Behavioral Sleep Intervention Research Articles

0476 A Mobile App-Based Behavioral Intervention for Insomnia Among College Students

Abstract Introduction Nearly 60% of college students suffer from poor sleep quality and 7.7% of students meet criteria for a sleep disorder (Schlarb et al., 2017). The most common of these sleep disorders is insomnia. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the frontline treatment for insomnia. The time and cost of CBT-I, however, has limited overall treatment uptake, especially among individuals with less severe symptom profiles or who are otherwise relatively healthy (e.g., college students). The goal of this study is to pilot-test a mobile application version of CBT-I (i.e., CBT-I Coach) to evaluate its effectiveness in treating insomnia symptoms among college students. The testing will also demonstrate the feasibility of using a CBT-I app for insomnia symptom treatment. Methods The study uses a between- and within-subjects design to assess biweekly variations in insomnia symptom severity among college students over a period of 8 weeks. Participants are randomized into the intervention group or a wait-list control group (where they were asked to initiate the intervention after a four-week delay). Participants in both groups are asked to use the CBT-I Coach app daily for 4 weeks. Every two weeks, online surveys are completed to assess sleepiness (via the Epworth Sleepiness Scale) and the insomnia symptom severity (via the Insomnia Severity Index). Results While data collection is ongoing, to-date we have collected data from 17 participants. The mean baseline ISI score was 15.3. Of the 17 participants that completed the baseline, 65% (n=11) filled out the 4-week online survey. The mean ISI score at the 4-week follow-up was 12.7. Ten participants (or 59% of those that completed the baseline) completed the eight-week follow-up survey. Data collection is scheduled to be completed in April 2022, and a full summary of the results will be presented at the APSS conference in Charlotte. Conclusion An effective app-based version of CBT-I has the potential to increase the accessibility of behavioral interventions for sleep to populations that are often missed by healthcare providers. Making CBT-I more available to college students and young adults may also decrease the onset of more chronic forms of insomnia. Support (If Any) N/A

The Effectiveness of Sleep Training: Fact or Fiction?

IntroductionIn Western cultures, parents often view infant sleep as problematic. Family, friends, and doctors may advise parents to “sleep train” assuming it is safe and effective, without considering its possible side effects, including its impact on breastfeeding. Unfortunately, it may reduce night feeds and result in earlier supplementation or weaning. The larger question is whether sleep training is worth the risk (i.e., does it improve infant sleep?). Our goal was to examine the data on the effectiveness of sleep training interventions on infant/toddler sleep.MethodsPubMed and Google Scholar were searched for specific terms to identify articles that included behavioral sleep interventions and objective measures of sleep pre-and postntervention. Two objective infant sleep measures were examined: Night wakings and total sleep duration. Articles were then reviewed for evidence of the effectiveness of these interventions to reduce night wakings and increase total sleep duration.ResultsFive articles were identified that met the criteria for inclusion. Overall, there was no evidence that sleep training improves infant sleep.Applications for PracticeThe claim that sleep training is effective in changing infant sleep is not warranted. Given the potential side effects on breastfeeding, parents should be cautioned about engaging these behavioral sleep interventions if they have breastfeeding goals they want to achieve.

Effectiveness of behavioral sleep interventions on children\u2019s and mothers\u2019 sleep quality and maternal depression: a systematic review and meta-analysis

This systematic review and meta-analysis was conducted to investigate the effectiveness of behavioral sleep interventions (BSIs) on the number of child night awakenings, and maternal sleep quality and depression. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) using PubMed, CINAHL, Cochrane, and EMBASE databases and retrieved studies published until April 2021. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for child sleep problems, and the mean differences (MD) and 95% CI for the number of child night awakenings, and maternal sleep quality and depression. Ten studies of 1628 initial searched were included in the final analysis. Two of the 10 studies were divided into two subgroups by participants and intervention type; thus, 12 subgroups were included in the meta-analysis. BSIs significantly reduced child sleep problems (OR 0.51; 95% CI 0.37–0.69) and improved maternal sleep quality (MD − 1.30; 95% CI − 1.82 to − 0.77) in the intervention group. There were no significant differences in the number of child night awakenings and maternal depression between the two groups. More RCTs to examine the effect of BSIs considering children’s age, duration of intervention, and outcome measuring time points are needed.

