Dual Orexin Receptor Antagonist, Almorexant, in Elderly Patients With Primary Insomnia: A Randomized, Controlled Study.

Objective: Sleep laboratory study to determine the dose-related efficacy and safety of almorexant in elderly patients with primary chronic insomnia. Methods: Patients aged ≥65 years with primary insomnia were enrolled into a prospective, randomized, double-blind, placebo-controlled, multicenter dose-finding study with a five-period, five-way Latin square cross-over design. Patients were randomized to one of 10 unique sequences of two-night treatment with oral almorexant 25, 50, 100, or 200 mg capsules, or matching placebo. The primary efficacy endpoint was polysomnography (PSG)-determined mean wake time after sleep onset (WASO). Secondary and exploratory efficacy endpoints were also assessed. Results: 112 patients were randomized (mean [SD] age 72.1 [5.0] years; 69.9% female). Significant, dose-related improvements (reductions) in mean WASO were observed with almorexant. Least-squares mean (95% CI) treatment effects in the almorexant 200, 100, 50, and 25 mg dose groups versus placebo were -46.5 minutes (-53.0, -39.9; p < .0001), -31.4 minutes (-38.0, -24.9; p < .0001), -19.2 minutes (-25.7, -12.6; p < .0001), and -10.4 minutes (-17.0, -3.9; p = .0018), respectively. Mean total sleep time was significantly increased with each almorexant dose (mean increases versus placebo ranged 55.1-14.3 minutes; p < .0001 for each dose). Latency to persistent sleep was statistically significantly reduced only with almorexant 200 mg versus placebo (mean [95% CI] treatment effect -10.2 minutes, [-15.4, -5.0]; p = .0001). No unexpected safety concerns were identified. Adverse events were similar between all almorexant dose groups and placebo. Conclusions: Two-night oral administration of almorexant was effective and well tolerated in treating primary insomnia in elderly patients.

Field study on the impact of nocturnal road traffic noise on sleep: the importance of in- and outdoor noise assessment, the bedroom location and nighttime noise disturbances.

The aim of this field study is to gain more insight into the way nocturnal road traffic noise impacts the sleep of inhabitants living in noisy regions, by taking into account several modifying variables. Participants were tested during five consecutive nights in their homes and comparisons between effective indoor and outdoor noise levels (LAeq, LAmax, number of noise events), sleep (actigraphy and sleep logs) and aspects of well-being (questionnaires) were made. Also, we investigated into what extent nocturnal noise exposure - objectively measured as well as perceived - directly relates to sleep outcomes and how the bedroom location influenced our measurements. We found that subjects living and sleeping in noisy regions correctly perceive their environment in terms of noise exposure and reported an overall discomfort due to traffic noise. In the evaluation of the objective noise levels, the inside noise levels did not follow the outside noise levels, though the different noise patterns could be described as characteristic for a noise and quiet environment. The impact on sleep, however, was only modest and we did not find any influence of noise intrusion on mood or pre-sleep arousal levels. Concerning the subjectively reported noise disturbances during the night, a clear relationship between noise and sleep outcomes could be established; with sleep onset latencies and judged sleep quality being particularly affected. The importance of inside and outside noise assessment as well as the use of multiple noise indicators in a home environment is further described. Additional emphasis is put on the determination of quiet control regions and the bedroom location, as this can alter noise levels and sleep outcomes. Also, including subjective noise evaluations during the night might not only provide crucial information on how participants experience the noise, but also allows for a more qualitative interpretation of the actual noise situation.

Effects of pre-sleep media use on sleep/wake patterns and daytime functioning among adolescents: the moderating role of parental control.

The aim of this cross-sectional study was to investigate the influence of media use in the hour before bedtime on sleep/wake patterns and daytime functioning among adolescents and to examine the moderating role of parental control. A total of 1,926 Belgian students, 55% girls and 45% boys, with a mean age of 16.9 ± 1.5 years, completed a modified version of the School Sleep Habits Survey. Correlational analyses showed that media use, except television viewing, was associated with later bedtimes and longer sleep latencies. Cell phone and computer usage was negatively associated with daytime functioning. On schooldays, parental control had a moderating effect on the relationship between bedtime and computer use (ß = .05; p < .05) and between bedtime and mp3 player use (ß = .08; p < .01). During the weekend, parental control played a moderating role between bedtime and television viewing (ß = .06; p = .01). As media use can influence the sleep of adolescents considerably, parental control is necessary to regulate the exposure of adolescents to media and to moderate the detrimental effect of media use on sleep.

