To our knowledge, this is the first study to dem- onstrate an association between bottle feeding in the bed or crib before sleep time in the first year of life and asthma at the age of 5 years and wheezing between the ages of 1 to 5 years. Because bottle feeding in the bed or crib before sleep time in the first year of life was associated with wheezing and asthma but not with allergic rhinitis or total serum IgE, a likely explanation for our findings is broncho- spasm resulting from repeated irritation of the air- ways as a result of postprandial reflux and mi- croaspiration in the recumbent position. Given that bottle feeding the child in the bed or crib before sleep time in the first year of life was correlated with the same behavior in the second year of life, this feeding habit may continue in some cases as the children grow older. In rabbits, weekly aspiration of a small volume of milk for 5 weeks is associated with an increased proportion of neutrophils in bronchoalveo- lar lavage and increased airway responsiveness to methacholine. 7 Gastroesophageal reflux (GER) and
This study has reinforced the importance of the mother- infant relationship during bed sharing, whether the fa- ther or siblings are present or not. The focus around breastfeeding in many instances dictates the sleep posi- tion of the infant and mother. However, room temper- ature may also influence sleep position. In colder rooms, infants tend to spend more time with their face covered by bedding. Frequent maternal checking and response to infant cues are characteristics of bed sharing that rely on the ability of the mother to arouse with little stimula- tion. Mothers, perhaps impaired by alcohol, smoking, or overtiredness, may not be able to respond appropriately. Future studies aimed at targeting these practices associ- ated with bed sharing may shed light on the harmful factors associated with bed sharing and SIDS.
Actigraph and sleep diary data were analyzed to de- termine TIB. TIB was defined as the time from when the child first went to bed as recorded on their sleep diary and as indicated by a decrease in wrist activity until they got out of bed as recorded in their diary and as indicated by an increase in wrist activity level. Discrepancies be- tween diaries and Actigraph recordings were resolved by contacting parents and or by consensus review among the investigators who did not have knowledge of cogni- tive scores or other results. Subjects were excluded if they did not wear the Actigraph for all 6 nights or if there were irreconcilable differences between their sleep diary and their Actigraph recordings. TIB was averaged for the 6 nights before cognitive function studies (TIB 1– 6 ).
There was information on the undersurface of the infant’s bed in 17 of 53. There were many differences in the materials on which infants were put to sleep. Some examples include: “It is laid to sleep on a bed of bark-cloth, padded with many thicknesses, . . . A short supplementary piece of this stuff is kept un- derneath its body, and changed when necessary. Both this and the other material on which the child is laid is of the kind called mami, of great softness” (Tikopia, Oceania). “Moss or chips of wood are put at the bottom of the cradle, with soft fawn-skins on top of them” (Lapps, Europe). “These cradles use a thin kapok mattress or a folded blanket . . . ” (Central Thai, Asia).
were men and of these, forty percent met the sleep dis- turbance criteria of OSAS (i.e. AHI > 5). These findings are in line with the results from a population-based study on the prevalence of sleep-disordered breathing . In our sample, 13% of all couples habitually slept alone, which matched the results Doherty et al. , reporting that 18% of partners of OSAS patients waiting for CPAP titration preferred separate bedrooms. In contrast to a previous study  we could rule out anxiety or depres- sion as confounding factors for the choice of sleeping arrangements, since snorers and bed partners did not dif- fer regarding SAS- or SDS-scores. To summarize, in our sample with predominantly male snorers, subjective sleep quality was significantly worse in non-snoring partners than in snorers. Besides the fact that snoring and OSAS were “conditions of the listeners”  and there- fore disturbed the sleep of the bed partners, men usually reacted to pair sleep as if it were a group sleep condition and sleep better .
program for insomnia was effective at improving sleep time, total wake time in bed, and sleep efficiency in a Swedish community sample of insomnia sufferers, albeit with small effect sizes. Furthermore, Vincent and Lewycky, (2009) found an online insomnia program to be effective for patients undergoing treatment for chronic insomnia, while in a randomised placebo controlled trial, Espie et al. (2012) found improvements in sleep efficiency, sleep diary outcomes, daytime outcomes, and sleep-wake functioning among adults with insomnia disorder using web-provided CBT versus imagery relief therapy. Similarly, in a comparison between internet and pen and paper self-help CBT, Lancee et al. (2012) found that both formats were effective compared to a wait-list control at improving daily sleep, insomnia, depression, and anxiety. Finally, among students, Trockel et al. (2011) found that emailed PDFs containing CBT self-help reading material for insomnia was effective at reducing symptoms among those who had sleep problems. However, the extent to which commercially available, fully-automated and online self-help programs can improve sleep quality in a student population is yet to be examined.
