Katri Räikkönen, Department of Psychology, University of Helsinki, PO Box 9, FI 00014, Helsinki, Finland. Tel.: +358 9 191 29501; fax: +358 9 191 29521; e-mail: firstname.lastname@example.org
We tested the relationship of objectively measured sleep quantity and quality with positive characteristics of the child. Sleep duration, sleep latency and sleep efficiency were measured by an actigraph for an average of seven (range = 3–14) consecutive nights in 291 8-year-old children (standard deviation = 0.3 years). Children’s optimism, self-esteem and social competence were rated by parents and/or teachers. Sleep duration showed a non-linear, reverse J-shaped relationship with optimism (P =0.02), such that children with sleep duration in the middle of the distribution scored higher in optimism compared with children who slept relatively little. Shorter sleep latency was related to higher optimism (P =0.01). The associations remained when adjusting for child’s age, sex, body mass index, and parental level of education and optimism. In conclusion, sufficient sleep quantity and good sleep quality are related to children’s positive characteristics. Our findings may inform why sleep quantity and quality and positive characteristics are associated with wellbeing in children.
Relative to the wealth of studies focusing on the negative consequences of poor sleep, much less is known about the beneficial consequences of sufficient sleep quantity and good sleep quality. There is evidence that adults who get adequate sleep report more optimism and satisfaction with life compared with adults who sleep less than 6 h a night (National Sleep Foundation, 2002). Experimentally induced sleep deprivation in adults results in a gradual reduction in optimism and sociability, suggesting that the association between sufficient sleep and these positive characteristics may be causal (Haack and Mullington, 2005). In adolescents, longer sleep duration predicts prospectively higher self-esteem (Fredriksen et al., 2004). We are not aware of any studies focusing on associations between sufficient sleep quantity, good sleep quality and positive characteristics in young children.
The children came from an initial cohort comprising 1049 infants born between 1 March and 30 November 1998 in Helsinki, Finland, and their mothers. In 2006, children and their parents were invited to participate in a follow-up with a focus on individual differences in physical and psychological development (Räikkönen et al., 2009). Nine-hundred and fifty-eight (91.3%) mothers of the initial cohort gave permission to be included in the follow-up; 922 (87.9%) could be contacted. Of these, a subsample of 413 children was invited for a follow-up examination, and 321 (77.7%) agreed to participate. Non-participation did not relate to child’s gender, birth date, weight, length, head circumference or BMI at birth, birth order, mode of delivery, mother’s gestational diabetes, gestational hypertension, preeclampsia, age, height, weight, BMI, occupational status or blood pressure at delivery, alcohol consumption, licorice confectionery consumption or stress during pregnancy (all P-values > 0.10); non-participation was related to more frequent maternal smoking during pregnancy (P =0.02). The Ethical Committee of the City of Helsinki Health Department and the Ethical Committee of the Helsinki University Hospital of Children and Adolescents and the Uusimaa Hospital District approved the project. Each child and its parent gave an informed consent.
Of the 321 children participating in the follow-up, 305 participated in the actigraphy protocol, of whom 291 (91%; 150 girls and 141 boys) provided valid readings. Three-hundred and five children had maternal and 227 children had paternal ratings of child optimism, self-esteem and social competence available; 255 children had teacher ratings of child self-esteem and social competence available. The analyses excluded children who, according to parental report, had been diagnosed with a developmental delay (n =3) or Asperger syndrome (n =1).