Excitatory versus inhibitory impairments in insomnia patients: an ERP study.

According to the neurocognitive perspective on insomnia, conditioned arousal results in impairment of information processing, as such interfering with normal sleep processes. In the present study, evening event-related potentials N100 and P200 were evaluated to assess hyperarousal in patients with insomnia and controls. 13 patients (mean age = 40.8) with polysomnographically verified sleep disruptions and 11 good sleepers (mean age = 45.4) were included. An auditory oddball paradigm was administered the evening of the polysomnography. N100 and P200 mean amplitudes and peak latencies at Fz and Cz were analyzed as a measure of respectively general arousability and inhibition of information processing. Patients experiencing insomnia were characterized by decreased P200 amplitudes compared to good sleepers. No significant differences were found for N100 amplitudes and latencies of both ERP waves. These results suggest that this group of patients with objectified insomnia is characterized by an arousal impairment. However, there was no evidence of hyperarousal, considering the normal N100 amplitudes. On the other hand, the inhibition of information processing was distorted. As such, the impairment of de-arousal or de-activation in insomnia is put forward as an additional factor within the arousal model.

Sleepiness phenomics: modeling individual differences in subjective sleepiness profiles.

The present study investigates individual differences in subjective sleepiness profiles during 36 h of sustained wakefulness in a modified constant routine protocol. Twenty-three volunteers (11 females), aged between 18 and 47 yrs (M age = 30.41, SD = 10.26) enrolled in the study. Subjective sleepiness ratings were collected every 2 h by means of visual analogue scales. Circadian rhythmicity was assessed by means of salivary cortisol. Subjective sleepiness data were analyzed using functional principal component analysis (fPCA). Our results show that approximately 80% of the variance is accounted for by three functional components. The first component explains 50.28% of the variance and is characterized by a profile of exclusively positive loadings, representing vertical shifts from the mean sleepiness profile. Scores on this component are positively related to self-reported habitual sleep times and mean slow wave activity (SWA) during wake. Positive scores on the second component (18.40% of the variance) are characterized by a higher than average peak-to-trough amplitude in subjective sleepiness profiles. Participants with higher than average scores on this component show a significantly higher amplitude in salivary cortisol profiles as opposed to participants with lower than average scores. Participants with positive scores on the third component (10.09% of the variance) show higher than average levels of subjective sleepiness during morning hours, a buildup of wake effort occurring later and more afternoon sleepiness after sleep deprivation than negative scorers. Peak levels of salivary cortisol occur significantly later in these participants. Taken together, our results suggest that component 1 represents tonic differences in sleepiness profiles primarily related to mechanisms of sleep homeostasis, component 2 to circadian amplitude differences and component 3 to diurnal preference. However, since the components are additions to a mean profile, each of the three components is likely to correspond to a mixture of multiple physiological parameters, rather than to a single process. The approach shows interesting potential for (1) revealing unidentified physiological processes, (2) testing existing assumptions about regulatory mechanisms at the basis of interindividual variability in sleepiness profiles and (3) the specification of sleepiness phenotypes on a quantitative basis.

Effects of pre-sleep simulated on-call instructions on subsequent sleep.

Nightly interventions, prevalent to on-call situations, can have negative consequences for those involved. We investigated if intervention-free-on-call-nights would also mean disturbance-free-sleep for people on-call. 16 healthy sleepers spent three nights in the laboratory: after a habituation night, reference and on-call night were counterbalanced. Subjects were instructed to react to a sound, presented at unpredictable moments during the night. Participants were unaware of the fact that the sound would never be presented. These vigilance instructions resulted in more subjective wake after sleep onset (WASO), lower subjective sleep efficiency and significantly lower experienced sleep quality. Objectively, a longer sleep onset, an increased amount of WASO and significantly lower sleep efficiency were observed. During deep sleep, significantly more beta activity was recorded. Apart from real nightly interventions increased vigilance during the night causes sleep to be less efficient and less qualitative as shown by an increase in wake-activity and a distorted sleep perception.

The influence of pre-sleep cognitive arousal on sleep onset processes.