Sleep and rest are human needs essential to all individual physical and physiological wellbeing. Pain, stress anxiety, and sleep disorders are common after surgery. Poor level of sleep on the post operative period may be due to several factors including pain from surgical incision, presence of thoracic drain, pain caused by prolonged time in bed, and high anxiety levels. Massage therapy (MT) is a technique that promotes the manual mobilization of several structures from both muscle and subcutaneous tissue, by applying mechanical force to tissues. This mobilization improves lymph movement and venous return, reduces swelling, and mobilizes muscle fibers, tendons and skin. Thus, massage therapy may be used to promote muscle relaxation and to reduce pain, stress and anxiety, which help patients improve their level of sleep and speed the recovery.
Stimulus control therapy is considered to be the first line behavioural treatment for chronic primary insomnia and therefore should be prioritized accordingly. Stimulus control instructions limit the amount of time patients spend awake in bed or the bedroom and are designed to decondition pre-sleep arousal. Typical instructions include: (i) keep a fixed wake time 7 days/wk, irrespective of how much sleepyou get during the night; (ii) avoid any behavior in the bed or bedroom other than sleep or sexual activity; (iii) sleep only in the bedroom; (iv) leave the bedroom when awake for approximately 10 to 15 min; and (v) return to bed only when sleepy. The combination of these instructions re-establishes the bed and bedroom as strong cues for sleep and entrains the circadian sleep-wake cycle to the desired phase.
sheet and should be the appropriate size for the crib. Infants should not sleep in an adult bed or with other persons espe- cially if they have taken medication that increases fatigue, have consumed alcohol, smoked, or are excessively tired. It is recommended in the US that all infants share a room with parents, but not share a bed. In breastfed infants, this may also facilitate breastfeeding. If the infant is brought to the adult bed for feeding, he or she should be returned to the crib prior to the parent falling back to sleep. 64,65 In Australia and
The most important property of smoke alarm signals is the proportion of people who are not woken up. These are the people most likely to be injured or killed in a fire. Thus it is clear that although all intensity levels of the strobe lights were above the level as required in the NFPA standard  they were very ineffective. It was found that ~75% of both hard of hearing and alcohol impaired groups did not wake up to the lowest intensity level and 42% for hard of hearing and 32% for alcohol impaired did not wake up to the extended duration at the highest intensity. This result is consistent with the two previous studies that controlled for sleep stage [11,12], both finding that more than two thirds of their normal hearing participants slept through a strobe that was less intense than the lowest intensity level in the present study. The findings of the current study do not support the use of even very high intensity strobes to awaken hearing-able people (i.e. with hearing threshold levels of less than 70 dBA).
Sleep deprivation has adverse effect to a variety of cognitive functions. Within working memory, some component processes are more vulnerable to SD than others. In a well-controlled study, Drummond et al. (2012) found that both one night of total sleep deprivation (TSD) and four nights of partial sleep deprivation (PSD) where subjects were allowed four hours of bed time at night, did not have any significant effect on visual working memory capacity. They observed TSD’s negative impact only on performance in the filtering task where subjects had to ignore distracter stimuli in a visual scene (filtering efficiency) only. They suggest that components of visual working memory are differentially vulnerable to the effects of SD, and different types of SD influence visual working memory to the different degrees. Such findings have implications in operational settings where discriminating the relevant from irrelevant things is essential in taking decision such as look-out and watch-keeping duties. In visual memory, SD of one night did not have any effect on recognition (Alhola, Tallus, Kylmälä, Portin, & Po- lo-Kantola, 2005). No effect was observed for visuospatial working memory after one night of sleep restriction (Nilsson et al., 2005).
