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Understanding sleep–wake behavior and sleep disorders in children: the value of a model

Jenni, Oskar Ga; LeBourgeois, Monique Kb

Current Opinion in Psychiatry: May 2006 - Volume 19 - Issue 3 - p 282–287
doi: 10.1097/01.yco.0000218599.32969.03

Purpose of review Sleep–wake problems such as night wakings, excessive crying, or difficulties in falling asleep are frequent behavioral issues during childhood. Maturational changes in sleep and circadian regulation likely contribute to the development and maintenance of such problems. This review highlights the recent research examining bioregulatory sleep mechanisms during development and provides a model for predicting sleep–wake behavior in young humans.

Recent findings Findings demonstrate that circadian and sleep homeostatic processes exhibit maturational changes during the first two decades of life. The developing interaction of both processes may be a key determinant of sleep–wake and crying behavior in infancy. Evidence shows that the dynamics of sleep homeostatic processes slow down in the course of childhood (i.e., sleep pressure accumulates more slowly with increasing age) enabling children to be awake for consolidated periods during the day. Another current topic is the adolescent sleep phase delay, which appears to be driven primarily by maturational changes in sleep homeostatic and circadian processes.

Summary The two-process model of sleep regulation is a valuable framework for understanding and predicting sleep–wake behavior in young humans. Such knowledge is important for improving anticipatory guidance, parental education, and patient care, as well as for developing appropriate social policies.

aChild Development Center, Department of Pediatrics, University Children's Hospital Zürich, Zürich, Switzerland

bCenter for the Study of Human Development, Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA

Correspondence to Oskar G. Jenni MD, Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland Tel: +41 44 266 77 51; fax: +41 44 266 71 64; e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.