Cognitive hyperarousal, resulting in enhanced cognitive activation, has been cited as an important contributor to the development and preservation of insomnia. To further understand this process, our study examined the effects of acutely-induced pre-sleep cognitive hyperarousal on sleep onset processes in healthy volunteers. Following an adaptation night, 15 subjects slept two nights in our sleep laboratory: one reference night and another one with cognitive arousal induction, in a counterbalanced order. In the cognitive arousal condition, subjects worked through half an hour of cognitive tasks without interference of an emotional component prior to retiring to bed. Objective sleep onset latency was significantly prolonged in the cognitive arousal condition compared to the reference condition. Significantly more high frequency activity was recorded during the first and second deep-sleep period. Moreover, differences in heart rate and proximal temperature during and after sleep onset were observed in the nights after the cognitive induction. Pre-sleep cognitive activation successfully induced a significant cognitive load and activation in our subjects to influence subsequent sleep (onset) processes.

Judgment of daytime sleepiness in self-reported short, long and midrange sleepers

Sleep-wake behavior, as well as sleepiness, is regulated by the joint action of an exponentially increasing drive for sleep -sleep homeostasis- and by variations in sleep propensity due to a biological circadian oscillator. However, large inter-individual differences remain. Short and long sleepers have been known to differ in the amount of homeostatic sleep pressure: long sleepers report higher levels of subjective sleepiness after sleep deprivation, whereas short sleepers exhibit no significant increase in sleepiness. The circadian pacemaker’s program might be at the origin of the variability in habitual sleep duration in long and short sleepers. Previous studies within our group showed that the dynamics of both processes are similar in experienced sleepiness as in judged sleepiness. The aim of the present investigation was to determine whether habitual short, long and midrange sleepers exhibit similar integration patterns or whether the biological underpinnings of habitual sleep time variability emerge when judging sleepiness. Our results show an additive integration rule for homeostatic and circadian determinants of daytime sleepiness in all groups. However, rescaled functional values (RSFVs) and relative range indices (RRIs) suggest that short sleepers seem to tolerate higher levels of homeostatic sleep pressure in comparison to long sleepers and that in long sleepers, circadian variability plays a less prominent role in functional daytime sleepiness. As sleep-wake behavior is governed by both physiological mechanisms and psychological processes influenced by past experiences related to sleep and wake, these results have implications for sleep-wake-related health and safety(AU)

Comparing real-life and laboratory-induced stress reactivity on cardio-respiratory parameters: differentiation of a tonic and a phasic component.

To recreate stress in laboratory conditions, the nature of the elicited physiological reactions to the presentation of mental tasks has been extensively studied. However, whether this experimental response is equivalent to real-life stress reactivity is still under debate. We investigated cardio-respiratory reactivity to a sequential protocol of different mental tasks of varying difficulties, some of them involving emotional material, and repeated the measures in a baseline and in a real-life stress situation. R-R interval (RRI), breathing frequency and volumes, and respiratory sinus arrhythmia (RSA) were computed. Baseline results showed a superior sensitivity of respiratory parameters to mental task load over RRI and RSA, no effect of task difficulty or emotional material, and a habituation response of all parameters along the protocol. Stress results showed a dual effect: first, a decreased RRI and RSA in rest values, and second, a decreased reactivity in RRI in response to mental tasks. These findings are discussed through the interaction of activation, considered to be a tonic variable, and arousal, as a phasic response.

Nocturnal road traffic noise: A review on its assessment and consequences on sleep and health.

Research on the impact of nocturnal road traffic noise on sleep and the consequences on daytime functioning demonstrates detrimental effects that cannot be ignored. The physiological reactions due to continuing noise processing during night time lead to primary sleep disturbances, which in turn impair daytime functioning. This review focuses on noise processing in general and in relation to sleep, as well as methodological aspects in the study of noise and sleep. More specifically, the choice of a research setting and noise assessment procedure is discussed and the concept of sleep quality is elaborated. In assessing sleep disturbances, we differentiate between objectively measured and subjectively reported complaints, which demonstrates the need for further understanding of the impact of noise on several sleep variables. Hereby, mediating factors such as noise sensitivity appear to play an important role. Research on long term effects of noise intrusion on sleep up till now has mainly focused on cardiovascular outcomes. The domain might benefit from additional longitudinal studies on deleterious effects of noise on mental health and general well-being.

The emotional brain and sleep: an intimate relationship.