Further, the questions could potentially help determine which photoreceptors are being stimulated by a light source. For example, a question regarding the perception of objects, when used in conjunction with a question regarding color visibility, could potentially help determine if the rods and/or cones are being activated (see Figure 1). Specifically, a bed- room fashioned with blackout curtains and other modifications may create scotopic conditions (with only rod activation), wherein an individual would only be able to see in shades of gray, if at all. By contrast, natural nighttime light from the moon and stars is typical of mesopic conditions, wherein both rods and cones are stimulated, allowing for the perception of color, even if it is not extremely vivid. Finally, under photopic conditions, as is typical of indoor architectural lighting, cones are stimulated and thus colors should be readily apparent (Figure 1). Therefore, asking whether light and objects are visible and whether objects can be perceived in color or in gray may be sufficient to distinguish among the three conditions. Of note, if an individual reports perceiving objects in color in the sleeping environment, ipRGCs are also likely to be activated, though it will depend on the spectral com- position of the light source, given their short-wavelength dependence. For example, a light source with significant long- wavelength energy and very little energy in the more potent shorter-wavelength region may allow for visual stimulation and color perception without stimulating ipRGCs sufficiently
Index (PSQI). PSQI is a self-report questionnaire which examines the quality of sleep. It has 18 questions which are classi ﬁ ed into seven components: the ﬁ rst component is the subjective sleep quality which is determined with Question 9. The second component is related to delays in falling asleep, where the score is calculated by two ques- tions, the mean score of Question 2 and part of Question 5. The third component deals with sleep duration and is determined by Question 4. The fourth component is related to the ef ﬁ ciency and effectiveness of sleeping in patients. Its score is calculated via dividing the total hours of sleep by total hours in the bed multiplied by 100. Then, the ﬁ fth component deals with sleep disorders and is achieved by calculating the mean value of Question 5. The sixth component is related to hypnotic drugs and is determined based on Question 6. Finally, the seventh component captures inadequate performance throughout the day and is determined by two questions (mean scores of Questions 7 and 8). Each question is rated between 0 and 3 points where maximum score for each component is 3. The total scores range of the seven components making up the total score range from 0 to 21. Higher scores represent a lower sleep quality, where a score above 6 indicates poor sleep quality. The reliability and validity of this inventory have also been approved in Iran, where the Cronbach ’ s alpha coef ﬁ cient of the questionnaire was 0.78 to 0.82. 18 In another study, Cronbach ’ s alpha for the Persian version was 0.77. In cut-off point 5, the sensitivity and speci ﬁ city were 94% and 72%, and in cut-off point 6, they were 85% and 84%, respectively. 19
In becoming a parent, mothers and fathers step onto a metaphorical life-long ‘travelator’ which takes them past a non-stop array of choices related to their family and parenting style—home birth or hospital? Midwife or specialist obstetrician care? Pharmacological pain relief in labour or not? Breastfeed or formula? Baby in the parental bed/room for sleep or not? Immunise? Leave to cry or pick up at the first whimper? Get a routine going straight away or go with the flow? Parenting is as varied as the individuals involved in the family and because of this, it would be presumptuous to assume that all parents want or need what may be perceived as expert advice when it comes to their infant’s sleep. However, at least 30% of New Zealand parents report their infant or toddler’s sleep to be a problem (Mindell et al., 2010). Given the number of parents who report their child’s sleep to be problematic, and the distress associated with poor sleep and poor maternal mood (separately and collectively), the provision of evidence-based information on infant and maternal sleep represents a cost-effective, low level intervention which has the potential to ameliorate some of this distress. Further, given the current cultural milieu, in which pressures exist for parents to return to work within a few months of birth, and culturally prevalent expectations around infant sleep that are focused on early childhood independence and a minimum of disruption during the night, such intervention may help parents balance the tensions between what they want and what they need to achieve in their unique family life balance. Finally, in viewing sleep as a transdiagnostic mechanism in a range of disorders including perinatal distress, the benefit of evidence-based interventions may extend beyond just the mother who is in search of a good night’s slumber.
All subjects were recruited from the same urban area, were of Caucasian origin, and of middle class socioeconomic status. An initial screening interview was carried out by a child and adolescent neuropsychiatrist. A preliminary diag- nosis for inclusion in the study was made according to Inter- national Classification of Sleep Disorders (ICSD-2) criteria. The subjects had to report having at least two symptoms of insomnia (fragmented sleep, frequent awakenings, early morning awakenings followed by an inability to fall back to sleep, or feeling tired in the morning despite having spent a normal period of time in bed) for at least 2 years before- hand, which were not related to an obvious environmental stressor. Potential participants with any concurrent medical, psychological, or psychiatric factors which might account for their sleep difficulties were excluded. Other exclusion criteria were presence of other sleep disorders, history of alcohol or drug abuse, current treatment with psychoactive drugs, or concurrent psychotherapy.
providing the following measurements: (1) sleep onset latency (time to fall asleep), (2) sleep efficiency (effective sleep time during total bed time, which is calculated as a percentage), (3) wake after sleep onset (awake time after awakening in minutes), and 4) total sleep time (Souza et al., 2003). The model used was AW-64 (Mini-Mitter Co., Inc.), and the records were analyzed using special- ized software (Actiware-Sleep, v. 5.0). For the actigraphy analysis, only participants who had records for at least five nights at each stage (pre- and post-intervention and follow-up assessment) were considered. Thus, partici- pants with incomplete records and absence of records in the pre, post or follow-up stages were excluded. The re- cords were analyzed with a large threshold (= 80) to identify awakenings, which are more appropriate for children at this age. The device was used only at night on the non-dominant wrist.