Sleep quantity and quality
Sleep parameters were estimated from actigraphy data by automatic scoring (Actiwatch AW4, Cambridge Neurotechnology, UK) and subsequent manual verification. The wrist actigraph is approximately the size of a standard wristwatch and provides a non-intrusive instrument to measure sleep parameters by assessing body movement (Sadeh et al., 1995). As described elsewhere (Paavonen et al., 2009; Pesonen et al., 2009a), the participants were instructed to wear the actigraphs for at least seven consecutive days on their non-dominant wrist; on average, the devices were worn for 7.1 days (SD = 1.2; 3–4 days, n =2; 5 days, n =6; 6 days, n =43; 7 days, n =171; 8 days, n =41; 9 days, n =25; 10 days, n =6; 11–14 days, n =3), including nights on weekdays (mean = 5.1, SD = 1.0; range 1–10) and weekends (mean = 2.0, SD = 0.4; range 1–4). We instructed the parents to keep a sleep log on bedtimes and waking times, temporary pauses in actigraph registration (e.g. while taking a shower), and significant events that might affect sleep quantity or quality (illness, pain, injury, travel or other events likely to disturb sleep). The child was instructed to press a button (event marker) on the actigraph at bedtime and waking times. A completed sleep log was obtained from all participants, including both parent-reported sleep log and event markers on bedtimes and waking times reported by the child. The activity data were visually inspected to detect significant discrepancies among the sleep log, event markers and the activity pattern. If there were several event markers for one night, the most recent was used and compared with the sleep log. If the sleep log was not synchronous with the event marker, the event marker was used to define the bedtime. We found high concordance between the sleep log records and the event markers; for 71% of the participants, no discrepancies were found; for 21%, a discrepancy was found for one or two nights; and, for 8%, a discrepancy was found for three or more nights. Nights were excluded from further sleep analysis if: (a) the actigraph was not in use; (b) information on bedtime was missing; (c) the child was asleep according to the data of reported bedtime; (d) information on waking time was missing and the activity pattern was not unequivocally interpretable; or (e) the parent reported a change in normal life due to, for example, illness or travel. There were 257 participants (89%) without excluded nights. Data were scored with Actiwatch Activity & Sleep Analysis version 5.4 software with medium sensitivity and a 1-min epoch duration. Sleep duration refers to the actual sleeping time. Sleep latency was defined as the time it takes the child to fall asleep after he or she went to bed. We used the validated Actiwatch algorithm (Tonetti et al., 2008), which defines ‘sleep start’ as 10 min of consecutively recorded immobile data. Sleep efficiency was defined as the actual sleep time divided by the time in bed, thus including sleep latency.
Dispositional optimism of the children was rated by their parents. The parents completed the Parent-rated Life Orientation Test of children (PLOT; Lemola et al., 2010). The PLOT is composed of eight items rated on a scale ranging from ‘not at all true of my child’ (1) to ‘very true of my child’ (4). Four items measure generalized optimistic expectations; a sample item is ‘When entering a new situation, my child expects to have fun’. The other four items measure generalized pessimistic expectations; a sample item is ‘My child often expects that the day will not turn out to be nice’. In addition to a total score derived from summing the optimism and reverse-scored pessimism items (a higher score indicates higher optimism), two subscale scores measuring higher optimism and higher pessimism can be derived by summing the four optimism items and the four pessimism items, respectively. As shown previously, the scale has good construct and convergent validity (Lemola et al., 2010). For the current analyses, mother and father ratings were averaged to increase reliability of measurement. The general coefficients of reliability (Tarkkonen and Vehkalahti, 2005) were 0.82, 0.85 and 0.78 for the combined mother- and father-rated total optimism scale, and optimism and pessimism subscales, respectively.
Parents and teachers completed the Behavioral Rating Scale of Presented Self-Esteem in Young Children (Fuchs-Beauchamp, 1996; Haltiwanger and Harter, 1988). The scale has 15 items assessing young children’s behavioural manifestations of self-esteem (e.g. self-confidence, independence, initiative), which are rated on a four-point Likert scale. A sample item is ‘My child approaches challenging tasks with confidence’. The scale has good validity, internal consistency (Fuchs-Beauchamp, 1996; Verschueren et al., 2001) and stability over a 3-year period (r =0.59; Verschueren et al., 1998). For the current analyses, mother, father and teacher ratings were averaged to increase reliability of measurement. In the current study, the general coefficient of reliability (Tarkkonen and Vehkalahti, 2005) was 0.92 for the combined mother-, father- and teacher-rated scale.