Optimizing a Behavioral Sleep Intervention for Gynecologic Cancer Survivors: Study Design and Protocol

Sleep difficulties, particularly symptoms of insomnia and circadian disruption, are among the primary complaints of gynecologic cancer survivors before, during, and after treatment. Moreover, difficulty sleeping has been linked to poorer health-related quality of life and elevated symptom burden in this population. Although leading behavioral sleep interventions have demonstrated efficacy among cancer survivors, up to 50% of survivors are non-adherent to these treatments, likely because these interventions require labor-intensive behavior and lifestyle changes. Therefore, there is a need for more effective and acceptable approaches to diminish sleep disturbance among cancer survivors. This manuscript describes the methodology of a two-part study guided by the Multiphase Optimization Strategy (MOST) framework to identify a streamlined behavioral sleep intervention for gynecologic cancer survivors. Three candidate intervention components previously shown to decrease sleep disturbance will be evaluated, including sleep restriction, stimulus control, and systematic bright light exposure. Participants will be adult women with a history of non-metastatic gynecologic cancer who have completed primary treatment and who report current poor sleep quality. Fifteen participants will be recruited for Part 1 of the study, which will utilize qualitative methods to identify barriers to and facilitators of intervention adherence. Results will inform changes to the delivery of the candidate intervention components to promote adherence in Part 2, where 80 participants will be recruited and randomized to one of eight conditions reflecting every possible combination of the three candidate intervention components in a full factorial design. Participants will complete assessments at baseline, post-intervention, and 3-months post-intervention. Part 2 results will identify the combination of candidate intervention components that yields the most efficacious yet efficient 6-week intervention for diminishing sleep disturbance. This is the first known study to apply the MOST framework to optimize a behavioral sleep intervention and will yield a resource-efficient treatment to diminish sleep disturbance, improve health-related quality of life, and decrease symptom burden among gynecologic cancer survivors. ClinicalTrials.gov Identifier: NCT05044975.

Parent Perceptions of Sleep-Related Stereotypy Within Sleep Problems in Children on the Autism Spectrum: Implications for Behavioral Treatment

ObjectivesSleep problems in children on the autism spectrum may be affected by core diagnostic characteristics, including stereotypy (restricted and repetitive behaviors). Little is known about the nature of sleep-related stereotypy and its role within sleep disturbance. This study aimed to improve our understanding of the types of sleep-related stereotypy, its potential role within sleep difficulties, and how parents manage night-time stereotypy, in children on the autism spectrum.MethodsThis qualitative study used thematic analysis to analyze clinical assessment reports obtained from 21 parents of children on the autism spectrum referred for behavioral sleep intervention. Five themes, including the types of stereotypy, timing within sleep problems, stereotypy as sleep-interfering, stereotypy as sleep-conducive, and parent-responses, were identified. A clinical case study illustrates the potential role of vocal stereotypy within night wakings, through functional assessment and treatment of sleep problems in a child on the autism spectrum.ResultsStereotypy included vocal and motor behaviors and repetitive manipulation of objects. Parents perceived stereotypy as both problematic and as beneficial to sleep, which may differentially affect behavioral treatment. Parent responses to stereotypy were varied and included co-sleeping. The case study highlights the complexity of the sleep and stereotypy relationship and the difficulty in treating automatically maintained behavior in the sleep context.ConclusionThe function that stereotypy serves in relation to sleep disturbance is unclear and may differ across and within children. It is important we seek to better understand the specific ways that stereotypy may affect sleep, and vice versa, to improve clinical management of sleep problems in children on the autism spectrum.

Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder.

