Association between morningness‐eveningness,sleep duration,weekend catch‐up sleep and depression among Korean high‐school students

The present study aimed to examine the association between morningness‐eveningness preferences, sleep duration, weekend catch‐up sleep duration and depression among Korean high‐school students. A total of 8,655 high‐school students participated from 15 districts in South Korea and completed an online self‐report questionnaire. The following sleep characteristics were assessed: weekday and weekend sleep duration, weekend catch‐up sleep duration, morningness‐eveningness preference, perceived sufficiency of sleep, self‐reported snoring and sleep apnea, daytime sleepiness, and sleep environment. Age, gender, body mass index, number of private classes, proneness to internet addiction, and depressive mood were also evaluated. A logistic regression analysis was conducted to compute odds ratios for the association between depression and sleep characteristics, after controlling for relevant covariates. Eveningness preference was a significant predictor of depressive mood (adjusted OR, 1.71; 95% CI, 1.47–1.99). Weekend CUS durations that were ≥2 hr and enrollment in numerous private classes were associated with a lower risk for depression (0.68, 0.55–0.85; 0.76, 0.60–0.95; respectively). Female gender, underweight and obese body weight, short weekday sleep durations, excessive daytime sleepiness, perceived excessiveness and insufficiency of sleep, self‐reported snoring and sleep apnea, proneness to internet addiction and a non‐optimal sleep environment were associated with an increased risk for depression. Eveningness preference and insufficient weekday sleep duration were associated with an increased risk for depression. Weekend CUS duration ≥2 hr reduced the risk for depression. Diverse aspects, including sleeping habits and sleep‐related environmental factors, should be considered to reduce depressive symptoms in late adolescents.     

Self‐administered acupressure for insomnia disorder: a pilot randomized controlled trial

Self‐administered acupressure has potential as a low‐cost alternative treatment for insomnia. To evaluate the short‐term effects of self‐administered acupressure for alleviating insomnia, a pilot randomized controlled trial was conducted. Thirty‐one subjects (mean age: 53.2 years; 77.4% female) with insomnia disorder were recruited from a community. The participants were randomized to receive two lessons on either self‐administered acupressure or sleep hygiene education. The subjects in the self‐administered acupressure group (n = 15) were taught to practise self‐administered acupressure daily for 4 weeks. The subjects in the comparison group (n = 16) were advised to follow sleep hygiene education. The primary outcome was the Insomnia Severity Index (ISI). Other measures included a sleep diary, Hospital Anxiety and Depression Scale and Short‐form Six‐Dimension. The subjects in the self‐administered acupressure group had a significantly lower ISI score than the subjects in the sleep hygiene education group at week 8 (effect size = 0.56, P = 0.03). However, this observed group difference did not reach a statistically significant level after Bonferroni correction. With regard to the secondary outcomes, moderate between‐group effect sizes were observed in sleep onset latency and wake after sleep onset based on the sleep diary, although the differences were not significant. The adherence to self‐administered acupressure practice was satisfactory, with 92.3% of the subjects who completed the lessons still practising acupressure at week 8. In conclusion, self‐administered acupressure taught in a short training course may be a feasible approach to improve insomnia. Further fully powered confirmatory trials are warranted.     

Integrative body–mind–spirit intervention for concurrent sleep and mood disturbances: sleep‐specific daytime functioning mediates sleep and mood improvements

