Sleep Hygiene Recommendations Research Articles

CHANGES IN CIRCADIAN CHARACTERISTICS OF PATIENTS WITH PARKINSON DISEASE AFTER CORRECTION OF POOR SLEEP QUALITY USING MELATONIN: AN OPEN-LABEL CONTROLLED RANDOMISED TRIAL

Introduction. Recent studies are increasing the amount of evidence suggesting that the circadian system is disrupted in Parkinson's disease that can lead to poor sleep. Currently, international guidelines for managing non-motor symptoms of Parkinson's disease do not have recommendations with proven efficacy, but only methods with potential benefit. Two of the most widely available methods for correcting poor sleep quality in patients with Parkinson's disease in Ukraine are sleep hygiene training, also known as somnoeducation, and melatonin administration. The aim of the study is to compare the state of circadian characteristics before and after the correction of poor sleep quality in patients with Parkinson's disease in the context of sleep hygiene and an integrated approach with the implementation of chronotherapy using melatonin. Materials and methods. We conducted a clinical trial at the Centre for Patients with Parkinson's Disease and Other Neurodegenerative Diseases, which included 34 patients with poor sleep quality who were randomised into 2 groups: group 1a (n = 17) consisted of patients with Parkinson's disease who followed sleep hygiene rules and received chronotherapy; group 1b (n = 17) involved patients with Parkinson's disease who followed sleep hygiene rules but did not take any medications to improve sleep. Circadian characteristics were analysed using the Munich Chronotype Questionnaire. Results. Our study has found that the correction of poor sleep quality by introducing sleep hygiene into the treatment process of patients with Parkinson's disease demonstrates a shift in the time of sleep onset and mid-sleep to earlier, accompanied by a shift in chronotypes towards earlier, as well as an increase in sleep duration against a decrease in the time spent in bed, which led to an increase in the average actual sleep efficiency. At the same time, melatonin supplementation helps to reduce sleep latency in Parkinson's disease. Conclusions. Adherence to sleep hygiene recommendations contributes to changes in circadian characteristics and improves sleep efficiency in patients with Parkinson's disease, regardless of melatonin administration. Additional use of melatonin to correct the quality of sleep for 1 month is accompanied by a reduction in the sleep latency period.

Re-considering the Role of Sleep Hygiene Behaviours in Sleep: Associations Between Sleep Hygiene, Perceptions and Sleep.

Sleep hygiene behaviours are a suggested set of behaviours people can engage in to improve sleep. However, there are numerous issues relating to the measurement of sleep hygiene, primarily, the lack of consensus as to which behaviours impact sleep and should therefore be included in scales. Cross-sectional correlational methods were used to assess the association between sleep quality, a highly inclusive range of sleep hygiene behaviours, and individual perceptions of those behaviours in a non-clinical sample of 300 participants. Of the 35 sleep hygiene behaviours assessed, 18 were independently associated with sleep quality. Post-hoc factor analysis revealed that behaviours clustered together across four factors. A 'routine' factor included behaviours such as going to bed and waking up at the same time each night, and were important predictors of sleep quality, as were behaviours belonging to the 'perseverative cognition' and 'negative emotionality' factor. Other behaviours related to physiological processes like exposure to sunlight during the day and going to bed hungry were also significantly associated with sleep. Negative perceptions moderated the relationship between daytime exposure to sunlight and sleep. Although certain behaviours were significantly related to sleep, almost half were not, supporting the need to examine the association between sleep and behaviours used for sleep hygiene recommendations more critically. Reframing sleep hygiene recommendations into a condensed set of shared underlying mechanisms may be of benefit for the development of sleep hygiene scales and interventions in non-clinical populations.