This study compared the benefits of cognitive-behavioral therapy for insomnia for sleep, mental health symptoms, and quality of life (QoL) in a sample of women veterans with and without probable post-traumatic stress disorder (PTSD) comorbid with insomnia disorder. Seventy-three women veterans (30 with probable PTSD) received a manual-based 5-week cognitive-behavioral therapy for insomnia treatment as part of a behavioral sleep intervention study. Measures were completed at baseline, post-treatment, and 3-month follow-up. Sleep measures included the Insomnia Severity Index, Pittsburgh Sleep Quality Index, sleep efficiency measured by actigraphy, and sleep efficiency and total sleep time measured by sleep diary. Mental health measures included the PTSD Checklist-5, nightmares per week, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scale. QoL was measured with the Short Form-12. Linear mixed models compared changes over time across groups. Independent t tests examined PTSD symptom changes in women veterans with probable PTSD. Both groups demonstrated improvements across sleep (ps<.001-.040), mental health symptoms (ps<.001), and QoL measures (ps<.001). The probable PTSD group reported greater improvements in diary sleep efficiency (p=.046) and nightmares per week (p=.001) at post-treatment and in total sleep time (p=.029) and nightmares per week (p=.006) at follow-up. Most participants with probable PTSD experienced clinically significant reductions in PTSD symptoms at post-treatment (66.7%) and follow-up (60.0%). Significant reductions in intrusive and arousal/reactivity symptoms were maintained at follow-up. Cognitive-behavioral therapy for insomnia improves insomnia, mental health symptoms, and QoL among women veterans, with greater improvement in those with probable PTSD.

Meeting families where they sleep: a collaborative approach to improving sleep health for urban children.

Meeting families where they sleep: a collaborative approach to improving sleep health for urban children.

A Randomized Controlled Trial to Test a Behavioral Sleep Intervention to Improve Insomnia Symptoms in Older Adults with Mild Cognitive Impairment: Multicomponent Behavioral Sleep Intervention (MBSI) Protocol

A Randomized Controlled Trial to Test a Behavioral Sleep Intervention to Improve Insomnia Symptoms in Older Adults with Mild Cognitive Impairment: Multicomponent Behavioral Sleep Intervention (MBSI) Protocol

Sleep Well! An adapted behavioral sleep intervention implemented in urban primary care.

To describe the adaptation, feasibility, and initial outcomes of Sleep Well!, an intervention for early childhood insomnia and insufficient sleep, designed for families from lower-socioeconomic status backgrounds presenting to large metropolitan primary care sites. Fifteen caregiver-child dyads (caregivers: 92.3% mothers, 80.0% Black, 53.3% ≤ 125% US poverty level; children: 73.3% female, 86.7% Black, mean age = 3.0 years) participated in this multimethod, single-arm trial. A family advisory board of caregivers (n = 4) and a clinician advisory board of sleep experts, primary care clinicians, and psychologists (n = 13) provided intervention feedback throughout the pilot. Most adaptations were related to intervention delivery methods, with some related to sleep strategies. At postintervention, caregivers completed surveys on intervention acceptability and cultural humility (primary outcomes) and completed semistructured interviews. Caregivers also reported on child sleep pre- and postintervention. Thirteen (86.6%) families completed Sleep Well! and 12 (80.0%) completed pre- and postintervention measures. Caregivers reported strong intervention acceptability and cultural humility. There were preintervention to postintervention reductions in child sleep problems, bedroom electronics, sleep onset latency, and night awakening frequency and duration. Nighttime sleep duration and overall insufficient sleep also improved. Qualitative data also showed strong intervention acceptability and perceived flexibility, with few participation barriers. A brief, early childhood behavioral sleep intervention delivered in primary care with families from primarily lower-socioeconomic status backgrounds and/or racially minoritized backgrounds is feasible to implement, with strong retention rates, acceptability, and perceptions of cultural humility. Child sleep improvements are positive and warrant replication in a randomized controlled trial. Registry: ClinicalTrials.gov; Name: Implementing Behavioral Sleep Intervention in Urban Primary Care; URL: https://clinicaltrials.gov/ct2/show/NCT04046341; Identifier: NCT04046341. Williamson AA, Okoroji C, Cicalese O, etal. Sleep Well! An adapted behavioral sleep intervention implemented in urban primary care. J Clin Sleep Med. 2022;18(4):1153-1166.

