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Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study.

CONTEXT: Studies have demonstrated strong associations between the prone sleep position (on the stomach) and sudden infant death syndrome (SIDS). In 1992, the American Academy of Pediatrics recommended that infants be placed to sleep laterally (on their side) or supine (on their back) to reduce SIDS risk, and in 1994, the national public education campaign "Back to Sleep" was launched. OBJECTIVE: To determine the typical sleep position of infants younger than 8 months in the United States, the changes that occurred after these recommendations, and the factors associated with the placement of infants prone or supine. DESIGN: Annual nationally representative telephone surveys. SETTING: The 48 contiguous states of the United States. PARTICIPANTS: Nighttime caregivers of infants born within the last 7 months between 1992 and 1996. Approximately 1000 interviews were conducted per year. MAIN OUTCOME MEASURES: The position the infant was usually placed in for sleep, and the position the infant was most commonly found in when checked during the night's sleep. RESULTS: Ninety-seven percent of respondents in each wave of the survey usually placed their infant to sleep in a specific position. Infants were placed in the prone position by 70% of caregivers in 1992, prior to the campaign, but only 24% in 1996. Supine and lateral placements increased during this time period, from 13% in 1992 to 35% in 1996 and from 15% in 1992 to 39% in 1996, respectively. Significant predictors of prone placement included maternal race reported as black (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.68-3.26), mother's age 20 to 29 years (OR, 1.28; 95% CI, 1.09-1.50), region reported as the mid-Atlantic (OR, 1.41; 95% CI, 1.12-1.78) or southern states (OR, 1.47; 95% CI, 1.22-1.70), mothers with a previous child (OR, 1.68; 95% CI, 1.43-1.97), and infants younger than 8 weeks (OR, 0.63; 95% CI, 0.46-0.85). Infants aged 8 to 15 weeks were significantly more likely to be placed nonprone over time compared with the other age groups. Most of the risk factors for prone were significantly related in the opposite direction to supine placement. CONCLUSIONS: The prevalence of infants placed in the prone sleep position declined by 66% between 1992 and 1996. Although causality cannot be proved, SIDS rates declined approximately 38% during this period. To achieve further reduction in prone sleeping, efforts to promote the supine sleep position should be aimed at groups at high risk for prone placement.

Guidelines as Topic↗
PubMed2006

Sleep in captive chimpanzee (Pan troglodytes): the effects of individual and environmental factors on sleep duration and quality.

Various abiotic and social factors are hypothesized to influence sleep in primates. Chimpanzee sleeping behavior has been examined only in a limited fashion, both in the wild and in captivity. Previous research, however limited, has suggested that chimpanzee sleep is non-dynamic. This study used an objective behavioral model of sleep as a framework in which to test the hypothesis that changes in individual (age and sex) and environmental (temperature and humidity) factors influence sleep patterns in 20 captive chimpanzees. The nocturnal behavior of the subjects was recorded continuously using video cameras equipped with enhanced nighttime visibility connected to time-lapse videocassette recorders. Chimpanzees in this study slept 8.81 h per night, close to the averages reported for both industrialized and traditional human societies (7-9h), as opposed to that of previous chimpanzee studies (11-12h). Also, the idea that chimpanzees sleep in one continuous period with little to no nocturnal awakenings was also refuted. Captive chimpanzee sleep behavior was, in fact, dynamic and complex with frequent awakenings. Older chimpanzees slept longer, had higher sleep quality, and shorter nighttime disturbances than prime adult chimpanzees. Finally, ambient temperature and humidity affected sleep duration and quality. The results of this study reveal that chimpanzee sleep behaviors are complicated interactions between both intrinsic and extrinsic factors.

Age Factors↗
PubMed2004

Knowledge of sleep in Italian high school students: pilot-test of a school-based sleep educational program.