Methods. Twenty healthy infants with a median age of 11.5 weeks (range: 4 –22 weeks) were recorded poly- graphically for 1 night. Although they slept in their usual supine position, a bed sheet was placed over their face for 60 minutes. Fifteen of the 20 infants were chosen at random and were exposed to white noises of increasing intensities to determine their auditory arousal thresh- olds. All infants were challenged with the face covered and with the face free during both rapid eye movement (REM) and non-REM (NREM) sleep. Seven infants were first challenged with the face covered, and 8 were chal- lenged with the face free. The following variables were recorded simultaneously: electroencephalogram, breath- ing and heart rates, and rectal and pericephalic tempera- tures. In 5 infants who were not exposed to the auditory challenges, end tidal CO 2 was recorded for 30 minutes
There is a growing body of evidence that electronic media use during adolescence is related to later bedtimes, shorter sleep duration, and sleep disturbance (Cain and Gradisar 2010, for a systematic review). The greatest attention had been addressed towards the relationship between TV-consumption and sleep; of 20 studies examining this link, which were identified by Cain and Gradisar (2010), 17 have found a significant relationship between the amount of watching TV and poor sleep. With regard to the use of computers, internet, or video game playing, 15 studies have been identified which consistently reported later bed times, shorter sleep duration, and longer sleep latency to be related to greater use of these electronic media. Two out of three studies also reported more daytime sleepiness/tiredness (Van den Bulck 2004; Eggermont and Van den Bulck 2006), while one study could not confirm this relationship (Li et al. 2007). With regard to mobile phone use and sleep, seven studies had been conducted till 2010 (Cain and Gradisar 2010). Two studies found shorter sleep duration being related to greater mobile phone use (Harada et al. 2002; Punamäki et al. 2007), while one study could not confirm this link (Yen et al. 2008); three studies found that greater mobile phone use was associated with increased daytime sleepiness/tiredness (Van den Bulck 2003; Van den Bulck 2007; Söderqvist et al. 2008), while no relationship was found with sleep latency (Gaina et al. 2005) or sleep difficulties (Söderqvist et al. 2008; Yen et al. 2008).
Nine fathers described a range of negative effects of sleep problems on their partner relationships. The issue of bed-time resistance resulted in a lack of time for parents to spend together in the evenings: ‘we never get any time to ourselves. We can’t sort of sit and watch a late-night film because Jo is likely to just sort of wander down’ (F2). A father of a teenager with autism and obsessive compulsive disorder reflected on the impact on stressful bed-times over years on his partner relationship: ‘When you’re still faced with having to put your son to bed- every night, and that can take up to an hour, there’s not a lot of time in the evening for socialising and relaxing- And so it has put a strain on our relationship in many respects. (F21). For one couple, the strain caused by their child’s sleeping problems almost resulted in the breakdown of their relationship: ‘And it got to the stage where we were on the point of divorce. We’d literally reached the point where we had no life’ (F18). Several fathers reported that children’s sleeping difficulties affected not only the couple relationship inside the home but also their opportunities for socialising together outside it: ‘We’ve never been able to have a night out since probably Charlie [now aged 12] was born’ (F4). The result of co-sleeping meant that some couples
P: Ahaaaa….. hu…..m…..yes, you are not supposed to be provoked by anyone. You must not be tortured or shaken; you must be at peace at all times. For example, I don’t work, I don’t wake up to go to the boss, I still have my various needs. I have a step mother, she has my money, she does not want to give it to me. I….I…when I have had an injection, I must listen to the injection, I feel like sleeping, you find that yousleep a bit, yousleep a bit, yousleep and sleep a little, instead of resting properly, the step mother does not support you, she tortures you, and does not understand you. Unlike your parents, she also torturers your children, she tortures them. You find that she will take your child, she will take your child and pretend that she loves your child, not that she loves the child, she wants to use your child in her home, her girls sit on beds, you see, her children sleep on the bed, they just roll on the bed, and your child will be working and serving them. They get angry at my children and torturer them. I then stopped my children from going to the step mother. I told the step mother to stop, and I asked her not to touch the child. My life is so difficult now, I have no money, yet my money is being withheld by the step mother. There is not getting up to go to a boss to be, I don’t have that strength within me, it is difficult for me.