The Interventions for Sleep Disorders in Children with Attention Deficit and Hyperactivity Disorder: A Narrative Review

BACKGROUND: Attention deficit and hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood. Children with ADHD have more frequent comorbid sleep disorders than healthy children. The current methods of treating sleep disorders in ADHD children are still focused on pharmacological interventions which in fact only provide little benefit. AIM: This study aims to identify existing studies regarding the types of nonpharmacological and complementary interventions for sleep disorders in children with ADHD using a narrative review approach. METHODS: This was a narrative review. Inclusion criteria included articles in English and Bahasa, full-text articles, primary studies, and children with ADHD aged 18 years with or without comorbidities as the research sample, and the article having been published in the last 10 years. Searches were performed in several databases: PubMed, Springer, Web of Science, and Google Scholar. RESULTS: The result showed that programs for managing sleep disorder in ADHD are behavioral therapy, behavioral parent training (BPT), behavioral sleep intervention, neurofeedback, mind-body therapy, L-theanine supplementation, horse milk supplementation, and play therapy. The programs are found to be effective in improving sleep. CONCLUSION: The program most comprehensive with a high level of ease of implementation was BPT.

Impact of a Behavioral Sleep Intervention in Adolescents With ADHD: Feasibility, Acceptability, and Preliminary Effectiveness From a Pilot Open Trial

Objective: An open trial tested the feasibility, acceptability, and preliminary effectiveness of a behavioral sleep intervention in adolescents with ADHD. Method: Fourteen adolescents (ages 13–17 years; 50% male) with ADHD and co-occurring sleep problems received the cognitive-behavioral-based Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C). Adolescent, parent, and teacher ratings, actigraphy, and daily sleep diaries were collected at pre-intervention, post-intervention, and 3-month follow-up. Results: Adolescents experienced moderate to large improvements in sleep, mental health symptoms, and daily life executive functioning from pre-treatment to post-treatment, and improvements were generally maintained at 3 months. Pre-intervention, 71.4% of adolescents were classified as poor sleepers and this was reduced to 21.4% and 28.6% at post-treatment and follow-up, respectively. Conclusion: This study provides strong preliminary evidence that TranS-C improves sleep and associated outcomes in adolescents with ADHD and co-occurring sleep problems. A randomized controlled trial is needed to rigorously test the efficacy of TranS-C in this population.

312: Sleep-related outcomes following participation in a behavioral sleep intervention for youth with cystic fibrosis

312: Sleep-related outcomes following participation in a behavioral sleep intervention for youth with cystic fibrosis

P153 Sleep timing and chronotype in perinatal periods: Longitudinal changes and associations with wellbeing from pregnancy to 2 years postpartum

Abstract Introduction Significant changes to sleep occur during perinatal periods. Existing research focuses on sleep duration and quality, but not sleep timing or chronotype. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to two years postpartum, and examined associations between chronotype and insomnia, sleep-related impairment, and mood at seven different perinatal time-points. Methods Data were from a 2-arm randomised controlled trial testing behavioural sleep and diet interventions. A community sample of nulliparous females without severe sleep/mental health conditions participated. Participants self-reported bedtime, rise-time, chronotype (short Morningness-Eveningness Questionnaire), Insomnia Severity Index, and PROMIS Depression, Anxiety, and Sleep-Related Impairment over seven time points: gestation weeks 30 and 35, and postpartum months 1.5, 3, 6, 12 and 24. Results 163 participants (mean age 33.4±3.4 years) took part. Mixed effects models adjusting for age and group allocation showed that both bed- and rise-times became progressively earlier by approximately 20–30 minutes over time (p&amp;lt;.001); chronotype shifted progressively towards more morningness (p&amp;lt;.01). After adjusting for covariates (sleep duration and efficiency, mental health history, social support, age, group allocation), greater morningness was significantly associated with lower symptoms of insomnia and sleep-related impairment over time (p-values&amp;lt;.001); at each time-point, associations between chronotype and symptoms of depression and anxiety were non-significant (p-values&amp;gt;0.65). Conclusions Sleep timing and chronotype became progressively earlier over the first two postpartum years. Greater morningness was associated with less sleep complaints and sleep-related daytime impairment during the postpartum period. The mechanisms of these findings may be investigated through further research.