Parents and teachers completed the Social Competence subscale of the Social Competence and Behavior Evaluation Scale (the Short Form; SCBE-30; LaFreniere and Dumas, 1996). Social competence is defined as well-adjusted, flexible, emotionally mature and generally pro-social behaviour, and is assessed by 10 items rated on a six-point Likert scale. A sample item includes ‘My child comforts or assists another child in difficulty’. The scale has good construct validity and internal consistency (LaFreniere and Dumas, 1996). For the current analyses, mother, father and teacher ratings were averaged to increase reliability of measurement. In the current study, the general coefficient of reliability (Tarkkonen and Vehkalahti, 2005) was 0.87 for the combined mother-, father- and teacher-rated scale.
Mothers and fathers reported their level of education, and the highest achieved level of education of either parent was dummy coded (with the lower level of education as the referent) and used in the analyses. Further, the child’s weight (kg) and height (cm) were measured by a research nurse in a clinic, and BMI was calculated (kg m−2). Mothers and fathers also reported their own optimism using the Life Orientation Test – Revised (LOT-R; Scheier et al., 1994).
The linear associations of sleep duration, latency and efficiency with optimism, self-esteem and social competence were tested by multiple linear regression analyses. Multiple linear regression analysis was also used in testing if sleep duration displayed a non-linear association with the psychological outcomes, such that children in the middle of the distribution would show higher optimism, and higher self-esteem and social competence. Non-linearity was modelled by entering a squared term of sleep duration together with sleep duration as a linear term (squared and linear terms centred on grand mean) in the regression equation.
All analyses were adjusted for child’s sex, age, BMI and parental level of education. Additionally, the associations between sleep and optimism were tested adjusting for parental optimism.
We calculated effect sizes by using a hierarchical multiple linear regression approach where sleep variables (each tested in a separate model) were entered into the regression equation in the last step (after controlling the covariates sex, age, BMI and parental education), with effect size being the R-square change in the explained variance.
Moreover, we tested whether any associations varied for boys and girls by including interaction terms in the models. In no instance was there a significant sex interaction term (P-values > 0.10; data not shown). For this reason we report the results with both sexes combined.
On average the children slept for 8.4 h (SD = 40 min), their average sleep latency was 19 min (SD = 11 min), and they were asleep on average for 84.0% (SD = 5.9%) of the time they spent in bed. Sleep duration correlated significantly with sleep efficiency (r =0.80) and sleep latency (r = −0.19), and sleep latency correlated with sleep efficiency (r = −0.48; all P-values < 0.001). In Table 1, means and standard deviations for sleep duration, sleep latency and sleep efficiency are displayed separately for girls and boys. In comparison to boys, girls slept on average longer (P =0.001), their sleep latency was marginally shorter (P =0.06) and their sleep efficiency higher (P =0.01).
Table 1. Characteristics of the sample
Girls N = 150
Boys N = 141
BMI, body mass index; PLOT, Parent-rated Life Orientation Test.
BMI (kg m−2)
Maternal age (years)
Paternal age (years)
Highest education in the family
Degree beyond college
PLOT-Scales (mother- and father ratings averaged):
Self-esteem (mother, father and teacher ratings averaged)
Social competence (mother, father and teacher ratings averaged)
Sleep quantity and quality:
Sleep duration (h)
Sleep latency (min)
Sleep efficiency (%)
Table 1 also presents, for girls and boys separately, the means and standard deviations for parent-rated total optimism score, and optimism and pessimism subscale scores, as well as parent- and teacher-rated self-esteem and social competence scores. On average, the girls were rated as more optimistic (P-values < 0.03) and higher in self-esteem and social competence than were the boys (both P-values < 0.001); girls and boys did not differ in pessimism (P =0.20).
