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The postpartum period may pose a considerable challenge for both parent sleep and sexual activity. This study assessed the links between partnered sexual frequency and satisfaction postpartum and parent sleep, infant sleep, parent nighttime caregiving, and parent-infant room sharing. Participants were 897 parents of infants aged 1-18-months (

Introduction Despite the efficacy of cognitive behavioural therapy for insomnia (CBT-I) for treating youth insomnia, there remain individual differences in treatment outcomes. Previous studies found that demographic (e.g., age) and clinical features (e.g., depression, anxiety) could potentially affect treatment responses in adults but there has been limited research conducted in youth. This study aimed to identify potential predictors of treatment response and remission of insomnia following CBT-I in a sample of adolescents with insomnia and eveningness. Methods The sample consisted of 57 adolescents with insomnia with eveningness (Age: 20.21 ± 1.95, 15-24, female: 56.14%) who had completed a 6-session group-based cognitive behavioural therapy (CBT-I) with (n = 27) or without bright light therapy (n=30). Assessments were conducted at baseline and one-week post-intervention. Insomnia Severity Index (ISI) was used to measure self-reported insomnia symptoms. Treatment response was defined as a reduction in ISI score ≥ 6 after treatment, and remission was defined as an ISI score < 9 at post-treatment. Backward stepwise logistic regression was conducted to explore baseline demographic and clinical factors (e.g., comorbid depression or anxiety, suicidality) that might contribute to treatment response and remission of insomnia. Results About 64.9% and 68.4% of the participants achieved treatment response and remission of insomnia, respectively. There was no significant difference in response (60.0% vs. 73.4%) and remission (63.3% vs. 74.1%) rates between participants with and without adjunctive light therapy. Treatment response was significantly predicted by lower suicidality (p Conclusion CBT-I is more effective in adolescents with less eveningness, elevated insomnia symptoms, and less suicidality. Future research should explore whether addressing these factors in the delivery of CBT-I could improve treatment outcomes in youths with insomnia. Support (if any) This work was funded by General Research Fund (Ref. 17608918), Research Grants Council, University Grants Committee, Hong Kong SAR, China.

Study Objectives The aim of this study was to; (1) explore whether adolescents use technology as distraction from negative thoughts before sleep, (2) assess whether adolescents who perceive having a sleep problem use technology as distraction more compared to adolescents without sleep complaints, and (3) collect qualitative information about which devices and apps adolescents use as a distraction. Methods This study used a mixed-methods cross-sectional design, where 684 adolescents (M = 15.1, SD = 1.2, 46% female) answered both quantitative and qualitative questions about their sleep (perceived sleep problem, sleep onset time (SOT), and sleep onset latency [SOL]) and technology use as distraction from negative thoughts. Results The majority of adolescents answered “yes” or “sometimes” using technology as a distraction from negative thoughts (23.6% and 38.4%). Adolescents who answered “yes” to using technology as distraction were more likely to report having a sleep problem, longer SOL, and later SOT, compared to adolescents who answered “no”. The most popular device to distract was the phone, because of its availability, and the most common apps used for distraction included YouTube, Snapchat, and music apps. Conclusions This study shows that many adolescents use technology to distract themselves from negative thoughts, which may help them manage the sleep-onset process. Thus, distraction may be one mechanism explaining how sleep affects technology use, rather than vice versa.

Objective The COVID-19 pandemic has profoundly impacted families, yet studies on its effects on infants and their parents have thus far been sparse and based mostly on retrospective parent reporting. This study aimed to prospectively evaluate the impact of COVID-19 living conditions on infant and parent sleep, as well as infant screen exposure, parent daytime sleepiness, and parent depression levels, using multi-method assessment. Methods Infant and parent data collected in 2020 were compared with a matched cohort collected in 2019. The total sample included 1518 US infants aged 1–18 months (M = 8.5, SD = 4.6; 54% boys). Auto-videosomnography metrics were obtained from the 14-day period prior to survey completion (number of analyzed nights: M = 12.11 SD = 2.66 in the 2019 cohort; and M = 11.91 SD = 2.41 in the 2020 cohort). Parents completed online questionnaires regarding their infant's sleep and screen exposure, as well as their own sleep quality, daytime sleepiness, and depression levels. Results Compared to 2019, infants in 2020 slept ∼40 min more per night on average, as indicated by auto-videosomnography. Infants additionally had earlier sleep timing, and increased parent-reported sleep-onset latency and nocturnal wakefulness. Infant screen time rose by 18.3 min per day for older infants, but remained stable for younger infants. Parents reported lower daytime sleepiness and higher depression symptomology during 2020, whereas no change was apparent in their sleep quality ratings. Conclusions Restricted living conditions during COVID-19 in the USA led to increased infant screen exposure and parental depression, but also to increased infant sleep duration and reduced parent sleepiness. Future research is needed to examine the mechanistic pathways through which COVID-19 impacted on infant and parent well-being.