Sleep disturbances and depressive symptoms are associated closely with daytime dysfunctions, yet few studies have investigated their temporal relationship in a randomized controlled trial. We investigated the inter‐relationships among sleep, depressive symptoms and daytime functioning following an integrative body–mind–spirit (I‐BMS) intervention. One hundred and eighty‐five participants (mean age 55.28 years, 75.1% female) with co‐existing sleep and depressive symptoms were randomized to I‐BMS or waiting‐list. Daytime functioning variables included the daytime dysfunction items of the Pittsburg Sleep Quality Index (PSQI‐day), Somatic Symptom Inventory, Hospital Anxiety Depression Scale and Short Form Health Survey collected at baseline, post‐treatment and 3‐month follow‐up. Sleep and depressive symptoms were measured by the sleep items of the PSQI (PSQI‐night) and Center for Epidemiological Studies Depression Scale (excluding the sleep item) (CESD‐M). Regression and path analyses were used to understand the role of daytime functioning in sleep and depressive symptoms. We found significant group and time effects on almost all daytime variables and significant group × time interactions on PSQI‐day and somatic symptoms. The adjusted regression model showed that CESD‐M was associated with all daytime variables. However, PSQI‐night was associated only with PSQI‐day. Path analyses indicated that PSQI‐day bridged PSQI‐night and CESD‐M in a two‐way direction after the I‐BMS intervention. The conclusion was that, following I‐BMS intervention, improvement in daytime functioning was related predominantly to improvement in depressive symptoms. Night‐time sleep related only to daytime dysfunction that was specific to sleep disturbances. Therefore, ‘sleep‐specific daytime impairment’ could be regarded as a major link from night‐time sleep to depressive symptoms. More studies are required to understand the concept of ‘sleep‐specific daytime impairment’.     

Brief school‐based interventions to assist adolescents’ sleep‐onset latency: Comparing mindfulness and constructive worry versus controls

Difficulties falling asleep are common among adolescents, especially during times of stress. Adolescents may thus benefit from brief techniques (15 min) that decrease pre‐sleep cognitive‐emotional arousal and sleep‐onset latency. The present study used a 3 (intervention: mindfulness bodyscan mp3, constructive worry, control) by 3 (time: baseline, week 1, week 2) mixed‐model design on a school‐based sample of adolescents (N = 232; M_age = 15.9 ± 0.8 years, range = 14–18 years; 19% male), and a sub‐sample of adolescents with prolonged sleep‐onset latency (i.e. ≥30 min; N = 119; M_age = 16.9 ± 0.9 years; 21% male). It was expected that the 15‐min pre‐recorded breath‐based mindfulness bodyscan, and constructive worry, would decrease sleep‐onset latency and pre‐sleep arousal similarly over time, relative to the control condition. A significant interaction was observed among adolescents with prolonged sleep‐onset latency, who completed ≥3 days for at least 1 week (p = .001), where mindfulness decreased sleep‐onset latency relative to constructive worry and the control. Neither technique changed pre‐sleep worry or cognitive‐emotional arousal, or associated daytime functioning (both the whole sample and sub‐sample). A pre‐recorded mp3 breath‐based mindfulness bodyscan technique is a promising means by which adolescents with prolonged sleep‐onset latency can decrease sleep‐onset latency. This simple tool has potential for scalable dissemination by stakeholders (e.g. teachers), unqualified to treat adolescent sleep difficulties. Future studies are needed to determine whether benefits may extend to academic performance and mental health, if performed for a longer time period with increased compliance.     

Sleep condition and cognitive decline in Japanese community‐dwelling older people: Data from a 4‐year longitudinal study

This study examined whether sleep duration and excessive daytime sleepiness (EDS) are related to cognitive decline among community‐dwelling older adults with intact cognition at baseline, using 4‐year longitudinal data. A total of 3,151 community‐dwelling older individuals aged ≥65 years were studied. They were assessed for cognitive function, including memory, attention, executive function and processing speed. Cognitive impairment was defined based on a score >1.5 standard deviations below the age‐ and education‐specific mean. Cognitive decline was defined in one or more cognitive tests at follow‐up. Self‐reported sleep duration (short, ≤6.0 hr; medium, 6.1–8.9 hr; long, ≥9.0 hr) and EDS at first‐wave examination were assessed and logistic regression analyses were used to examine the associations of sleep duration and EDS with cognitive status at second‐wave examination. The incidence of cognitive decline differed significantly among the sleep‐duration groups (short, 15.9%; medium, 11.9%; long, 20.1%; p = 0.001). The prevalence of having EDS was 13.1%, which was associated with a higher rate of cognitive decline than having no EDS (18.9% vs. 12.5%, p = 0.004). Long sleep duration compared with medium sleep duration (OR, 1.50; 95% CI, 1.05–2.13) and EDS (1.43; 1.01–2.03) independently impacted the incidence of cognitive decline. The results were similar after multiple imputations (long, 1.68, 1.12–2.52; EDS, 1.55, 1.05–2.29). In conclusion, our study revealed that both long sleep duration and EDS were independent risk factors associated with cognitive decline after 4 years among older adults.     