Research findings confirm our own experiences in life where daytime events and especially emotionally stressful events have an impact on sleep quality and well-being. Obviously, daytime emotional stress may have a differentiated effect on sleep by influencing sleep physiology and dream patterns, dream content and the emotion within a dream, although its exact role is still unclear. Other effects that have been found are the exaggerated startle response, decreased dream recall and elevated awakening thresholds from rapid eye movement (REM)-sleep, increased or decreased latency to REM-sleep, increased REM-density, REM-sleep duration and the occurrence of arousals in sleep as a marker of sleep disruption. However, not only do daytime events affect sleep, also the quality and amount of sleep influences the way we react to these events and may be an important determinant in general well-being. Sleep seems restorative in daily functioning, whereas deprivation of sleep makes us more sensitive to emotional and stressful stimuli and events in particular. The way sleep impacts next day mood/emotion is thought to be affected particularly via REM-sleep, where we observe a hyperlimbic and hypoactive dorsolateral prefrontal functioning in combination with a normal functioning of the medial prefrontal cortex, probably adaptive in coping with the continuous stream of emotional events we experience.

An exploratory study on the effects of tele-neurofeedback and tele-biofeedback on objective and subjective sleep in patients with primary insomnia.

Insomnia is a sleeping disorder, usually studied from a behavioural perspective, with a focus on somatic and cognitive arousal. Recent studies have suggested that an impairment of information processes due to the presence of cortical hyperarousal might interfere with normal sleep onset and/or consolidation. As such, a treatment modality focussing on CNS arousal, and thus influencing information processing, might be of interest. Seventien insomnia patients were randomly assigned to either a tele-neurofeedback (n = 9) or an electromyography tele-biofeedback (n = 8) protocol. Twelve healthy controls were used to compare baseline sleep measures. A polysomnography was performed pre and post treatment. Total Sleep Time (TST), was considered as our primary outcome variable. Sleep latency decreased pre to post treatment in both groups, but a significant improvement in TST was found only after the neurofeedback (NFB) protocol. Furthermore, sleep logs at home showed an overall improvement only in the neurofeedback group, whereas the sleep logs in the lab remained the same pre to post training. Only NFB training resulted in an increase in TST. The mixed results concerning perception of sleep might be related to methodological issues, such as the different locations of the training and sleep measurements.

The algebra of sleepiness: investigating the interaction of homeostatic (S) and circadian (C) processes in sleepiness using linear metrics

The present studies were conducted to contribute to the debate on the interaction between circadian (C) and homeostatic (S) processes in models of sleep regulation. The Two-Process Model of Sleep Regulation assumes a linear relationship between processes S and C. However, recent elaborations of the model, based on data from forced desynchrony studies, suggest a nonlinear interaction between both processes. Whether this interaction is due to an interaction at substantial level or an artifact from the use of nonlinear metrics remain largely unknown, partly because usual experimental procedures in sleep research do not provide the necessary means to make this distinction. In this study we apply Functional Measurement methodology to demonstrate the linearity of two subjective sleepiness scales (Karolinska Sleepiness Scale and Visual Analogue Scale for sleepiness/alertness) and subsequently use these instruments in a judgment task based on information on prior sleep and time of day. Our results show that, when using linear metrics, processes S and C are integrated according to a differential weighting averaging rule, which consequently implies that both processes are psychologically related in a nonlinear way when sleepiness judgments are performed(AU)

Comparative sensitivity of outcome variables of a software-based Behavioral Sleep Resistance Task.

Unintentional sleep and performance impairment due to extended wakefulness are often the cause of traffic and work accidents. Therefore, large-scale screening instruments assessing the ability to resist falling asleep during monotonous tasks are needed. The current widespread computer use in industrial and home settings offers the possibility to use software-based instruments as an alternative for expensive hardware interfaces to assess sleep resistance. Therefore, we propose a software-based sleep resistance task based on the procedure of the Oxford SLEep Resistance test (OSLER): the Behavioral Sleep Resistance Task (BSRT). In order to validate this instrument we submitted 36 healthy individuals to four 40-min sleep resistance challenges during a night of extended wakefulness (14, 16, 18 and 20 h). Subjective sleepiness was assessed by means of the Karolinska Sleepiness Scale and a Visual Analogue Scale for sleepiness/alertness and objective sleepiness by means of a 4-min EEG-monitored fixation task. Our results show significant correlations of BSRT hit ratio, error profiles and sleep onset latency variables with subjective sleepiness and of BSRT hit ratio and 3-6 error profiles with High-Beta Central EEG activity. Additionally, using a distribution- and scale-free sensitivity index, we found that subjective sleepiness measures are the most sensitive to the effects of sustained wakefulness, closely followed by the BSRT hit ratio and BSRT error profile 3-6.

Simulator driving performance, subjective sleepiness and salivary cortisol in a fast-forward versus a slow-backward rotating shift system.