Screen exposure and sleep: How the COVID-19 pandemic influenced children and adolescents – A questionnaire-based study

BackgroundCOVID-19 pandemic has drastically increased the exposure to electronic devices in children, influencing their lifestyle and their sleep. This study was conducted to explore the relationship between the augmented screen exposure and sleep habits in children during and after the pandemic. MethodsUsing the "Google Forms" tool, we created an online questionnaire addressed to parents of children and adolescents aged 2–18 years. We explored the use of screens before and during/after the lockdown and assessed the presence of sleep disturbances through the Sleep Disturbance Scale for Children (SDSC), referring to the period before and during/after COVID-19 pandemic. ResultsWe collected 1084 valid questionnaires (median age 8.5 ± 4.1 years). We observed a significant increase in screens exposure for school (72%) and for leisure (49.7%) during the pandemic. We reported an increased sleep disturbances prevalence from 22.1% before the pandemic to 33.9% during the outbreak (p < 0.001). Even before the pandemic, the highest risks for sleep disorders were related to daily screen time for school reasons (OR 1.65, p < 0.001) and total screen time after 6 p.m. (OR 1.59, p < 0.001). The augmented exposure to screens for any reasons during the pandemic was significantly related to an increase of sleep disorders, especially regarding the increased exposure after 6 p.m. (OR 1.67, p < 0.001). ConclusionsThe augmented use of electronic devices was recognized to be a significant predisposing factor in increasing the rate of sleep disorders during and after the pandemic, thus sleep hygiene recommendations should be highlighted to improve sleep habits.

Chronic Insomnia Disorder across Europe: Expert Opinion on Challenges and Opportunities to Improve Care

One in ten adults in Europe have chronic insomnia, which is characterised by frequent and persistent difficulties initiating and/or maintaining sleep and daily functioning impairments. Regional differences in practices and access to healthcare services lead to variable clinical care across Europe. Typically, a patient with chronic insomnia (a) will usually present to a primary care physician; (b) will not be offered cognitive behavioural therapy for insomnia-the recommended first-line treatment; (c) will instead receive sleep hygiene recommendations and eventually pharmacotherapy to manage their long-term condition; and (d) will use medications such as GABA receptor agonists for longer than the approved duration. Available evidence suggests that patients in Europe have multiple unmet needs, and actions for clearer diagnosis of chronic insomnia and effective management of this condition are long overdue. In this article, we provide an update on the clinical management of chronic insomnia in Europe. Old and new treatments are summarised with information on indications, contraindications, precautions, warnings, and side effects. Challenges of treating chronic insomnia in European healthcare systems, considering patients' perspectives and preferences are presented and discussed. Finally, suggestions are provided-with healthcare providers and healthcare policy makers in mind-for strategies to achieve the optimal clinical management.

A low-threshold sleep intervention for improving sleep quality and well-being.

Approximately one-third of the healthy population suffer from sleep problems, but only a small proportion of those affected receive professional help. Therefore, there is an urgent need for easily accessible, affordable, and efficacious sleep interventions. A randomized controlled study was conducted to investigate the efficacy of a low-threshold sleep intervention consisting of either (i) sleep data feedback plus sleep education or (ii) sleep data feedback alone in comparison with (iii) no intervention. A total of 100 employees of the University of Salzburg (age: 39.51 ± 11.43 years, range: 22-62 years) were randomly assigned to one of the three groups. During the 2-week study period, objective sleep parameters were assessed via actigraphy. In addition, an online questionnaire and a daily digital diary were used to record subjective sleep parameters, work-related factors, as well as mood and well-being. After 1 week, a personal appointment was conducted with participants of both experimental group 1 (EG1) and experimental group 2 (EG2). While the EG2 only received feedback about their sleep data from week 1, the EG1 additionally received a 45-min sleep education intervention containing sleep hygiene rules and recommendations regarding stimulus control. A waiting-list control group (CG) did not receive any feedback until the end of the study. Results indicate positive effects on sleep and well-being following sleep monitoring over the course of 2 weeks and minimal intervention with a single in-person appointment including sleep data feedback. Improvements are seen in sleep quality, mood, vitality, and actigraphy-measured sleep efficiency (SE; EG1), as well as in well-being and sleep onset latency (SOL) in EG2. The inactive CG did not improve in any parameter. Results suggest small and beneficial effects on sleep and well-being in people being continuously monitored and receiving (actigraphy-based) sleep feedback when paired with a single-time personal intervention.