Self‐reported sleep quantity,quality and sleep hygiene in elite athletes

Sleep is essential for recovery and performance in elite athletes. While actigraphy‐based studies revealed suboptimal sleep in athletes, information on their subjective experience of sleep is scarce. Relatively unexplored is also the extent to which athletes’ sleep is adversely affected by environmental conditions and daytime behaviours, that is sleep hygiene. This study aimed to provide insight in sleep quantity, quality and its putative association with sleep hygiene. Participants were 98 elite (youth) athletes competing at the highest (inter‐)national level. Sleep quantity, quality and sleep hygiene were assessed once covering a 1‐month period by using established (sub)clinical questionnaires, and repeatedly during 7 consecutive days. Sleep quality was generally healthy, although 41% of all athletes could be classified as ‘poor sleeper’, and 12% were identified as having a sleep disorder. Daily self‐monitoring revealed sleep durations of 8:11 ± 0:45 h, but elevated wake after sleep onset of 13 ± 19 min. Sleep quality, feeling refreshed, and morning vigor were moderate at best. Regarding sleep hygiene, general measures revealed irregular sleep–wake patterns, psychological strain and activating pre‐sleep behaviours. At the daily level, blue‐light exposure and late‐evening consumption of heavy meals were frequently reported. General sleep hygiene revealed significant associations with sleep quality (0.45 < r > 0.50; P < 0.001). Results indicate that there is ample room for optimization, specifically in onset latency and in wake after sleep onset. Subtle improvements in sleep seem possible, and optimizing sleep hygiene, such as regular sleep–wake patterns and reducing psychological strain, may facilitate this sleep upgrading process.     

Increasing sleep duration to lower beat‐to‐beat blood pressure: a pilot study

Strong evidence has accumulated over the last several years, showing that low sleep quantity and/or quality plays an important role in the elevation of blood pressure. We hypothesized that increasing sleep duration serves as an effective behavioral strategy to reduce blood pressure in prehypertension or type 1 hypertension. Twenty‐two participants with prehypertension or stage 1 hypertension, and habitual sleep durations of 7 h or less, participated in a 6‐week intervention study. Subjects were randomized to a sleep extension group (48 ± 12 years, N = 13) aiming to increase bedtime by 1 h daily over a 6‐week intervention period, or to a sleep maintenance group (47 ± 12 years, N = 9) aiming to maintain habitual bedtimes. Both groups received sleep hygiene instructions. Beat‐to‐beat blood pressure was monitored over 24 h, and 24‐h urine and a fasting blood sample were collected pre‐ and post‐intervention. Subjects in the sleep extension group increased their actigraphy‐assessed daily sleep duration by 35 ± 9 min, while subjects in the sleep maintenance condition increased slightly by 4 ± 9 min (P = 0.03 for group effect). Systolic and diastolic beat‐to‐beat blood pressure averaged across the 24‐h recording period significantly decreased from pre‐ to post‐intervention visit in the sleep extension group by 14 ± 3 and 8 ± 3 mmHg, respectively (P < 0.05). Though the reduction of 7 ± 5 and 3 ± 4 mmHg in the sleep maintenance group was not significant, it did not differ from the blood pressure reduction in the sleep extension group (P = 0.15 for interaction effect). These changes were not paralleled by pre‐ to post‐intervention changes in inflammatory or sympatho‐adrenal markers, nor by changes in caloric intake. While these preliminary findings have to be interpreted with caution due to the small sample size, they encourage future investigations to test whether behavioral interventions designed to increase sleep duration serve as an effective strategy in the treatment of hypertension.     

