitative criteria for insomnia.
Sleep/wake timing shifts later in young humans during the second decade of life. In this review we describe sleep/wake patterns, changes in these patterns across adolescence, and evidence for the role of environmental, psychosocial, and biological factors underlying these changes. A two-process model incorporating circadian (Process C) and sleep/wake homeostatic (Process S) components is outlined. This model may help us to understand how developmental changes translate to shifted sleep/wake patterns. Delayed sleep phase syndrome (DSPS), which has a typical onset during the second decade of life, may be an extreme manifestation of homeostatic and circadian changes in adolescence. We describe symptoms, prevalence, and possible etiology of DSPS, as well as treatment approaches in adolescents.
Changes in total amout of stage 4 sleep as a function of total sleep deprivation
- W C Dement
- S Grenber
Dement, W. C. and Grenber, S. Changes in total amout of stage 4
sleep as a function of total sleep deprivation. Electroencephalog
Clin Neurophysiol, 1966, 20: 523-526.
Sleep duration versus sleep insufficiency as predictors of cardiometabolic health outcomes
- N G Altman
- B Izci-Balserak
- E Shopfer
Altman, N. G., Izci-Balserak, B., Shopfer, E. et al. Sleep duration
versus sleep insufficiency as predictors of cardiometabolic health
outcomes. Sleep Med., 2012, 13: 1261-1270.
School start times and the sleep-wake cycle of adolescents: a review and critical evaluation of available evidence
- Kirby
Understanding sleep depbt: theoretical and empirical issues
- Dongen H. P. A.