Sleep Routines Research Articles

Sensory Processing Patterns and Sleep Quality in Primary School Children.

Sensory processing and sleep quality affect children's academic performance and their quality of life. This study aimed to investigate the relationship between sensory processing patterns and sleep quality in primary school children. In this cross-sectional study, 231 primary school students aged 7 to 12 years old (133 girls and 98 boys, the mean age of 8.68±1.51) who were studying in schools in Tehran were randomly selected through cluster sampling. The researchers distributed a questionnaire on children's sleep habits to assess the quality of sleep and a sensory profile questionnaire to assess the sensory processing patterns (avoidance, sensitivity, seeking, and registration) among the students. In this study, we found a meaningful moderate relationship between sensory processing patterns and overall scores of sleep habits (p <0.001). Moreover, each of the sensory processing patterns had a negative relationship with areas of sleep habits (p = 0.005). There was also a significant difference between children who had more challenges with sleep maintenance and children with normal sleep patterns in sensory processing; mean differences were significant in all the four sensory quadrants (registration, seeking, sensitivity, and avoiding) (p <0.001). The sensory processing patterns are moderately correlated with sleep habits in primary school children. Occupational therapists and other specialists working in the field of children's sleep should consider the relationship between sensory challenges and sleep habits while making decisions about sensory challenges and sleep problems. Better sleep may occur with attention to sensory needs in sleep routines. Better sleep may lead to improved quality of life in families and enhanced student performance at school.

Changes in sleep pattern and sleep quality during COVID-19 lockdown.

Introduction:To mitigate the spread of the pandemic coronavirus infection (COVID-19), governments across the world have adopted “lockdowns” which have confined many individuals to their homes. This disrupts normal life routines, elements of which are important circadian cues. The pandemic is also associated with new stressors, altered roles, and uncertainties about health and economic security, which are also likely to affect sleep. The current study is an online survey of sleep experience, routines, physical activity, and symptoms of anxiety and depression, to study the alterations associated with the lockdown.Materials and Methods:The survey was conducted in early May 2020 using a questionnaire circulated through social media platforms. Questions related to demographic characteristics, current and previous sleep schedules, routine, and working patterns. Insomnia (Insomnia Severity Index - 4), Stress (Perceived Stress Scale - 4), anxiety and depressive symptoms (Patient Health Questionnaire - 4) and physical activity (International Physical Activities Questionnaire) were assessed using standardized instruments.Results:A total of 958 valid responses were received. Compared to the prelockdown period, there was a shift to a later bedtime and waking time, with a reduction in night-time sleep and an increase in day-time napping. These effects were visible across occupational groups, but mostly affected working individuals except health professionals. Sleep quality deteriorated across groups. Reductions in sleep duration were associated with depressive symptoms.Conclusions:The COVID-19 lockdown is associated with changes in sleep schedule and in the quantity and quality of night-time sleep. Although these changes are associated with elevated rates of emotional symptoms, it is unclear from these cross-sectional results, whether sleep deterioration produces psychological distress, or vice versa.

Sleep Quality, Emotion Regulation and Parenting Stress in Children with Congenital Heart Disease

The aim of this study is to evaluate parental perceptions of parent-infant bedtime interactions and quality of sleep, after hospital discharge, in a group of children diagnosed at birth with congenital heart disease (CHD), as compared with the perceptions of parents in a control group of children who were healthy at birth. More specifically, we evaluated the associations between parental stress, parental perceptions of infant emotion regulation, and infants’ bedtime and sleep routines in each of the two groups. Fifty Italian intact two-parent families (23 boys) of toddlers ageing from 11 to 36 months (M= 23.42, SD=7.10) were recruited. 20 families of CHD children group were recruited from the Department of Cardiology at the Bambino Gesu Children’s Hospital in Rome, Italy; 30 families of the healthy children group were recruited from two childcare units. Parents completed Emotion Regulation Checklist (Shields & Cicchetti, 1997), Parent-Child Sleep Interaction Scale (PSIS; Alfano et al., 2013), Parent-Stress Index-Short Form (PSI-SF; Abidin, 1990) and ad-hoc semi-structured interview on child’s sleep quality. The independent-samples t-test evidenced that parents of healthy children reported significantly higher scores on children's emotion regulation compared with the CHD group Specifically CHD children and healthy children's emotion regulation reported both by mothers (respectively CHD children’s mothers: M= 26.11, SD= 2.9; healthy children’s mothers: M= 28.85, SD= 2.71; t(37) = 3.10, p= .004) and fathers (respectively CHD children’s fathers: M=25.76, SD= 2.79; healthy children’s fathers: M= 27.37, SD= 2.02; t(31)= 2.71, p= .010). Main correlational findings showed in the CHD children’s group that parenting stress total scores were positive related to difficult parent-infant bedtime interactions both for mothers ( r =.58, p < .01) and fathers ( r = .70, p < .01). Results show significant differences in emotion regulation between the two groups. The results of this research will show to the clinicians the aspects of parent-infant bedtime interactions to be addressed in parents of children with CHD.