Multiple sleep latency test in narcolepsy type 1 and narcolepsy type 2: A 5‐year follow‐up study

Excessively sleepy teenagers and young adults without sleep‐disordered breathing are diagnosed with either narcolepsy type 1 or narcolepsy type 2, or hypersomnia, based on the presence/absence of cataplexy and the results of a multiple sleep latency test. However, there is controversy surrounding this nomenclature. We will try to find the differences between different diagnoses of hypersomnia from the results of the long‐term follow‐up evaluation of a sleep study. We diagnosed teenagers who had developed excessive daytime sleepiness based on the criteria of the International Classification of Sleep Disorders, 3rd edition. Each individual received the same clinical neurophysiologic testing every year for 5 years after the initial diagnosis of narcolepsy type 1 (n = 111) or type 2 (n = 46). The follow‐up evaluation demonstrated that narcolepsy type 1 (narcolepsy‐cataplexy) is a well‐defined clinical entity, with very reproducible clinical neurophysiologic findings over time, whereas patients with narcolepsy type 2 presented clear clinical and test variability. By the fifth year of the follow‐up evaluation, 17.6% of subjects did not meet the diagnostic criteria of narcolepsy type 2, and 23.9% didn't show any two sleep‐onset rapid eye movement periods in multiple sleep latency during the 5‐year follow‐up. Therefore narcolepsy type 1 (narcolepsy‐cataplexy) is a well‐defined syndrome, with the presentation clearly related to the known consequences of destruction of hypocretin/orexin neurons. Narcolepsy type 2 covers patients with clinical and test variability over time, thus bringing into question the usage of the term “narcolepsy” to label these patients.     

Changes in sleep quality with age–a 36‐year follow‐up study of Finnish working‐aged adults

Long‐term follow‐up data on changes in sleep quality among middle‐aged adults is scarce. We assessed sleep quality in a population‐based cohort (n = 4847) of twins born between 1945 and 1957 during a follow‐up of 36 years, with four measurement points in 1975, 1981, 1990 and 2011. Sleep quality was categorized as sleeping well, fairly well, fairly poorly or poorly. The mean age at the beginning of follow‐up was 24.0, and at the end was 60.3 years. Of all the adults, 71.1% slept well or fairly well at each time‐point throughout the follow‐up and 0.5% poorly or fairly poorly. The proportion of those sleeping poorly or fairly poorly increased linearly over time; 3.5% among both sexes at the start, and 15.5% among men and 20.9% among women at the end of the follow‐up. The last survey indicated a strong association between self‐rated health and sleep quality: sleeping poorly or fairly poorly was reported 15 times more frequently by those rating their health as fairly poor than by those rating their health as very good. There was a strong association between indicators of depression and poor sleep. Although many studies have reported increasing frequencies in sleep problems, our results, based on a long‐term cohort study, indicate that the majority of people sleep well or fairly well. Sleep quality declines with age, but only a very small fraction of the adults in this long follow‐up consistently slept poorly.     

The effect of sleep‐specific brain activity versus reduced stimulus interference on declarative memory consolidation

Studies suggest that the consolidation of newly acquired memories and underlying long‐term synaptic plasticity might represent a major function of sleep. In a combined repeated‐measures and parallel‐group sleep laboratory study (active waking versus sleep, passive waking versus sleep), we provide evidence that brief periods of daytime sleep (42.1 ± 8.9 min of non‐rapid eye movement sleep) in healthy adolescents (16 years old, all female), compared with equal periods of waking, promote the consolidation of declarative memory (word‐pairs) in participants with high power in the electroencephalographic sleep spindle (sigma) frequency range. This observation supports the notion that sleep‐specific brain activity when reaching a critical dose, beyond a mere reduction of interference, promotes synaptic plasticity in a hippocampal‐neocortical network that underlies the consolidation of declarative memory.     

Start Later,Sleep Later: School Start Times and Adolescent Sleep in Homeschool Versus Public/Private School Students

Homeschooled students provide a naturalistic comparison group for later/flexible school start times. This study compared sleep patterns and sleep hygiene for homeschooled students and public/private school students (grades 6–12). Public/private school students (n = 245) and homeschooled students (n = 162) completed a survey about sleep patterns and sleep hygiene. Significant school group differences were found for weekday bedtime, wake time, and total sleep time, with homeschooled students waking later and obtaining more sleep. Homeschooled students had later school start times, waking at the same time that public/private school students were starting school. Public/private school students had poorer sleep hygiene practices, reporting more homework and use of technology in the hour before bed. Regardless of school type, technology in the bedroom was associated with shorter sleep duration. Later school start times may be a potential countermeasure for insufficient sleep in adolescents. Future studies should further examine the relationship between school start times and daytime outcomes, including academic performance, mood, and health.     

