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Sleep, depression, and attention.

In general, sleep problems are of considerable significance to children's well-being. One of the most studied issues in sleep research is the effect of sleep duration. Concern has been raised in many countries about sleep deprivation in school-aged children. Much less attention has been paid to other aspects of sleep.

In a Finnish study, more than 400 eleven- and twelve-year olds from a small town reported how they slept during the school week and during the weekend. They rated their symptoms of depression and how attentive they felt themselves to be. The children also reported how tired they felt on school mornings and days as well as how much they experienced adverse bedtime behavior.

During the school week, the children had 9 hours and 5 minutes sleep per night but during the weekend they slept 1 hour and 14 minutes longer per night. Although this study did not find alarmingly short hours of sleep, the difference in sleep duration between the school week and the weekend suggests that the children suffer from sleep deprivation during the week. Indeed, many pediatricians have recommended that children in primary schools should sleep 10 hours a night.

Previous literature has shown that short sleep duration increases the risk of developing depression symptoms in adolescence. This was also found in Finnish children: The less the children slept, the more depression symptoms they experienced. Because sleep problems are often inherent in depression, no causal conclusion can be drawn. Short sleeping time may be caused by depression or vice versa. Some evidence gathered from adolescents seems to suggest, however, that generous hours of sleep prevent depression symptoms and suicidal thoughts. Our results do not mean that sleep deprivation leads to major depression. Rather, on a population level sleep deprivation works to decrease general well-being.

The Finnish study also discovered that short nights of sleep during the school week were related to poor attention. There is a great deal of data confirming that, under experimental conditions of sleep restriction, adult and adolescent participants show inattention.

By contrast, there is some evidence demonstrating that children, who regularly get little sleep, show hyperactivity rather than inattention. The results in the Finnish study, conducted by a colleague and myself, were thus not unexpected: Short sleeping hours are related to poor attention and symptoms of depression.

Somewhat surprisingly, daytime sleepiness and adverse bedtime behavior were able to predict depression and poor attention more than short sleep duration on school days. The meaning of these findings is still somewhat uncertain. Perhaps the measures of adverse bedtime behavior and poor attention tap the same underlying behavior type, but why would daytime sleepiness have such an important role in depression symptoms and poor attention? Daytime sleepiness was only weakly correlated with sleep duration.

We did not measure the quality of sleep, but we suspect that it may be a key element in triggering daytime sleepiness. Indeed, my recent, still unpublished data suggest that sleep behavior (e.g., waking at night and having difficulty falling asleep again, moving to someone else's bed, snoring) together with sleep duration during the school week explain the level of daytime sleepiness.

In summary, our results suggest that children's sleep deprivation may lead to increased depression symptoms and poor attention. Teachers often say that children's attention problems have increased over the past decades, although scientists do not necessarily share this impression. One option, or just mere a guess, might be that insufficient sleep amount and poor sleep quality may be detrimental to attention capacity, resulting in ADHD-type behaviors: hyperactivity and impulsivity.

Primarily, parents have a major role in ensuring that children get enough sleep, but even general practitioners and teachers should be able to identify children with sleep deprivation. Although much more work is needed, our results suggest that sleep deprivation and poor sleep quality may lead to daytime sleepiness and undesirable consequences, including low academic achievement, mood disturbance, and low well-being.

Dr. Juhani E. Lehto works as a senior lecturer in Special Education at the Open University, the University of Helsinki, Finland. His main research interest is children's well-being.
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Publication:Pediatrics for Parents
Date:May 1, 2013
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