The sleep of professional cyclists during a 5-day UCI Europe Tour road cycling race

Background: A review of sleep and athletic performance (Fullagar et al. , 2015) reported that lack of sleep could have a negative impact on cognitive and physical performance. Numerous factors (i.e. jet-lag , hotels, pre-competition anxiety, early start times) can potentially disturb the sleep routine of athletes during competition (Lastella, Lovell and Sargent, 2014). Similar research has been done during a 3-day cycling race (Lastella et al. , 2014) and during a simulated cycling grand tour (Lastella et al. , 2015). Purpose: The aim of the study was to investigate whether cyclists sleep parameters would worsen during a 5-day cycling competition. We hypothesised that total sleep time and sleep efficiency would decrease over the course of the race. Methods: 5 professional male cyclists from Androni Giocattoli – Sidermec Professional Cycling Team participated in this study during Vuelta a AndalucA­a 2019. (Mean ± SD; age: 32 ± 4 years; stature: 179.8 ± 4.2 cm; body mass 67.8 ± 1.9 kg). In order to monitor quantity and quality of sleep, actigraph watches (Actiwatch Spectrum PRO, Philips Respironics, Murrysville, PA, USA) and sleep diaries were used following a method applied several times in the literature (Halson et al. , 2014; Lastella et al. , 2014, 2015; Sargent, Halson and Roach, 2014). Data were collected for 5 days (from the night before the start of the race until the morning of the last day of competition). Since the number of cyclists per team is limited by race regulations, the Bayesian Statistical Analysis framework offers an advantage over null-hypothesis significance testing as not depending on large samples (van de Schoot and Depaoli, 2014). Results: Details of the Tour stages are shown in Table 1. A summary of the data collected are presented in Table 2. Results of Bayesian analysis can be found in Table 3. Get up time decreased over the stages (Figure 1). Cyclists woke up earlier on the first day of competition than the day before the start. Get up time was earlier the last day of competition than the first day of the race. Total sleep time decreased during the race (Figure 2) compared to the night before the start, cyclists slept less the first and the last night of the Tour, and sleep efficiency decreased during the event (Figure 3). Sleep efficiency was lower during the last night of competition compared to the night before the start of the Tour. The rest of the parameters were not affected by time. Discussion: The findings of this study demonstrate that some sleep parameters decreased over time during a multi-day cycling Tour. Sleep time decreased over the course of the Tour, with cyclists sleeping more the night before the start of the event than after the first stage. Sleep efficiency decreased during the Tour, particularly, the night prior to the final stage. Conclusions: The results of this study demonstrate that the sleep of professional cyclists is affected during a 5-day cycling Tour. These data emphasise the importance for athletes and coaches of sleep hygiene routines to optimise the quality and quantity of sleep, such as setup a consistent bedtime, control room temperature, avoid caffeine consumption 4-5h before going to bed, and reduce the use of electronic equipment prior to bedtime.