BACKGROUND: With the outbreak of the COVID-19 pandemic, pediatric experts called attention to the potential adverse effects of living restrictions (e.g., lockdown) on child well-being, but at the same time- acknowledged their possible benefits. To date, only few data-driven reports have been published on child sleep during COVID-19, and all have been based on parent- or self-reports. This study used auto-videosomnography to capture the effects of COVID-19 stay-at-home orders imposed in the USA on objectively measured infant sleep. METHODS: Auto-videosomnography metrics of infants assessed nightly between January and May 2020 were compared with metrics of an equivalent infant cohort, assessed in the corresponding 2019 period. A total of 610 infants (50.7% girls) aged 6-18 months (M = 11.8, SD = 3.6) were included, with 71,472 analyzed nights. Multilevel models were applied to assess differences between 2019 and 2020 infant sleep pre- and during-lockdown. RESULTS: Whereas infant cohorts were equivalent in demographic and January-March/April sleep characteristics, during the 2020 lockdown infants had longer nighttime sleep durations (Mdifference = 11.0 min, p = .01), later morning rise times (Mdifference = 9.5 min, p = .008), and later out-of-crib times (Mdifference = 12.3 min, p

Background. Changing lifestyles and the widespread use of artificial lighting have contributed to the disruption of circadian rhythms in modern society. As various aspects of affect and cognition are also controlled by circadian rhythms, this is of concern. Thus, circadian phase assessment is increasingly applied in the diagnostic process in clinical practice, as knowledge of circadian timing and the etiology of symptoms associated with circadianVer misalignment inform treatment choices. However, clinicians should be aware that certain psychopharmaceuticals may influence endogenous melatonin profiles. Other pharmacological agents and behaviors have shown to mask, suppress, or promote DLMO and nighttime melatonin levels (e.g. caffeine, bright light, exercise). Moreover, health and nutritional organizations are increasingly emphasizing certain foods and dietary supplements (e.g. magnesium, tryptophan) that contain melatonin or boost the body’s natural melatonin production. Although it remains unclear whether the increase in melatonin through these foods and supplements can enhance sleep or cause a significant phase shifting effect for accurate diagnosis, it is important to consider possible masking effects when assessing DLMO and treating circadian misalignment. To date, a comprehensive overview of findings relevant for the application in routine clinical care is lacking.Aim. To review the melatonin altering effect of common behaviors, supplements and pharmaceuticals, which are relevant in clinical cases where circadian phase assessments are indicated. Findings will highlight the possible melatonin promoting and/or inhibiting pathways of certain behaviors or substances. We will end by providing suggestions for clinical practice and future research studies. Methods. First, a “mini systematic review” was conducted, in which a sample of papers was synthesized. This ensured that in the full review all important keywords are included in the search strings, and that the most useful and relevant information will be extracted. Next, the full systematic literature search will be conducted in the online databases of PubMed and EMBASE. To collect all relevant studies, we will search abstract, title and keyword fields, and if available, the corresponding Mesh term (for PubMed) and/or Emtree term (for EMBASE). Separate searches for the three main topics of this review will be conducted: 1) (Psycho)pharmaceuticals and substances; 2) food, beverages, and supplements; and 3) behaviors (light exposure, exercise, meal timing, and sleep scheduling).Results. Appendix A of the present systematic review protocol contains a comprehensive overview of the generated search strings.

Objective: This study tested the efficacy of a group-based, parent-focused, behavioural sleep intervention (BI) targeting insomnia in preschool children. Methods: Parents of children in the year prior to formal schooling were randomized to either the BI condition or a care as usual (CAU) condition. Outcomes included sleep, anxiety, behavioural problems, internalizing and externalizing behaviours, academic outcomes, and transition to school (teacher-rated child wellbeing, language and communication, and socio-emotional ability). Assessments were conducted at pre- and post-intervention in the year before formal schooling, and at the end of terms 1 (follow-up 1) and 2 (follow-up 2) of the first year of formal schooling. Results: It was found that, relative to the CAU children, those whose parents participated in the BI condition demonstrated significantly greater improvements in sleep, anxiety, behaviour problems and internalising and externalising behaviours from pre- to post-intervention, and that these effects were either maintained (sleep, anxiety, internalising and externalising behaviours) or improved upon (behaviour problems) at follow-up. In addition, it was found that improvements in sleep at post-assessment mediated the improvements found in other outcome variables at follow-up (with the exception of behaviour problems). However, there were no significant effects of condition on any of the school transition or academic outcome measures. Conclusion: A parent-focused, group-based behavioural sleep intervention for preschool children is effective in improving sleep problems, anxiety, behavioural problems and internalising and externalising behaviours, but is not effective in improving school transition or academic outcomes.