PURPOSE: To evaluate knowledge about sleep and the effect of a sleep educational program on a group of Italian adolescents. METHODS: The program consisted of a 2-hour interactive sleep educational course. To assess students' sleep patterns and habits, the School Sleep Habits Survey was completed by 540 students, aged 17 to 19 years, who were attending three secondary public schools. Students were randomly assigned to the control and intervention group. Only the latter participated in the educational program. A pre-test evaluated baseline knowledge about sleep, a post-test measured the gain in knowledge after the course, and a 3-month follow-up test evaluated long-term retention of information. Improvement in knowledge was measured by increase in correct answers and comparisons of means between baseline and follow-up mean scores. Control group completed only baseline and 3-month follow-up tests. Data were analyzed using repeated measures analysis of variance, Cochran Q, and McNemar tests. RESULTS: Paired data were available for 425 students. Results showed unhealthy sleeping habits in 34% of students associated with high level of subjective sleepiness, increased vulnerability to injuries, and poor daytime functioning. Pre-test score showed a value of 4.2, post-test of 8.6 and 3-month follow-up of 6.7. Low baseline knowledge about sleep, an increase in knowledge, with an average of 50% gain in the percentage of correct answers immediately after the course, with a good long-term retention of information were found for the students who received the intervention as compared with control group. CONCLUSION: Sleep educational programs for secondary students are recommended to improve information about sleep.

Adolescent↗
PubMed1999

Pretreatment REM sleep and subjective sleep quality distinguish depressed psychotherapy remitters and nonremitters.

BACKGROUND: We compared pretreatment subjective and electroencephalographic sleep measures among depressed patients who remitted with psychotherapy alone and those who did not remit. METHODS: Patients were 111 midlife women with recurrent major depressive disorder. Baseline psychiatric ratings and sleep studies were conducted prior to treatment with weekly interpersonal psychotherapy. Remission was defined as a score of < or = 7 for 3 consecutive weeks on the Hamilton Depression Rating Scale. Clinical and sleep measures were compared between remitters (n = 62) and nonremitters (n = 49) using t tests and random regression. Linear discriminant function analyses were used to categorize remitters and nonremitters on the basis of sleep measures. RESULTS: Treatment nonremitters had significantly worse subjective sleep quality and significantly elevated phasic REM sleep as measured by multivariate and univariate analyses. The linear accumulation of REM activity during sleep occurred at a significantly higher rate in nonremitters than in remitters. Linear discriminant function analyses based on subjective sleep quality and REM activity correctly identified 68.3% of nonremitters and 68.5% of remitters. CONCLUSIONS: These findings highlight the role of subjective and REM sleep measures as correlates of short-term psychotherapy treatment response in major depressive disorder. Disturbed sleep may be a physiological indicator of increased limbic and brain stem arousal.

Adult↗
PubMed2002

Sleep complaints cosegregate with illness in older adults: clinical research informed by and informing epidemiological studies of sleep.

OBJECTIVE: The more recent epidemiological studies of sleep complaints have shown that when factors such as physical and psychiatric illness, medication use and drug and alcohol use are accounted for, the age-related increase in prevalence of sleep complaints is strikingly less than in those earlier studies without such controls. In an effort to support this finding, we examined the relationships between clinical health screenings and sleep complaints and disorders in two large groups of potential research volunteers (total N=2954). METHODS: As part of a study of older adults at risk for Alzheimer's disease, two large groups of potential research volunteers (n=1619 and 1335, respectively) replied to advertisements that made no mention of sleep and underwent three increasingly rigorous levels of health screening. At each level of screening, medical and psychiatric health and history were assessed and, where appropriate, subjects were excluded from further study participation before any mention of sleep quality or sleep complaint was made. The remaining subjects then underwent polysomnography. RESULTS: Of 1619 elderly adult volunteers screened in this manner, only 51 (3.14%) were found to have significant sleep complaints or disorders. The second group of 1335 screened in this manner revealed a similar pattern with only 18 (1.35%) having significant sleep complaints or disorders. CONCLUSIONS: These findings indicate that careful health assessments will screen out most sleep complaints and disorders in the older population and lend further support to the epidemiological evidence demonstrating that the bulk of geriatric sleep complaints and disorders is not the result of age per se, but rather cosegregates with medical and psychiatric disorders and related health burdens.

Aged↗
PubMed2000

Physiological basis: how NREM sleep components can promote and REM sleep components can suppress seizure discharge propagation.