Actigraphy‐assessed sleep during school and vacation periods: a naturalistic study of restricted and extended sleep opportunities in adolescents

School‐related sleep restriction in adolescents has been identified by studies comparing weekday and weekend sleep. This study compared weekday and vacation sleep to assess restricted and extended sleep opportunities. One‐hundred and forty‐six adolescents (47.3% male) aged 16.2 ± 1.0 years (M ± SD) from the general community wore an actigraph continuously for 4 weeks: the last week of a school term (Time‐E), the following 2‐week vacation, and the first week of the next term. Self‐reported sleep was assessed for each of the three time intervals, and chronotype was assessed using the Morningness–Eveningness Questionnaire at Time‐E. Daily actigraphy bedtime, rise‐time, time‐in‐bed, total sleep time, sleep onset latency, sleep efficiency, and % wake after sleep onset were analysed using latent growth curve modelling. The removal of school‐related sleep restriction was associated with an abrupt delay in sleep timing and increase in sleep duration. Subsequently, bedtime and rise‐time showed further linear delays throughout the vacation, while changes in time‐in‐bed were non‐significant. Sleep onset latency increased linearly, peaking in the middle of the second vacation week. Across the first vacation week, total sleep time and sleep efficiency linearly decreased, while % wake after sleep onset increased. These changes stabilized during the second vacation week. Older age and eveningness were associated with later bedtime and rise‐time, whilst females had longer time‐in‐bed, total sleep time and sleep onset latency. Compared with school days, sleep during the vacation was characterized by later timing, longer duration, lower quality and greater variability. Recovery from school‐related sleep restriction appeared to be completed within the 2 weeks of naturalistic extended sleep.     

Sleep‐deprivation and autobiographical memory: evidence from sleep‐deprived nurses

Negative effects of sleep deprivation on different types of memory are well documented, but the specific effects on autobiographical memory performance are not well studied. In this study, we investigated performance on the autobiographical memory test in a group of sleep‐deprived and well‐rested nurses. One‐hundred participants divided into sleep‐deprived (N = 50, 25 females) and well‐rested (N = 50, 25 females) groups took part in the study. The sleep‐deprived group included night‐shift nurses with 8–12 hr sleep deprivation, while the well‐rested group had the usual night sleep before performance assessment. All participants were matched for gender, age, education and employment status. They completed depression and anxiety inventories, and underwent the autobiographical memory test, which included 18 cue words with positive, negative and neutral valence. The sleep‐deprived group scored significantly higher in depression scores. Analysis of covariance (ANCOVA) results showed that sleep‐deprived participants had a significantly poorer autobiographical memory compared with the well‐rested group. Additionally, specific memories were significantly declined in the sleep‐deprived group. This group remembered significantly less positive and more negative memories. Findings implicate that sleep deprivation has detrimental effects on autobiographical memory specificity and valence, and is associated with mood dysregulation.     

Four years comparative follow‐up evaluation of community‐based,step‐down,and residential specialist psychodynamic programmes for personality disorders

Although the fulcrum of service provision for personality disorder (PD) has shifted from hospital‐based to psychodynamically‐ and cognitively‐oriented outpatient programmes, very few studies have attempted to compare specialist moderate intensity outpatient programmes with specialist high‐intensity residential models, or to explore whether a period of inpatient treatment may be necessary to improve outcome and prognosis. In this article, we prospectively compare changes over a 4‐year period in 3 groups of patients with personality disorders (N  = 162) treated in a specialist community‐based (CBP, N  = 30), a step‐down (RT‐CBP, N  = 87), and a specialist residential programme (RT, N  = 45) in psychiatric distress, deliberate self‐injury, and suicide attempt using multilevel modelling and multivariate logistic regression analyses. The results showed that percentages of early‐dropout were significantly different (p  = .0001) for the 3 programmes (CBP = 13.4%, RT‐CBP = 10.2%, and RT = 41.4%). A significant interaction between treatment model and time was found for psychiatric distress (p  = .001), with CBP and RT‐CBP achieving more marked changes (g  = 1.20 and g  = 0.68, respectively) compared to RT (g  = 0.30) at 48‐month follow‐up. CBP and RT‐CBP were found to significantly reduce impulsive behaviour (deliberate self‐injury and suicide attempt) compared to RT. Severity of presentation was not found to be a significant predictor of outcome. Long‐term RT showed no advantage over long‐term CBP, either as stand‐alone or as step‐down treatment. Replication may be needed to confirm generalizability of results, and a number of limitations in the study design may moderate the inferences that can be drawn from the results.     

