Factors associated with insomnia and complementary medicine use in children: results of a national survey

doi:10.1016/j.sleep.2018.01.007

Sleep Medicine

Volume 44, April 2018, Pages 82-88

https://doi.org/10.1016/j.sleep.2018.01.007 Get rights and content

Highlights

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Difficulty sleeping is very common in the pediatric population.
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Older age, poorer health status and multiple comorbidities are all associated with sleep difficulties.
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Complementary and alternative medicine (CAM) use is common in children with difficulty sleeping.
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Parental education level and CAM use are highly associated with child CAM use.

Abstract

Objectives

Sleep difficulties are a serious health problem in children, and interest in using complementary and alternative medicine (CAM) therapies to treat sleep is growing. In this study, we aimed to identify: the prevalence of sleep difficulties in children, and the prevalence and patterns of CAM use among children with trouble sleeping.

Methods

We used the 2012 National Health Interview Survey (NHIS) dataset to estimate the prevalence of sleep difficulties and CAM use in children ages 6–17 years. Prevalence estimates were weighted to reflect the survey's sampling design. We used logistic regression to explore associations between sleep difficulties, psychosocial factors, comorbidities and CAM use.

Results

6.4% of children in the 2012 NHIS dataset reported regular difficulty sleeping in the last year, corresponding to an estimated 1.5 million children in the US. Older age, poorer health status, more missed school days, and multiple comorbidities were all associated with sleep difficulties (p ≤ 0.001). Among children with sleep difficulties, 29% used at least one CAM therapy. Of the CAM therapies surveyed, non-vitamin, non-mineral supplements were the most commonly used (14.6%), followed by manipulation therapies (9.2%) and mind-body techniques (8.8%). Parental education and CAM use were most strongly associated with child CAM use (p ≤ 0.001).

Conclusions

CAM therapies, particularly non-vitamin, non-mineral supplements, are commonly used among children with sleeping problems. More research is needed to characterize the safety and efficacy of CAM therapies for sleep in this population.

Introduction

The revised International Classification of Sleep Disorders published by the American Academy of Sleep Medicine defines insomnia as “an almost nightly complaint of an insufficient amount of sleep or not feeling rested after the habitual sleep episode” [1]. While a separate definition for pediatric insomnia is not provided, insomnia in children is unique, in causing widespread disruptions in the family environment. Prevalence of childhood insomnia estimates range from 10% to 40%, depending on the particular definition of sleep difficulties used and the age of children surveyed [2], [3], [4], [5].

Difficulty sleeping in children is associated with many other health problems, particularly behavioral problems. In one cross-sectional study of 4351 children aged 8–11 years, sleep disorders were associated with emotional difficulties, hyperactivity, conduct problems, peer problems and social difficulties [4]. Another study of children aged 5–12 years reported associations between sleep-onset delays and psychiatric and medical comorbidities [6]. A longitudinal study of 943 children found that sleep difficulties in school-age children were associated with anxiety in early adulthood with an odds ratio of 1.60, controlling for a number of covariates (including childhood internalizing problems) [7].

Treatments for sleep difficulties in children range from medication use, behavioral methods, and complementary therapies [8], [9]. One survey study of 671 pediatricians reported that for young children approximately 3% of primary care visits in a typical six month practice period were for sleep concerns [10]. For patients with sleep problems, 75% of these practitioners recommended nonprescription medications, and >50% prescribed a sleep medication. Many providers recommended Melatonin, and herbs were recommended by 15%. While 54% of those surveyed raised concerns about the side effects of the medications prescribed. Although the results of this retrospective survey may be affected by recall bias, it appears that sleep problems in children are commonly treated with medications despite practitioners’ concerns about their safety.

Complementary and alternative medicine (CAM) describes a set of practices and treatments which people choose in addition or as alternatives to Western medical practices [11]. Current figures from the National Center for Complementary and Integrative Health, whose data are derived from the National Health Interview Survey (NHIS), estimate that about 30% of adults and 12% of children utilize CAM therapies [12]. A global survey study of pediatric CAM prescriptions in many countries suggests that up to 17% of all prescription are herbal therapies, and 15% of all prescription are homeopathic remedies [13]. An analysis of the 2002 NHIS data in adults found a 12-month prevalence rate of insomnia or trouble sleeping of 17.4% [14]. Of those with insomnia or trouble sleeping, 4.5% used some form of CAM therapy to treat insomnia.

We aimed to describe the prevalence of insomnia in children in the U.S. and to understand the psychosocial factors and comorbidities associated with insomnia. Given the high rate of medications prescribed for insomnia in children and practitioner concerns about side effects, we aimed to evaluate the prevalence of, and factors associated with, CAM use in children with insomnia. The clinical impact of this analysis would be to identify those children at high-risk for sleep difficulties and understand what CAM treatments are most commonly used in this population.

