A Qualitative Exploration of Barriers and Facilitators to Implementing Sleep and Cognitive Behavioral Therapy for Insomnia Knowledge Into Graduate Psychology Students’ Practice

Behavioral Sleep Medicine · 2025-10-30

OBJECTIVES: Insomnia is highly comorbid with mental health conditions, yet graduate psychology students receive limited training in sleep and insomnia management. An online introductory sleep workshop focused on insomnia management with Cognitive Behavioral Therapy for Insomnia (CBT-I) was developed for Australian graduate psychology students to address this training gap. However, some students reported difficulties applying CBT-I knowledge to clinical practice. This study explored the barriers and facilitators to implementing CBT-I knowledge into graduate psychology students' practice post-workshop. METHODS: Semi-structured interviews were conducted with 15 graduate psychology students who attended an online introductory sleep and CBT-I workshop. Data were analyzed using reflexive thematic analysis. RESULTS: Facilitators of CBT-I implementation included: (1) Helpful workshop resources; (2) Increased awareness of the importance of sleep's role in mental health; (3) Enhanced self-efficacy with introductory sleep skills (e.g. sleep history taking); and (4) Knowing where to access further training. Barriers included: (1) Limited ongoing training and clinical supervision; (2) Accessibility challenges; (3) Clinical implementation challenges; and (4) Constraints of being a graduate student. CONCLUSION: The introductory workshop facilitated the development of introductory CBT-I skills among graduate psychology students, but ongoing training and supervision are needed to enhance implementation and expand Australia's CBT-I workforce.

Feasibility of an Unguided, Parent-Focused, Online Program for Sleep Problems in Young Children: The Lights Out Online Program

Child Psychiatry & Human Development · 2025-04-23 · 1 citations

Abstract Sleep problems in young children are highly prevalent and place children at risk for numerous detrimental child and family outcomes. This pilot study aimed to assess the feasibility of an unguided, parent-focused, online sleep intervention, the Lights Out Online program, in terms of adherence rates, acceptability to parents, and effects on (a) child sleep, anxiety, and behaviour problems, and (b) parental self-efficacy, and parent sleep, depression, anxiety. The study was a pilot, open (uncontrolled) trial with a within-group repeated measures (baseline (T1), 12-weeks post-baseline (T2)) design. Participants were 24 parents (M age = 36.2, SD = 4.1) of children aged 3–6 years ( M age = 4.1 years, SD = 1.1) with sleep problems. Participants completed an average of 3.58 out of 4 sessions by T2, and parents reported satisfaction with program content and presentation. A series of mixed-effects linear regression models demonstrated significant improvements in child sleep, child anxiety, child behaviour problems, parent sleep, parent anxiety and parental self-efficacy, from T1 to T2. However, significant improvements were not demonstrated for parent depression and parent stress. The results of this study should be taken with caution given the small sample size and lack of control group. However, the study provides preliminary support for the feasibility of Lights Out Online.

1061 Naps Among Mexican American Toddlers: Parental Beliefs and Toddler Nap Duration, Sleep Location, and Sleep Duration

SLEEP · 2025-05-01

Abstract Introduction Naps are important for early childhood development, yet few studies have considered parental beliefs about naps. This study characterizes parental beliefs about naps, and how nap beliefs relate to toddler nap duration, toddler bedsharing, and toddler sleep duration among Mexican American families. Methods 172 parents (170 mothers; 19-45 years; mean education 12.3 + 3.0 years; 87% room sharing, 41% bedsharing) of Mexican American toddlers (62% boys; 12-16 months) completed a 12-item nap belief measure in Spanish (55%) or English. Toddlers wore an actigraph for 7 days/nights to measure average nap, nighttime, and 24-hour sleep duration. Results Frequencies report on those who agreed/strongly agreed (vs. disagreed/strongly disagreed). Parents believed naps were important (100%), good for their child (99%), and an important part of the child’s (99%) and parent’s day (95%). Most parents believed naps affect the child’s (77%) and parent’s mood (52%), with almost half of parents wishing their child napped longer (47%) or fell asleep faster for naps (49%). Of the 73% of parents not wanting to change something about their child’s nap, 53% wanted their child to nap longer and/or fall asleep faster. More parents with long napping toddlers (average nap >1 hour vs. < 1 hour) agreed the child’s nap affected the parent’s mood (57% vs. 38%, X2=4.5, p=.04), while more parents with short napping toddlers wished the child napped longer (60% vs. 38%, X2=6.3, p=.01). More parents of bedsharing toddlers (vs. sleeping in their own bed/crib) reported they wished their child napped longer (57% vs. 41%, X2=4.1, p=.04). Among parents who agreed naps affected the child’s mood, toddler nighttime sleep duration was 20 minutes longer (t=2.35, p=.01) and toddler 24-hour sleep duration was 27 minutes longer (t=2.67, p=.005). Conclusion Findings from this ongoing study suggest that parents of Mexican American toddlers believe naps are important and affect both child and parent mood. The desire for longer naps in bedsharing parents may be related to the toddler needing parental presence to fall asleep. Longer nighttime and 24-hour sleep duration among toddlers whose parents believe naps impact the child’s mood may suggest parents place an increased importance on sleep. Support (if any) R01HL163859

