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Keywords:

  • maternal health;
  • napping;
  • parenting;
  • sleep disruption;
  • sleep

Summary

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Participants and procedures
  6. Measures
  7. Maternal and infant sleep patterns
  8. Maternal perceptions of sleep quality
  9. Results
  10. Discussion
  11. References

Many researchers and clinicians have promoted nap taking to combat the deleterious effects of disrupted sleep. Unfortunately, only a small portion of sleep-deprived individuals take naps. The goal of the present study was to identify cognitive and opportunity factors related to nap taking of mothers of young infants. Fifty-one mothers of young infants completed measures that recorded various characteristics of their nighttime sleep patterns, their perceptions of their sleep, and factors influencing their opportunities to take naps. Results revealed that mothers' perceptions of sleep disturbance and opportunity factors were more predictive of napping than total nighttime sleep or actual time spent caring for the infant during the night.


Introduction

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Participants and procedures
  6. Measures
  7. Maternal and infant sleep patterns
  8. Maternal perceptions of sleep quality
  9. Results
  10. Discussion
  11. References

The incidence of sleep fragmentation among mothers of infants and young children has become a concern for researchers and clinicians. Recent reports suggest that mothers lose an average of 350 h of sleep during their infant's first year (Dement and Vaughan 1999). In fact, mothers have been described as one of many groups of individuals most at risk for severe sleep disorders (NCSDR 1992). Much of mothers' sleep fragmentation has been linked to caring for the needs of their infants throughout the night (Halpern et al. 1994; Messer and Richards 1993).

Mothers' sleep fragmentation caused by infant night waking has been routinely associated with maternal psychological, psychosomatic, emotional, and social disturbances (Chavin and Tinson 1980; Richman 1981; Scott and Richards 1990). Despite the high prevalence of sleep fragmentation among mothers of young infants, research in this area has revealed that many mothers fail to identify the impact of sleep fragmentation on their functioning (Maas 1999; NCSDR 1992; Wolfson 1998). Scott and Richards (1990) reported that although infant night waking was the most common problem parents reported to pediatricians, many parents did not perceive significant numbers of night wakings as a problem for their own functioning. By not recognizing this problem, mothers may subsequently choose not to engage in restorative sleep behaviours such as sharing nighttime responsibilities with a partner or taking naps.

The present study had two goals. First, we sought to examine the relationship between mothers' nap taking and both subjective and objective measures of their nighttime sleep. Observations of the absence of restorative sleep behaviors among mothers who are impaired by sleep fragmentation led us to hypothesize that mothers' perceptions of the disturbance of their sleep would be more strongly related to their nap taking than their actual total nighttime sleep or amount of infant night waking. The second goal of the study was to assess if mothers are more likely to nap if they have the opportunity. Mothers who did not work outside the home or who did not have additional children in the home were expected to nap more than mothers who worked or had more than one child.

Participants and procedures

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Participants and procedures
  6. Measures
  7. Maternal and infant sleep patterns
  8. Maternal perceptions of sleep quality
  9. Results
  10. Discussion
  11. References

Participants included 51 mothers of 12- to 16-week-old healthy infants born at full-term. The average age of the mothers was 30.6 years (SD = 4.63) and of the infants was 12.71 weeks (SD = 1.15). Mothers identified through local county birth records received an introductory letter describing the purpose, general design, and enrollment criteria of the study, followed by a telephone call. Interested mothers then received a packet of questionnaires to complete when their infants were 3-months old. Mothers returned these questionnaires and completed several others at a subsequent laboratory visit. A total of 64 mothers were contacted by telephone and 52 of those agreed to participate. One of these mothers failed to participate because her child was ill. Characteristics of the mothers who participated in the study are provided in Table 1.