OBJECTIVES: The objectives of this study were to examine simulator driving and subjective sleepiness after morning, afternoon, and night shifts and to compare these differences, as well as objective stress, between a fast-forward and a slow-backward rotating shift system. METHODS: The participants were male volunteers working in a chemical plant, 18 in a slow-backward rotating system and 18 in a fast-forward rotating system. All of the participants performed a driving simulator test and subjectively estimated sleepiness after a night, afternoon, and morning shift. Salivary cortisol samples, as indicators of the objective stress level, at the beginning of the workweek-after the second morning shift-were compared between the two rotating shift systems. RESULTS: Lane drifting was higher after a night shift than after an afternoon shift. No effect of rotation system on driving performance could be shown. The subjective sleepiness scores were significantly higher in the slow-backward rotating group than in the fast-forward rotating group. A significant effect of shift type was also observed, with lower levels of sleepiness after the afternoon shift than after the morning and night shifts. Salivary cortisol samples taken at the start of the workweek did not significantly differ between the fast-forward and the slow-backward rotation shift systems. CONCLUSIONS: This study indicated that shift type is more important than shift schedule-direction and speed of rotation-in determining driving performance. Performance seemed to be threatened mostly by a night shift and the least by an afternoon shift. In contrast, subjective sleepiness also differed between rotation groups and indicated an advantage of the fast-forward rotation system. The exploratory salivary cortisol measurements suggested that the shift systems studied do not differ in the level of stress they induce, that is to say at the beginning of the workweek.

Defining the occurrence and influence of alpha-delta sleep in chronic fatigue syndrome.

BACKGROUND: Patients with chronic fatigue syndrome (CFS) present a disordered sleep pattern and frequently undergo polysomnography to exclude a primary sleep disorder. Such studies have shown reduced sleep efficiency, a reduction of deep sleep, prolonged sleep initiation, and alpha-wave intrusion during deep sleep. Deregulation of the 2-5A synthetase/RNase L antiviral pathway and a potential acquired channelopathy are also found in a subset of CFS patients and could lead to sleep disturbances. This article compiles a large sleep study database on CFS patients and correlates these data with a limited number of immune parameters as it has been thought that RNase L could be associated with these sleep disturbances. METHODS: Forty-eight patients who fulfilled 1994 Centers for Disease Control and Prevention criteria for CFS underwent extensive medical evaluation, routine laboratory testing, and a structured psychiatric interview. Subjects then completed a complaint checklist and a two-night polysomnographic investigation. RNase L analysis was performed by gel electrophoresis using a radiolabeled 2',5'-oligoadenylate trimer. Basic descriptive statistical parameters were calculated. RESULTS: Patients experienced a prolonged sleep latency, showed a low sleep efficiency index, and had a low percentage of slow wave sleep. The present alpha-delta intrusion correlated with anxiety; no correlations appeared, however, between alpha-delta sleep and immunologic parameters, including RNase L. CONCLUSIONS: The main findings are 1) validation of sleep latency problems and other sleep disturbances as already suggested by several authors; 2) alpha-delta intrusion seems associated with anxiety; and 3) elevated RNase L did not correlate with alpha-delta sleep.

Neurophysiological aspects of primary insomnia: implications for its treatment.

Insomnia has usually been studied from a behavioral perspective. Somatic and/or cognitive conditioned arousal was shown to play a central role in sleep complaints becoming chronic, and was used as a starting point for the development of treatment modalities. The introduction of the neurocognitive perspective, with its focus on cortical or CNS arousal, has given rise to a renewed interest in the neurophysiological characteristics of insomnia. Recent research, using quantitative EEG, neuroimaging techniques and the study of the microstructure of sleep, suggests a state of hyperarousal with a biological basis. Furthermore, insomnia might not be restricted to sleep complaints alone because it appears to be a 24-h disorder, affecting several aspects of daytime functioning as well. These new findings have implications for the treatments used and indicate that a focus on cortical or CNS arousal should be pursued. As such, the use of EEG neurofeedback, a self-regulation method based on the paradigm of operant conditioning, might be a promising treatment modality. Preliminary results for insomnia and successful applications for other disorders suggest that this treatment can have the necessary stabilizing effects on the EEG activity, possibly resulting in a normalizing effect on daytime as well as nighttime functioning.

Individualized and time-variant model for the functional link between thermoregulation and sleep onset.