Discrepancy between wrist‐actigraph and polysomnographic measures of sleep in patients with stable heart failure and a novel approach to evaluating discrepancy

Wrist‐actigraphy is often used to measure sleep characteristics in a variety of populations, but discrepancies between actigraphic and polysomnographic measures have been noted in populations experiencing poor sleep quality. The purpose of this study is to examine the discrepancy between these measures and risk factors for discrepancy in people with heart failure using a novel index. We used sleep measures simultaneously recorded by actigraphy and polysomnography, and clinical data from a cross‐sectional study of 155 patients with heart failure (age = 60.5 [16.1] years; 65.2% male) recruited from evidence‐based heart failure disease management programmes. The discrepancy and consistency between the two measures were evaluated using Bland–Altman plots, intra‐class correlations and a newly developed index that represents activity counts in wake episodes. Overall, participants had short total sleep time (327.7 [95.9] min) and poor sleep efficiency (71.3 [16.0]%) on polysomnography. The discrepancies between sleep measures were small in patients less than 60 years old, and there was excellent consistency (intra‐class correlation = 0.81) compared with older patients who had poorer consistency (intra‐class correlation = 0.53) on total sleep time. Higher daytime motor activity, poor sleep quality and more severe insomnia were associated with smaller discrepancies in older, but not younger, patients, and associations were more sensitively detected by the new index. These findings suggest the importance of aging, disability and co‐morbidity that may influence motor activity from which sleep estimates are scored with actigraphy. The new index may be useful in identifying factors associated with the correspondence between actigraphy and polysomnography.     

An approach to understanding sleep and depressed mood in adolescents: person‐centred sleep classification

Depressive mood in youth has been associated with distinct sleep dimensions, such as timing, duration and quality. To identify discrete sleep phenotypes, we applied person‐centred analysis (latent class mixture models) based on self‐reported sleep patterns and quality, and examined associations between phenotypes and mood in high‐school seniors. Students (n = 1451; mean age = 18.4 ± 0.3 years; 648 M) completed a survey near the end of high‐school. Indicators used for classification included school night bed‐ and rise‐times, differences between non‐school night and school night bed‐ and rise‐times, sleep‐onset latency, number of awakenings, naps, and sleep quality and disturbance. Mood was measured using the total score on the Center for Epidemiologic Studies‐Depression Scale. One‐way anova tested differences between phenotype for mood. Fit indexes were split between 3‐, 4‐ and 5‐phenotype solutions. For all solutions, between phenotype differences were shown for all indicators: bedtime showed the largest difference; thus, classes were labelled from earliest to latest bedtime as ‘A’ (n = 751), ‘B’ (n = 428) and ‘C’ (n = 272) in the 3‐class solution. Class B showed the lowest sleep disturbances and remained stable, whereas classes C and A each split in the 4‐ and 5‐class solutions, respectively. Associations with mood were consistent, albeit small, with class B showing the lowest scores. Person‐centred analysis identified sleep phenotypes that differed in mood, such that those with the fewest depressive symptoms had moderate sleep timing, shorter sleep‐onset latencies and fewer arousals. Sleep characteristics in these groups may add to our understanding of how sleep and depressed mood associate in teens.     