Objective This study aimed to provide the first estimate of sleep knowledge, practices, and attitudes regarding paediatric sleep in Australian health professionals. Methods 263 Australian health professionals (medical practitioners, nurses, psychologists, social workers, occupational therapists, pharmacists, dentists and sleep coaches) completed an anonymous survey. Results Clients with sleep disorders were commonly encountered by health professionals, yet professionals reported little time spent on clinical training in sleep medicine at the undergraduate (∼1–5 hrs) or postgraduate (∼0.5–3.5 hrs) level. Health professionals reported seeking continuing professional development (CPD) in sleep (∼6+ hrs), and CPD had the most influence on health professionals’ practice, relative to other sources of information. Over half of health professionals (∼56–58%) reported that they were not trained in sleep measurement (i.e., sleep diaries and questionnaires), or how to take a sleep history. On average, professionals answered less than half (44.5%) of paediatric sleep knowledge questions correctly (M = 13.35, SD = 6.03). Approximately one third of health professionals reported not routinely screening for sleep disorders in paediatric patients and many did not routinely recommend evidence based treatments. The impact and importance of paediatric sleep was well recognised, but sleep was considered less important than a healthy diet and exercise. Conclusions Results from the current study highlight key knowledge gaps regarding paediatric sleep across a wide range of Australian health professions, and may inform future efforts to reform clinical sleep medicine training in Australia.

Two adolescent mental health fields - sleep and depression - have advanced largely in parallel until about four years ago. Although sleep problems have been thought to be a symptom of adolescent depression, emerging evidence suggests that sleep difficulties arise before depression does. In this Review, we describe how the combination of adolescent sleep biology and psychology uniquely predispose adolescents to develop depression. We describe multiple pathways and contributors, including a delayed circadian rhythm, restricted sleep duration and greater opportunity for repetitive negative thinking while waiting for sleep. We match each contributor with evidence-based sleep interventions, including bright light therapy, exogenous melatonin and cognitive-behaviour therapy techniques. Such treatments improve sleep and alleviate depression symptoms, highlighting the utility of sleep treatment for comorbid disorders experienced by adolescents.

To compare the real-world frequency, timing, duration, difficulty, and helpfulness of three infant Behavioral Sleep Intervention (BSI) approaches: Unmodified Extinction, Modified Extinction, and Parental Presence, and to examine the effectiveness and safety of these approaches by comparing infant sleep, parent sleep, daytime sleepiness, depression, and parent-infant bonding between parents who had and had not implemented these interventions.Participants were 2090 parents (75% mothers, 79% White/Caucasian) of US infants (49% girls) aged 3-18 months (M=9.1, SD=4.1). Parents completed online questionnaires regarding their infant's sleep, their own sleep, daytime sleepiness, depression levels, and parent-infant bonding. Infant sleep was assessed via objective- albeit exploratory- auto-videosomnography data obtained from the 14-days prior to survey completion.64% of parents reported implementing BSIs. The average age at intervention was 5.3 months (SD=2.6). Unmodified and Modified Extinction were rated as significantly more difficult to implement compared with Parental Presence, but also as more helpful, shorter, and quicker to show improvements. Infant nighttime sleep was longer and more consolidated in the Unmodified and Modified Extinction groups compared with the Parental Presence and no-BSI groups. No differences were found between BSI groups in parent sleep, sleepiness, depression, or parent-infant bonding.Implementation of BSIs outside clinical settings is pervasive and occurs earlier than generally recommended. Unmodified and Modified Extinction were associated with longer and more consolidated infant sleep. Despite concerns regarding the potential harm of BSIs, implementation of these approaches was not linked with negative outcomes, providing additional evidence for their safety and effectiveness.

Sleep restriction therapies likely drive improvement in insomnia in middle childhood via increases in homeostatic sleep pressure (e.g., evening sleepiness). Increased evening sleepiness may also dampen comorbid anxiety symptoms; and reduced wakefulness in bed may reduce worry. However, sleep restriction therapies have never been evaluated as a standalone intervention in this population. The mechanism of action needs testing, as do effects on anxiety, and cognitive performance and parasomnias (possible contraindications). This randomised controlled trial evaluated the efficacy of two "doses" of sleep restriction therapy (sleep restriction therapy, bedtime restriction therapy), compared to a control condition (time in bed regularisation). A total of 61 children (mean [SD, range] age 9.1 [2.1, 6-14] years; 54% female) with chronic insomnia disorder received two weekly 60-min treatment sessions with a psychologist. Sleep, sleepiness, anxiety, worry, cognitive performance, and parasomnias were measured pre-treatment, across treatment, and at 4-weeks post-treatment. Both the sleep and bedtime restriction groups experienced reductions in total sleep time (d = 1.38-2.27) and increases in evening sleepiness (d = 1.01-1.47) during the 2-week treatment, and improvements in insomnia (i.e., sleep onset latency; d = 1.10-1.21), relative to the control group. All groups reported improved anxiety and worry, yet there were no differences between the control and restriction groups (all p 0.658). Time in bed increased at the 1-month follow-up, and benefits to sleep and insomnia were maintained. There were no adverse effects on cognitive functioning (all p 0.259), nor parasomnia occurrence (all p 0.740). These results suggest that sleep restriction therapies are brief, yet effective, standalone interventions for insomnia in middle childhood, and improvements are likely due to increased sleepiness, not sleep regularisation.

