Sleep and bedtime-related anxiety are important targets for children with emotional difficulties
Submitted by Alina Marinca
Sleep problems like insomnia and hypersomnia are increasingly recognised as a central feature of children's mental health. However, not much is known about how specific sleep problems relate to both behavioural and emotional symptoms.
Using data from 876 children aged 8-12 years from East London (48% boys, 58% British Asian, 25% receiving free school meals), we used a statistical method called network analysis to examine the relationships between different sleep, behavioural, and emotional problems. To do this, we used children's self-reported sleep problems, teacher-reported behavioural symptoms (hyperactivity/impulsivity, inattention, and conduct problems), and children's self-reported emotional symptoms (anxiety and depression).
We identified seven groups of symptoms that tend to occur together. More specifically, we found that:
Anxiety and sleep-anxiety symptoms had the most connections to other symptoms
Emotional symptoms were more closely connected to specific types of sleep problems than behavioural symptoms, which were more peripheral
Problems with appetite, trouble sleeping, daytime sleepiness, and worrying about going to bed were symptoms that showed possible links between different groups of symptoms (but more research is needed on this before we can be sure)
There were similarities between boys and girls, although boys' difficulties tended to centre more on worries and being easily distracted, whereas girls' difficulties tended to centre more on bedtime worries and sleep-anxiety.
Our findings suggest that sleep and bedtime-related anxiety may be an important target for interventions supporting school-aged children experiencing behavioural and emotional difficulties. This highlights the importance of tailoring sleep interventions to specific sleep problems, rather than treating sleep more generally.
I’m a young person – what does this mean for me?
Sleep is important for your mental health. If you have worries about bedtime or difficulties sleeping, it is important to talk to a trusted adult. Having a good night's sleep can help you feel better during the day, concentrate better at school, enjoy spending time with your friends, and feel good overall.
I’m a parent - what does this mean for me?
If your child has bedtime worries or sleep difficulties, such as avoiding bedtime, worrying about sleeping alone, or struggling to settle to sleep, it is important to take these concerns seriously, even when they seem mild.
I’m a teacher - what does this mean for me?
Sleep is an important but often overlooked target for early intervention and the promotion of wellbeing. While schools increasingly support children's emotional wellbeing, sleep education and sleep-supportive routines should also be integrated into mental health approaches.
I’m a clinician – what does this mean for me?
Sleep should not be viewed as secondary to children's mental health. Instead, specific sleep problems, particularly sleep anxiety and bedtime-related worries, may sit near the centre of children's emotional symptom networks. Our findings support the value of more targeted and modular interventions, rather than treating sleep as a single construct. Behavioural and cognitive behavioural interventions that specifically address sleep-related anxiety may benefit school-aged children experiencing emotional and behavioural difficulties.