Sleep Education and the Importance of Starting Early

In this issue of SLEEP, Wilson and her colleagues¹ have made an important contribution toward advancing our knowledge of the efficacy of sleep education programs. The authors targeted low income families whose preschool age children were enrolled in Head Start, an early education program. They thus addressed the sleep needs of two critical populations: preschool age children and low-income families. Research has demonstrated that both groups have significant difficulties with sleep,^2,3 but to date there have not been randomized control studies that examine the efficacy of a sleep education program for young children of low-income families.

The authors implemented an innovative and creative 2-week sleep curriculum that was incorporated into the children's preschool experience. Parents were given direct information during a one-time group presentation. Children ranged in age from 2.9 to 5.2 years of age. The authors demonstrate a significant parent-reported increase in sleep duration one month after the preschool intervention. Thus, they provide compelling evidence that direct teaching about sleep to very young children and their parents in low-income families is an effective means of improving their sleep. The implications of this research are important and wide reaching, and offer promising evidence that teaching preschoolers about sleep and providing some group instruction to their parents is a an efficient model of promoting good sleep habits.

The finding by Wilson et al. that their approach was helpful to low-income families is also worth comment. The importance of addressing poor sleep in preschoolers in low-income families is crucial given the strong associations between poor sleep and daytime behavior. The relationship between sleep quality, cognitive functioning, academic achievement, and behavioral health has been well documented. Research has also demonstrated that the adverse impacts of poor sleep on daytime behaviors and learning may be greater for children from lower socioeconomic backgrounds than it is for children from families with more financial resources. For example, El-Sheikh and colleagues⁴ have found that children with poor sleep had internalizing and externalizing behavior problems two years later, and that children from low socioeconomic backgrounds were most likely to have these problems. Thus, addressing sleep in preschool programs for low income children may be an effective way to help improve long term outcomes for these children.

The study of Wilson et al. suggests new areas of research that should be considered. First, their study relied on parent report, and as the authors note, it would be valuable to obtain objective measures of sleep to verify parent report. Additional work also needs to be done to understand the mechanisms behind the improvements that were noted in children's sleep. The authors discuss ways in which topics discussed in school were reinforced during the group parent meeting and by providing a variety of supportive materials that were used at home and at school. It would be informative to learn more about the ways in which parents and children talked about what they had learned and how they actually changed their sleep habits.

While the study found that children's sleep duration improved one month after intervention, parent knowledge of sleep concepts did not remain constant. We need to understand how children's sleep could continue to improve even when measures of their parent's understanding of sleep concepts did not remain at a level that would explain this improvement. Longitudinal work that examines how changes in sleep are maintained and what impact these changes might have on daytime functioning would also be valuable. Additionally, it would be useful to learn how this method of sleep education might impact other aspects of family functioning. For example, Malow et al.⁵ found that providing sleep education to parents of children with autism spectrum disorders positively impacted children's sleep as well as parental sense of competency. Improving a parent's sense of efficacy may have important implications for day to day family behaviors and may be particularly beneficial in low income groups. Finally, as the authors note, their study was limited to children from low socioeconomic backgrounds. It will be valuable to determine whether families from other socioeconomic groups would also benefit from this intervention.

CITATION

Katz T, Malow BA. Sleep education and the importance of starting early. SLEEP 2014;37(6):1033-1034.

DISCLOSURE STATEMENT

The authors have indicated no financial conflicts of interest.