Background and Objective Although sleep is a potentially important determinant of performance in esports, there have been no published data on the sleep behavior of professional esports athletes. The aim of this study is to investigate sleep aspects and sleep risk factors in esports athletes. Methods Thirty-four esports athletes were compared with 21 nonathletes from the general population to assess their sleep patterns and mood. Study 1 is a quantitative study with a 2-week observation period of sleep that was performed after evaluating insomnia severity, daytime sleepiness, sleep knowledge, and mood state. During the sleep observation period, participants recorded sleep diaries. In study 2, qualitative research was conducted with in-depth interviews from 6 participants. Results The esports athlete group reported significantly delayed sleep phase compared to the nonathlete group (d = 2.10 hours, p < 0.001). The esports athlete group reported significantly lower sleep quality and scores for feeling refreshed upon awakening, higher depression scores and significantly higher proportion of individuals with clinical symptoms of depression compared to the nonathlete group (ps < 0.01). In study 2, six themes emerged from the interviews: sleep risk factors, sleep protective factors, lifestyle, stressors, organizational management, and demands for sleep/psychological intervention. Conclusions The professional esports athletes showed more depressed mood and more delayed sleep phase compared to the non-athletes. A wide range of interventions tailored to esports athletes should be developed and implemented on both individual and organizational levels.

Introduction Perfectionism is an often overlooked yet consistent construct related to insomnia in the scientific literature. Perfectionism and insomnia are both highly prevalent in adolescence. However, there is a dearth of research examining mechanisms linking perfectionism with insomnia, particularly in young people. The current study aimed to investigate whether vulnerability to stress, a factor common to both constructs, accounts for the relationship between perfectionism and insomnia symptoms in a sample of adolescents. Methods 281 Australian participants (Mage = 16.53, SD = 1.91, range = 13–19 years, 78% female) completed questionnaires assessing perfectionism, vulnerability to stress and insomnia on one occasion. Results Vulnerability to stress accounted for the relationship between self-oriented striving perfectionism, self-oriented critical perfectionism and insomnia symptom severity in females, but not males. Females reported higher self-oriented critical perfectionism, vulnerability to stress and insomnia severity, with a stronger relationship between vulnerability to stress and insomnia symptoms observed for females. Conclusions These results may partly explain the preponderance of insomnia in adolescent females. Possible implications for the prevention and treatment of insomnia in young people are discussed.

Growing evidence shows a link between mood and chronotype. The majority of studies measure chronotype as a preference for morning/evening activities, rather than actual sleep behaviour (i.e. midsleep) or biological markers of sleep timing (e.g. dim light melatonin onset). Most studies show an association between chronotype and mood and identify eveningness as a potential risk for depression, but the directionality is unclear. Some evidence shows a stronger association between misalignment with the biological clock and depressive symptoms. This review provides a snapshot of recent research on chronotype and unipolar depression. We conclude that future studies should strive to integrate different measures of chronotype. This will give a clearer picture of the association between early/late chronotype and mood, which will in turn better inform clinical practice.

This study investigated the associations between adolescent evening use of technology devices and apps, night time sleep, and daytime sleepiness. Participants were 711 adolescents aged 12-18 years old (46% Female, M

Study Objectives Recurrent nightmares in childhood may have a range of detrimental effects for both the child and parents. This randomized controlled trial evaluated the efficacy of a novel parent-based intervention for childhood nightmares, using a new device called the “Dream Changer.” Methods A total of 56 children aged 3–10 years (M = 7.1 ± 2.1 years; 51.8% boys), and one of their parents were randomized to either the intervention or waitlist control group. The intervention group received a “Dream Changer”—a light-emitting remote-control-like device that the child was encouraged to take to bed and use upon experiencing a nightmare. Parents completed online surveys at baseline, 1-week, and 2-weeks following the intervention. Parents in the intervention group additionally completed a 3-month follow-up survey. Outcome variables included children’s nightmare frequency, sleep-wake patterns, and sleep anxiety, as well as parents’ daytime sleepiness. Results Significant group-by-time interaction effects were found for nightmare frequency (p = 0.001) and sleep anxiety (p = 0.006). Parents of children who received the “Dream Changer” reported fewer nightmares (Mdifference = 1.7, p < 0.001, d = 1.06) and decreased anxiety (Mdifference = 0.9, p = 0.001, d =0.41) at post-intervention, whereas such benefits were not found in the waitlist control group. Three-month follow-up assessments demonstrated that gains were maintained over-time. Interaction effects were not significant for children’s sleep metrics or for parents’ daytime sleepiness. Conclusions The present study provides preliminary evidence for the efficacy of a brief, highly accessible intervention for reducing children’s nightmares and nighttime anxiety. Future research may wish to test these effects using larger samples and longer follow-up assessments. Clinical Trial Registration The trial has been registered at the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/; Identifier:ACTRN12620000633987).

