Early Sleep Interventions Help Stave Off Insomnia

Julio Fernandez-Mendoza, PhD

Early sleep interventions has clinical value in childhood in helping individuals avoid insomnia as adults.

A team, led by Julio Fernandez-Mendoza, PhD, Sleep Research & Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, identified the developmental trajectories of insomnia symptoms, their evolution into adult insomnia, and the role of objective sleep duration in the transition to adulthood.

While it is known that insomnia symptoms are transdiagnostic to both physical and mental health disorders, there is a lack of population-based cohorts with objective sleep measures and long-term follow-ups. This results in a dearth of knowledge about the chronicity of childhood insomnia symptoms.

The Study

The study included 502 pediatric patients with a median age of 9 years and a 71.7% response rate. Each participant was studied 7.4 years later as adolescents with a median age of 16 years and 15 years later as adults with a median age of 24 years.

The investigators ascertained insomnia symptoms as moderate-to-severe difficulties initiating and/or maintaining sleep through parental or self-reports at all 3 time points. They also used self-reporting in young adulthood for adult insomnia and polysomnography in childhood and adolescence for objective short-sleep duration.

Results

The results show the most frequent trajectory for children with insomnia symptoms was persistence, which occurred in 43.3% of participants, followed by remission in 26.9% since childhood and 11.2% since adolescence. Waxing-and-waning patterns also occurred in 18.6% of participants.

For children with normal sleep, the most frequent trajectory was once again persistence, which occurred in 48.1% of participants. This was followed by developing insomnia symptoms for 15.2% of participants since adolescence and 20.7% since adulthood and a waxing-and-waning pattern in 16% of participants.

The odds an individual’s insomnia symptoms will worsen into adult insomnia occurred in 22% of children and 20.8% of adolescents were 2.6-fold and 5.5-fold among short-sleeping children and adolescents, respectively.

“Early sleep interventions are a health priority because pediatricians should not expect insomnia symptoms to developmentally remit in a high proportion of children,” the authors wrote. “Objective sleep measures may be clinically useful in adolescence, a critical period for the adverse prognosis of the insomnia with short-sleep duration phenotype.”

School Closure

Recently, a new investigation into adolescent’s sleep and health-related characteristics during the COVID-19 pandemic identified 2 opposing associations between school closures and general adolescent health.

A negative association with psychological distress was observed, as was a beneficial association with increased sleep duration.

Investigators led by Helene Werner, PhD, Department of Psychology, University of Zurich, considered these findings to be important when evaluating and implementing school closures.

They added that previous studies had shown a positive association between increased adolescent sleep and later school start times (SSTs).

However, they could not identify whether the longer sleep duration during school closures was associated with health benefits, which prompted Werner and investigators to launch a survey study intended to fill the research hap regarding sleep and adolescents’ health during school closure.

During school closures, the surveys indicated that the sleep period on scheduled days was 75 minutes longer (semipartial R2 statistic [R2 0.222-0.254; P < .001).

Additionally, students reported better HRQoL (R2 P < .001) and less consumption of caffeine and other substances including alcohol. The data obtained from the study contrasted the findings from a recent study in Germany, which investigators believed may be contributed to stricter pandemic rules.

The study, “Trajectories of Insomnia Symptoms From Childhood Through Young Adulthood,” was published online in Pediatrics.