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Aims: The main aim of this research was to add depth of understanding and a human voice to existing research on the maternal experience of having a child with night-time sleep difficulties. It was hoped that this increased understanding could be used by counselling psychologists, not only in their own clinical practice but also when supporting physical health practitioners who have direct contact with this client group. Method: Five semi-structured interviews were conducted with mothers who had children over the age of one who were experiencing night-time sleep difficulties. The interviews were transcribed and analysed in accordance with grounded theory methods. A constructivist version of grounded theory was utilised as outlined by Charmaz (2006). Analysis: A central story line of ‘no choice but to function’ emerged. This refers to the place where these mothers found themselves after attempts to solve their child’s sleep problem had proved ineffective, and describes a state of both ‘coping’ and immense struggle. A number of categories were identified which contribute to this central storyline. A process was identified that outlined the stages that all participants moved through as they encountered and adapted to this experience. Personal Conflicts were also identified which described the experience and impact of fatigue, uncertainty and conflicting emotions. Categories of Responsibility and Isolation also emerged and were found to potentially lead to many personal needs not being met iii and a lack of engagement with support (including that of health professionals). Furthermore, a category of Coping highlighted not only the participants’ reflections on how they coped but also potential future avenues of support. Conclusion: The aims of this research were met with a deeper understanding of this population being obtained and a human voice being added to the existing research on this subject. Findings from this research offer a theoretical model which highlights not only the physical, emotional and systemic struggles encountered by the participants that were interviewed, but also provides suggestions based on these findings for future research and clinical practice.

The work presented in this dissertation focuses on the association between sleep medication use, poor sleep, and falls in community-dwelling adults 65 years or older. Sleep complaints and the consumption of medications to aid sleep are common in older adults. Psychotropic medications, such as sedative hypnotics, are associated with risk of falls in older adults. However, very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls in community-dwelling older adults. In the first project, a cross-sectional analysis of the Health and Retirement Study (HRS) 2010 data was conducted to determine the prevalence of sleep problems, sleep medication use and falls; and to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. A multiple logistic model adjusted for covariates was used. In the sample of community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the older adults. Older adults who had sleep problems and took sleep medications had a significantly higher risk of falls compared with older adults who did not have sleep problems and did not take sleep medications. The other two groups, older adults who had sleep problems and did not take sleep medications, and those who did not have sleep problems and took sleep medications also had a significantly greater risk for falls. The second project was a prospective cohort study of independently-living older adults from senior congregate housing. The effect of combined poor sleep quality and sleep medication use on risk of falls was assessed using logistic regression modeling. In this study of 113 community-dwelling older adults, 46.9% had at least one fall, and 62.8% had poor sleep quality. Sleep medication use was reported by 44.2% of the older adults. Older adults with poor sleep quality and sleep medication use had a significantly increased risk of falls compared with older adults with good sleep quality and no sleep medication use. Older adults with good sleep quality and sleep medication use, and those with poor sleep quality and no sleep medication use did not have a significantly greater risk for falls. In conclusion, poor sleep added to sleep medication use significantly increased the risk of falls in community-dwelling older adults. The research undertaken in this dissertation was the first to evaluate the associations between poor sleep, use of sleep medications, and falls in community-dwelling older adults.

( Sleep Problems in Children and Adolescents ) The main topic of the thesis is the issue of sleep in children and adolescents. The theoretical part deals with the physiology of sleep and sleep disorders. The practical part were processed by means of qualitative and quantitative research . The aim of our thesis and our research was to determine the incidence of sleep disorders in different age categories. The aim of the qualitative part was to determine the causes and effects of sleep disorders in children and adolescents. In practice , the qualitative part certainly importance , especially for teachers , case reports indicate that some other sleep disorders affect child development , behavior and school performance. In this thesis we compare the quantitative survey targeted four designated groups of children . One group of preschool children are 1-6 years old . The second group consists of a sample of pupils of primary school 7 - 11 years . The penultimate group of children at the elementary school , aged 12 - 15 years. The last group are secondary school students aged 16-18 years . At the beginning of quantitative research, we set three hypotheses. Hypothesis 1 were not confirmed . Our research shows that pupils of primary schools suffer from sleepwalking more (9%) than children of preschool age...

Sleep problems are robust suicide risk correlates. According to the interpersonal theory of suicide, thwarted belongingness (TB) and perceived burdensomeness (PB) may explain the link between sleep problems and suicide risk. This study examined these relationships among 331 community-dwelling adults identifying as sexual and/or gender minorities. Self-report measures of sleep problems, TB, PB, suicide risk, and anxiety were completed. Bootstrap mediation analyses were conducted to test TB and PB as interacting, individual, and parallel explanatory factors linking sleep problems and suicide risk. Sleep problems were associated with greater TB, PB, and suicide risk. TB and PB, in parallel and individually, accounted for the relationship between sleep problems and suicide risk, beyond age and anxiety. In contrast to the interpersonal theory, the indirect effect of PB was stronger at lower levels of TB and the indirect effect of TB was stronger at lower levels of PB. Exploratory analyses indicated significant differences between sexual minorities, gender minorities, and individuals identifying as both sexual and gender minorities: the indirect effect of sleep problems on suicide risk through PB was descriptively strongest among sexual minorities, and the indirect effect through TB was descriptively stronger among gender minorities and individuals identifying with both minority groups. Findings suggest that intervening upon TB and PB may thwart the trajectory from sleep problems to suicide risk among sexual and gender minorities. Further work is needed to determine whether suicide risk pathways differ across minority groups.