This study evaluated a brief sleep intervention designed to improve the sleep, mood, and cognitive performance of professional electronic sports (esports) athletes from three major esports regions (i.e., Asia, North America, and Oceania). Fifty-six esports athletes from South Korea (N = 34), the United States (N = 7), and Australia (N = 15) completed the study. Participants completed an initial 2-week pre-intervention phase to establish a baseline, followed by a 2-week intervention phase that involved a group sleep education class, 1:1 session with a trained clinical psychologist, and daily biofeedback. A wrist activity monitor and daily sleep diary were used to monitor sleep during both phases, while at pre- and post-intervention, participants completed a battery of sleep and mood questionnaires and underwent cognitive performance testing. Sleep knowledge increased from pre- to post-intervention (d = 0.83 [95% CI −1.21, −0.43], p =< 0.001), while there were modest improvements in sleep diary estimates (i.e., sleep onset latency (Mdiff = −2.9 min, p = 0.02), sleep onset time (Mdiff = −12 min, p = 0.03), and sleep efficiency (Mdiff = 1.1%, p = 0.004)) and wrist activity monitor estimates (i.e., sleep onset time (Mdiff = −18 min, p = 0.01)). Insomnia severity scores decreased significantly (d = 0.47 [95% CI 0.08, 0.84], p = 0.001), while sleepiness scores increased but not meaningfully (d = 0.23 [95% CI −0.61, 0.14], p = 0.025). However, there was no significant change in mood (i.e., depression and anxiety) or cognitive performance scores (i.e., mean reaction time or lapses). Sleep interventions for esports athletes require further investigation. Future research should examine whether a stepped-care model, whereby increasing therapeutic input is provided as needed, can optimize sleep, mood, and cognitive performance outcomes.

Study Objectives We examined how adolescents’ sleep patterns (i.e. insomnia symptoms and sleep duration) change from early- to mid-adolescence and whether adolescents follow different trajectories. Furthermore, we also examined the characteristics of adolescents within different trajectories, with a specific focus on the role of school-related stress. Methods We used three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1294; Mage = 13.2 [range: 12–15 years], SD = .42; 46.8% girls). Using established measures, the students reported on their sleep duration, insomnia symptoms, and perceived school-stress (including stress of school performance, peer and teacher relations, attendance, and school-leisure conflict). We used latent class growth analysis (LCGA) to identify adolescents’ sleep trajectories, and the BCH method to describe the characteristics of the adolescents in each trajectory. Results We found four trajectories for adolescents’ insomnia symptoms; (1) low insomnia (69%), (2) low-increasing (17%, ‘emerging risk-group’), (3) high-decreasing (9%), (4) high-increasing (5%; ‘risk-group’). For sleep duration, we found two trajectories; (1) ~8 h sufficient-decreasing (85%), (2) ~7 h insufficient- decreasing (15%; ‘risk-group’). Adolescents in risk-trajectories were more likely to be girls and consistently reported higher levels of school stress, particularly regarding school performance and attending school. Conclusions School stress was prominent among adolescents suffering from persistent sleep problems, especially insomnia, and deserves further attention.

© The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd., The current Russian war against Ukraine is of global concern. It builds on the annexation of Crimea in 2014 and subsequently the war in the Donbas region of Ukraine, and has become a large-scale Russian invasion of Ukraine from three directions, Crimea in the south, Russia in the east, and Belarus in the north. Despite the geopolitical background that, in the eyes of Russia, justifes its annexation of regions in and around Ukraine, we cannot turn a blind eye towards the untold miseries of the citizens of the invaded country. Although it is unclear as to how the situation will unfold, what is clear is that lives are being lost, many civilians are being injured, traumatized, and valuable assets destroyed. Taking into consideration that the population of the countries involved in this conflict totals nearly 200 million citizens, many lives on both sides will be sacrifced, millions of people displaced, Europe will be overrun with new refugees, and global world economics will be disrupted by the war itself and by the sanctions imposed on Russia.

There is limited evidence surrounding the relationship between parent-set technology rules and adolescent sleep. This study had two aims: 1) to investigate the relationship between presence of and compliance to parent-set technology rules and adolescent sleep outcomes and daytime sleepiness; 2) to investigate if compliance, non-compliance, or the absence of rules could moderate the relationship between Fear of Missing Out (FoMO) and Bedtime Procrastination (BtP) on sleep outcomes and daytime sleepiness. A total of 711 adolescents aged 12-18 years old (46% Female

Professional and colloquial sleep hygiene guidelines advise against evening physical activity, despite meta-analyses of laboratory studies concluding that evening exercise does not impair sleep. This study is the first to investigate the association between objectively measured evening physical activity and sleep within a real-world big-data sample. A total of 153,154 nights from 12,638 individuals aged 18–60 years (M = 40.1 SD = 10.1; 44.5% female) were analyzed. Nighttime sleep and minutes of physical activity were assessed using Polar wearable devices for 14 consecutive days. Thirty minutes or more of moderate-to-near maximal physical activity during the 3 h before sleep onset were recorded in 12.4% of evenings, and were more frequent on weekdays than weekends (13.3 vs. 10.2% respectively, p < 0.001). Linear mixed modeling revealed that sleep efficiency was not significantly associated with evening physical activity, and that sleep duration was 3.4 min longer on average on nights following evenings in which participants engaged in 30 min or more of moderate-intense physical activity. Effects were found for sleep timing metrics, as evening physical activity was linked with earlier sleep onset and offset times (−13.7 and −9.3 min, respectively). Overall, these effects were greater– but still very small– on weekdays compared to weekends. The present study provides further evidence for the lack of meaningful links between sleep duration or quality and physical activity in the hours preceding sleep. Taken together with recent meta-analytic findings, these findings suggest that changes in public health recommendations are warranted regarding evening physical activity and its relation to sleep.