The Efficacy of a Multimodal Recovery Strategy Implemented After a High-Intensity Rugby League Training Session.

Aben, HGJ, Hills, SP, Higgins, D, Cooke, CB, Davis, D, Jones, B, and Russell, M. The efficacy of a multimodal recovery strategy implemented after a high-intensity rugby league training session. J Strength Cond Res 37(8): 1634-1642, 2023-The efficacy of a multimodal recovery strategy implemented within 4 hours of rugby league (RL) training was investigated using repeated-measures, randomized, crossover methods in 10 professional academy RL players (age: 17 ± 1 years). Following standardized training (5,383 m covered, 350-m high-speed running, 28 repeated high-intensity efforts, 24 collisions), players completed a multimodal recovery (REC) strategy (i.e., ∼640 kcal meal + ∼1,285 kcal snacks or drinks, cold-water immersion, sleep hygiene recommendations) or control (i.e., ∼640 kcal meal: CONT) practices. Isometric mid-thigh pulls (IMTP), countermovement jumps (CMJ), and wellness questionnaires were completed before (-3 hours) and after (+24, +48 hours) training. The recovery strategy influenced IMTP peak force ( p = 0.026), but between-trial differences were undetectable. No other between-trial effects (all p > 0.05) were seen for IMTP, CMJ, or wellness variables. Training-induced reductions in CMJ peak power (-4 ± 6% vs baseline: 4,878 ± 642 W) at +24 hours ( p = 0.016) dissipated by +48 hours. Fatigue and lower-body soreness reduced by 16 ± 19% ( p = 0.01) and 32 ± 44% ( p = 0.024) at +48 hours versus +24 hours, respectively. Relative to CONT (i.e., posttraining nutrition), the effects of a single bout of recovery practices appeared limited when implemented after RL-specific training. Therefore, when training included limited collisions, balanced postexercise meals appeared equally effective relative to a multimodal recovery strategy. Transient changes in performance and wellness variables after training may have implications for practitioners. Consecutive training sessions, including a high frequency and intensity of eccentric muscle actions, should be carefully planned, especially near match-play.

O061 Sleep hygiene guidelines for shift workers: consensus guidelines via a Delphi study

Abstract Introduction Current sleep hygiene guidelines are impractical for shift workers, given their inability to maintain regular sleep schedules. Further, the present guidelines contradict fatigue risk management advice (e.g., advising against caffeine and daytime napping). The aim of the present study is to develop a set of tailored sleep hygiene guidelines for shift workers via a Delphi approach. Methods Draft guidelines were developed by the research team, who reviewed the current guidelines and examined existing evidence on sleep hygiene in shift workers. Experts from sleep, shift work, and occupational health fields (n=155) were invited to review these draft guidelines via a three-round series of online questionnaires. In each round, experts voted on each guideline, with consensus reached once there was 70% agreement on including the item as written. Expert feedback from each round was discussed and incorporated by the research team as appropriate. Results The research team drafted 17 sleep hygiene recommendations, covering sleep scheduling, napping, sleep environment, substance consumption, diet, and exercise. Of those experts invited, 68 (44%) agreed to participate, with 55 of these (81%) completing all three rounds. Consensus was reached on all original items after three rounds, with two additional items (medication use and sleep inertia) and an introductory statement developed, to create a final set of guidelines with 19 items. Discussion This is the first study to create evidence-based, expert-developed sleep hygiene guidelines for shift workers. Future research is planned to investigate the acceptability and implementation of the guidelines amongst end-users.

Do objective data support the claim that problematic smartphone use has a clinically meaningful impact upon adolescent sleep duration?