OBJECTIVES: To describe how the neural generators of different sleep components can provoke seizure discharge propagation during NREM sleep and can suppress it during REM sleep. METHODS: Experimental manipulations of discrete physiological components were conducted in feline epilepsy models (n=64), mostly in the systemic penicillin epilepsy model of primary generalized epilepsy and the amygdala kindling model of the localization-related seizure disorder, temporal lobe epilepsy. Procedures included seizure induction as well as quantifying norepinephrine concentrations (microdialysis) and the sleep-waking state distribution of seizures before and after lesions, systemic and localized drug administration and/or photic stimulation. RESULTS: (1) Neural generators of synchronous EEG oscillations, including tonic background slow waves and phasic 'arousal' events (sleep EEG transients such as sleep spindles, k-complexes), can combine to promote electrographic seizure propagation during NREM and drowsiness; anti-gravity muscle tone permits seizure-related movement. (2) Neural generators of asynchronous neuronal discharge patterns can reduce electrographic seizures during alert waking and REM sleep; skeletal motor paralysis blocks seizure-related movement during REM. (3) Etiology of the seizure disorder can interact with sleep and arousal mechanisms to determine sleep-waking state distribution of interictal and ictal events. CONCLUSIONS: Differential effects of NREM versus REM sleep components on seizure discharge propagation are to some extent non-specific and in other ways specific to seizure etiology.

Animals↗
PubMed2004

Sleep patterns and sleep disorders in children with autistic spectrum disorders: insights using parent report and actigraphy.

The present study sought to describe the profile of sleep disturbance reported in children with autistic spectrum disorders (ASDs) and to document any sleep disorders underlying reports of sleeplessness. Sixty-nine children aged 5 to 16 years (mean 9 years 4 months, SD 2 years 7 months; 14 females) with an ASD were assessed by detailed sleep histories taken from parents, the Simonds and Parraga Sleep Questionnaire, a 2-week sleep diary, and actigraphs worn by the child for five nights. Parent-reported sleeplessness featured prominently (64%). Sleep disorders underlying the sleeplessness were most commonly behavioural (i.e. to do with inappropriate sleep-related behaviours), although sleep-wake cycle disorders and anxiety-related problems were also seen. In addition, the sleeplessness patterns of a large minority of children could not be classified by conventional diagnostic criteria. Sleep patterns measured objectively did not differ between those children with or without reported sleeplessness, but the sleep quality of all children seemed to be compromised compared with normal values.

Adolescent↗
PubMed2004

The biologic effects of grounding the human body during sleep as measured by cortisol levels and subjective reporting of sleep, pain, and stress.

OBJECTIVES: Diurnal cortisol secretion levels were measured and circadian cortisol profiles were evaluated in a pilot study conducted to test the hypothesis that grounding the human body to earth during sleep will result in quantifiable changes in cortisol. It was also hypothesized that grounding the human body would result in changes in sleep, pain, and stress (anxiety, depression, irritability), as measured by subjective reporting. SUBJECTS AND INTERVENTIONS: Twelve (12) subjects with complaints of sleep dysfunction, pain, and stress were grounded to earth during sleep for 8 weeks in their own beds using a conductive mattress pad. Saliva tests were administered to establish pregrounding baseline cortisol levels. Levels were obtained at 4-hour intervals for a 24-hour period to determine the circadian cortisol profile. Cortisol testing was repeated at week 6. Subjective symptoms of sleep dysfunction, pain, and stress were reported daily throughout the 8-week test period. RESULTS: Measurable improvements in diurnal cortisol profiles were observed, with cortisol levels significantly reduced during night-time sleep. Subjects' 24-hour circadian cortisol profiles showed a trend toward normalization. Subjectively reported symptoms, including sleep dysfunction, pain, and stress, were reduced or eliminated in nearly all subjects. CONCLUSIONS: Results indicate that grounding the human body to earth ("earthing") during sleep reduces night-time levels of cortisol and resynchronizes cortisol hormone secretion more in alignment with the natural 24-hour circadian rhythm profile. Changes were most apparent in females. Furthermore, subjective reporting indicates that grounding the human body to earth during sleep improves sleep and reduces pain and stress.

Arousal↗
PubMed2005

Sleep complaints, subjective and objective sleep patterns, health, psychological adjustment, and daytime functioning in community-dwelling older adults.