Sleep quantity, quality and positive characteristics
Table 2 shows that sleep duration had a non-linear relationship with parent-rated optimism (total optimism score: R2 change = 2.0%, P =0.02; optimism subscale score: R2 change = 2.7%, P =0.005). Children in the middle of the distribution of sleep duration were rated as more optimistic (Fig. 1) than children in the shorter or longer ends of the distribution of sleep duration. Categorical analyses of sleep duration revealed that children whose sleep duration was between the 10th and 90th percentiles of the distribution were more optimistic (total optimism score: R2 change = 2.3%, P =0.01; optimism subscale score: R2 change = 2.6%, P =0.009) than children whose sleep duration was short (below 10th percentile); average (10th–90th percentiles) and long sleepers (above 90th percentile) did not differ significantly from each other (P-values > 0.16).
Table 2. Associations of sleep quantity and quality with parent-rated optimism, and parent- and teacher-rated self-esteem, and social competence of the child
Sleep quantity and quality
Note: coefficients represent standardized regression coefficients derived from multiple linear regression analyses adjusted for child’s sex, age, BMI and parental level of education.
BMI, body mass index.
Average (7.7–9.3 h) versus
Short (≤7.6 h)
Long (≥9.4 h)
Short-average (<32 min) versus
Long (>32 min)
Average-high (>77.4%) versus
Table 2 also shows that sleep latency and parent-rated optimism (total optimism score: R2 change = 2.3%, P =0.01; optimism subscale score: R2 change = 1.7%, P =0.02) and pessimism (R2 change = 1.4%, P =0.04), and combined parent- and teacher-rated self-esteem (R2 change = 1.1%, approaching statistical significance, P =0.06) were linearly related. The shorter the sleep latency, the higher was the child’s optimism and self-esteem, and the lower the child’s pessimism. Analyses of sleep latency as a dichotomous variable revealed no significant differences between children with short to average and long sleep latency in optimism and social competence, while there was a difference in self-esteem: the children with a short to average sleep latency were higher in parent- and teacher-rated self-esteem (R2 change = 1.5%, P =0.03). All the significant associations listed above were adjusted for child’s age, sex, BMI and highest education in the family. The significant associations between sleep and child optimism remained also when further controlling for maternal and paternal optimism (all P-values < 0.05).
We examined if sufficient sleep quantity and good sleep quality are associated with optimism, self-esteem and social competence in children. In accordance with our hypothesis, we found a non-linear relationship between sleep duration and optimism. The relation resembled a reverse J-shaped curve, such that children whose sleep duration was in the middle of the distribution scored higher on optimism compared with children who slept relatively little. Further, children with shorter sleep latency scored higher on optimism and tended to have higher scores on self-esteem. The associations remained when adjusting for child’s age, sex, BMI and parental level of education, factors that may increase risk for less optimal sleep patterns and/or for lower scores on positive characteristics. Additionally, the association of sleep with optimism did not change when the parent ratings of their own optimism were controlled.
Our findings in the 8-year-old children are consistent with the previous epidemiological and experimental studies in adults (Haack and Mullington, 2005; National Sleep Foundation, 2002). The findings are, however, not in line with those by Fredriksen et al. (2004) who showed that adolescents who report sleeping longer scored higher on self-esteem. There are methodological differences in the measurement of sleep duration, however, between the current and the Fredriksen et al. (2004) study that may explain the differences. While the present study relied on actigraphy measurement of sleep, participants of the Fredriksen et al. (2004) study reported their sleep duration on a survey questionnaire. It is also worth noting that adolescence is a period when the biological need for sleep is altered (e.g. Iglowstein et al., 2003). Therefore, our findings in prepubertal children do not necessarily apply to adolescents.