1041 Parental Sleep Knowledge and Toddler Sleep: Associations with Cultural Values and Acculturation Among Mexican American Families

SLEEP · 2025-05-01

Abstract Introduction Cultural values and acculturation strongly influence parenting behavior, yet few studies have considered how they may influence toddler sleep. This study characterized parental sleep knowledge, values, acculturation, and bedtime among toddlers from Mexican American families. Methods 158 parents (156 mothers; 19-45 years; mean education 12.3±3.0 years) of Mexican American toddlers (62% boys; 12-16 months) completed surveys in Spanish (54.4%) or English. Toddlers wore an actigraph for 7 days/nights to estimate average bedtime. Participants were asked about Mexican American cultural values of respect (V-Resp, 8 items, range 1-5, higher score indicating stronger endorsement), acculturation to non-Hispanic U.S. culture (6 items, range 1-4, ≥2.5=high acculturation), and sleep knowledge (10 True/False items; range 1-10). Results Parents averaged 7.5 + 1.7 correct on the sleep knowledge measure, with the most common incorrect responses for the items “children who do not get enough sleep are more likely to be overweight” (SK-OV, 50.7% incorrect) and “children only need a bedtime routine if they have trouble falling asleep” (SK-BR, 41.8% incorrect). More parents that incorrectly answered SK-OV (vs. correct) had high acculturation scores (72.7% vs. 27.3%, X2=4.0, p=.046). More parents that incorrectly answered SK-BR (vs. correct) had low acculturation scores (57.6% vs. 42.4%, X2=24.3, p=<.001). Parents that incorrectly answered SK-BR and SK-OV had higher V-Resp scores (SK-BR: x̄=4.0 vs. 3.7, F=10.2, p=.002; SK-OV: x̄=4.0 vs. 3.7, F=11.3, p=.001). Toddlers of parents that incorrectly answered SK-BR and SK-OV had significantly later bedtimes (22 min, p=.033; and 24 min, p=.021 respectively). In a stepwise regression controlling for parental age and education, V-Resp was significantly associated with later toddler bedtime (R2=.211, β=.364, p=.002). Conclusion High acculturation and Mexican American cultural values of respect were associated with parent sleep knowledge and toddler bedtime in Mexican American families. The measure used to assess cultural values focuses on intergenerational behaviors and the influence of elder wisdom, suggesting perhaps parental knowledge and toddler sleep routines are based on what has been learned from family vs. health professionals. Understanding cultural values and acculturative differences is crucial for personalizing sleep education and addressing common misconceptions about toddler sleep health for Mexican American families in both clinical and community settings. Support (if any) R01HL163859

1062 Mothers’ and Fathers’ Beliefs About Bedtime Screen Use and Toddlers’ Sleep in Mexican American Families

SLEEP · 2025-05-01

Abstract Introduction Parental beliefs about sleep are associated with sleep-related parenting behaviors and child sleep. However, few studies have considered parental beliefs about bedtime screen use and their relationship with children’s sleep, especially in early childhood. Further, most studies focus on mothers, despite the important role that fathers play in early child development. This study examined mothers’ and fathers’ beliefs about screen use at bedtime and toddler sleep in Mexican American families. Methods 42 mother-father dyads (mothers 21-43 years, education mean=13.0 years, sd=2.9; fathers 21-45 years; education mean=12.0 years, sd=2.8) of Mexican American toddlers (64.3% boys; 12-16 months) completed a measure regarding beliefs about bedtime screen use in Spanish (40.5%) or English. Toddlers wore an actigraph for 7 days/nights. T-tests compared bedtime and sleep duration between parents who agreed vs. disagreed with each belief. Due to the small sample size, meaningful effect sizes (Cohen’s d) vs. p-values are reported. Results 12% of mothers and 19% of fathers agreed that using a screen device at bedtime helps toddlers relax, with toddlers whose mothers agreed (vs. disagreed) having later bedtimes (31 minutes, d=.46) and shorter sleep duration (24 minutes, d=.52). Among fathers who agreed (vs. disagreed), toddlers had later bedtimes (50 minutes, d=.77) and shorter sleep duration (18 minutes, d=.36). Approximately 43% of mothers and 41% of fathers agreed that watching a screen device at bedtime helps toddlers remain quiet. Among mothers who agreed (vs. disagreed), toddlers slept 19 minutes less (d=.38). Finally, 10% of mothers and 21% of fathers agreed that using a screen device at bedtime helps toddlers fall asleep, with toddlers whose fathers agreed (vs. disagreed) having shorter sleep duration (16 minutes, d=.32). Conclusion More fathers than mothers were positive about screen use at bedtime. Positive parental beliefs in both mothers and fathers were associated with clinically meaningful sleep differences, including later toddler bedtimes and shorter toddler sleep duration. It is important to identify both mother and father sleep-related screen beliefs when addressing toddler sleep in clinical and community settings. Data collection is ongoing in a large, longitudinal study of Mexican American families. Support (if any) R01HL163859