We examined sleep complaints, subjective and objective sleep patterns, health, psychological adjustment, and daytime functioning in 103 community-dwelling older adults to identify factors associated with sleep complaints. We collected 2 weeks of sleep diaries and actigraphy. Only health distinguished complaining from noncomplaining sleepers. Noncomplaining good sleepers had poorer objective sleep quantity than complaining poor sleepers. Actigraphy distinguished noncomplaining good and complaining poor sleepers only. Subjective and objective sleep quantities were related for noncomplainers only; this relationship was stronger for women. Implications include a need for research exploring: 1. sleep complaints, sleep perceptions, and health; 2. interventions focusing on older individuals with insomnia secondary to/comorbid with poor health; 3. gender differences in subjective sleep estimates and in "single-shot" versus longitudinal sleep measures.

Adaptation, Psychological↗
PubMed1997

Arousal and cardiorespiratory responses to airflow obstruction in sleeping lambs: effects of sleep state, age, and repeated obstruction.

We studied the effects of postnatal age on arousal and cardiorespiratory responses to airflow obstruction in sleeping lambs: we also determined the influence of sleep states and repeated airflow obstruction. Sixteen lambs were chronically prepared for monitoring sleep states, arterial O2 saturation (SaO2), heart rate (HR), and intrapleural pressure (Pp1) and were studied from 2-29 days after birth. Obstruction of respiratory airflow by facemask occlusion led to arterial desaturation, augmentation of respiratory efforts, bradycardia, and arousal. Lambs aroused more rapidly and with less desaturation in non-rapid eye movement (NREM) sleep (7 +/- 1 second and 7 +/- 1%, respectively) than in rapid eye movement (REM) sleep (18 +/- 2 seconds and 22 +/- 2%), and cardiac slowing was less in NREM than in REM sleep. In REM sleep only, the arousal latency and desaturation at arousal were affected by postnatal age; arousal responses occurred most rapidly in the youngest (< or = 6 days) and oldest (> or = 13 days) age groups and were delayed at 7-12 days. Repeated episodes of airflow obstruction led to reduced arousability in REM sleep only. We conclude that arousal from REM. but not NREM, sleep in response to the obstruction of respiratory airflow is transiently depressed during early postnatal development and that repeated obstructions and arousals also lead to depressed arousal from REM sleep.

Age Factors↗
PubMed2004

Effects of maternal separation on baseline sleep and cold stress-induced sleep rebound in adult Wistar rats.

STUDY OBJECTIVES: To evaluate the influence of early life environments on basal and cold stress-induced sleep patterns in rats. DESIGN: The design was a 3 (Groups [control, early handling, maternal separation]) x 2 (Situations [basal, poststress]) x 11 (Time-blocks) factorial design. From postnatal days 2 to 14, whole litters were either submitted to early handling (15 minutes per day away from the mother) or maternal separation (180 minutes per day away from the mother). At 75 to 90 days of age, sleep was recorded for 22 hours (beginning at 9:00 AM) before and after 1 hour of cold stress (4 degrees C). SUBJECTS: Wistar male rats (n = 7-10 animals per group). MEASUREMENTS AND RESULTS: Sleep was analyzed in blocks of 2 hours, in 30-second epochs, separately in the daytime and nighttime sleep recordings. Maternally separated rats exhibited more paradoxical sleep at baseline, compared to both control and early-handled rats. In the first 2 hours following the end of cold stress, all groups showed a decrease in paradoxical sleep, whereas slow-wave sleep was reduced only in the control group. The highest corticosterone plasma concentration was observed immediately after stress. Sleep rebound after stress was equally manifested in all groups in the dark part of the light-dark cycle. CONCLUSIONS: Maternal separation during early infancy resulted in permanent changes of the sleep architecture reflected by augmented time spent in paradoxical sleep. Although these findings were not expected in light of the literature, they emphasize the importance of the early familiar environment on future behavior of rats.

Animals↗
PubMed1982

The threshold of sleep: perception of sleep as a function of time asleep and auditory threshold.

A number of studies have found that many subjects have reported being awake when awakened during various periods of electroencephalographically (EEG)-defined sleep. These observations have led to an examination of the perception of sleep after periods when EEG-defined sleep was experimentally varied between 1 and 140 min. Twelve normal young adult subjects slept in the laboratory for 5 consecutive nights. Each subject was briefly awakened five times on each night, and subjective state, auditory arousal threshold, and sleep/wake time estimation data were collected. The threshold of sleep onset (i.e., the point at which a report of sleep was given 50% of the time) occurred 2-4 min after the first sleep spindle. In contrast, auditory thresholds rose rapidly within 1 min of the first sleep spindle. The threshold data corroborate the appearance of a sleep spindle as an objective measure of sleep onset. However, subjective sleep onset appears to be a relatively lengthy period during which perception of state is blurred and uncertain.