Table 1.  Characteristics of study participants
CharacteristicNumberPercent
Race
 Caucasian4996.1
 Hispanic12.0
 Biracial12.0
Education completed
 Less than high school degree12.0
 High school completion1937.3
 College degree1937.2
 Graduate or professional degree1223.5
Marital status
 Married4996.1
 Not married23.9
Employment status
 Not employed2447.1
 Employed 20 h week−1 or less1121.6
 Employed more than 20 h week−11631.4
Family income
 <$40 0001835.3
 $40 000–59 9991529.4
 $60 000–79 9991019.6
 >$80 000815.7
Other children in the home
 01835.3
 12549.0
 247.8
 347.8
Infant feeding method
 Breast only2039.2
 Formula only1835.3
 Combination1325.5
Who provides infant care at night?
 Mother4588.2
 Father12.0
 Shared47.8
 [Missing data]12.0
Where does infant sleep?
 In parents' room2752.9
 In other room2447.1

Maternal and infant sleep patterns

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Participants and procedures
  6. Measures
  7. Maternal and infant sleep patterns
  8. Maternal perceptions of sleep quality
  9. Results
  10. Discussion
  11. References

A 3-day Mother and Infant Activity Log asked mothers to record actual mother and infant sleep as well as other activities such as infant care (i.e. diapering, playing). Mothers recorded the presence or absence of each behaviour during 15-min intervals for a 3-day period during the week prior to their laboratory visit. The average amount of sleep at night, amount of time awake for infant care during the night, and the amount of time spent napping were specifically examined in the present analyses.

Maternal perceptions of sleep quality

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Participants and procedures
  6. Measures
  7. Maternal and infant sleep patterns
  8. Maternal perceptions of sleep quality
  9. Results
  10. Discussion
  11. References

The Visual Analog Sleep Scales (VAS; Snyder-Halpern and Verran 1987) were used to appraise mothers' perceptions of their sleep efficiency during the night preceding the laboratory visit. The VAS consists of 15 subjective characteristics of sleep quality arranged in a visual analog design. Only the sleep disturbance scale was examined in the present report. Items on this scale assess the quality of mothers' sleep (e.g. amount of movement, depth), number and duration of awakenings, and degree of difficulty returning to sleep. Each item is scored from 0 to 100 with higher scores reflecting sleep disturbance. Seven items were averaged to obtain a total sleep disturbance scale score.

Results

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Participants and procedures
  6. Measures
  7. Maternal and infant sleep patterns
  8. Maternal perceptions of sleep quality
  9. Results
  10. Discussion
  11. References

On average, mothers reported that they obtained 6.75 h of sleep per night (SD = 1.14, range from 4.17 to 9.42 h). Only four mothers reported no sleep interruptions by their infants during the 3-day reporting period; others reported an average of between one and four interruptions per night (M = 1.17, SD = 1.04). Twenty-four mothers (47.1%) took no naps during the 3-day reporting period. Sixteen mothers (31.4%) took one nap and nine mothers (17.6%) took two or more naps. Those mothers who took naps over this period of time recorded naps averaging 30 min (SD = 0.51). The mean level of sleep disturbance reported by mothers on the VAS was 34.0 (SD = 12.8), indicating moderate sleep disturbance.

Pearson product–moment correlations among the study variables are reported in Table 2. Nap taking was related to the mother's perception of her sleep disturbance as well as the actual amount of time the mother was awakened at night for infant care. [Note that the number of times the infant awoke at night was highly correlated with the amount of time the infant was awake, r = 0.79, and because results of analyses using these two variables were very similar, only the amount of time results are reported.] The total amount of sleep mothers received at night did not relate to nap taking. Nap taking also was related to opportunity factors. More napping was reported by mothers who were employed for fewer hours and by mothers who had fewer other children. Additional correlations not reported in the table indicated that nap taking was not related to mothers' sleep deprivation (the difference between the actual amount of sleep mothers received and the amount mothers reported they needed to function well), depression (as measured by the Beck Depression Inventory), family income, mother's education, whether or not the mother was breast feeding, or whether or not the infant slept in the parents' room, all P-values (P > 0.05).

Table 2.  Pearson product–moment correlations among study variables
 123456
  1. Note: Sample size ranges from 49 to 51 due to missing data. P < 0.10, *P < 0.05, **P < 0.01.

