Exploration of Toddler Sleep and Maternal Sleep/Mental Health in Low-income Families at Risk for Sleep Disparities

Abstract

Introduction: Sleep plays an important role in children's physical growth, behavior and development. The National Sleep Foundation recommends that toddlers get 11-14 hours of sleep in 24-hours and go to bed before 9 pm. Accurate sleep assessment is necessary to explore if toddlers are meeting these recommendations. Mothers play a primary role in toddler's sleep routines and duration. Conversely, toddler sleep is associated with maternal sleep quality. Poor maternal sleep has been linked to increased mental health symptoms. This reciprocal relationship requires investigation of the mother-toddler dyad, especially among low-income families in whom sleep deficiencies have previously been identified. Purpose: The purpose of this dissertation was to explore toddler sleep and maternal sleep/mental health in low-income families at risk for sleep disparities. Methods: Three cross-sectional studies were conducted. The first tested an integrated model to examine whether associations between perceived toddler sleep problems and maternal mental health varied by co-sleeping versus independent sleeping. The second identified differences between nightly versus non-nightly bedtime routine implementation based on maternal and demographic characteristics, and explored relationships between bedtime routines, awakenings and sleep duration. The final study compared sleep diary to actigraphy measurement of sleep. Results: Perceived toddler sleep problems were associated with an average decrease of 51 minutes in maternal sleep when co-sleeping. Maternal sleep duration mediated the relation between perceived toddler sleep problems and mental health symptoms for co-sleeping mothers. Presence of maternal depressive symptoms, housing insecurity, and food insecurity were associated with decreased likelihood of nightly bedtime routine implementation (all p<0.05); a practice that was found to be associated with long nighttime sleep duration through few nighttime awakenings (β = 22.93, 95% CI = 7.41 to 47.04). Compared to actigraphy, sleep diaries underestimated bedtime by an hour, overestimated nighttime sleep duration by 2.5 hours, and overestimated 24-hour sleep duration by 2.25 hours. Conclusions: The relation between maternal/toddler sleep and maternal mental health supports the necessary consideration of the mother-toddler dyad. Factors associated with low socioeconomic status may negatively impact the sleep environment and be related to poor sleep quality. Sleep diaries may not be an accurate sleep measure in this population.