Adolescent insomnia is common, persistent and impairing, yet little is known about how and where young people with sleep difficulties are identified and treated in regular care. Recent calls to prioritise sleep health as a public health imperative underscore the need to understand diagnostic and treatment pathways for those affected. To characterise where adolescents with sleep-related difficulties are diagnosed, describe patterns of comorbidity and examine healthcare professionals' (HCPs') diagnostic practices, treatment approaches and perceived treatment barriers, we combined nationwide statutory outpatient billing data (2018-2024) for adolescents aged 15-17 years with an online survey of HCPs across clinical disciplines in Germany. Claims data captured incident sleep-disorder diagnoses and co-occurring psychiatric conditions. The survey assessed diagnostic procedures, treatment approaches, use of clinical guidelines and perceived systemic constraints. Incident sleep-disorder diagnoses increased after 2022 and were more common in girls. Comorbid depression and ADHD were frequently coded at first diagnosis, which occurred mostly in general practice. HCPs, however, viewed paediatrics as the typical first contact and primary provider of ongoing care. Sleep-hygiene counselling was widely used, whereas cognitive-behavioural therapy for insomnia (CBT-I) was rarely delivered. Contrary to guideline recommendations, pharmacological treatments were commonly employed. Reported barriers included insufficient specialised providers, diagnostic overshadowing, long waits for CBT-I and limited consultation time. Current care structures do not reliably support timely recognition or guideline-concordant management of adolescent insomnia. Priority areas include expanding CBT-I availability, enhancing referral pathways, improving assessment practices and developing parent- and youth-focused educational resources to support earlier recognition and help-seeking.

Dieses Buch bietet das Praxiswissen für die notwendige differenzierte schlafmedizinische Diagnostik und eine darauf basierende optimale kurz-, mittel- und langfristige Therapie. Schlafstörungen - eine

Objectives To identify family- and work-related factors of shift-working parents associated with various aspects of children's sleep behavior. Additionally, the study aimed to explore further potential influences on the relationship between shift work and children's sleep. Methods Data were collected in working parents using a nationwide online survey. The survey relied on parent-reported information about their youngest child addressing the following domains: demographics, working patterns, children's and parents' sleep habits, duration and bedtime routines. Standardized instruments included the Children's Sleep Habits Questionnaire and Pittsburgh Sleep Quality Index-score. Results A total of 770 parents participated. 627 (82 %) were female; mean age 37.7 ± 1.2 years. Families had on average 1.8 children (mean child age 7.9 years; youngest child 5.7 years). In 503 (65 %) families at least one parent worked in shifts and in 160 (21 %) families both parents were shift-workers. Overall, no substantial differences were found in parent-reported child-sleep duration, or general sleep quality across shift work groups. Exploratory analyses suggested a moderating effect of job satisfaction and parental sleep quality on the association between child parasomnia and shift work. Conclusions In this cross-sectional study, most aspects of children's sleep parameters did not differ between families with or without shift work, based on parent-reported measures. While a weak statistical association was observed between parasomnia scores, the effect size was limited. Future research should consider the role of work schedules in supporting family sleep health, especially in shift-working households.

Paediatric sleep medicine has rapidly evolved and expanded over the past half century as it became increasingly recognised as a unique field related to but distinct from adult sleep medicine. In looking forward to the next years, the focus of the following discussion is two-fold: to summarise a brief history of the field, recent developments and current trends, and to present a blueprint for the future across various key domains. Using Bronfenbrenner's Ecological Systems Theory as a model for the interaction between the five interconnected ecosystems and sleep in children, we discuss a variety of topics relevant for the present state and future of paediatric sleep medicine. Such topics include the potential effects of climate change and war on children's sleep, the development of public policy initiatives-such as sleep education in schools and in communities, and global efforts to reduce the epidemic of insufficient sleep. Indeed, insufficient sleep contributes to a myriad of negative medical, mental health, functional, and safety consequences. We also focus on the development of paediatric sleep medicine-specific educational initiatives and training programmes, and we showcase professional organisations such as the International Paediatric Sleep Association that are dedicated to the global expansion of paediatric sleep medicine. Finally, we address the need for further interdisciplinary collaborations, identify critical research gaps and explore the potential role of artificial intelligence and other new technologies in paediatric sleep research, including standardisation of sleep measurements, and novel methods of monitoring sleep in children.

