It's past your bedtime, but does it matter anymore? How longitudinal changes in bedtime rules relate to adolescents' sleep.

This study investigated how changing or maintaining parent-set bedtimes over time relates to adolescents' sleep timing, latency, and duration. Adolescents (n = 2509; Mage = 12.6 [0.5] years; 47% m) self-reported their sleep patterns, and whether they had parent-set bedtimes on two separate occasions in 2019 (T1; 12.6 years) and 2020 (T2; 13.7 years). We identified four groups based on parent-set bedtimes: (1) bedtime rules at both T1 and T2 (46%, n = 1155), (2) no bedtime rules at T1 nor T2 (26%, n = 656), (3) bedtime rules at T1 but not T2 (19%, n = 472), (4) no bedtime rules at T1 but a parent-set bedtime at T2 (9%, n = 226). As expected, the entire sample showed that bedtimes generally became later and sleep duration shorter across adolescence, but the change differed among the groups. Adolescents whose parents introduced bedtime rules at T2 reported earlier bedtimes and longer sleep duration (~20 min) compared with adolescents with no bedtime rules at T2. Importantly, they no longer differed from adolescents who consistently had bedtimes across T1 and T2. There was no significant interaction for sleep latency, which declined at a similar rate for all groups. These results are the first to suggest that maintaining or re-introducing a parent-set bedtime may be possible and beneficial for adolescents' sleep.

Paediatric sleep literacy in australian health professionals.

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.

Using big data to explore worldwide trends in objective sleep in the transition to adulthood.

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.

Altering Adolescents' Pre-Bedtime Phone Use to Achieve Better Sleep Health.

Mobile phone use is often blamed for adolescent sleeping difficulties in the popular and scientific literature, with correlations observed between adolescents' mobile phone use and their bedtime. We aimed to obtain experimental evidence to support these causal claims. A within-subjects experiment (baseline, intervention) was conducted in adolescents' homes, to determine the effect of restricting adolescents' pre-bed mobile phone use on school night sleep habits. Following a baseline week, adolescents were given individualized phone stop times, 1 hour before bed for one school week. An online sleep diary was used to monitor bedtime, lights out time, sleep latency and total sleep. Sixty three adolescents (age range 14-18, M = 16.3, SD = 0.93yrs; 17%male) provided data. During one week of phone restriction, adolescents stopped using their phones earlier (80 min, p < .001), turned their lights off earlier (17 min, p = .01), and slept longer (21 min, p = .01). Participant recruitment was low (26%), indicating many adolescents lack motivation to negotiate changes to their evening phone use. Overall, there are potential benefits of restricted mobile phone use during the pre-sleep period, yet, future research is needed to identify non-technological interventions to increase adherence to phone restriction (e.g., motivational interviewing) or otherwise decrease pre-sleep arousal (e.g., cognitive strategies).

Sleep spindles and cognitive performance across adolescence: A meta-analytic review.

Higher sleep spindle activity generally relates to better cognitive performance in adults, while studies in children often show the opposite. As children become young adults, there is rapid brain maturation and development of higher-order cognitive functions, and therefore investigations within this age group may elucidate the relationship between spindles and cognition in this developmental period. Twelve studies published between 2009 and 2016 were identified. Meta-analyses revealed a positive relationship between spindles and cognition overall (r = 0.27), however effects varied depending on cognitive domain. Moderate positive relationships were seen for fluid IQ (r = 0.44), working memory/executive function (r = 0.40) and speed/accuracy (r = 0.33), while full IQ/verbal IQ was not significantly associated (r = -0.05). Meta-regressions indicated cognitive domain and spindle characteristic had a small influence over effect sizes, while age and gender did not have a significant influence. The relationship between spindles and cognition in adolescents is likely influenced by individual neural makeup and brain maturation.

A randomised controlled trial of bright light therapy and morning activity for adolescents and young adults with Delayed Sleep-Wake Phase Disorder.