P012 Maternal and infant stress during a bedtime separation: a pilot RCT

Abstract Background Behavioural sleep interventions to improve infant sleep disturbance commonly include extinction where an unwanted behaviour (night time crying) is periodically ignored. There have been conflicting findings regarding the impact of extinction methods on infant stress levels as measured with cortisol and as perceived by mothers and only one that measured cortisol at the time of the separation. This study aimed to compare a responsive method to extinction (controlled crying) and a control group evaluating subjective and objective stress for mother/infant dyads at the time of bedtime separation. Methods Mother/infant dyads were randomly allocated to behavioural sleep interventions (Responsive - n= 7, Controlled Crying - n=6 or Controls - n=4). Cortisol (two oral swabs on two nights at T2), maternal self-reported stress (Subjective Units of Distress - SUDS), and perceived infant distress (PIS) were compared over eight weeks. Correlations tested relationships between PIS, SUDS and infant cortisol levels. Mixed models analysis were used for cortisol analyses. Results There were no significant differences in cortisol levels between groups across time points but significant inter and intra-individual variability. Maternal stress was positively correlated with infant cortisol and PIS (p&amp;lt;0.05) and mothers in the Responsive group were significantly less stressed (p=0.02). Conclusion In this small sample, infant cortisol during bedtime separation was variable, elevated in all sleep interventions and not significantly different. Mothers were less stressed in the Responsive group. Findings indicate responsive methods are comparable to extinction and less stressful for mothers offering a possible gentler choice at bedtime separation.

A Qualitative Investigation Into What Parents Want From an Online Behavioural Sleep Intervention for Children With Epilepsy.

Many of the same sleep problems seen in typically developing (TD) children are frequently experienced by children with epilepsy (CWE). Behavioural sleep interventions (BSIs) are commonly and successfully used to treat these sleep problems in TD children and in some neurodevelopmental disorder populations. Therefore, BSIs should be effective in CWE, however, there are special seizure-related considerations for CWE and their parents which may be salient to consider in any future BSI development for this group. The current study sought to identify, from parents, if there were special considerations for the content and delivery of an online BSI for parents of CWE. Semi-structured interviews were conducted with nine mothers of CWE and thematic analysis was conducted on the interview data. Ten themes were apparent which represented what parents wanted from any online BSI for CWE. Parents wanted (i) other parents’ views and real-life experiences to be included, (ii) recognition of how changes over time may influence the appropriateness of using various sleep-management options, (iii) to be presented with a range of sleep management options from which they could select, (iv) personalised information and suggestions for behaviour-change options, (v) help to address child anxiety around sleep, (vi) for the advice and behaviour-change options to be practical, (vii) general educational information about sleep and the relationship between sleep and epilepsy, (viii) for parental worries and concerns to be acknowledged, (ix) to receive help, support, and reassurance around children’s sleep; and (x) to include the child in the intervention. It was clear that any online BSI would require specific adaptations and additions (to content and delivery format) to best meet the needs of parents of CWE. It is hoped that having identified what parents want from on online BSI for CWE will allow these factors to be acknowledged in future intervention development, with the intention to optimise parental engagement and intervention effectiveness. Practical suggestions for how these aspects could be integrated into any online BSI are suggested.

Cognitive-behavioral treatment of sleep disturbance in children and adolescents with autism: Eight case studies using functional behavior assessment

BackgroundIndividuals with autism spectrum disorder (ASD) experience high rates of sleep problems. Parent-implemented behavioral sleep interventions for young children with ASD are increasingly supported by research. Few studies have evaluated such interventions for older children and adolescents, nor has research investigated the effectiveness of having the young person collaborate in the design and implementation of their intervention (hereafter termed ‘young person-implemented interventions’). MethodFunctional behavioral assessment (FBA) was used to identify putative cognitive-behavioral factors maintaining sleep disturbance in eight 9- to 15-year-old participants with ASD. A series of case studies is presented that investigated the effectiveness of individualized, FBA-informed, young person-implemented sleep interventions, with parent-implemented treatments provided as necessary. ResultsTreatment was effective in reducing sleep disturbance (e.g., extended night wakings, unwanted co-sleeping) for all participants, with results mostly maintained at follow-up. Young people and their parents generally viewed treatments favorably. ConclusionsResults demonstrate the feasibility, effectiveness, and acceptability of treating sleep disturbance in ASD via young person-implemented, parent-assisted, treatment.