Schlafstorungen im Kindesalter sind weit verbreitet. Viele klassische schlafmedizinische Erkrankungen, wie z. B. das Restless-Legs-Syndrom oder die Narkolepsie konnen sich im Kindes- oder Jugendalter manifestieren. Auch Parasomnien konnen im Kindesalter auftreten, einige sogar typischerweise. Daneben sind schlafbezogene Atmungsstorungen sowie insomnische Storungen im Kindesalter von besonderer Bedeutung. Wahrend klinisches Bild und Pathophysiologie der obstruktiven schlafbezogenen Atmungsstorungen bei Kindern und Erwachsenen vieles gemein haben, unterscheidet sich die Therapie in vielfaltiger Weise. Das folgende Kapitel befasst sich mit schlafbezogenen Atmungsstorungen, die klassisch fur das fruhe Kindesalter sind. Das anschliesende Kapitel beschaftigt sich mit kindlichen Schlafstorungen ohne Atmungsstorungen, insbesondere mit insomnischen Storungen im Kindes- und Jugendalter, bei denen die Interaktion zwischen Eltern und Kind eine wichtige Rolle spielt.

Pre-sleep worrying is associated with sleep disturbance, which in turn is associated with impaired affective wellbeing. However, studies examining the fine-grained temporal order of these variables are still lacking. In particular, within-person mediation of the association between pre-sleep worrying and the following day's affective wellbeing by subjective and objective indicators of sleep has not been tested yet. This study investigates the extent to which pre-sleep worrying predicts positive/negative affect the following day, and whether subjective/objective sleep disturbances are possible mediators for this relationship. Data from two experience sampling studies were pooled for the analyses, resulting in a total sample of 220 participants aged between 18 and 30 years (M = 23.2 years, SD = 2.8). The hypotheses were tested at both the between- and within-subject level using causal mediation analysis. The within-subject analyses revealed partial mediation of the relationship between pre-sleep worrying and positive as well as negative affect the next day by subjective sleep quality. By contrast, sleep as measured by actigraphy appears not to be relevant for the link between pre-sleep worrying and affective wellbeing the following day. Baseline levels of depressive symptoms and sleep disturbances did not moderate the associations between pre-sleep worrying, sleep indices and affective states the following day. Improving perceived sleep quality by addressing pre-sleep worrying could be a potential avenue to enhance affective wellbeing and promote better mental health in young adults.

Adequate sleep is crucial for healthy development, contributing significantly to physical and mental well-being. While research on paediatric sleep is expanding, there remain several open questions. This narrative review provides an overview of our current knowledge on paediatric sleep health and identifies literature gaps, considering factors such as age, gender, cultural differences, and the interplay between sleep, physical activity, nutrition, and mental health. It also considers sleep health in the more specific group of children with neurodevelopmental disorders. By viewing paediatric sleep health as a multidimensional construct, this review discusses age-specific issues, including the different factors affecting satisfaction, daytime alertness, sleep timing, efficiency and duration, and sleep-related behaviours. While gender differences in sleep health become apparent after puberty, few studies have addressed sex differences in children or different parental attitudes toward sleep in boys and girls. Cultural differences in sleep duration, timing, and setting are reported from infancy through adolescence; however, the cultural influence on sleep health, particularly during adolescence, remains unclear. This is crucial when considering the effects of screen time, smartphone use, and social media exposure on sleep. Further research is required to understand how sleep, nutrition, and physical health interact throughout the developmental span. Additionally, this review underscores the protective nature of sleep for adolescent mental health and for the management of emotional and behavioural problems in children with neurodevelopmental disorders. The review identifies critical areas for future research to enhance our understanding of paediatric sleep health and develop more effective and tailored interventions and preventive programmes.