ABSTRACT Sleep insufficiency is a risk factor for mental and physical ill-health. In recent years, research has attributed sleep insufficiency to problematic smartphone use (PSU). In addition, research has indicated a relationship between sleep and the construct of mental toughness (MT). However, previous research exploring the relationship between sleep, PSU and MT has relied on self-report measures. Therefore, this study aimed to explore the tentative links between sleep, PSU and MT by gathering objective data. 2053 participants completed measures of sleep quality, PSU and MT. Objective smartphone usage data were collected using pre-installed smartphone applications. A sub-sample of 614 participants provided sleep duration data from validated sleep tracking devices. In line with previous research, sleep quality was found to correlate weakly with both MT and PSU. While several significant correlations emerged when objective data were explored, in all cases, the effect sizes were negligible. This study does not support the claim that PSU has a clinically meaningful impact upon sleep duration. Sleep hygiene recommendations with more well-established empirical support should be prioritised during sleep promotion efforts.

3.2 Sleep Education and Sleep Hygiene

The presentation will provide participants with an understanding of standard sleep hygiene recommendations and their utility, along with other, less commonly addressed interventions to promote a good night’s sleep. At the end of this presentation, participants will be able to: 1) describe the evidence base for typical sleep hygiene recommendations; 2) identify the effects of electronic devices, media, exercise, napping, caffeine, alcohol, tobacco, and marijuana on sleep; and 3) determine which sleep hygiene practices are likely to be most effective for children and adolescents.

Does knowledge of sleep hygiene recommendations match behaviour in Australian shift workers? A cross-sectional study

ObjectivesShiftworkers routinely obtain inadequate sleep, which has major health consequences. Sleep hygiene describes a range of behaviours, lifestyle and environmental factors that can improve sleep. To date, limited research has...

Chronotype and trait self-control as unique predictors of sleep quality in Chinese adults: The mediating effects of sleep hygiene habits and bedtime media use.

This study examined the distinctive roles of chronotype and trait self-control in predicting sleep quality and the mediation of sleep hygiene habits and bedtime media use of the relations between chronotype, trait self-control and sleep quality. Self-report questionnaire measuring chronotype, trait self-control, sleep hygiene behaviors, bedtime media use and sleep quality was administered to 224 Chinese adult participants (83.5% female). A multiple mediation model was estimated with sleep hygiene habits and bedtime media use as parallel mediators of the relations between chronotype, trait self-control, and sleep quality. Chronotype and trait self-control positively predicted sleep quality. Results of mediation analyses indicated that trait self-control predicted sleep quality both directly and indirectly through pre-sleep stress management and keeping a restful sleep environment, whereas chronotype predicted sleep quality indirectly through pre-sleep stress management and bedtime media use. This study provides evidence for the possible mechanism through which eveningness and low trait self-control undermine sleep quality: Whereas bedtime media use and sleep timing irregularity are linked to poor sleep quality in evening types, environmental interference (e.g., noise or disorganization) appears to be more relevant to poor sleep quality in individuals low in self-control. These findings can inform the design of personalized sleep hygiene recommendations appropriate for the target population. Practical implications regarding sleep hygiene education and interventions are discussed.

The effects of napping on night-time sleep in healthy young adults.

The discrepancies in the effects of napping on sleep quality may be due to differences in methodologies, napping behaviours, and daytime activity levels across studies. We determined whether napping behaviours and daytime activity levels are associated with night-time sleep fragmentation and sleep quality in young adults. A total of 62 healthy adults (mean [SD] age 23.5[4.2]years) completed screening questionnaires for sleep habits, physical activity, medical and psychological history. Actigraphy was used to record sleep including naps. The fragmentation algorithm (KRA ) was applied to the actigraphic data to measure night-time sleep fragmentation. We classified participants' nap frequency as "non-nappers" (0naps/8days), "moderate nappers" (1-2naps/8days) or "frequent nappers" (≥3naps/8days) naps. Nap duration was defined as "short" (≤60min) or "long" (>60min). Naps' proximity to the night sleep episode was defined as "early" (≥7h) and "late" (<7h) naps. Outcome variables were night-time KRA and actigraphic sleep variables. Frequent nappers had a significantly higher KRA than moderate nappers (p<0.01) and non-nappers (p<0.02). Late naps were associated with poorer measures of night sleep quality versus early naps (all p≤0.02). Nap duration and daytime activity were not associated with significant differences in the outcome variables (all p>0.05). KRA correlated with sleep duration, sleep efficiency, and awakenings (r=-0.32, -0.32, and 0.53, respectively; all p<0.05). Frequent napping and late naps may be associated with increased sleep fragmentation and poorer sleep quality, reflected in longer sleep onsets and increased awakenings. These findings have implications for public health sleep hygiene recommendations.