Development and Evaluation of the CASTLE Trial Online Sleep Intervention for Parents of Children with Epilepsy.

Introduction: Many of the sleep problems experienced by children with epilepsy (CWE) have the same behavioural basis as common sleep problems seen in typically developing (TD) children. Behavioural sleep interventions (BSIs) are widely used to treat these sleep problems in TD children and are hypothesised to be effective for CWE. However, specific considerations need to be addressed and incorporated into a BSI for CWE to ensure the intervention is tailored to this population's needs. This paper details developing and tailoring an online BSI for parents of CWE, to be used in the CASTLE (Changing Agendas on Sleep, Treatment and Learning in Epilepsy) Sleep-E clinical trial.Method: In phase one, two existing theory-driven paediatric BSIs were adapted into a novel online behavioural sleep intervention (CASTLE Online Sleep Intervention or COSI) which specifically incorporated the needs and requirements reported by nine parents of CWE. Scoping their needs included conducting interviews with three CWE so that they could contribute to the overall intervention content. In phase two, six of these parents evaluated COSI, reviewing and feeding back on COSI until parental approval for content and functionality was achieved.Results: In phase one, a range of adaptations was made to the content and presentation of standardised intervention material to acknowledge and emphasise the key seizure-specific issues to ensure COSI best met parents of CWE's needs. Adaptations included embedding parent and child experiences in the intervention, including particular information requested by parents, such as the links between sleep and seizures and managing child and parental anxieties around sleep, as well as developing functionality to personalise the delivery of content. In phase two, parents confirmed that they found the final version of COSI to be functional and appropriate (after one round of review) for use by parents of CWE and that 100% would recommend it to other families who have CWE.Discussion: It is hoped that the use of evidence-based BSIs, adapted to consider salient epilepsy-specific factors, will increase parent-engagement, COSI's relevance for this particular patient group and overall efficacy in improving sleep in CWE. The effectiveness of COSI will be tested in the CASTLE Sleep-E clinical trial (https://castlestudy.org.uk/).

Collateral Child and Parent Effects of Function‑Based Behavioral Interventions for Sleep Problems in Children and Adolescents with Autism.

This study follows McLay et al., Journal of Autism and Developmental Disorders, (2020) to investigate whether the function-based behavioral sleep interventions received by 41 children and adolescents with autism spectrum disorder (ASD) produced collateral improvements in ASD severity, internalizing and externalizing symptoms and parent relationship quality, ratings of depression, anxiety and stress, and personal sleep quality. Concomitant with reduced sleep problem severity, improvements were found in children's internalizing and externalizing behavior and ASD symptom severity. Small improvements were also found in maternal sleep quality and parental stress. There was little change in parental relationship quality post-treatment, possibly reflecting high baseline scores. Overall, collateral benefits were generally small but positive, consistent with the limited extant research, and underscore the importance of investigating collateral effects across a range of variables.