Background: Insomnia disorder in childhood and adolescence has severe implications on overall well-being and development. Age-specific treatments for insomnia disorder with cognitive behavioral interventions (CBT-I) are available and effective. Nightmare disorder also has severe consequences in children and adolescents. However, less is known about children with insomnia (I) and comorbid nightmare disorder (I + N). Methods: In this retrospective study, data from 499 children and adolescents with insomnia disorder were included. The prevalence of a comorbid nightmare disorder (I + N) was calculated within three subsamples (toddlers and preschoolers 0.5–4 years, elementary school children 5–10 years, and adolescents 11–18 years). Differences between children with insomnia (I) and those with additional nightmare disorder (I + N) regarding age, sex, family background, sleep quality (SOL, WASO, TST, and SE) based on sleep logs, behavior sleep problems (based on interviews), and behavioral problems (CBCL and YSR) were calculated within each age group. Results: The overall prevalence of additional nightmares or nightmare disorder in children or adolescents with insomnia was 15–24%. We found various clinically relevant differences between I and I + N for each age group; for example, there were more sleep onset association problems in I + N elementary school children, prolonged SOL of 56 min, and about 50 min less TST and SE of 76.8% in I + N adolescents. However, most statistical tests were not significant. Especially sleep parameters but also emotional burden were more pronounced in I + N groups than in the I groups. Toddlers and preschoolers with I + N were significantly older than those with only I, had another family situation (e.g., divorced parents) significantly more often, and I + N adolescents were statistically more often anxious and depressed. Discussion: Descriptively, I + N children and adolescents seemed to be more impaired than those with insomnia only. However, a comorbid nightmare disorder cannot be recognized by insomnia-specific sleep parameters. Therefore, diagnostic procedures for insomnia should always screen for nightmares but also other sleep disorders. If necessary, CBT-I should be supplemented with nightmare-specific interventions.

Background: Sleep problems in childhood are frequent. Approximately two thirds of all children and adolescents experience distressing sleep-related anxieties as they grow up. This taken by itself is indeed not a diagnosis, but it has far-reaching consequences, as the prevalence of secondary disorders such as anxiety or insomnia disorders increases. Single case studies have shown that even short bibliotherapeutic intervention programs of just a few weeks can change about changes in anxiety and problematic bedtime behavior. Picture books are an early, low-risk and cost-effective intervention of coping with sleep-related anxiety, especially for younger children, for whom sleep-related anxiety is particularly common. The aim of the study was therefore to examine the effectiveness of a low-threshold, preventive, guided and supervised bibliotherapeutic intervention with regard to sleep-related anxiety. Methods: Nineteen children aged 4.5-7 years and their parents were asked about their fears and bedtime behavior in a pre-post design with baseline and follow-up before and after reading selected picture books. Each family received an identical set of four picture books and standardized reading instructions on reading behavior. Sleep logs, parental and child assessment instruments, and interviews were used for the data collection. A two-week baseline was followed by a two-week test phase and a follow-up survey four weeks later. Results: The results show a significant improvement of sleep-related anxieties and in some problematic bedtime behavior in a pre-post comparison. The number of fears expressed, resistance to going to bed, and the frequency of waking up at night were reduced significantly. The changes remained stable four weeks after the test phase. The pilot study at hand showed positive effects of picture books on sleep-related anxieties and problematic bedtime behavior. The effects were reported from the parents and from the children. However, larger studies with control group design are necessary.