False beliefs about sleep and their associations with sleep-related behavior

ObjectivesUnderstanding the association between sleep-related beliefs and behaviors may be useful in improving sleep health in the general population. This study examines false beliefs about sleep and their associations with self-reported sleep and related behaviors. MethodsRespondents in an online survey indicated the degree to which they agreed with 20 statements previously identified as sleep myths by experts in the field. A total sleep myths score was calculated for each participant, with higher scores reflecting greater false beliefs. Sociodemographic factors, behaviors, and knowledge related to sleep were also assessed. ResultsTotal sample size was 1120 adults residing in the United States (51.5% female; M age = 47.22). Overall, belief in sleep myths was relatively common, with 10 of 20 false statements endorsed by at least 50% of the sample. Sleep myth scores varied by sociodemographic factors, including age, gender, socioeconomic indicators, and region of residence. Higher sleep myth scores were associated with greater inconsistency in bedtimes (odds ratio: 1.07 [1.04-1.09]), more frequent napping (odds ratio: 1.11 [1.09-1.14]), more in-bed activities (β = 0.35, p < .001), engaging in behaviors incompatible with sleep hygiene recommendations (β = 0.24, p < .001), and perceiving fewer consequences of insufficient sleep (β = −0.13, p < .001). Those endorsing more myths reported shorter sleep on non-worknights (β = −0.09, p = .01) but not on worknights. ConclusionsBelief in sleep myths is related to sleep health behavior and may be a modifiable target for intervention.

Daily associations between modifiable sleep behaviors and nighttime sleep among young adult drinkers with insomnia.

Empirical evidence linking individual sleep hygiene practices to subsequent sleep parameters is limited, particularly at the daily level. This study compared the strength of daily, within-person associations between these modifiable sleep behaviors and nighttime sleep in young adult drinkers with insomnia. Young adults (ages 18-30 years; n = 56) who met diagnostic criteria for insomnia and reported past-month binge drinking wore wrist actigraphy and completed online sleep diaries for 8.5 days (standard deviation = 2.3; 477 reports). Diaries assessed engagement in 11 sleep hygiene recommendations. Multilevel models tested daily associations between sleep behaviors and 3 outcomes: sleep quality, self-reported sleep efficiency, and actigraphy-measured sleep efficiency. Participants self-reported better sleep quality/efficiency on days that they slept in a comfortable environment, limited naps to 30 minutes, and maintained a consistent wake time. They self-reported worse sleep quality and efficiency on nights that they avoided alcohol use before bedtime. No sleep behaviors were significantly associated with actigraphy-measured sleep efficiency after correcting for inflation in type I error. The sleep hygiene recommendations most strongly associated with sleep at the daily level were consistent with stimulus control. Creating a comfortable sleep environment also emerged as an important correlate of daily sleep. Heavy drinkers with insomnia may perceive better sleep if they drink before bedtime; however, this finding may be unique to this population. Miller MB, Curtis AF, Hall NA, etal. Daily associations between modifiable sleep behaviors and nighttime sleep among young adult drinkers with insomnia. J Clin Sleep Med. 2022;18(3):703-712.

Relationships Between Internet Use and Sleep Duration in Chinese Adults: A Cross-Sectional Study.

