A 2.5-year follow-up of infants treated for severe sleep problems

Abstract

Objective Sleep problems are common during infancy, and treatment programmes based on behavioural techniques have been reported to have high rates of short-term improvement (80–90%) when used with support from a therapist.

However, follow-up periods longer than 3 months are rare. The aim of this study was to describe the changes in sleep of 24 sleep-disturbed infants after an interventional sleep programme. Comparisons with a healthy control group were made for a follow-up period of 2.5 years.

Settings The case group was recruited from a parental questionnaire population study and sample of 2518 children aged between 6 and 18 months. The response rate was 83%. The group consisted of those 6–12-month-old children who fulfilled specific criteria for severe and chronic sleep problems (n = 27). A healthy control group was matched with regard to age and sex.

Methods The parents of the case group were offered a sleep programme based on the premise of controlled crying, and 24 families chose to participate. In addition to the behavioural technique, an interdisciplinary approach was used, taking the whole family situation into consideration. Sleep diaries and questionnaires were sent to cases and controls for follow-ups at 1 month, 1 year and 2.5 years, respectively, after admission.

Results One month after initiation of the treatment programme in the case group, significant changes had taken place. The average number of times the case babies

woke up had diminished from 6.0 to 1.8 times per night, and night-time sleep had

increased, on average by 67 minutes. A 92% rate of improvement was reported.

The changes were stable over time. Comparisons with the healthy controls after 1 year and after 2.5 years revealed no significant group differences in sleep characteristics. The families in the case group managed to maintain the achieved changes in infant sleep behaviour on their own; continuous therapist support was not necessary. This was true even for formerly depressed and psychosocially burdened parents.

Conclusions A combination of behavioural technique and interdisciplinary family work has positive and long-lasting effects in children with severe and chronic sleep problems.

Implication for practice Even severely sleep-disturbed infants coming from families with depression and psychosocial problems can be helped to sleep well with a relatively short but intense and multidisciplinary sleep programme.