631 Sleep SMART in Adolescents with Neurodevelopmental Disorders

Abstract Introduction: Introduction Sleep disturbances are common in adolescents with neurodevelopmental disorders (NDDs). Inclusion of vulnerable populations such as adolescents with NDDs into sleep intervention efforts is essential as they are at high-risk for poor physical/mental health outcomes. The objective of this study is to pilot a sequential, multiple assignment, randomized trial (SMART) design to compare the impact of a sequence of sleep interventions, based on treatment response, to optimize sleep health in adolescents with NDDs. Methods: Methods Recruitment began June 2019 using convenience sampling. The SMART pilot feasibility study includes 1-week of baseline sleep data, and two 4-week periods of a sleep intervention (9-week total study enrollment). Interventions include exogenous melatonin, The Bedtime Bank, and their combination. Exogenous melatonin (liquid, immediate release, 3mg) is administered 30 minutes before bedtime. The Bedtime Bank, a behavioral sleep intervention, is based upon contingency contracting that relies on a credit- or debt-based system to hold adolescents accountable for maintaining a consistent bedtime. At baseline participants completed demographics, PROMIS pediatric sleep questionnaires, the Cleveland Adolescent Sleepiness Questionnaire (CASQ), salivary &amp; urinary endogenous melatonin measurement, and one week of actigraphy. Upon enrollment, participants were randomly assigned to either melatonin or The Bedtime Bank. Participants who respond (nightly increase in total sleep time (TST) ≥18 minutes) remain on the assigned intervention; if non-responsive participants are re-randomized to a different sleep intervention or combination. Results: Results At baseline, participants (n=29, aged 10–18 years) had an average TST of 7 hours 11 minutes. PROMIS Sleep Disturbance (M=64.3, SE=2.5), PROMIS Sleep-Related Impairment scores (M=58.9, SE=2.2), and CASQ scores (M=40.0, SD= 10.5) were higher than reported normative values. Salivary DLMO &amp; urinary 6-sulfatoyxmelatonin analysis is ongoing. For participants who completed the full 9-week trial, nearly 30% (n=7/24) were responsive (increased baseline TST ≥18 minutes) to one of the 4-week interventions. Conclusion: Conclusion Baseline data of the enrolled participants demonstrates poor indicators of TST, sleep disturbance, and sleep related impairment. Preliminary results of this SMART indicate some adolescents are responsive to sleep interventions aimed to improve their TST. Support (if any) Support: This clinical trial is funded by the National Institute of Nursing Research, National Institutes of Health (1K01NR017465-01A1).

225 Sleep Timing and Chronotype in Mothers: Longitudinal Changes and Associations with Wellbeing from Pregnancy to 2 Years Postpartum

Abstract Introduction Women experience significant changes to sleep during perinatal periods. Existing research focuses on sleep duration and quality, but not sleep timing or chronotype (i.e., preferred timing for activity and sleep). This study investigated change trajectories of sleep timing and chronotype from late pregnancy to two years postpartum, and examined longitudinal associations between chronotype and insomnia, sleep-related daytime impairment, and mood. Methods Data were from a 2-arm randomized controlled trial testing behavioral sleep and diet interventions. A community sample of nulliparous women without severe sleep/mental health conditions participated. Women self-reported bedtime, risetime, chronotype (reduced Morningness-Eveningness Questionnaire), Insomnia Severity Index, and PROMIS Depression, Anxiety, and Sleep-Related Impairment over 7 time points: 30 and 35 weeks’ gestation, and postpartum months 1.5, 3, 6, 12 and 24. Results 163 women (mean age 33.35 ± 3.42 years) took part. Mixed effects models controlling for age and group allocation showed that both bed- and risetimes became progressively earlier over time by approximately 20-30 minutes on average (p &amp;lt; .001); chronotype also shifted progressively towards morningness (p &amp;lt; .01). After controlling for covariates (sleep duration and efficiency, mental health history, social support, age, group allocation), greater morningness was significantly associated with lower symptoms of insomnia and sleep-related impairment over time (p-values &amp;lt; .001); longitudinal associations between chronotype and symptoms of depression and anxiety were non-significant (p-values &amp;gt; .65). Conclusion This is one of the first studies to examine longitudinal changes in sleep timing and chronotype from pregnancy to two years postpartum. Sleep timing and chronotype became progressively earlier over the first two postpartum years. The magnitude of changes is beyond what is expected with increasing age. Greater morningness was associated with lower sleep complaints and sleep-related daytime impairment during the postpartum period. The mechanisms underlying these associations require further research. Support (if any) Australasian Sleep Association, Monash University, Australian Government RTP Scholarship and National Health and Medical Research Council.