PurposeMost studies that examined the relationship between internet use and sleep were conducted mainly in children and adolescents, and we know little about the use of internet among adults. The purpose of this study is to understand the internet use patterns of Chinese adults and to measure their associations with sleep duration from variety, frequency and type.MethodsA total of 19,730 samples were selected from 2018 data of the China Health and Retirement Longitudinal study. Internet usage was obtained by specific questions, and the range of sleep period was grouped according to recommendations from the National Sleep Foundation. Kruskal–Wallis H-test and the chi-squared test were used for basic descriptive analysis, and multinomial logistic regression was used to analyze the relationships between internet use and sleep duration. Stata version 15.0 was used for data cleaning, and SPSS version 20.0 was used for statistics analysis.ResultsAfter screening, a total of 6346 persons were included in the analysis, of which 3148 (49.61%) were males and 3198 (50.39%) were females. Age ranged from 21 to 95 years, most persons were over 45 years old, with the median age of 56 years. Only 1180 (18.59%) participants used the internet, and almost all of them used mobile phones (1137, 96.36%), the other three types were desktop computer (232, 19.66%), laptop computer (69, 5.85%) and tablet (73, 6.19%). There were 912 (77.28%) and 268 (22.71%) participants who used only one and two or more types, respectively. In the unadjusted model, both short sleep and long sleep were associated with internet use compared with normal sleep duration (0.806 [0.708–0.918] p = 0.001; 0.345 [0.251–0.475] p < 0.000). After adjusting for all covariates, the association between long sleep and internet use still persisted (0.612 [0.433–0.865] p = 0.005), but no significant difference was found in short sleep (0.929 [0.803–1.075] p = 0.325).ConclusionInternet use was found to be closely associated with sleep and the duration of sleep negatively affected, which may provide new ideas for sleep hygiene recommendations and healthy media use. This conclusion needs more evidence to support.

The acute effects of aerobic exercise on sleep in patients with unipolar depression: a randomized controlled trial.

Study ObjectivesInsomnia increases the risk of negative disease trajectory, relapse, and suicide in patients with depression. We aimed at investigating the effects of a single bout of aerobic exercise, performed after 02:00 pm, on the subsequent night’s sleep in patients with depression.MethodsThe study was designed as a two-arm parallel-group, randomized, outcome assessor-blinded, controlled, superiority trial. Patients between 18 and 65 years of age with a primary diagnosis of unipolar depression were included. The intervention was a single 30-minute bout of moderate aerobic exercise. The control group sat and read for 30 minutes. The primary outcome was sleep efficiency measured by polysomnography. Secondary outcomes were other polysomnographic variables, subjective sleep quality, daytime sleepiness, mood states, and adverse events.ResultsNinety-two patients were randomized to the exercise (N = 46) or control group (N = 46). There were no clinically relevant differences at baseline. Intent-to-treat analysis ANCOVA of follow-up sleep efficiency, adjusted for baseline levels and minimization factors, did not detect a significant effect of the allocation (β = −0.93, p = 0.59). There was no evidence for significant differences between both groups in any other objective or subjective sleep outcomes, daytime sleepiness, or adverse events. The intervention had an immediate positive effect on mood states, including depressiveness (β = −0.40, p = 0.003).ConclusionsThis is the first trial to study the effects of a single bout of aerobic exercise on sleep in patients with depression to the best of our knowledge. Aerobic exercise had no effect on sleep efficiency but had a strong beneficial effect on mood and did not increase adverse outcomes. These results add to the growing body of evidence that, contrary to sleep hygiene recommendations, exercise after 02:00 pm is not detrimental for sleep.Clinical Trial RegistrationClinicaltrials.gov, https://clinicaltrials.gov/ct2/show/NCT03673397. Protocol registered on September 17, 2018.