“I don’t stress about it like I used to”: Perceptions of non-problematic sleep amongst people in residential treatment for substance use disorders

ABSTRACTBackground: Sleep problems are common amongst people who use alcohol and other drugs, but treatment options are limited. This paper explores how people in residential treatment for alcohol and other drug problems perceived and described ‘non-problematic’ sleep to provide insights that might inform sleep interventions for this population.Methods: Qualitative interviews were conducted with 28 residents (19 women, 9 men; ages 24–83 years) in two residential drug and alcohol treatment centres in England during 2014/15. Interviews were audio-recorded, transcribed, and coded. Accounts of non-problematic sleep were then analysed inductively.Results: Non-problematic sleep comprised three linked components: i. personal sleep patterns and routines; ii. sleep perceptions; and iii. sleep metacognitions. Some participants reported they slept well; others described their sleep as problematic but improving. Participants believed that sleep improved naturally with residential treatment and abstinence, but perceptions of ‘good’ sleep varied greatly. Participants used a range of metacognitive strategies (e.g. downgrading the importance of sleep; adapting their sleeping patterns; and focusing on sleep quality alongside sleep quantity) to manage sleep problems and render them non-problematic.Conclusions: Metacognitive strategies that focus on changing perceptions of sleep can potentially inform sleep interventions for people with a history of alcohol and other drug use.

It Will Feel Really Bad Unromantically Soon

AbstractThis paper reads insomnia in Imogen Binnie's queer/trans novel Nevada (2013) not as a body problem to be cured but as a valuable site of resistance to hetero, able-bodied norms. Binnie, however, depicts the daily effects of capitalism on regimenting sleep routines, rendering insomnia not as a glamorous all-night adventure but as a “boring” daily struggle, akin to Maria's exhausting experience of navigating trauma. Though this novel offers generic promises of self-discovery, recovery, and trans epiphany/catharsis, it inevitably frustrates all possibilities for its heroine's self-growth, thus challenging fictions about using self-care to “overcome” disability and gender-based violence. In exposing the narrative process by which insomnia is constructed, this crip reading of Nevada reimagines the representational possibilities for bodies that fail to sleep.

Longitudinal associations of childhood bedtime and sleep routines with adolescent body mass index.

Having a regular, age-appropriate bedtime and sufficient sleep from early childhood may be important for healthy weight in adolescence. This study aimed to (1) identify heterogeneous groups of children by bedtime and sleep routines and (2) test longitudinal associations of childhood bedtime and sleep routine groups with adolescent body mass index (BMI). We analyzed longitudinal data from the Fragile Families and Child Wellbeing Study, a national birth cohort from 20 US cities (N = 2196). Childhood bedtime and sleep routines were assessed by mothers' reports of their children's presence and timing of bedtimes, adherence to bedtimes, and habitual sleep duration at ages 5 and 9. At age 15, these adolescents reported their height and weight, which were used to calculate BMI z-score. Latent Class Analysis revealed four groups of childhood bedtime and sleep routines: No Bedtime Routine Age 5 (Group 1), No Bedtime Routine Age 9 (Group 2), Borderline Bedtimes Ages 5 and 9 (Group 3), and Age-Appropriate Bedtime and Sleep Routines Ages 5 and 9 (Group 4, reference). Compared with adolescents in the reference group, those in the No Bedtime Routine Age 9 (Group 2) had +0.38 SD greater BMI (95% CI = [0.13 to 0.63]), above the level for overweight (1.02 SD BMI/85th percentile). Associations persisted after adjusting for age 3 BMI and sociodemographic characteristics. Results demonstrate heterogeneity in childhood bedtime routine groups and their associations with adolescent BMI. Future studies should focus on whether childhood sleep behavior interventions promote healthier sleep and weight in later life course stages.

A pilot randomized controlled trial examining the impact of a sleep intervention targeting home routines on young children's (3-6years) physical activity.

Given evidence suggesting that sleep impacts on metabolic processes, interventions targeting sleep may improve child physical activity (PA). To describe the potential effect of an intervention to increase sleep on young children's (3-6years) moderate to vigorous PA (MVPA) and total PA. To determine adherence to the intervention, impact on sleep duration as well as feasibility, uptake and acceptability was also assessed. Pilot randomized controlled trial with 76 parent-child dyads randomly allocated to an intervention (n=38) or control group (n=38). Parents in the intervention group received a 3-month theory-informed intervention consisting of an online video, a telephone call and two text messages. Child PA was assessed using accelerometers at baseline and approximately 3months. Parents also completed a sleep log and a telephone interview. The consent rate was 41% (76/186). Estimated effect size for the intervention relative to control was 10.8min/day for MVPA, 2.7min/day for PA and 0.9h for sleep. Sixteen (44%) parents accessed the video, and 18 (50%) received the telephone call. Over 40% of parents found the video and telephone call useful/very useful. This study reports promising effects that an intervention targeting sleep may improve child MVPA and sleep duration. Some modifications to data collection methods and intervention delivery are needed.

