In the current global home confinement situation due to the COVID-19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels, but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation, sleep disturbance can have direct consequences upon next day emotional functioning. In this paper, we summarize what is known about the stress-sleep link and confinement as well as effective insomnia treatment. We discuss those effects of the current home confinement situation that can disrupt sleep but also those that could benefit sleep quality. We suggest adaptions of cognitive behavioural therapy elements that are feasible to implement for those facing changed work schedules and requirements, those with health anxiety and those handling childcare and home-schooling, whilst also recognizing the general limitations imposed on physical exercise and social interaction. Managing sleep problems as best as possible during home confinement can limit stress and possibly prevent disruptions of social relationships.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jsr.13052

Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy.

Despite the widespread use of actigraphy in pediatric sleep studies, there are currently no age-related normative data. To systematically review the literature, calculate pooled mean estimates of actigraphy-derived pediatric nighttime sleep variables and to examine the magnitude of change with age. A systematic search was performed across eight databases of studies that included at least one actigraphy sleep variable from healthy children aged 0-18 years. Data suitable for meta-analysis were confined to ages 3-18 years with seven actigraphy variables analyzed using random effects meta-analysis and meta-regression performed using age as a covariate. In total, 1334 articles did not meet inclusion criteria; 87 had data suitable for review and 79 were suitable for meta-analysis. Pooled mean estimates for overnight sleep duration declined from 9.68 hours (3-5 years age band) to 8.98, 8.85, 8.05, and 7.4 for age bands 6-8, 9-11, 12-14, and 15-18 years, respectively. For continuous data, the best-fit (R2 = 0.74) equation for hours over the 0-18 years age range was 9.02 - 1.04 × [(age/10)^2 - 0.83]. There was a significant curvilinear association between both sleep onset and offset with age (p These normative values have potential application to assist the interpretation of actigraphy measures from nighttime recordings across the pediatric age range, and aid future research.

Establishing normal values for pediatric nighttime sleep measured by actigraphy: a systematic review and meta-analysis.

The Role of the Father in Child Development, 3rd. Ed.

Parent-child bed-sharing: The good, the bad, and the burden of evidence.

Maternal and paternal sleep during pregnancy in the Child-sleep birth cohort.

The aims of this longitudinal study were to examine (a) development of infant sleep and maternal sleep from 3 to 6 months postpartum; (b) concomitant and prospective links between maternal sleep and infant sleep; and (c) triadic links between paternal involvement in infant caregiving and maternal and infant sleep. The study included 57 families that were recruited during pregnancy. Maternal and infant sleep was assessed using actigraphy and sleep diaries for 5 nights. Both fathers and mothers completed a questionnaire assessing the involvement of fathers relative to mothers in infant caregiving. The results demonstrated moderate improvement in infant and maternal sleep percent between 3 and 6 months. Maternal sleep percent at 3 months significantly predicted infant sleep percent at 6 months. Greater paternal involvement in infant daytime and nighttime caregiving at 3 months significantly predicted more consolidated maternal and infant sleep at 6 months. These findings suggest that maternal sleep is an important predictor of infant sleep and that increased involvement of fathers in infant caregiving responsibilities may contribute to improvements in both maternal and infant sleep during the first 6 months postpartum.

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Vii. infant sleep development from 3 to 6 months postpartum: links with maternal sleep and paternal involvement

Sleep patterns of co-sleeping and solitary sleeping infants and mothers: a longitudinal study.

The aims of this paper are to study the associations between objective and subjective sleep in pregnant women, to examine which specific aspects of women's sleep are associated with depressive and anxiety symptoms and to test the moderating role of depressive and anxiety symptoms in the relations between objective and subjective sleep. The sample included 148 pregnant women. Objective sleep was measured by actigraphy for five nights at the participants' home, and subjective sleep was measured with the Pittsburgh sleep quality index. Depressive symptoms were assessed with the Edinburgh postnatal depression scale and anxiety symptoms with the Beck anxiety inventory. Significant associations were found between the subjective sleep measures and the depressive and anxiety scores, but there were no significant associations between actigraphic sleep measures and the depressive and anxiety scores. Depressive and anxiety scores emerged as significant moderators of the links between objective and subjective sleep. The findings suggest that emotional distress (i.e., depressive and anxiety symptoms severity) during pregnancy is associated with subjective sleep disturbances but not with objective sleep disturbances. Importantly, only among women with higher levels of emotional distress was subjective sleep quality associated with objective sleep quality. These findings may suggest that women with higher levels of emotional distress are not necessarily biased in their perception of sleep quality. However, they may perceive fragmented sleep as more detrimental to their wellbeing.