Adolescents with a late chronotype are at greater risk for mood disorders, risk-taking behaviors, school absenteeism, and lower academic achievement. As there are multiple causes for late chronotype, the field lacks studies on the relationship between mood, circadian phase, and phase angle of entrainment in late chronotype adolescents. Three objectives guide this explorative study: (1) to describe sleep, circadian phase, and phase angle of entrainment in late chronotype adolescents, (2) to explore how different levels of lateness are associated with sleep quality, sleep propensity, and mood, and (3) to investigate the influence of circadian phase on bedtime choice and sleep duration.Baseline data from 19 male adolescents (M = 16.4 ± 1.0 yrs), who were part of a larger intervention trial, were analyzed. Chronotype was measured with the Munich Chronotype Questionnaire, circadian timing via dim light melatonin onset (DLMO), and sleep habits with a 7-day sleep log. Further questionnaires assessed daytime sleepiness, sleep quality, and mood. Evening sleepiness and sustained attention were used as a proxy for evening sleep propensity.On school nights, sleep duration averaged 7.78 h (±1.65), and 9.00 h (±1.42) on weekend nights. Mean DLMO was observed at 23.13 h (± 1.65), with a weekend phase angle of entrainment of 2.48 h. Regression fittings revealed a tendency for shorter phase angles with delayed DLMOs. Further analysis with chronotype subgroups revealed that this was only true for light and moderate late types, whereas extreme late types showed wide phase angles. Even though daytime sleepiness and sleep duration did not differ between subgroups, mood and sleep quality declined as lateness increased. Extreme late chronotypes experienced higher evening sleepiness, while slight late chronotypes showed higher evening attention. Chronotype but not DLMO predicted bedtime on school- and particularly weekend-nights.Our findings suggest that with increasing lateness, the likelihood of experiencing poor sleep quality and mood disorders increases. As DLMO did not predict bedtime, our data indicate that the factors contributing to a late chronotype are versatile and complex, particularly for extreme late types. Further studies involving a larger and gender-balanced sample are needed to confirm findings.

Circadian dysregulation and depressed mood commonly co-occur in young people, yet mechanisms linking Delayed Sleep-Wake Phase disorder (DSWPD) with depression are poorly understood. The present study aimed to examine the role of repetitive negative thinking (RNT), by comparing sleep, RNT and depressive symptomology between 40 'good' sleeping young people and 63 with DSWPD, with (n = 30) and without (n = 33) self-reported doctor-diagnosed depression. Secondary analysis from a randomised controlled trial was also undertaken to observe changes in depressive symptoms and RNT as a result of treatment for DSWPD. The 60 young people with DSWPD (mean [SD] age of 15.9 [2.2] years, 63% female) received either short (green) or long (red) wavelength bright light therapy (BLT) over 3 weeks. Cross-sectional baseline comparisons revealed an escalating pattern of worse sleep, more RNT and higher depressed mood scores in the DSWPD young people compared to good sleepers. Across all participants, RNT accounted for the associations between sleep-onset difficulties and depressed mood at baseline. Symptoms of depression, RNT and sleep onset difficulties in DSWPD individuals significantly improved after treatment (d = 0.47-0.65) and at the 1- (d = 0.43-1.00) and 3-month follow-up (d = 0.39-1.38), yet there were no differences between short- and long-wavelength BLT. Results provide preliminary evidence that RNT may link delayed sleep phase with depression. BLT conferred sleep benefits, but also improvements in depressed mood and RNT, and thus represents a potentially cost-effective strategy for young people experiencing delayed sleep phase and low mood.

'Hippocrates flagged the value of sleep for good health' was the first line of the Annual Research Review (ARR) by Gregory and Sadeh (2016) in this journal, titled Sleep problems in childhood psychiatric disorders - a review of the latest science. Where Hippocrates has been referred to as the 'Father of Medicine', Professor Avi Sadeh has been respected as a 'Father of Paediatric Sleep Medicine' by those who had the privilege to meet him or read his science. Sadly, Avi Sadeh passed away in the same year this ARR was published. What he left behind was a legacy - including his predecessors (Professor Mary Carskadon), successors and those he inspired, who could be guided by the key findings from his 2016 ARR. These include (a) greater attention to the assessment of sleep in children; (b) sleep research on a wider range of psychiatric disorders; (c) a greater focus on and examination of mechanisms underlying associations; (d) a clearer consideration of developmental questions; and (e) large-scale well-designed treatment studies.