Improving More than Just Sleep: A Pilot Study of the Lights Out Online Program and its Transdiagnostic Effects on Young Children and their Parents

2025-03-05

Sleep problems in young children are highly prevalent and represent a risk factor for numerous detrimental child and family outcomes. This pilot study aimed to test the preliminary efficacy and transdiagnostic impact of an online, parent-focused sleep intervention, the Lights Out Online program, in terms of its ability to a) reduce child sleep, anxiety, and behaviour problems, and b) to reduce parent sleep, depression, anxiety and stress problems, and improve parental self-efficacy. The study was an open (uncontrolled) trial with a within-group repeated measures (pre-treatment, post-treatment) design. Participants were 24 parents (Mage = 36.2, SD = 4.1) of children aged 3-6 years (Mage = 4.1 years, SD = 1.1) with sleep problems. Measures of child sleep, anxiety, and behaviour problems, as well as parental self-efficacy, and parent sleep, anxiety, depression and stress, were taken. A series of mixed-effects linear regression models demonstrated significant improvements in child sleep, child anxiety, child behaviour problems, parent sleep, parent anxiety and parental self-efficacy, from pre- to post-intervention. However, significant improvements were not demonstrated for parent depression and parent stress. Post-program feedback from parents suggested that they were satisfied with the program content and presentation. This study provides preliminary support for the efficacy and acceptability of an online, parent-focused program targeting child sleep problems.

1042 Parenting Practices Regarding Screen Use at Bedtime and Its Relationship with Toddler Sleep in Mexican American Families

SLEEP · 2025-05-01

Abstract Introduction Screen use around bedtime starts for many children in early childhood despite recommendations to restrict such use. Evidence is currently lacking on the relationship of parenting practices regarding sleep and screens with objectively measured toddler sleep. Such findings could inform the design of culturally-relevant interventions promoting healthy screen use and sleep in toddlers. The objective of this study was to evaluate whether maternal parenting practices regarding sleep and screens are associated with toddler sleep in Mexican American families. Methods Mexican American families with toddlers were recruited from a safety-net health system. Mothers completed orally administered surveys that included items on parenting practices regarding screen use and sleep: (1) the frequency of having their toddler use a screen device to help their child fall asleep and (2) the frequency of allowing their toddler to use a screen device before bedtime. Responses to each item were dichotomized (never/ever). Toddler average bedtime, sleep-onset time, and duration were measured with 7 days/nights of actigraphy. Data were analyzed using t-tests to evaluate the relationship between each parenting practice and sleep outcomes. Results 384 mother-toddler dyads participated. Mothers were on average 31.4 years old (SD=6.0), 85% were partnered, and mean education level was 11.6 years (SD=2.5). Toddlers were on average 21.2 months old (SD=3.1) and about half were boys (49%). Mothers who reported ever using screens to help their toddler fall asleep, versus those who reported never, had toddlers with significantly later average bedtime (24 minutes, p<.01), later average sleep-onset time (24 minutes, p<.01), and shorter average sleep duration (18 minutes, p< 0.03). There were no differences in toddler sleep (average bedtime, sleep onset-time, and sleep duration) in those with mothers who reported ever versus never allowing toddler screen use before bed. Conclusion Parental use of screens to help a toddler fall asleep is associated with toddler sleep, including later bedtimes and shorter sleep durations, whereas the general practice of allowing screen use before bed was not associated with toddler sleep. Parental use of screens as a behavioral tool to help their toddler fall asleep may create a sleep onset association that negatively impacts child sleep. Support (if any) R01NR017605

637-P: Sleep Screening in Adolescents with Type 1 Diabetes (T1D) Using the PROMIS Four-Item Sleep Surveys

