Barbara Caldwell, PhD, APRN-BC, associate professor, UMDNJ-School of Nursing
At UMDNJ-School of Nursing several researchers are involved in a sleep research program headed up by Nancy Redeker, PhD, Associate Dean for Research. I am currently working on a study that was awarded the Gloria Smith Scholar’s Research Grant from the American Nurses Foundation. The grant, entitled “Maternal Stress and Sleep in Preschool Children,” will evaluate the feasibility of methods of recruitment and data collection for a larger planned study of maternal stress, psychological trauma, and sleep patterns of children living in underserved communities.
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The maternal-child relationship is associated with early development of sleep-wake state organization, the child’s emotional regulation, and the child’s ability to experience a broad range of emotions and regulate their intensity and duration. For many mother-child dyads living in underserved inner city communities, levels of stress, depressed mood, and psychological trauma may be particularly high. Past studies have suggested that maternal psychiatric symptoms have serious implications for the development of a child’s sleep patterns. Unfortunately, little is known about developmental characteristics of sleep or psychosocial risk factors for sleep disturbance in young children.
In this study, 25 preschool children and their mothers are being recruited from WIC. The mother is being asked to have her preschool child wear a small wristwatch-like device, called an actigraph, for 5 days and to monitor the time the child wakes up and goes to sleep in the evening. The children are being provided with a bag of incentives as a reward for wearing the actigraph. Additionally, mothers are asked to complete questionnaires on their own stress levels and associated feelings. At the present time, data is still being collected and will shortly be ready for analysis.
I was also the principal investigator on another related study, “Sleep Patterns and Inner City Childbearing Women,” which examined the association of sleep patterns and psychological problems in inner-city childbearing women between the ages of 18 and 40. While sleep disturbance is known to be common in women of childbearing age, little is known about the characteristics of sleep patterns of these inner-city women. Studies show they comprise a vulnerable population, at risk for poor physical, psychological and social health, and they tend to be more adversely affected by stressors. We hypothesized, therefore, that sleep disturbances, compounded by symptoms of stress, could have major implications for the mental health status of inner-city women during their childbearing years. We also believe that sleep disturbances among this population contribute to symptoms of psychiatric mental health disturbances, such as anxiety, depression, and post traumatic stress disorder. These disorders often lead to negative parenting behaviors.
A total of 120 women participated in the study. Each completed a questionnaire on her symptoms of anxiety, depression, and psychological trauma. Each woman also kept a standard sleep diary for three days, in which she recorded daily bed times, times of sleep onset, times and durations of awakenings during the night, and nap times during the day. A numeric rating scale was included to indicate quality of daily sleep and sleepiness for the preceding day.
In addition to the written assessments, each woman wore an actigraph for three consecutive days. The participants were instructed to press a button upon going to bed and again upon waking. The device senses and counts the number of movements in a pre-programmed amount of time; that information is later downloaded into a computer for analysis.
We have analyzed the data and submitted the study for publication. To our knowledge, it is the first study to use both objective and subjective sleep measurements of sleep patterns and correlate them with a cluster of co-occurring psychological variables in inner-city childbearing women. The sleep findings suggest that the women reported sleep disturbances, slept less and had less efficient sleep than the reported norms, and may be at risk for insomnia or sleep deprivation.
The study participants were predominantly minority women. The findings provide a better understanding of the influence of life events, sleep efficiency, and sleep quality, and the relationship to depression, anxiety, and psychological traumatic symptoms, and can be the basis for additional studies to validate insomnia in this sample. Since the sample was from the inner city, the study provided a beginning understanding of the potential need for treatment services for this underserved group. Cognitive-behavioral treatment programs may be an effective intervention for these women and will be the next step in the research team study agenda.
Barbara Caldwell, PhD, APRN-BC, is an associate professor in the UMDNJ-School of Nursing and the MSN coordinator for the Adult Psychiatric - Mental Health Graduate Nursing Track. Dr. Caldwell is one of the Project Directors for the clinical affiliation with the New Jersey Department of Health Division of Mental Health Services. She was inducted into the UMDNJ Master Educators' Guild in 2002, and received the UMDNJ Foundation Teaching Award for Excellence in 1994 and 2004 and the Healthcare Foundation of New Jersey's Humanism in Healthcare Award in 2003.