Adolescent↗
PubMed1996

Beyond the stages of sleep: an emerging nursing model of sleep phases.

The stages of rapid eye movement and non-rapid eye movement sleep are common topics in most nursing texts. It is impractical, however, to verify the stages of sleep in hospitalized patients. The article present a nursing model of sleep phases that uses observed behavior to identify which phase of sleep the adult patient is experiencing. The model is based on the findings from a qualitative study of 16 women hospitalized with myocardial infarction. Subsequent analysis of the data led to the development of Dreher's model of sleep phases. The retiring phase begins with declining arousal and preparations for sleep and continues until the onset of sleep. The resting phase begins with the onset of sleep and continues until the onset of final awakening. The rising phase commences with the onset of awakening and continues until the complete arousal. This model is presented as an emerging nursing model in which the behavior of sleep in hospitalized adults can be described. It is hoped that the model can be used to help nurses conceptualize sleep pattern disturbances so that appropriate nursing interventions can be implemented.

Female↗
PubMed2007

Obstructive sleep apnoea syndrome--patients' perceptions of their sleep and its effects on their life situation.

AIM: This paper reports a descriptive study of how untreated patients with obstructive sleep apnoea syndrome perceived their sleep situation and how the syndrome affected their life situation. BACKGROUND: Obstructive sleep apnoea syndrome is a prevalent problem independently associated with an increased risk for hypertension, cardiovascular disease, chronic heart failure and mortality. Increased consumption of healthcare resources can often be seen among patients over a long period of time since many have been undiagnosed and untreated. METHODS: A phenomenographic approach was employed. Data were collected by interviews during 2005 with 20 purposively selected participants with untreated obstructive sleep apnoea syndrome. Findings. Participants described loud snoring, frequent awakenings, dyspnoea, frustration over nocturia, fear of dying during sleep and partners' anxiety about the apnoea, as being night-time effects of obstructive sleep apnoea syndrome. They described dry and sore throats, tiredness and daytime sleepiness, shame about falling asleep and snoring, thoughts about complications and depressed mood as daytime effects. Needs, such as increased alertness, improved ability to concentrate, improved relationship, adequate information as well as effective treatment, were described. Participants tried self-care strategies such as information-seeking about sleep disturbances and treatment, adapted sleeping routines, change of bedroom arrangements, adapted daily schedules, hyperactivity and avoidance of difficult situations. CONCLUSION: The perceived effects and needs, as well as tried self-care actions by the patients with obstructive sleep apnoea syndrome in this study, could be used to identify and evaluate concerns of other patients with obstructive sleep apnoea syndrome waiting for treatment.

Adult↗
PubMed2006

Learning-dependent changes in sleep spindles and Stage 2 sleep.

It has become increasingly clear that sleep is necessary for efficient memory consolidation. Recently, it has been found that Stage 2 sleep disruption impairs procedural memory performance, and that memory performance is correlated with the duration of Stage 2 sleep; but the mechanisms involved in synaptic plasticity for procedural memory during sleep have not been identified. The present study examined the learning-dependent changes in sleep, including Stage 2 sleep spindles. Following an intense period of simple motor procedural learning, the duration of Stage 2 sleep and spindle density increased. There were no changes observed in the duration of any other stage of sleep or in the density of rapid eye movements. These findings support the hypothesis that sleep spindles are involved in the off-line reprocessing of simple motor procedural memory during Stage 2 sleep.

Adult↗
PubMed2005

Changes in sleep problems, parents distress and impact of sleep problems from infancy to preschool age for referred and unreferred children.