Diabetes · 2025-06-13

Introduction and Objective: Most adolescents do not achieve sleep recommendations and T1D causes unique nocturnal disruptions which may contribute to poor sleep. Yet, screening for sleep health is not regularly part of diabetes visits. The purpose of this study was to evaluate the feasibility of sleep screening in adolescents with T1D. Methods: Adolescents (11-17yo) with T1D completed sleep screening consisting of PROMIS Sleep Disturbance (SD) and Sleep-Related Impairment (SRI) surveys (4-items each, t-scores >50 indicate more problems than the population mean). For this study, a score of >55 was considered clinically significant, indicating need for further assessment. Participants were categorized by gender and age (11-13yo and 14-17yo). Results: 50 adolescents (age 14.7±2.2yrs, T1D duration 6.4±4.5yrs, 50% Female, 66% NHW) participated. PROMIS SD and SRI mean (SE) t-scores were 55.1 (3.2) and 53.6 (3.1), respectively, and took 5.5 minutes to complete. 31 (62%) scored above 55 on at least one survey. Females had significantly higher t-scores for both SD and SRI (Table). There were no differences by age. Conclusion: PROMIS sleep surveys identified a high proportion of adolescents with T1D with sleep concerns. Females reported higher levels. Routine screening for sleep health in adolescents using the PROMIS SD and SRI surveys is feasible during routine diabetes visits and can be an important part of T1D care. Disclosure E.C. Cobry: Advisory Panel; Dexcom, Inc. E. Fivekiller: None. S.S. Jaser: None. L.J. Meltzer: Consultant; Harmony Biosciences, Egetis Therapeutics, Zepp Health. R. Wadwa: Consultant; Dexcom, Inc., Tandem Diabetes Care, Inc. Advisory Panel; Provention Bio, Inc, Provention Bio, Inc, Microbion, Microbion, Sequel Med Tech. Research Support; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care, Inc. Funding Breakthrough T1D (5-ECR-2022-1179-A-N)

Sleep problems in youth with WAGR syndrome

Sleep Medicine · 2025-02-17 · 1 citations

0818 Room-sharing and Bed-sharing: Reasons, Beliefs, and Sleep in Mothers and Toddlers from Mexican American Families

SLEEP · 2024-04-20

Abstract Introduction Sleep is essential for development, yet best practices in pediatric sleep are based on studies of primarily non-Latino White families, where rates of room-sharing, bed-sharing, and feeding to sleep are relatively low in toddlers. This ongoing study characterizes room-sharing and bed-sharing reasons, beliefs, practices, and sleep among mothers and toddlers in Mexican American families. Methods 51 Mexican American mothers (19-43 years; mean education 12.3 + 3.2 years) of toddlers (77% boys; 12-15 months) completed surveys in Spanish (67%) or English. Mothers and toddlers wore an actigraph for 7 nights. Surveys included Bed-sharing and Room-sharing Beliefs (poor parent sleep, poor child sleep, child dependent on parent for sleep, parent preference to have child nearby) and the Brief Infant Sleep Questionnaire (sleep ecology, room-sharing reasons, sleep-related practices). Results Room-sharing was common (88%), with room-sharing reasons including parental preference to have child nearby (PREF, 53%), space/logistics (SPACE, 33%), and child needing parent to sleep (NEED, 13%). All NEED mothers reported bed-sharing with their toddler, with 50% of PREF and 47% of SPACE mothers reporting bed-sharing. SPACE mothers agreed that bed-sharing contributed to poor parent and child sleep more than PREF or NEED mothers (medium effect size). PREF mothers disagreed that bed-sharing made a child depend on parent for sleep more than the other groups (large effect size). Toddlers falling asleep at bedtime while feeding was common among all room-sharing mothers (SPACE=67%, PREF=88%, NEED=100%), although higher in bed-sharing families (96% vs. 65% own bed). Parent sleep timing (midpoint) was delayed 48 minutes for SPACE mothers vs. NEED mothers, while child sleep timing was 30 minutes delayed in bed-sharing toddlers and 54 minutes delayed in toddlers who fell asleep feeding. Toddlers who fell asleep feeding had a 35 minute longer sleep opportunity, but a 33 minute shorter sleep duration than non-feeding toddlers. Conclusion Early findings from our ongoing study of sleep in mothers and toddlers from Mexican American families suggest sleep ecology beliefs and practices differ from findings in U.S. non-Latino White families. Findings highlight the importance of cultural and ecological sensitivity when designing interventions to reduce sleep disparities and improve overall toddler health. Support (if any) R01HL163859