An Examination of Adult Women’s Sleep Quality and Sleep Routines in Relation to Pet Ownership and Bedsharing

ABSTRACTPeople in many parts of the world commonly share their beds not only with human partners but also with dogs and cats. Self-report and actigraphy data have shown that sleeping with an adult human partner has both positive and negative impacts on human sleep, but there has been little exploration of the impacts that pets have on human sleep quality. We collected survey data online from 962 adult women living in the United States to investigate relationships between pet ownership and human sleep. Fifty-five percent of participants shared their bed with at least one dog and 31% with at least one cat. In addition, 57% of participants shared their bed with a human partner. Our findings did not show a strong relationship between pet ownership status or bedsharing conditions and sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI), although according to this measure, a high percentage of study participants did experience sleep quality deficits. It is possible that pet ownership contributed to the high global PSQI scores we observed, especially since all but 7% of participants resided with dogs and/or cats. Other measures included in this study indicate that dogs and cats, and where they sleep, may indeed affect sleep habits and perceptions of sleep quality. Dog owners had earlier bedtimes and wake times than individuals who had cats but no dogs. Compared with human bed partners, dogs who slept in the owner’s bed were perceived to disturb sleep less and were associated with stronger feelings of comfort and security. Conversely, cats who slept in their owner’s bed were reported to be equally as disruptive as human partners, and were associated with weaker feelings of comfort and security than both human and dog bed partners. Follow-up research is necessary to determine if pet owners’ perceptions of pets’ impacts on their sleep align with objective measures of sleep quality.

Sleep habits in infants: the role of maternal education

ObjectiveSleep disturbances are frequent in infants. Early development of sleep routines has a positive effect on sleep quality. The objective of this study was to assess the impact of maternal education on the development of infants’ sleep habits (SHs). MethodsThis was an experimental, longitudinal study. Postnatal mothers were allocated into two groups: to receive (intervention group, IG), or not receive (control group, CG) information on sleep hygiene. Individual 15-min sessions were provided and a leaflet was handed to the IG. A questionnaire on infants’ SHs was applied by telephone/e-mail at 1, 2, 4, and 6 months of age. ResultsAt least three questionnaires were answered by 314 mothers. Results were adjusted for maternal age, education, and race. In the IG, infants acquired more independent sleep habits, an effect still present at six months; slept more frequently in their own beds; adjusted odds ratio (ORadj) 3.8, 95% confidence interval (CI) (1.1–13.5); fell asleep more frequently alone (ORadj, 4.29; 95% CI, 2.4–7.6); fell asleep more frequently in their own beds (ORadj, 6.1; 95% CI, 3.5–10.6) and needed less breast/bottle feeding to fall asleep (ORadj, 2.68; 95% CI, 1.5–4.6). The autonomy was greater in IG infants after night awakenings; also until six months they went back to sleep more frequently alone (ORadj, 3.88; 95% CI, 2–7.5) and needed less breast/bottle feeding (ORadj, 2.35; 95% CI, 1.3–4.3). No differences were found regarding the need for light, television or other routines to fall asleep or after night awakenings. ConclusionMaternal education is positively associated with the adoption of autonomous SHs in infants. Early maternal education is an adequate prevention strategy to be considered in neonatal care.

Exploring Brazilian Immigrant Mothers' Beliefs, Attitudes, and Practices Related to Their Preschool-Age Children's Sleep and Bedtime Routines: A Qualitative Study Conducted in the United States.