372 Sleep Hygiene Compliance and Sleep in Young Adult Drinkers with Insomnia: A Daily Analysis

Abstract Introduction Empirical evidence linking sleep hygiene practices to subsequent sleep parameters – and the extent to which those compare to evidence-based practices such as stimulus control – is limited. This study examined the daily impact of recommendation compliance on sleep in a sample of young adult drinkers with insomnia. Methods Young adults (18-30y; N=56, 75% female) who met diagnostic criteria for insomnia and reported past-month binge drinking wore wrist actigraphy and completed online sleep diaries for 7+ days (492 reports). Diaries assessed compliance with nine sleep hygiene recommendations: to limit naps; limit caffeine; avoid caffeine after 12p; avoid tobacco, alcohol, vigorous exercise, and heavy meals within 2 hours of bedtime; avoid bright light within 30 minutes of bedtime; and utilize a bedtime routine. If participants reported wake after sleep onset, diaries also assessed if they had gotten out of bed and returned to bed only when sleepy (partial stimulus control instructions). Multilevel models examined three outcomes: sleep quality, self-reported sleep efficiency, and actigraphy-measured sleep efficiency (α=.05/3≤.017). Covariates included gender; college enrollment; weekday versus weekend; and between-person differences in insomnia severity, hazardous drinking, and average compliance, Results Participants self-reported better sleep efficiency on days that they avoided naps (B=3.64, p=.004; 95% CI=1.20, 6.08). They also self-reported better sleep quality (B=0.40, p&amp;lt;.001; 95% CI=0.19, 0.60) and sleep efficiency (B=3.94, p&amp;lt;.001; 95% CI=1.76; 6.12) on days that they followed stimulus control. Surprisingly, they reported worse sleep quality (B=-0.28, p=.017; 95% CI=-0.51, -0.05) and sleep efficiency (B=-3.74, p=.002; 95% CI=-6.08, -1.40) on days that they avoided alcohol use before bedtime. No variables were significantly associated with actigraphy-based sleep efficiency. At the between-person level, participants reporting more at-risk drinking reported worse sleep quality (B=-0.04, p=.017; 95% CI=-0.08, -0.01). Conclusion Data provide empirical support for recommendations that young adult drinkers with insomnia avoid naps and get out of bed during nighttime awakenings. Although heavier drinkers reported worse sleep quality than lighter drinkers, they also reported better subjective (but not objective) sleep on nights they drank close to bedtime. We speculate that this is due to later bedtimes on heavy-drinking nights. Support (if any) University of Missouri Research Board (PI Miller)

Sleep practices in pediatric cancer patients: Indirect effects on sleep disturbances and symptom burden.

Sleep hygiene recommendations are commonly given to address patient-reported concerns about sleep, yet few studies have examined the relationship between sleep hygiene and sleep disturbances in the context of pediatric oncology. Because poor sleep may affect the patient's experience of cancer-related symptoms, understanding whether sleep hygiene practices influence sleep disturbances and symptoms may be important to improving symptom burden. One hundred and two caregivers of children ages 5-17 and 59 patients ages 8-17 receiving treatment for cancer completed parallel measures of child sleep, sleep hygiene, pain, fatigue, and nausea. Sleep hygiene practices were described, correlates between measures were examined, and the indirect relationship of sleep hygiene on symptom burden through sleep disturbances was tested using PROCESS. Patients received adequate sleep for age but sleep timing was later than recommended for more than half of the sample and consistency in sleep times was poor. Sleep disturbances were moderately related to all symptoms, with the exception of patient-reported fatigue. Consistent sleep habits were indirectly related to fewer cancer-related symptoms of pain, fatigue, and nausea through sleep disturbances by caregiver report but not patient report. Sleep disturbances are closely related to pain, fatigue, and nausea in pediatric cancer. Consistency in sleep/wake routines and schedules may be important to experiencing fewer sleep disturbances and lower symptom burden. Providing recommendations supporting consistent sleep habits broadly across pediatric oncology may be more effective than only presenting sleep hygiene recommendations to patients experiencing poor sleep.

A Good Night's Sleep: Learning About Sleep From Autistic Adolescents' Personal Accounts.