Pediatric sleep problems are among the most common yet significant pediatric health issues faced by families. Sleep problems can impact social-emotional and academic functioning of schoolchildren. Once identified, pediatric sleep problems and disorders are treatable with effective and rapid behavioral and medical interventions. The purpose of the current study was to determine the prevalence rates of symptoms of sleep disorders in a diverse school-based sample as well as the relationship between symptoms of sleep disorders and school behavior, academic achievement, and quality of life. The present study examined the relationship between the independent variables of No Sleep Disorders symptoms and Sleep Disorders symptoms derived from the Sleep Disorders Inventory for Students, Children's Form (SDIS-C) and the dependent variables Externalizing and Internalizing scales of the Behavior Assessment System for Children, Second Edition (BASC-2), Curriculum-based Measurement Re ading (R-CBM), Curriculum-based Measurement Math (M-CBM), PedsQL TM 4.0, and Students' Life Satisfaction Scale (SLSS). A Multivariate analysis of variance (MANOVA) was used to identify a significant difference between students with and without symptoms of sleep disorders on behavior, academics, and quality of life. Follow-up analyses using a modified Bonferroni adjustment determined significant differences between students with and without symptoms of sleep disorders on R-CBM, externalizing behaviors and internalizing behaviors. Medium effect sizes were reported for R-CBM, externalizing and internalizing behaviors and M-CBM. Very small effect sizes were found for PedsQL TM 4.0 and SLSS. Implications for School Psychologists and directions for future practice and research are discussed including understanding prevention, early identification and intervention, broadening the scope of school psychology training at the preservice and inservice levels and educating locally and nationall y.

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Sleep, emotions and pain are intimately connected, physiologically, by their location and utilization of the same brain centers and neurotransmitters. Sleep disturbances have been clinically observed in chronic pain populations; yet, no treatment program has formally addressed this aspect of patient care. It is hypothesized that a pain population (PN) will differ significantly from a non-injured workforce (WF) when reviewing quantitative and qualitative sleep data. This study strongly supports that sleep disturbances and socioeconomic decrements exist in chronic pain patients. Forty-seven variables were surveyed and 13 were found to show significant differences between the groups and seven were found to discriminate between the PN and WF groups at less than the .0001 level. A discriminant analysis was performed to determine the smallest model which could efficiently classify cases, according to successive root variables. The major discriminators are pain levels, medication, amount of sleep obtained and number of awakenings.

SAMMANFATTNING Bakgrund   Psykisk ohälsa och sömnproblem är stora folkhälsoproblem idag både i Sverige och globalt. Dessa två faktorer har en dubbelriktad verkan där personer med psykisk ohälsa ofta även besväras av sömnproblem. Sömnproblem har negativa konsekvenser både för den psykiska och fysiska hälsan men får trots detta ofta låg prioritet vid behandling av patienter med både psykisk ohälsa och sömnproblem. Syfte  Syftet är att belysa omvårdnadsåtgärder som beskrivs att kunna förbättra sömnen hos personer med psykisk ohälsa.  Metod  En icke-systematisk litteraturöversikt gjordes baserad på 15 stycken vetenskapliga artiklar. Samtliga inkluderade artiklar var av kvantitativ metod. Litteratursökningen genomfördes i databaserna CINAHL och PubMed. Artiklarnas kvalitet granskades med hjälp av Sophiahemmets bedömningsunderlag för vetenskaplig kvalitetsgranskning och klassificering. Sedan gjordes en integrativ dataanalys av artiklarna där de olika datakällorna kombinerades och analyserades som en helhet. Resultat Fyra stycken teman och 12 subteman på sömnfrämjande åtgärder hittades. Teman på sömnfrämjande åtgärder funna i de analyserade artiklarna är KBT, sömnhygien, mindfulness och alternativa metoder såsom aromaterapi och musik. Resultaten visar generellt en positiv effekt av riktad behandling mot sömnproblem och med det ofta även en positiv effekt på den mentala hälsan hos personen.  Slutsats Flertalet alternativ till sömnfrämjande åtgärder med måttligt till god effekt på sömnproblem hittades i resultatet och detta har även ofta en positiv inverkan på personens mentala hälsa. Det finns dock bristande tillgänglighet till denna typ av vård vilket visar på en förbättringspotential. Hur tillgängligheten kan förbättras är ett ämne för vidare studier men våra resultat pekar mot att sjuksköterskor skulle kunna ha en nyckelroll i detta. / ABSTRACT Background Mental health issues and sleep problems are big health issues in society today both in Sweden and globally around the world.  These two factors of mental health issues and sleep problems often correlate. Sleepi problems have a negative impact on both mental and physical health but is despite this not prioritized when treating patients with both mental health issues and sleep problem Aim The aim was to highlight nursing care that can help improve sleep for people with mental health issues.  Method A non-systematic literature review was made based on 15 different articles. All of the included articles used quantitative research methods.  The literature search was made using the databases CINAHL and PubMed. Furthermore, chosen articles were quality reviewed using the Sophiahemmet assessment basis for quality evaluation and classification. After this an integrative data analysis was made of the articles where the different data sets were combined and analyzed as a whole. Results Four themes and 12 sub themes were found with working practices for sleep-improvement. These themes that were found in the analyzed articles were cognitive-behavioural therapy, sleep hygiene, mindfulness and alternative methods such as aromatherapy and music therapy. The results show a positive outcome and improvement for sleep problems when using focused treatment and the results also indicate an improved mental health.  Conclusions There are several different methods available which can give moderate to good impact on sleep problems. When sleep improves in most cases the mental health also improves. All methods are not available in all places and there is a potential for improvement of nursing care for persons with mental health issues and sleep problems.

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