This article compares and describes changes in sleep problems in 3- to 5-year-old Icelandic children referred and unreferred for sleep problems in infancy and explores changes in parents' distress and the impact of children's sleep problems on families over time. The sample consisted of a clinical group (n = 31) that had been referred to a sleep-disorder clinic in infancy, and a comparative group (n = 150) of age-matched unreferred community children. Self-report scales assessed infant/child sleep pattern, the impact of the sleep problem on family life and parents' distress. Results showed that about half the children in the community group have had a sleep problem in infancy. Nightwakings improved in both the referred and unreferred group over time but remained more frequent in the unreferred group. The referred group had significantly more settling problems in infancy than the other group but settling improved markedly over time. Parents of referred children were more fatigued compared with others despite improvement of children's sleep problems over time. Mothers of referred children were however, less likely to perceive the sleep problem as troublesome for family life than the others. It is concluded that parents of referred children are more fatigued than parents of unreferred children and nightwakings are more likely to persist in children who had sleep problems in infancy than in those with no such problems.

Age Distribution↗
PubMed1968

Sleep disorders: disorders of arousal? Enuresis, somnambulism, and nightmares occur in confusional states of arousal, not in "dreaming sleep".

In summary, the classical sleep disorders of nocturnal enuresis, somnambulism, the nightmare, and the sleep terror occur preferentially during arousal from slow-wave sleep and are virtually never associated with the rapid-eye-movement dreaming state. Original data are reported here which indicate that physiological differences from normal subjects, of a type predisposing the individual to a particular attack pattern, are present throughout the night. The episode, at least in the case of enuresis, appears to be simply a reinforcement of these differences to a clinically overt level. A number of features are common to all four sleep disorders. These had been shown previously to be attributable to the arousal itself. New data obtained by means of evoked potential techniques suggest that these common symptoms of the confusional period that follows non-REM sleep are related to alterations of cerebral reactivity, at least of the visual system. The symptoms which distinguish the individual attack types (that is, micturition, prolonged confusional fugues, overt terror) appear to be based upon physiological changes present throughout sleep which are markedly accentuated during arousal from slow-wave sleep. These changes may in some way be related to diurnal psychic conflicts. But, to date, it has proved impossible to demonstrate potentially causal psychological activity, dreaming or other forms of mental activity, or even a psychological void in sleep just preceding the attacks. The presence of all-night or even daytime predisposing physiological changes and the difficulty in obtaining any solid evidence of a preceding psychological cause explain, no doubt, why the results of efforts to cure the disorders at the moment of their occurrence (for example, by conditioning procedures in nocturnal enuresis) have been far from satisfactory. I stress the points that the attacks are best considered disorders of arousal and that the slow-wave sleep arousal episode which sets the stage for these attacks is a normal cyclic event. Indeed it is the most intense recurrent arousal that an individual regularly experiences. The most fruitful possibilities for future research would appear to be more detailed studies of those physiological changes that predispose individuals to certain types of attacks when they undergo intense arousal or stress; the reversal of these changes by psychological or pharmacological means; and more refined investigations of the physiological and psychological characteristics of the process of cyclic arousal from non-REM sleep.

Adolescent↗
PubMed2002

Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood.

OBJECTIVE: To compare the effect of a behavioural sleep intervention with written information about normal sleep on infant sleep problems and maternal depression. DESIGN: Randomised controlled trial. SETTING: Well child clinics, Melbourne, Australia. PARTICIPANTS: 156 mothers of infants aged 6-12 months with severe sleep problems according to the parents. MAIN OUTCOME MEASURES: Maternal report of infant sleep problem; scores on Edinburgh postnatal depression scale at two and four months. INTERVENTION: Discussion on behavioural infant sleep intervention (controlled crying) delivered over three consultations. RESULTS: At two months more sleep problems had resolved in the intervention group than in the control group (53/76 v 36/76, P=0.005). Overall depression scores fell further in the intervention group than in the control group (mean change -3.7, 95% confidence interval -4.7 to -2.7, v -2.5, -1.7 to -3.4, P=0.06). For the subgroup of mothers with depression scores of 10 and over more sleep problems had resolved in the intervention group than in the control group (26/33 v 13/33, P=0.001). In this subgroup depression scores also fell further for intervention mothers than control mothers at two months (-6.0, -7.5 to -4.0, v -3.7, -4.9 to -2.6, P=0.01) and at four months (-6.5, -7.9 to 5.1 v -4.2, -5.9 to -2.5, P=0.04). By four months, changes in sleep problems and depression scores were similar. CONCLUSIONS: Behavioural intervention significantly reduces infant sleep problems at two but not four months. Maternal report of symptoms of depression decreased significantly at two months, and this was sustained at four months for mothers with high depression scores.

Adult↗