Zusammenfassung Hintergrund Mittlerweile gibt es eine zunehmende Anzahl an Apps und digitalen Spielen mit dem mehr oder weniger expliziten Ziel der Gesundheitsförderung. Eines der häufig gesuchten Themen für Health-Apps ist Schlaf. Diese werden meist im Rahmen des abendlichen Zu-Bett-Geh-Rituals oder als Einschlafhilfe eingesetzt. Die Bewertung solcher Apps oder Spiele aus schlafspezifischer Perspektive wurde bislang jedoch wenig berücksichtigt. Daher hat diese Arbeit zum Ziel, einen Kriterienkatalog zur Bewertung für Expert*innen zu entwickeln und diesen in einer ersten Testphase zu erproben. Methode Mittels einer umfangreichen Literaturrecherche zum Thema Game-Kriterien sowie unter Hinzunahme ähnlicher Vorarbeiten wurde in einem mehrstufigen Prozess mit einem interdisziplinären Expertenteam ein Kriterienkatalog mit Fokus auf schlaf- und entspannungsbezogene Aspekte entwickelt. Dieser wurde in einer Pilotphase getestet. Ergebnisse Es zeigte sich, dass für „serious games“ bestehende Kriterienvorschläge zwar einige relevante Themenbereiche abdecken, diese jedoch bei einer Anwendung zur Schlafförderung durch ihre Ausrichtung aversive Effekte erwarten lassen. Neben einer zwingend erforderlichen Adaptation der Kriterien auf die Thematik Einschlafen bzw. Entspannung sind diese zudem um weitere Kriterien für Apps der Gesundheitsförderung zu erweitern. Diese Änderungen bzw. Adaptationen sind in der vorliegenden Arbeit erfolgt. In der Pilotphase zeigten sich die vom interdisziplinären Team entwickelten Kriterien als weitestgehend sinnvoll und adäquat für die Thematik Schlaf bzw. Entspannung. Diskussion Neue Apps und Games hinsichtlich der Thematik Schlaf sollten unreflektiert weder genutzt noch von Fachpersonen empfohlen werden. Bereits bei der Erstellung einer solchen Anwendung ist dringend der Einbezug eines interdisziplinären Teams anzuraten. Der erarbeitete Kriterienkatalog kann in Zukunft Fachpersonal dabei unterstützen, schlaf- oder entspannungsbezogene Apps und Spiele zu bewerten und einzuordnen.

Zusammenfassung Hintergrund Schlafschwierigkeiten im Kindesalter sind weit verbreitet. Etwa zwei Drittel aller Kinder und Jugendlichen erleben im Laufe ihres Heranwachsens belastende schlafbezogene Ängste. Dies allein ist keine Diagnose, hat jedoch weitreichende Folgen, da sich die Prävalenz für Folgestörungen wie beispielsweise Angststörungen und Insomnie erhöht. Einzelfallstudien haben ergeben, dass bereits kurze bibliotherapeutische Interventionsprogramme von wenigen Wochen Veränderungen im Angsterleben und problematischen Zubettgehverhalten bewirken können. Bilderbücher sind, vor allem für jüngere Kinder, bei denen schlafbezogene Ängste besonders häufig auftreten, eine frühe, risikoarme und kosteneffektive Hilfe bei der Bewältigung. Ziel der Studie war daher, die Wirksamkeit einer niederschwelligen, präventiv ausgerichteten, strukturiert angeleiteten und supervidierten bibliotherapeutischen Maßnahme im Hinblick auf schlafbezogene Ängste zu überprüfen. Methoden 19 Kinder im Alter von 4,5–7 Jahren und deren Eltern wurden in einem Vorher-Nachher-Design mit Baseline und Follow-up vor und nach dem Lesen ausgewählter Bilderbücher nach ihren Ängsten und ihrem Zubettgehverhalten befragt. Jede Familie erhielt ein gleiches Set aus vier Bilderbüchern sowie standardisierten Instruktionen zum Vorleseverhalten. Zur Befragung wurden Schlafprotokolle, Interviews, Fremdbeurteilungs- und Selbstbeurteilungsinstrumente eingesetzt. Nach einer zweiwöchigen Baseline folgte eine zweiwöchige Testphase und nach vier Wochen eine Nachbefragung. Ergebnisse Die Ergebnisse zeigen eine signifikante Verbesserung der schlafbezogenen Ängste und einiger problematischer Verhaltensweisen beim Zubettgehen im Prä-Post-Vergleich. Die Anzahl der geäußerten Ängste, der Widerstand beim Zubettgehen sowie die Häufigkeit des nächtlichen Erwachens wurden signifikant reduziert. Die Veränderungen blieben vier Wochen nach der Testphase stabil. In der vorliegenden Pilotstudie konnte erstmals anhand einer größeren Stichprobe die positive Wirkung von Bilderbüchern auf schlafbezogene Ängste und problematisches Zubettgehverhalten gezeigt werden. Die positiven Effekte wurden sowohl von den Eltern als auch von den Kindern berichtet. Umfassendere Studien mit Kontrollgruppendesign sind notwendig.