This study makes use of control system model identification techniques to examine the relationship between thermoregulation and sleep regulation. Specifically, data-based mechanistic (DBM) modelling is used to formulate and experimentally test the hypothesis, put forth by Gilbert et al., that there exists a connection between distal heat loss and sleepiness. Six healthy sleepers each spent three nights and the following day in the sleep laboratory: an adaptation, a cognitive arousal and a neutral testing day. In the cognitive arousal condition, a visit of a television camera crew took place and subjects were asked to be interviewed. During each of the three 25-min driving simulator tasks per day, the distal-to-proximal gradient and the electroencephalogram are recorded. It is observed from these experimental data that there exists a feedback connection between thermoregulation and sleep. In addition to providing experimental evidence in support of the Gilbert et al. (2004) hypothesis, the authors propose that the nature of the feedback connection is determined by the nature of sleep/wake state (i.e. NREM sleep versus unwanted sleepiness in active subjects). Besides this, an individualized and time-variant model for the linkage between thermoregulation and sleep onset is presented. This compact model feeds on real-time data regarding distal heat loss and sleepiness and contains a physically meaningful parameter that delivers an individual- and time-depending quantification of a well known biological features in the field of thermoregulation: the thermoregulatory error signal T(hypo)(t)-T(set)(t). A validation of these physical/biological features emphasizes the reliability and power of DBM in describing individual differences related to the sleep process.

Multidimensional scaling of pediatric sleep breathing problems and bio-behavioral correlates.

STUDY OBJECTIVES: Complex relationships exist between pediatric sleep disorders and daytime behavior. Using a multidimensional scaling model, we investigated these relationships in 126 children with sleep breathing disorders (SBD). METHOD: Validated questionnaires on nighttime behavior, daytime behavior, and respiratory health were administered to a large number of school children in Belgium. Children who met the criterion of having at least one sleep-related breathing problem (three or more times per week during the past six months) were selected for further analyses. A total of 26 indicators were defined and modeled, including sleep problems, sleep efficiency, sleep environment, sleep enuresis, internalised and externalised behavioral problems, respiratory health of the child and relatives, smoking exposure, and caffeine consumption. RESULTS: From 3,045 questionnaire responses 4.1% of the children were reported to have a SBD symptom. SBD children differed on sleep and health domains from non-SBD children. Furthermore, through scaling of the (dis)similarities among the 26 indicators the SBD child was able to be modeled. By way of an internal analysis of the data-matrix the following indicators were eliminated: sleep correlates, health of the family, and behavior rated by teachers, followed by caffeine intake, drugs, and behavior rated by the parents. This revealed a two-dimensional model, consisting of primary SBD and secondary SBD. CONCLUSION: Children with SBD differ on many domains from children without such disorders and an underlying two-fold SBD concept was found. Firstly, the SBD-indicator positioned in between investigated correlates with disorders of initiating and maintaining sleep and sleep hyperhydrosis on one hand and with respiratory-related illnesses on the other; this was labeled primary SBD. Secondly, the SDB-indicator not closely associated with any of the investigated correlates can be interpreted as secondary SBD.

Odds, prevalence and predictors of sleep problems in school-age normal children.

The objectives of the study were to describe the prevalence, odds, and predictors of 36 paediatric sleep behaviours and describe their coexistence in a school-age normal population. The design was community-based questionnaire survey of sleep-wake patterns, sleep environment, and 36 sleep behaviours indicative of six sleep disorder-subscales using the Health-Behaviour Questionnaire. A caregivers' report of 3045 children aged 6-13 years in Belgium constituted the participants. Prevalence of each sleep behaviour was calculated. Log-linear modelling within and between the sleep disorder-subscales was used to screen for coexistence. The effect size of selected night-time parameters to the likelihood of sleep behaviours and disorder-subscale was expressed as odds ratios via logit regression analysis. Significant differences in sleep-wake patterns were found between weekday and weekend. Ranking by odds showed that: (1) sleep problems such as 'tired when waking up', 'repetitive limb movements', 'going to bed reluctantly', and 'sleep paralysis' and; (2) the disorder-subscale 'excessive somnolence' are common in children. Coexistences within and between disorder-subscales of sleep problems are evident in a school-age, normal population. These results suggest that disorders of excessive somnolence (DES) are highly prevalent in a non-clinical sample of school-age children. Furthermore, sleep-onset latency and a noisy, not well-darkened room are predictive towards the odds for exhibiting sleep problems and disorders. It is advocated that more information on the importance of good sleep-wake hygiene should reach parents and children.