BackgroundSleep is a strong predictor of quality of life and has been related to cognitive and behavioral functioning. However, research has shown that most autistic people experience sleep problems throughout their life. The most common sleep problems include sleep onset delay, frequent night-time wakings and shorter total sleep time. Despite the importance of sleep on many domains, it is still unclear from first-hand accounts what helps autistic people to sleep. The purpose of this study is to explore together with autistic adolescents their sleep-related practices before bedtime and during the day which contribute to a good night’s sleep.MethodsFifty-four autistic adolescents collaborated with an academic researcher in a novel adapted photo-elicitation methodology, rooted in a Lifeworld framework. The adolescents were invited to collect and analyze their data. The data were also presented in a community knowledge exchange event.ResultsSeveral self-reported practices that facilitate better nocturnal sleep were identified. Those were organized into two thematics: Evening/bedtime factors and Day time factors. These included practices such as personalized sensory and relaxation tools before bed and during night-time, engaging in a range of physical activities during daytime and accommodating personal time to engage with highly preferred and intense focus activities and hobbies. It also included spending time in predictable and fun ways with family members before bedtime.ConclusionThis is the first time that a study uses a novel methodological approach based on personal accounts elicited by photos rooted in a Lifeworld framework to describe personal sleep-related practices before bedtime and during the day to identify a “good night of sleep” in autistic adolescents. The outcomes from the current study showed that sleep facilitating factors are in a direct contrast to the sleep hygiene recommendations. Therefore, it is thus important for the sleep practitioners and healthcare providers to move beyond providing standardized sleep hygiene interventions. A Lifeworld led care model that pays attention to personal experiences, promotes sense of agency, evaluates both autism-specific strengths and struggles could and should complement biomedical approaches.Lay SummaryThis is the first study to examine autistic adolescents’ self-reported sleep habits and factors which facilitate autistic adolescents’ sleep by employing adapted photo-elicitation interviews. This study is innovative in at least three ways. First, it examines the factors that may facilitate a good night’s sleep through personal accounts of autistic adolescents. Second, this is the first sleep study to adopt a collaborative, flexible approach to understanding positive sleep factors in the lives of autistic adolescents. This study employed a personalized approach into collecting, categorizing, coding, and analyzing qualitative data allowing autistic adolescents and the researcher to work together across key stages of data collection and data analysis. Third, we adopted a theoretical framework that allows us to consider autistic adolescents in both agency and vulnerability positions when it comes to their sleep difficulties. Our results highlight that sleep should be treated individually and in relation to the environmental and personal factors that affect each autistic person. Hence, researchers and professionals may benefit from working collaboratively with autistic adolescents with the aim to identify individual strengths and adopt a positive narrative around sleep. Furthermore, it is important to further examine both the daytime and evening factors that may affect bedtime and the quality and quantity of sleep as well as the role of intense focused interests and physical activities that cultivate positive feelings and help autistic people to relax before bedtime.

A Combined Sleep Hygiene and Mindfulness Intervention to Improve Sleep and Well-Being During High-Performance Youth Tennis Tournaments.

To investigate the effects of combined sleep hygiene recommendations and mindfulness on actigraphy-based sleep parameters, perceptual well-being, anxiety, and match outcomes during high-performance junior tennis tournaments. In a randomized crossover design, 17 high-performance junior tennis players completed the baseline, control, and intervention (INT) conditions across 3 separate weeks. The baseline consisted of unassisted, habitual sleep during a regular training week, and the control was unassisted sleep during a tournament week. The players attended a sleep education workshop and completed a nightly sleep hygiene protocol during a tournament week for the INT. Analysis was performed on the weekly means and on the night prior to the first match of the tournament (T-1). Significant differences were observed for increased time in bed, total sleep time, and an earlier bedtime (P < .05) across the INT week. These parameters also significantly improved on T-1 of the INT. A moderate effect size (P > .05, d > 1.00) was evident for decreased worry on T-1 of the INT. Small effect sizes were also evident for improved mood, cognitive anxiety, and sleep rating across the INT week. The match performance outcomes remained unchanged (P > .05). Sleep hygiene INTs increase the sleep duration of high-performance junior tennis players in tournament settings, including the night prior to the tournament's first match. The effects on perceptual well-being and anxiety are unclear, although small trends suggest improved mood, despite no effect on generic match performance outcomes.