Toddler's self‐regulation strategies in a challenge context are nap‐dependent

Early childhood represents a time of developmental changes in both sleep and self‐regulation, a construct reflecting the ability to control one's behaviour, attention and emotions when challenged. Links between sleep and self‐regulation processes have been proposed, but experimental evidence with young children is lacking. In the current study, we tested the effects of acute sleep restriction (nap deprivation) on toddlers’ self‐regulation. Healthy children (n = 12; four males; aged 30–36 months (33.9 ± 1.7)) slept on a strict schedule (verified with actigraphy and sleep diaries) for 5 days before each of two afternoon assessments following a nap and a no‐nap condition (~11‐day protocol). Children were videotaped while attempting an unsolvable puzzle, and 10 mutually exclusive self‐regulation strategies were later coded. On average, children lost ~90 min of sleep on the no‐nap versus the nap day. Nap deprivation resulted in moderate‐to‐large effects on self‐regulation strategies, with decreases in scepticism (d = 0.77; 7% change), negative self‐appraisal (d = 0.92; 5% change) and increases in physical self‐soothing (d = 0.68; 10% change), focus on the puzzle piece that would not fit (perseveration; d = 0.50; 9% change) and insistence on completing the unsolvable puzzle (d = 0.91; 10% change). Results suggest that sleep serves an important role in the way that toddlers respond to challenging events in their daily lives. After losing daytime sleep, toddlers were less able to engage effectively in a difficult task and reverted to less mature self‐regulation strategies than when they were well rested. Over time, chronically missed sleep may impair young children's self‐regulation abilities, resulting in risk for social–emotional, behavioural and school problems.     

Blue‐blocking glasses as additive treatment for mania: Effects on actigraphy‐derived sleep parameters

Improvement of sleep is a central treatment goal for patients in a manic state. Blue‐blocking (BB) glasses as adjunctive treatment hasten overall recovery from mania. This method is an evolvement from dark therapy and builds on the discovery of the blue‐light‐sensitive retinal ganglion cell that signals daytime to the brain. We report effects of adjunctive BB glasses on actigraphy‐derived sleep parameters for manic inpatients as compared to placebo. Hospitalized patients with bipolar disorder in a manic state aged 18–70 years were recruited from five clinics in Norway from February 2012 to February 2015. The participants were randomly allocated to wearing BB glasses or placebo (clear glasses) as an adjunctive treatment from 18:00 to 08:00 hours for seven consecutive nights. Sleep and wake were monitored by actigraphy. From 32 eligible patients, 10 patients in each group qualified for the group analyses. The BB group's mean sleep efficiency was significantly higher at night 5 as compared to the placebo group (92.6% vs. 83.1%, p = .027). The 95% confidence interval (CI) was 89.4%–95.8% in the BB group and 75.9%–90.3% in the placebo group. There were fewer nights of interrupted sleep in the BB group: 29.6% versus 43.8% in the placebo group. The BB group received less‐intensive sleep‐promoting pharmacological treatment and showed significantly higher sleep efficiency and more consolidated sleep as compared to the placebo group. Our findings suggest sleep‐promoting effects through deactivating mechanisms. Adjunctive BB glasses seem to be useful for improving sleep for manic patients in the hospital setting.     

Sleep patterns and insomnia in a large population‐based study of middle‐aged and older adults: The Tromsø study 2015–2016

Epidemiological studies assessing adult sleep duration have yielded inconsistent findings and there are still large variations in estimation of insomnia prevalence according to the most recent diagnostic criteria. Our objective was to describe sleep patterns in a large population of middle‐aged and older adults, by employing accurate measures of both sleep duration and insomnia. Data stem from the Tromsø Study (2015–2016), an ongoing population‐based study in northern Norway comprising citizens aged 40 years and older (n = 21,083, attendance = 64.7%). Sleep parameters were reported separately for weekdays and weekends and included bedtime, rise time, sleep latency and total sleep time. Insomnia was defined according to recent diagnostic criteria (International Classification of Sleep Disorders; ICSD‐3). The results show that 20% (95% confidence interval,19.4–20.6) fulfilled the inclusion criteria for insomnia. The prevalence was especially high among women (25%), for whom the prevalence also increased with age. For men, the prevalence was around 15% across all age groups. In all, 42% of the women reported sleeping <7 hr (mean sleep duration of 7:07 hr), whereas the corresponding proportion among males was 52% (mean sleep duration of 6:55 hr). We conclude that the proportion of middle‐aged and older adults not getting the recommended amount of sleep is worryingly high, as is also the observed prevalence of insomnia. This warrants attention as a public health problem in this population.