The Relationship Between Reported Sleep Quality and Sleep Hygiene in Italian and American Adolescents

Abstract

Objective-The purpose of the study was to examine the relationship between self-reported sleep quality and sleep hygiene in Italian and American adolescents and to assess whether sleephygiene practices mediate the relationship between culture and sleep quality.Methods-Two nonprobability samples were collected from public schools in Rome, Italy, and Hattiesburg, Mississippi. Students completed the following self-report measures: Adolescent Sleep-Wake Scale, Adolescent Sleep Hygiene Scale, Pubertal Developmental Scale, and Morningness/Eveningness Scale.Results-The final sample included 776 Italian and 572 American adolescents 12 to 17 years old. Italian adolescents reported much better sleep hygiene and substantially better sleep quality than American adolescents. A moderate-to-strong linear relationship was found between sleep hygiene and sleep quality in both samples. Separate hierarchical multiple regression analyses were performed on both samples. Demographic and individual characteristics explained a significant proportion of the variance in sleep quality (Italians: 18%; Americans: 25%), and the addition of sleep-hygiene domains explained significantly more variance in sleep quality (Italians: 17%; Americans: 16%). A final hierarchical multiple regression analysis with both samples combined showed that culture (Italy versus United States) only explained 0.8% of the variance in sleep quality after controlling for sleep hygiene and all other variables.Conclusions-Cross-cultural differences in sleep quality, for the most part, were due to differences in sleep-hygiene practices. Sleep hygiene is an important predictor of sleep quality in Italian and American adolescents, thus supporting the implementation and evaluation of educational programs on good sleep-hygiene practices. Adolescence is a period characterized by important changes in cognitive, behavioral, social, and emotional functioning attributable to biological development (ie, puberty) and to new roles and demands in the familial and social milieu (eg, decreased parental involvement, increased academic requirements). There also are dramatic changes in sleep/wake patterns during adolescence, including a decrease in sleep duration, 1-3 a delay in the timing of sleep, 4,5 and an increasingly large discrepancy between weekday and weekend sleep patterns. 6-9 Sleep quality is reduced as well. 10 Community-and school-based studies conducted in Europe, Asia, and the United States suggest that between 6% and 37% of adolescents report difficulties on ≥1 of the following behavioral dimensions of sleep quality: going to bed, 11,12 falling asleep, 3,13-17 maintaining undisturbed sleep, 10,16-18 reinitiating sleep after nocturnal awakenings, 3,16,17 and returning to wakefulness in the morning. 7,9,15,17 Furthermore, up to 16% of adolescents are considered to have clinically significant insomnia. 16,19,20 There is ample evidence that inadequate sleep quantity and quality are linked to significant problems in several aspects of teenagers' lives. 5,8 Sleepiness ...

The Relationship Between Caffeine, Sleep, and Behavior in Children

“…40 Previously good sleep routine has been shown to have a positive effect on sleep quality. 41 This model indicated that sleep routine and restless sleep completely mediate the relationship between caffeine consumption and morning tiredness but only partially mediated the relationship between morning tiredness and internalizing behaviors. This is important because it gives further insight into the importance of sleep and further understanding of the effect of caffeine on the relationship between sleep and behavior in children.…”

Technology Use and Sleep Quality in Preadolescence and Adolescence

“…[17][18][19] The types of circadian preference are intrinsic and heritable characteristics of the individual associated with differences in habits, performance rhythms, physiological, and behavioral variables. 20 According to the literature, M-type individuals wake up early in the morning, fall asleep at an early hour and prefer early morning activities, while E-types seem to have problems waking up in the morning (e.g., need to be waked up by parents), 20,21 staying awake during the day (especially during school time), and feeling more exhausted during the day. 20,22 Circadian preference changes from preadolescence and adolescence, when a consistent shift to evening preference has been reported.…”

Stress-related sleep disturbance and polysomnographic response to caffeine

“…However, there is an increasing body of literature regarding the psychological and physiological differences between insomniacs and good sleepers. Several studies have demonstrated a greater prevalence of intrusive thoughts, worry, and rumination [8], poor sleep hygiene [9,10], dysregulation of the hypothalamic pituitary axis [11], elevations in sympathetic activity [12], and metabolic rate [13], increased daytime alertness [14], and elevated high-frequency electroencephalographic (EEG) activity [15][16][17] in patients with insomnia compared to good sleepers.…”