Esports is a booming global industry and has been officially included in the lead-up to the 2020 Olympics in Tokyo. Given that esports is a cognitive based activity, and sleep is well known to be critical for optimal cognitive functioning, our research group recently proposed that sleep might be an important determinant of esports performance. The focus of the current review was to expand our limited understanding regarding the role of sleep in esports by exploring risk factors for suboptimal sleep and developing an associated intervention framework. More specifically, we aimed to 1) examine how gaming culture and game genre might negatively influence sleep behaviour, 2) describe a conceptual model to explain how sub-optimal sleep occurs in esports, and 3) outline sleep intervention considerations that specifically meet the needs of esports athletes. We conclude that gaming culture and game genre could both impact the sleep behaviour of esports athletes, via cognitive and behavioural mechanisms. Furthermore, adapting Spielman’s three-factor model to esports may provide a useful and easy to understand conceptualisation for sub-optimal sleep in esports. Lastly, sleep interventions for traditional athletes can be suitably modified for esports but must be comprehensive and extend from a theoretically grounded conceptual model.

Background: Development induces changes in sleep, and its duration has been reported to change as a function of aging. Additionally, sleep timing is a marker of pubertal maturation, where during adolescence, the circadian rhythm shifts later. Typically, this is manifested in a later sleep onset in the evening and later awakening in the morning. These changes across development seem to be universal around the world but are unlikely to persist into adulthood. Methods: This study utilized accelerometer data from 17,355 participants aged 16-30 years (56% female) measured by validated Polar wearables over a 14-day period. We compared sleep duration, chronotype (sleep midpoint) and weekend catch-up (ie, social jetlag) sleep across ages and regions over 242,948 nights. Results: The data indicate a decline in sleep duration as well as a dramatic shift in sleep onset times throughout adolescence. This continues well into early adulthood and stabilizes nearer age 30. Differences in sleep duration across ages were significant, and ranged from 7:53 h at age 16 to 7:29 h at age 30 in the sample. Additionally, there was a clear difference between females and males throughout adolescence and young adulthood: girls had longer sleep duration and earlier timed sleep in the current study. Differences in sleep were found between regions across the world, and across European areas. Conclusions: Both sleep duration and sleep timing go through a clear developmental pattern, particularly in early adulthood. Females had an earlier sleep midpoint and obtained more sleep. Regional differences in sleep occurred across the world. Crown Copyright (C) 2019 Published by Elsevier B.V. All rights reserved.

Light is a potent circadian entraining agent. For many people, daily light exposure is fundamentally dysregulated with reduced light during the day and increased light into the late evening. This lighting schedule promotes chronic disruption to circadian physiology resulting in a myriad of impairments. Developmental changes in sleep-wake physiology suggest that such light exposure patterns may be particularly disruptive for adolescents and further compounded by lifestyle factors such as early school start times. This narrative review describes evidence that reduced light exposure during the school day delays the circadian clock, and longer exposure durations to light-emitting electronic devices in the evening suppress melatonin. While home lighting in the evening can suppress melatonin secretion and delay circadian phase, the patterning of light exposure across the day and evening can have moderating effects. Photic countermeasures may be flexibly and scalably implemented to support sleep-wake health; including manipulations of light intensity, spectra, duration and delivery modality across multiple contexts. An integrative approach addressing physiology, attitudes, and behaviors will support optimization of light-driven sleep-wake outcomes in adolescents.

Study Objectives. During adolescence, an interplay between biological and environmental factors leads to constrained sleep duration and timing. Given the importance of restorative sleep for cognitive, emotional, and physical health during this developmental period, the high prevalence of sleep deprivation is a public health concern. One of the primary contributing factors is the normative delay of the circadian rhythm. Therefore, the present study aimed to evaluate the effect of a gradually advanced morning exercise schedule (30 min shift each day) completed for 45 minutes on 5 consecutive mornings, on circadian timing and daytime functioning of adolescents with a late chronotype, compared to a sedentary control group. Methods. 19 sedentary male adolescents aged 15-18 years spent one week of school holiday at the sleep laboratory. Morning procedure included either 45 min walking on a treadmill or sedentary activities in dim light. Saliva dim light melatonin onset (DLMO), evening sleepiness and daytime functioning were assessed during the first and last night of laboratory attendance. Results. The morning exercise group had significantly advanced (earlier) circadian timing (27.5 min ± 32.0), while sedentary activity resulted in a phase delay (-34.3 min ± 53.2). Morning exercise also led to higher evening sleepiness in the earlier hours of the night, but not at bedtime. Mood measures reduced meaningfully in both study conditions.Conclusions. These findings highlight the preventative effect of low-intensity morning exercise among this population. Future studies are needed to test the transference of these laboratory findings to adolescents’ real life.

Behavioural sleep interventions (eg, extinction-based methods) are among the most efficacious evidence-based techniques in the treatment of infant sleep problems. However, behavioural sleep interventions can be challenging for families to successfully implement. This review aims to summarise current research surrounding the potential barriers that arise when clinicians attempt to implement extinction-based methods with parents of infants. We provide a model that summarises 3 types of contextual-barriers; socio-cultural barriers, parent barriers, and infant barriers. Based on the current evidence, we propose that adopting a stepped care approach, planning ahead, increasing support, motivational interviewing, and/or emotional regulation may serve as useful tools for parents when implementing extinction-based methods. By considering these techniques, more families may receive the benefits of improved infant sleep.