Total time spent napping0.050.35*0.37*−0.34*−0.24
Total nighttime sleep −0.27−0.10−0.25−0.03
Total time infant awake  during mother's sleep time  0.45**−0.24−0.08
Perceived sleep  disturbance (VAS)   −0.260.09
Hours per week employed     −0.31*
Number of other children  at home     

Because many of the variables used as predictors of napping were intercorrelated, a multiple regression procedure was used to determine which variables independently predicted napping. All variables in Table 2 were simultaneously entered as predictors into an equation with napping as the dependent variable. Results are reported in Table 3. The overall r of 0.58 was significant, F(5, 43) = 4.40, P < 0.01, and the amount of variance accounted for using the adjusted r2 was 26%. Mothers' perceptions of sleep disturbance, hours of employment, and number of other children each independently predicted napping whereas total nighttime sleep and the time the infant was awake at night did not.

Table 3.  Summary of regression analysis for variables predicting total time spent napping (n=49)
VariableBSE BBeta
  • *

    P < 0.05, one-tailed;

  • P < 0.05, two-tailed.

Total nighttime sleep0.010.060.02
Total time infant awake  during mother's sleep time0.100.110.14
Perceived sleep  disturbance (VAS)0.000.000.25*
Hours per week employed0.010.00−0.34
Number of other  children at home−0.220.08−0.35

Discussion

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Participants and procedures
  6. Measures
  7. Maternal and infant sleep patterns
  8. Maternal perceptions of sleep quality
  9. Results
  10. Discussion
  11. References

The present study attempted to identify social and cognitive factors related to mothers' decisions to take naps. Although the majority of mothers' nighttime sleep was regularly disrupted, maternal nap taking was more strongly predicted by perceptions of sleep disturbance than by actual amount of sleep (even when adjusted for differences in mothers' need for sleep) or infant awake time. These findings introduce the question of whether mothers' sleep patterns are problems if mothers do not consciously address the severity of their sleep fragmentation. Previous studies have shown that objective measures of sleep loss are related to cognitive, emotional and physical impairment (Babkoff et al. 1985; Bonnet 1989; Krueger 1989). That is, although mothers may only be motivated to take naps when they feel subjectively sleep deprived, they may be experiencing negative effects of sleep deprivation without being fully aware of it (Coren 1997). Convincing women to take naps although they do not feel seriously sleep deprived may be a particular challenge. Similarly, the benefits of napping are not always immediately evident to the person who has napped (Maas 1999). A substantial educational effort may be required to convince women that their lives would be markedly improved by finding ways to incorporate short naps into their days.

Opportunity was also significantly related to mothers' nap taking in the present study. Mothers who worked more or who had more children at home engaged in less napping than mothers who worked less or had fewer children. Although these two variables were correlated (i.e. women who worked more had fewer children), both factors independently contributed to nap taking. Most napping by mothers in this sample took place between 9 am and 5 pm, during the time when most full-time working mothers are expected to be alert and actively engaged in their work. Few employers provide accommodations for napping, although arguments have been made that allowing and encouraging workers to take short naps could improve worker productivity (Maas 1999).

Mothers with more children also found it difficult to take naps, probably because their older children either did not take naps anymore or did not always nap at the same time as the infant, thereby allowing mothers a time free of child care responsibilities during which to nap. Even if a mother with multiple children manages to have them all nap at the same time, she may be less inclined to take a nap herself during that time because of the increased number of household chores generated by multiple children.

Recognition of the social and cognitive factors involved in mothers' decisions to engage in healthy sleep behaviours is particularly important for practitioners when constructing appropriate and effective interventions to help mothers cope with the high incidence of nighttime infant awakenings. The results of the present study emphasize the importance of recognizing the role of mothers' perceptions of their experiences as well as the role of social factors that increase or reduce mothers' opportunities for napping in addition to absolute measures of sleep disruption.

The findings from the present study additionally argue for the inclusion of objective measures of opportunity for mothers to take naps when they perceive their sleep disruption to be severe. Given that significant sleep disruption in mothers of young infants is generally accepted and often neglected as a problem, researchers should also examine the strength of societal and cultural views on mothers' decisions to engage in healthy sleep behaviour. By incorporating multiple sources of information concerning mothers' sleep disruption experiences, future studies will provide new and fundamental information, both about the nature and magnitude of this public health threat and the strategies likely to be most effective in combating it.

References

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Participants and procedures
  6. Measures
  7. Maternal and infant sleep patterns
  8. Maternal perceptions of sleep quality
  9. Results
  10. Discussion
  11. References
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