In the United States (US), racial/ethnic minority children, low-income children, and children of immigrant families are at increased risk of childhood obesity. Mounting evidence documents that sleep duration and sleep quality are important modifiable factors associated with increased risk of obesity among preschool-aged children. The number of Brazilian immigrants in the US is increasing, yet no existing research, to our knowledge, has examined factors affecting sleep and bedtime routines of children of Brazilian immigrant families. Therefore, the purpose of this qualitative study was to explore Brazilian immigrant mothers’ beliefs, attitudes, and practices related to sleep and bedtime routines among preschool-aged children. Seven focus group discussions (FGDs) were conducted with 37 Brazilian immigrant mothers of preschool-age children living in the US. The audio-recordings of the FGDs were transcribed verbatim in Portuguese without identifiers and analyzed using thematic analyses. Mothers also completed a brief questionnaire assessing socio-demographic and acculturation. Analyses revealed that most mothers were aware of the importance of sleep and sleep duration for their children’s healthy growth and development. Mothers also spoke of children needing consistent bedtime routines. Nevertheless, many mothers reported inconsistent and suboptimal bedtime routines (e.g., lack of predictable and orderly bedtime activities such as bath, reading, etc. and use of electronics in bed). These suboptimal routines appeared to be influenced by day-to-day social contextual and environmental factors that are part of Brazilian immigrant families’ lives such as parents’ work schedule, living with extended family, living in multi-family housing, neighborhood noise, etc. Analyses identified several modifiable parenting practices related to young children’s sleep and bedtime routines (e.g., irregular bedtime, late bedtime, inconsistent bedtime routines, use of electronics in bed, etc.) that can be addressed in parenting- and family-based obesity prevention interventions. Interventions should consider the social context of the home/family (e.g., parents’ work schedules) and the environment (e.g., multi-family housing; neighborhood noise, etc.) faced by Brazilian immigrant families when developing health promotion messages and parenting interventions tailored to this ethnic group.

Double trouble: Weekend sleep changes are associated with increased impulsivity among adolescents with bipolar I disorder.

Both sleep disruption and impulsivity are important predictors of the course of bipolar disorder (BD). Although sleep disruption has been shown to intensify impulsivity, little research has considered how these two important domains interact within BD. Adolescence is a critical period for the onset of BD, and is often associated with increases in impulsivity and substantial changes in sleep. We tested the hypothesis that disruptions in sleep would increase impulsivity among adolescents, and that this effect would be more pronounced among those with BD. Thirteen- to nineteen-year-olds diagnosed with BD-I (n=33, age [mean ± standard deviation (SD)] 16.2± 1.66years, 54.5% female) and psychiatrically healthy controls (n=26, age [mean ± SD] 15.5 ± 1.45years, 55.6% female) reported their past-week bedtime, rise time, and sleep duration, separately for school days and weekends, and completed a self-report questionnaire on impulsivity. Stepwise regression was used to examine the effects of sleep on impulsivity, and the moderation of this effect by BD status. Adolescents with BD reported significantly higher impulsivity, later and more variable rise time, and more variable time in bed and sleep duration on school days than did controls. Greater change in sleep duration between school days and weekends was associated with significantly more impulsivity among adolescents with BD as compared to controls. These findings highlight the important effect of sleep on impulsivity among adolescents with BD and add to the growing evidence that establishing sleep routines may be an important therapeutic target for youth with BD.

Paternal perception of infant sleep risks and safety

BackgroundSudden Unexpected Infant Death (SUID) results in 3400 sleep-related deaths yearly in the United States, yet caregivers’ compliance with safe sleep recommendations remains less than optimal. Paternal caregiver’s attitudes toward infant safe sleep messages are largely unaddressed, despite established differences between female and male caregiver perceptions. This study aimed to explore the determinants of safe sleep practices among male caregivers.MethodsFocus groups were conducted in Arkansas with male caregivers of infants ages 2–12 months to discuss infant sleep routines, parental roles, sources for safe sleep information, and messaging suggestions for safe sleep promotion. The Health Belief Model of behavior change framed a moderator guide. Transcript-based analysis was used, and data were managed using HyperRESEARCH (version 2.8.3). The transcribed data were coded to identify significant themes.ResultsTen focus groups were conducted with 46 participants. Inconsistent adherence to safe sleep practices was reported. Participants were more likely to describe safe location (57% of participants) and supine position behaviors (42%) than an uncluttered bed environment (26%). Caregivers acknowledged the importance of recommended safe sleep behavior, but admitted to unsafe practices, such as co-sleeping and unsafe daytime sleep. Lack of perceived risk, comfort, and/or resources, and disagreement among family members about safety practices were identified as barriers. Participants voiced concerns that current advertising portrays males as incompetent caregivers. Suggestions included portraying positive images of fathers and male caregivers acting to promote safety and the incorporation of statistics about the hazards of unsafe sleep to better engage fathers. Potential distribution venues included sporting events, home improvement and/or automotive stores, and social media from trusted sites (e.g. hospitals or medical professionals).ConclusionsMale caregivers demonstrate some knowledge base about infant sleep safety, but are not fully practicing all aspects of safe sleep. Targeted messaging towards male caregivers that includes factual information and statistics along with representing males in a positive light is desired.