OBJECTIVES: This study longitudinally compared the sleep of infants in the United States whose mothers were in home confinement to those whose mothers were working as usual throughout the COVID-19 pandemic. METHODS: Mothers of 572 infants (46% girls) aged 1-12 months (M = 5.9, standard deviation = 2.9) participated. Assessments were conducted on 4 occasions from late March to May 2020. Infant sleep was measured objectively using auto-videosomnography. Mothers reported their sheltering status, demographic characteristics, and infant sleep. RESULTS: Infants of mothers in home confinement had later sleep offset times and longer nighttime sleep durations, compared to infants of mothers who were working as usual. At the end of March, these infants also had earlier bedtimes, more nighttime awakenings, and more parental nighttime visits, but differences were not apparent during April and May. CONCLUSIONS: Living restrictions issued in the United States may have led to longer sleep durations and temporary delays in sleep consolidation for infants of mothers in home confinement.

Esports is becoming increasingly professionalized, yet research on performance management is remarkably lacking. The present study aimed to investigate the sleep and mood of professional esports athletes. Participants were 17 professional esports athletes from South Korea (N = 8), Australia (N = 4), and the United States (N = 5) who played first person shooter games (mean age 20 ± 3.5 years, 100% male). All participants wore a wrist-activity monitor for 7–14 days and completed subjective sleep and mood questionnaires. Participants had a median total sleep time of 6.8 h and a sleep efficiency of 86.4% per night. All participants had significantly delayed sleep patterns (median sleep onset 3:43 a.m. and wake time 11:24 a.m.). Participants had a median sleep onset latency of 20.4 min and prolonged wake after sleep onset of 47.9 min. Korean players had significantly higher depression scores compared to the other groups (p &lt, 0.01) and trained longer per day than the Australian or United States teams (13.4 vs. 4.8 vs. 6.1 h, respectively). Depression scores were strongly correlated with number of awakenings, wake after sleep onset, and daily training time (p &lt, 0.05). As the first pilot sleep study in the esports field, this study indicates that esports athletes show delayed sleep patterns and have prolonged wake after sleep onset. These sleep patterns may be associated with mood (depression) and training time. Sleep interventions designed specifically for esports athletes appear warranted.

Study objectives To investigate circadian typology in a large, representative sample of Norwegian adolescents, and its implications for sleep health. Methods The sample included 3920 1st year high school students aged 16–17 years. Respondents completed a web-based survey, including the short version of the Horne-Ostberg Morningness-Eveningness Questionnaire (rMEQ), the Munich Chronotype Questionnaire (MCTQ) and items on sleep-related behaviors (eg electronic media usage in bed, consumption of caffeinated beverages), sleep beliefs and daytime sleepiness. Data were analyzed using one-way ANOVAs and Chi-squared tests. Results In all, 7.8% were categorized as morning, 52.3% as intermediate and 39.9% as evening types, respectively. Evening types had later sleep timing, longer sleep latency, more social jetlag and shorter school day sleep duration than morning types, with intermediate types displaying a sleep pattern between these two extremes. None of the circadian types met the minimum recommended amount of sleep on school nights (ie 8+ hours), and only morning types had a mean sleep duration of 7+ hours (7:19 h, nearly 1 h more than evening types who slept 6:20 h, p < 0.001). Evening types reported more use of electronic media in bed, more consumption of caffeinated beverages and more daytime sleepiness than the other circadian types. They were also less satisfied with their school day sleep duration and perceived it more difficult to change their sleep pattern. Conclusions Results from this study suggest that eveningness represents a sleep health challenge for older adolescents. publishedVersion

Background\ud Sleep problems are common in adolescence, and frequently comorbid with both anxiety and depression. Research studies have suggested a bidirectional relationship between sleep and psychopathology, which includes evidence that sleep interventions can alleviate symptoms of anxiety and depression. However, little is known about the nature of sleep problems amongst adolescents with anxiety and depression, and whether specific sleeping difficulties are involved in the longitudinal relationship between sleep, anxiety and depression.\ud \ud Method\ud The sample was derived from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population‐based, prospective, birth cohort study of children born in 1991–1992. Data were explored from a subset of participants who took part in a clinical assessment at age 15, on self‐report sleep patterns and quality, and diagnostic outcomes of anxiety and depression (N = 5,033). Subsequent diagnostic and symptom severity data on anxiety and depression at ages 17, 21 and 24 were also examined.\ud \ud Results\ud Cross‐sectional and longitudinal analyses were conducted to explore the relationship between sleep problems, anxiety and depression. Results revealed that adolescents aged 15 with depression experience difficulties with both sleep patterns and sleep quality, whereas adolescents with anxiety only reported problems with sleep quality. A range of sleep variables at age 15 predicted the severity of anxiety and depression symptoms and the diagnoses of anxiety and depressive disorders at age 17, 21 and 24 years.\ud \ud Conclusions\ud The results provide further insight into the nature of sleep problems amongst adolescents with anxiety and depression, and the prospective relationship between sleep disturbance and future psychopathology. These data suggest that targeting sleep difficulties during adolescence may have long‐term mental health benefits.