Zusammenfassung Hintergrund Viele Eltern berichten, nach der Geburt ihres Kindes übermüdet zu sein und Schwierigkeiten zu haben, den Alltag zu bewältigen. Dies betrifft vor allem erstgebärende Mütter. Schlafmangel und Schlafschwierigkeiten gelten als Risikofaktor für viele Beeinträchtigungen wie Depression, Aggressivität, Abnahme der Beziehungsqualität und Kindeswohlgefährdung. Ziel dieser Arbeit war es daher, eine Reihe an Verhaltensempfehlungen für Eltern zu geben, um einer möglichen Gefährdung der eigenen Person oder des Kindes entgegenzuwirken. Methode In einem interdisziplinären Team wurden basierend auf der gegenwärtigen Literatur sowie der klinischen Expertise die Empfehlungen formuliert, reflektiert und diskutiert. Ergebnisse Es wurden insgesamt 33 Verhaltensempfehlungen für müde Eltern formuliert, die sich auf die Person selbst, die Partnerschaft und Familie, den Abend und die Nacht sowie die Arbeit beziehen. Die Empfehlungen sind vor allem für Eltern jüngerer Kinder geeignet. Diskussion Mithilfe der hier formulierten Empfehlungen sollen alltagsnahe Hilfen geschaffen werden, um Eltern niederschwellig Unterstützung zukommen zu lassen. Solche Tipps können als Selbsthilfemaßnahmen, als Basis für eine Schlafberatung sowie für eine weiterführende ausführliche Behandlung dienen.

Background: Many parents report being overtired after the birth of their child and having difficulty coping with everyday life. This particularly affects first-time mothers. Lack of sleep and sleep difficulties are considered a risk factor for many impairments such as depression, aggressiveness, a decline in the quality of relationships, and endangerment of the well-being of children. The aim of this work was therefore to provide a series of behavioral recommendations for parents to counteract any possible danger to themselves or their child. Methods: In an interdisciplinary team, the recommendations were formulated, reflected upon, and discussed based on the current literature and clinical expertise. Results: A total of 33 behavioral recommendations for tired parents were formulated that relate to the persons themselves, the partnership and family, the evening and night, as well as work. The recommendations apply primarily to parents of younger children. Discussion: With the help of the recommendations formulated here, everyday help should be created to provide parents with low-threshold support. Such tips can serve as self-help strategies, as a basis for sleep advice and for further detailed treatment.

Insomnia in children is common and causes many mental health problems. Nevertheless, only little is known about influencing factors for sleep help-seeking behavior of parents with children with insomnia. The aim of this study was to evaluate the duration and severity of insomnia in children as well as to assess the influence of additional mental disorders on insomnia duration and severity. The influence of a child’s insomnia duration and severity on parental sleep help-seeking behavior was examined. Patients at three German outpatient sleep clinics were evaluated. A self-developed parental sleep interview according to the third edition of the International Classification of Sleep Disorders (ICSD-3) criteria was conducted for each child. Additionally, information about insomnia severity and duration, the number of sleep help-seeking efforts, and mental disorders were retrieved from the family registration form. A total of 175 children (4–11 years) with a mean insomnia duration of 54 months were included. Insomnia severity was high, with no differences between children with and without comorbid mental disorders. Most parents (88.6

Objective The existing literature has focused little on the health-promoting role of resources for sleep. Mainly risk factors have been highlighted regarding mental health in general. Moreover, for the vulnerable age group of adolescents, resources and their relation to sleep have hardly been explored. Therefore, this study aims to investigate the predictive role of personal/social resources for the likelihood of having chronic sleep problems in adolescents. Methods and measures A sample of n = 131 adolescents (M = 14.31 years, SD = 1.84) completed the Sleep Disturbance Scale for Children and the Questionnaire to Assess Resources for Children and Adolescents at two measurement points about 8 months apart. Results Binomial logistic regressions controlling for age and sex revealed that higher levels of personal and social resources were associated with a lower likelihood of having chronic sleep problems. Especially optimism and school integration were associated with not experiencing chronic sleep problems. Conclusion For the first time, this study highlighted multiple resources and their health-promoting role in adolescent sleep. Both personal and social resources seem to be relevant for preventing adolescents from chronic sleep problems. Prevention and intervention programs for sleep disorders in teenagers should especially promote optimism and school integration.