Sleep Pattern of Adolescents in a School in Delhi, India: Impact on their Mood and Academic Performance.

To examine the sleep pattern and observe differences in sleep routines, phase preferences, mood, attendance, and academic performance among different adolescent age students. Secondly, to observe the age at which sleep phase transition and changes in sleep requirement become evident. A cross-sectional study was conducted among 501 students (aged 11-15 y) of a school in Delhi, India. Students were evaluated for their sleep patterns, sleep duration, habits of napping, quality of sleep, sleepiness, depression, phase preferences by self-reported school sleep habits survey questionnaire along with school performance and attendance. Significant differences were found in sleep pattern of students aged 11-12 y and 13-15 y. Bedtime shifted to a later time with increasing age but early morning schools kept the wake time same, leading to a decline in total sleep duration of older adolescents. Older adolescents had higher depression but poor attendance and academic performance. Prevalence of sleep deprivation increased with age, from 83.7% to 87.1% in 11-12 y to 90.5% to 92.5% in 13-15 y. The study clearly identifies 12-13 y as age of transition of sleep pattern among adolescents. Though significant differences were found in the academic performance, mood and attendance among preteens and teens but no direct association was seen between academic performances and sleep pattern. A complex multifactorial association between sleep patterns, attendance, mood and academic performance which may change over days, months, or years should be explored further in a longitudinal follow up study.

A Qualitative Assessment of the Acceptability of Smartphone Applications for Improving Sleep Behaviors in Low-Income and Minority Adolescents

ABSTRACTBackground: Daily behaviors such as sleep can be targeted by smartphone app-based interventions, with potential utility among young people of minority ethnic backgrounds who commonly access smartphone devices and are short sleepers. There is a need to understand the acceptability and youth’s readiness to use apps to improve sleep, and to identify desired app components that would motivate engagement. Participants and Methods: We conducted three focus group discussions (N = 27 total, age 14–18 years) within low- and middle-income ethnically diverse Boston neighborhoods. We also interviewed 10 participants who provided specific feedback on two commercially available sleep-promoting apps, one of which they had used on their smartphone preceding the interviews. All focus group discussions and interviews were audio-recorded, transcribed, and thematically analyzed. Results: We identified several barriers to adoption of sleep hygiene interventions, namely reluctance to follow scheduled sleep routines on weekends and concern about “parting” with electronics at bedtime. Participants were intrigued by the idea of adopting an app-based sleep intervention, but were skeptical that they could successfully adopt sleep hygiene practices, and were more interested in making changes on school days than on weekends. Nonetheless, the overall feedback on two commercial sleep apps, neither targeted at youth, was positive, with a good adherence and engagement rate, and perceived health benefits. Conclusions: Our findings highlight the need to adapt sleep hygiene recommendations to targeted populations, considering preferences and social and cultural contextual factors. Our research also underscores the importance of the platform, setting, and messenger when delivering health information to adolescents.

Sleep/wake behavior prior to and following competition in elite female netball athletes

To determine the sleep routines of elite athletes in the lead up to and following competition. Ten elite female netballers (mean ± SD; age = 23 ± 6 years) completed a survey on their perceived sleep duration (PSD) and perceived sleep quality (PSQ) on three consecutive nights, the night before the game (G − 1), the night of the game (G), and the night following the game (G + 1) on 15 separate occasions during the in-season competition period. Additionally, the sleep behavior of 11 elite female netballers (mean ± SD; age = 23 ± 4 years) was monitored on two separate occasions using wrist-actigraphy to assess total time in bed (TTB), total sleep time (TST), sleep efficiency (SE), sleep latency (SL), wake episodes per night (WE), sleep onset time (SOT), and wake time (WT) on G − 1, G, and G + 1 nights. There was a significant difference in PSD from G − 1 to G (8:29 to 6:52 h:min, d = − 1.98) and from G to G + 1 (6:52 to 8:09 h:min, d = 1.70). TST was significantly different from G − 1 to G (8:31 to 6:46 h:min, d = − 1.36). At G + 1, TST remained significantly below the G − 1 level (7:23 and 8:31 h:min, respectively, d = − 0.97). SOT was significantly later on the night of the game (23:57), and was also significantly delayed at G + 1 (23:17) compared to G − 1 (22:41). Following an evening netball game, PSD, TST, TTB and SOT are impaired. Additionally, TST and TTB remain impaired on the night following competition.