Objective and subjective sleep during pregnancy: links with depressive and anxiety symptoms

Study objectives To examine the convergence between actigraphy, sleep diaries, and the Brief Infant Sleep Questionnaire (BISQ) in the assessment of infant nocturnal wakefulness (i.e. minutes awake after sleep onset [WASO] and number of night-wakings [NW]) in the context of a longitudinal study. Methods The sample included 226 families, who were recruited during pregnancy. Data were collected at 3, 6, 12, and 18 months postpartum. Infants' sleep was monitored at home for five nights using actigraphy, sleep diaries, and the BISQ. Outcome measures included WASO and NW, as well as sleep latency, sleep duration, and sleep onset. Results Trajectory analyses demonstrated that all three methods showed declines in NW and WASO from 3 to 18 months. Statistically significant correlations were found between the three methods at all assessment points for all sleep variables. However, agreement rates (using Krippendorff's α and Bland-Altman analyses) between actigraphy and parental reports were poor. For NW, agreement between actigraphy and parental reports at 18 months was lower than that at 3 and 6 months. Diaries and BISQ showed satisfactory agreement for sleep latency. Conclusions Although the three methods' measures of infant nocturnal wakefulness are significantly correlated during infancy, absolute agreement between these methods is poor overall. The growing disagreement between actigraphy and parental reports (in NW) across development probably suggests that parents become less aware of infants' awakenings, due to the increasing ability of infants to self-soothe. Using both objective and subjective assessment methods seems especially important after the age of 6 months.

Infant nocturnal wakefulness: a longitudinal study comparing three sleep assessment methods.

Study objectives To examine longitudinally differences in (1) objective and subjective sleep patterns and (2) parenting functioning (i.e. maternal emotional distress, maternal separation anxiety, and parental involvement in infant care) between room-sharing and solitary-sleeping mother-infant dyads. Methods Maternal and infant sleep, sleeping arrangements, and parental functioning were assessed at 3 (N = 146), 6 (N = 141), 12 (N = 135), and 18 (N = 130) months postpartum. Maternal and infant sleep were assessed with actigraphy and sleep diaries for five nights. Questionnaires were used to assess sleeping arrangements, nighttime breastfeeding, and parental functioning. Results Persistent room-sharing mothers (i.e. sharing a room with the infant on at least three assessment points) had significantly lower actigraphy-based sleep percent, lower longest sleep periods, and more night-wakings than persistent solitary-sleeping mothers. For infants, differences in actigraphic sleep were found only in longest sleep period, although mothers of persistent room-sharing infants reported more infant night-wakings than mothers of persistent solitary-sleeping infants. The trajectories of maternal and infant sleep in both room-sharing and solitary-sleeping groups demonstrated that sleep became more consolidated with time. Group differences indicated higher maternal separation anxiety and lower paternal overall and nighttime involvement in infant caregiving in room-sharing families compared with solitary-sleeping families. Conclusions The findings are discussed in light of the latest American Academy of Pediatrics recommendation to share a room until 12 months postpartum. Although no causal effects can be inferred from this study, maternal sleep quality and certain parenting characteristics seem to be important factors to consider when parents consult about sleeping arrangements.

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Ella Volkovich

Papers

Vii. infant sleep development from 3 to 6 months postpartum: links with maternal sleep and paternal involvement

Sleep patterns of co-sleeping and solitary sleeping infants and mothers: a longitudinal study.

Objective and subjective sleep during pregnancy: links with depressive and anxiety symptoms

Infant nocturnal wakefulness: a longitudinal study comparing three sleep assessment methods.

Mother-infant sleep patterns and parental functioning of room-sharing and solitary-sleeping families: a longitudinal study from 3 to 18 months.