A randomised controlled trial evaluated bright light therapy and morning activity for the treatment of Delayed Sleep-Wake Phase Disorder (DSWPD) in young people. 60 adolescents and young adults (range = 13-24 years, mean = 15.9 ± 2.2 y, 63% f) diagnosed with DSWPD were randomised to receive three weeks of post-awakening Green Bright Light Therapy (∼507 nm) and Sedentary Activity (sitting, watching TV), Green Bright Light Therapy and Morning Activity (standing, playing motion-sensing videogame), Red Light Therapy (∼643 nm) and Sedentary Activity or Red Light Therapy and Morning Activity. Sleep (ie sleep onset time, wake up time, sleep onset latency, total sleep time) and daytime functioning (ie morning alertness, daytime sleepiness, fatigue, functional impairment) were measured pre-treatment, post-treatment and at one and three month follow-up. Contrary to predictions, there were no significant differences in outcomes between treatment groups; and interaction effects between treatment group and time for all outcome variables were not statistically significant. However, adolescents and young adults in morning activity conditions did not meaningfully increase their objective activity (ie movement frequency). Overall, adolescents reported significantly improved sleep timing (d = 0.30-0.46), sleep onset latency (d = 0.32) and daytime functioning (d = 0.45-0.87) post-treatment. Improvements in sleep timing (d = 0.53-0.61), sleep onset latency (d = 0.57), total sleep time (d = 0.51), and daytime functioning (d = 0.52-1.02) were maintained, or improved upon, at the three month follow-up. However, relapse of symptomology was common and 38% of adolescents and young adults requested further treatment in addition to the three weeks of light therapy. Although there is convincing evidence for the short-term efficacy of chronobiological treatments for DSWPD, long-term treatment outcomes can be improved. To address this gap in our current knowledge, avenues for future research are discussed. CLINICAL TRIAL: Australian & New Zealand Clinical Trials Registry, https://www.anzctr.org.au, ACTRN12614000308695.

Cognitive performance in adolescents with Delayed Sleep-Wake Phase Disorder: Treatment effects and a comparison with good sleepers.

The present study aimed to investigate whether Australian adolescents with Delayed Sleep-Wake Phase Disorder have impaired cognitive performance and whether chronobiological treatment for Delayed Sleep-Wake Phase Disorder improves adolescents' sleep, daytime functioning and cognitive performance. Adolescents with Delayed Sleep-Wake Phase Disorder (mean = 15.68 ±â€¯2.1 y, 62% f) reported significantly later sleep timing (d = 1.03-1.45), less total sleep time (d = 0.82) and greater daytime sleepiness (d = 2.66), fatigue (d = 0.63) and impairment (d = 2.41), compared to good sleeping adolescents (mean = 15.9 ±â€¯2.4 y, 75% f). However, there were no significant between-group differences (all p > 0.05) in performance on the Operation Span (ηp2 = 0.043), Digit Span (forwards: ηp2 = 0.002, backwards: ηp2 = 0.003), Letter Number Sequencing (ηp2 < 0.001) (working memory) and Digit-Symbol Substitution Tasks (ηp2 = 0.010) (processing speed). Adolescents with Delayed Sleep-Wake Phase Disorder went on to receive 3 weeks of light therapy. At 3 months post-treatment, adolescents with Delayed Sleep-Wake Phase Disorder reported significantly advanced sleep timing (d = 0.56-0.65), greater total sleep time (d = 0.52) and improved daytime sleepiness (d = 1.33), fatigue (d = 0.84) and impairment (d = 0.78). Performance on the Operation Span (d = 0.46), Letter Number Sequencing (d = 0.45) and Digit-Symbol Substitution tasks (d = 0.57) also significantly improved.

Nursing management and healthcare in Slovenia.

Nursing management and healthcare in Slovenia are undergoing rapid change as the country becomes independent. Nursing is changing the rigid hierarchy of health service and implementing professional development. Nurses are striving to become key players in delivery, decision making, and policy setting to ensure quality healthcare.