Combining cognitive therapy with medication in bipolar disorder

Although mood stabilisers have substantially improved the treatment of bipolar disorder, recent studies suggest that treatment with lithium is not as effective as originally claimed. Furthermore, patients still have high rates of relapse even when prescribed medication. Recent research has shown that poor coping strategies in response to bipolar prodromes and disruptions of sleep and social routines increase the risk of relapse. Combining a psychosocial approach with medication may improve the rate of relapse prevention. Cognitive therapy teaches patients better self-monitoring and coping skills and is therefore an appropriate means of minimising psychosocial risk factors for relapse. Recent randomised controlled trials suggest that combined medication and cognitive therapy significantly reduce bipolar relapse compared with medication alone.

Gender differences in sleeping hours and recovery experience among psychiatric nurses in Japan

In their attempts to balance sleep routines with service schedules, nurses working in shifts are at risk for developing sleep disorders. Furthermore, nurses often experience considerable stress. In recent years, research has acknowledged the importance of activities other than work, and in particular recovery experiences. Therefore, the current study aimed to explore gender differences in sleeping hours and recovery experience of psychiatric nurses from a 16-hour shift to two days off duty. We found that males went to bed late and that females rose slightly early on days where they worked night shifts. On average, the sleeping hours of males were about 2 hours longer than were those of females. Furthermore, sleeping hours was positively related to mastery in males, while in females working hours was negatively related to psychological detachment and relaxation. Before the night shift, females engaged more housekeeping and used short sleeping hours during rest to compensate for the lack of sleep. Thus, recovery experience had different relationships with various life activities between male and female nurses. The results highlighted the need for health management interventions

All tucked up

Make sleep and bedtime routines a focus for activities which practise being still and moving to music and rhyme. Invite children to a pyjama party and play pillow games that build gross motor skills.

Investigation of dose-dependent association between bedtime routines and sleep outcomes in infants and toddlers

Objective: To investigate the current bedtime routine among Chinese children less than 3 years of age and explore its dose-dependent association with sleep duration and sleep quality. Method: Healthy full-term born children aged 0-35 months were selected by stratified cluster random sampling method from 8 provinces in China following the "Hospital of Province-City-County" sampling technical route during 2012-2013.Brief Infant Sleep Questionnaire(BISQ) was used to assess sleep conditions of these children.Children's personal and family information was obtained by Shanghai Children's Medical Center Socio-demographic Questionnaire.Both of these questionnaires were filled in by parents. The effects of bedtime routine on children's sleep duration and quality were analyzed by multivariate analysis of variance. Result: The children's average age was(12±10) months(n=1 304), of whom 689 were males (52.8%, 689/1 304). There were 48.5%(632/1 304)of the parents reported that their children had not established regular sleep routines. There was a consistent dose-dependent association between bedtime routine and sleep duration, as well as other indicators for sleep quality (all P<0.05). The more regular the sleep routines, the longer the sleep duration, the earlier the children went to sleep, the shorter the sleep onset latency, the fewer the nighttime wakeup and the shorter the nighttime waking.The nighttime sleep duration was significantly longer for those with a bedtime routine 'every night' than those who 'never' had a bedtime routine (9.5(95%CI: 9.4-9.6)vs. 8.9(95%CI: 8.6-9.3)h, t=3.345, P=0.001). Compared with children who never had bedtime routines, children with regular bedtime routines had fewer night wakeup (1.3(95%CI: 1.2-1.4) vs. 2.4( 95%CI: 2.0-2.9), t=3.182, P=0.001) and shorter night waking duration(16.6(95%CI: 14.6-18.8) vs. 59.2 (95%CI: 47.0-72.7)min, t=6.383, P<0.01). Conclusion: The percentage of children who have established regular bedtime routine is low in China. There is significant dose-dependent association between regular bedtime routine and sleep outcomes, especially sleep quality. The more regular the sleep routines, the better the sleep quality.