The associations between the children’s sleep duration and latency with optimism and/or self-esteem were modest in effect size. In interpreting the effect sizes, one should, however, keep in mind that we examined a generally healthy population of young children. The effect sizes are comparable to, for instance, the size of the relation of sleep duration with BMI reported in some epidemiological studies in children. While it is well acknowledged that short sleep duration poses a risk for obesity in children/adolescents (Cappuccio et al., 2008; Chen et al., 2008), in some large-scale epidemiological studies the size of the cross-sectional association between sleep duration and BMI has been modest (Eisenmann et al., 2006; Snell et al., 2007) – comparable or even smaller than the effect sizes we report for the relation of sleep with optimism and self-esteem in this study. It should also be kept in mind that we cannot draw causal inferences from the cross-sectional findings of this study. Hence, it is possible that good sleep and positive characteristics are reciprocally related. In other words, good sleep, by promoting better physical and mental wellbeing, may result in a more positive psychological profile. Equally, it may be true that positive psychological characteristics, by promoting better physical and mental wellbeing, result in quantitatively and qualitatively better sleep. Further, the associations may also be determined by a common, but yet unknown, underlying factor, such as genetic variants for sleep–wake cycles. Thus, the underlying physical, genetic or psychological mechanisms linking sleep and positive characteristics have yet to be identified.
Apart from the cross-sectional study design and lack of data on the underlying mechanisms, a further limitation of our study relates to the generalizability of the findings; sleep pattern changes with age and pubertal maturation (Iglowstein et al., 2003). Thus, our findings cannot be generalized to much younger or older age groups. Further, our sample was predominantly Caucasian, and none of the children suffered from severe physical or mental health problems. Thus, our findings may not either generalize to samples with different ethnic backgrounds or with greater variance in health. Also, nearly half of the sample had rather well-educated parents with degrees beyond college. While we did not observe associations between parental level of education and sleep patterns, our findings may not generalize to less affluent populations.
Further, whereas sleep duration and sleep efficiency in children, measured with the chosen actigraph brand, have shown high agreement with polysomnography (with agreement rate of 87.3, sensitivity of 93.9 and specificity of 59.0 with a medium activity threshold; Hyde et al., 2007), concerns have been raised about the reliability of sleep latency in children (Sitnick et al., 2008), which is highly dependent on the reliability of the bedtime reported in a sleep log. However, very rarely have sleep logs and event marker data been compared to assess the reliability of the reported bedtime. We were able to do this in our study, and found very high correspondence between the sleep log completed by the parents and the event markers in the actigraph data. Still, it has to be kept in mind that results involving sleep latency should be interpreted cautiously.
Although the actigraphy measurement may lack the accuracy provided by polysomnography in measuring sleep quantity and quality in young children (Ohayon et al., 2004), actigraphy has the benefit of being ecologically valid as children sleep in their own beds over many consecutive nights (Acebo and LeBourgeois, 2006). A further strength to our study is that we did not rely on a single informant in measuring the children’s positive characteristics, as both mothers and fathers rated their children’s optimism, and mothers, fathers and teachers rated the children’s self-esteem and social competence.
In summary, we found associations between objectively measured sleep patterns and positive psychological characteristics in young children. Our results show that sufficient sleep quantity and good sleep quality are related to higher levels of optimism, and good sleep quality is related to higher levels of self-esteem. Thus, our results may inform why sleep quantity and quality and positive characteristics are associated with wellbeing in children.
This study was sponsored by grants from the Juho Vainio Foundation, the John D. and Catherine T. MacArthur Foundation, the European Science Foundation (EuroSTRESS), the Yrjö Jahnsson Foundation, the Emil Aaltonen Foundation, the Finnish Medical Society Duodecim, the Finnish Foundation for Pediatric Research, the Signe and Ane Gyllenberg Foundation, the Ahokas Foundation, the Finnish Ministry of Education, the University of Helsinki, and the Academy of Finland. Preparation of the manuscript was supported by a grant for individual short visits of the Swiss National Science Foundation awarded to Sakari Lemola (grant IZKOZ1-127779/1), and by grants from the National Heart, Lung and Blood Institute (NIH HL076852 and HL076858).