Section snippets

Study population

We analyzed data from the 2012 NHIS Household, Family, Person, Adult, and Child Core surveys, as well as the CAM supplements. This cross-sectional, in-person survey disproportionately includes underrepresented minorities and uses a complex sampling design to provide estimates for the U.S. civilian, non-institutionalized population. The NHIS 2012 survey interviewed 42,366 households, yielding 108,131 persons from 43,345 families. Overall, there were 8738 children aged 6–17 years. We restricted

Patient characteristics

Children with insomnia or regular trouble sleeping in the last year comprised 6.4% of all children (Table 1). Compared with children without sleep difficulties, children with sleep difficulties were predominantly white (78.3% vs. 74.4%; p = 0.01) and were more likely to have public insurance (42.7% vs. 33.0%, p < 0.001). Among those with sleep difficulties, there was a greater proportion close to the poverty line, with poor health, and with more school days missed (p = 0.004, p < 0.001,

Discussion

We found that 6.4% of children aged 6–17 years, corresponding to an estimated 1.5 million children in the US, reported regular difficulty sleeping in the past year. Factors most strongly associated with insomnia were older age, poorer health status, more missed school days and specific comorbidities (eg, anxiety/stress, migraines/headaches, asthma/respiratory allergies, eczema). In addition, we found that 29% of children with sleep difficulties reported use of at least one CAM therapy, nearly

Conclusions

Using the 2012 NHIS, we have reported the prevalence of sleep difficulties in a representative sample of U.S. children and the rate of CAM use in the affected subpopulation. Additionally, we demonstrated that older age, poor health status, missed school days and a number of comorbidities were associated with sleep difficulties. Among those with sleep difficulties, parental education and CAM use were most strongly associated with child CAM use, and supplements were the most commonly used

Disclosures

Dr. Lee reports a research grant from Pfizer and stock in Express Scripts. No other authors report conflicts of interest.

This work was conducted with support from R01 AR064850 (Lee), T32 AI007512 (Cohen) and K23 AT009218 (Dr. Dossett) from the National Center for Complementary and Integrative Health (NCCIH) as well as Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences,

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Willingness to pay for integrative healthcare services to treat sleep disturbances: Evidence from a nationwide survey
2023, European Journal of Integrative Medicine
Citation Excerpt :
As in our study, lower age and higher household income were positive factors of a higher WTP for HRQOL gain [51]. Interestingly, although an analysis of some previous healthcare utilization studies showed that older age positively affected the use of CAM for insomnia, our study showed a negative effect of age on the use of integrative healthcare services to treat their sleep disturbances [52, 53]. Similarly, a German study published in 2021 investigating treatment preferences for obstructive sleep apnea and WTP for positive airway pressure therapy found that age negatively affected WTP [46].
Willingness to pay (WTP) is an expression of product value in the choices available to medical consumers. This study examined Korean medical consumers’ WTP for sleep disturbance treatment through integrative healthcare services.
A random sample of subjects was acquired from 17 Korean regions by proportion of the population by region, sex, and age. This sample set was divided into three equally sized groups of 1,300 for each of the first three price bids proposed in the WTP questionnaire. An online survey was then conducted November 10–26, 2021, and anonymized data were obtained. The contingent valuation method was employed to estimate WTP for integrative healthcare services using the double-bounded dichotomous choice and open-ended question formats.
A total of 3,900 valid completed questionnaires were analyzed, and the following results were obtained: (1) 69.26% of the respondents were willing to pay the amount proposed in the first or second bid; (2) the mean WTP for integrative healthcare services for sleep disturbances was KRW 15,535.46 (USD 12.95) per consultation; and (3) the factors positively influencing WTP for integrative healthcare services were private health insurance coverage, household income, and health-related quality of life, while the sole negatively influencing factor was age.
The preferences and estimated WTP for sleep disturbance therapy via integrative healthcare services could support the legitimacy of this approach for people with this condition and the implementation of these healthcare policy decisions.
Parental socioeconomic status and childhood sleep: A systematic review and meta-analysis
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Parental socioeconomic status (SES) is increasingly understood to be a key contributor to sleep health, but the research in childhood has not been synthesized.
To examine the associations between indicators of child SES and child sleep (≤18 years old), we conducted a systematic review and meta-analyses.
CINAHL with Full Text, PsycINFO, MEDLINE/PubMed, and Embase were searched using terms to define SES and childhood to ascertain all relevant, peer-reviewed articles from database inception to 27 December 2019.
Studies were included if an association between an indicator of parental SES and a measure of child sleep (duration, quality, and problems) was reported.
Data was extracted from 46 studies (N = 72,915). Across these studies, total sample size across participants included in the meta-estimate was N = 69,373.
Data was extracted from 46 studies (N = 72,915). Across these studies, total sample size across participants included in the meta-estimate was N = 69,373. Higher parental education was associated with longer childhood sleep duration (stronger in samples with a higher proportion of White children) (OR = 1.302, 95% CI [1.111, 1.526], p = .001) and better sleep quality (OR = 1.332, 95% CI [1.014, 1.751], p = .040). Parental education was not directly associated with child sleep problems (OR = 1.191, 95% CI [0.733, 1.935], p = .479); moderation occurred by continent and the relationship was more pronounced in the Asian meta-estimate. Higher household income was not directly associated with longer childhood sleep duration (OR = 0.570, 95% CI [0.167, 1.943], p = 0.369), but moderation occurred by higher quality studies and the proportion of White children in the sample. Higher household income was associated with fewer sleep problems (moderated by continent) (OR = 0.764 (95% CI [0.689, 0.848], p < .001) and higher sleep quality (OR = 1.558, 95% CI [1.036, 2.342], p = .033).
This review was limited by the number and methods of available published studies meeting inclusion criteria.
Preventative programs that emphasize improvements in sleep of children and adolescents growing up in lower SES families are needed.
Efficacy and safety of Wuling capsule for insomnia disorder: a systematic review and meta-analysis of randomized controlled trials
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However, these conventional drug therapy may bring many problems such as hangover effect, drug resistance, insomnia disorder recurrence and addiction [27,28]. Therefore, more and more people begin to seek complementary and alternative therapies including traditional Chinese medicine [29–31]. Wuling capsule as a leading Chinese patent medicine for insomnia disorder in China [32] was approved by China Food and Drug Administration (approval number: Guoyao Zhunzi Z19990048) [33].
Wuling capsule has been used in treatment of insomnia disorder in China for decades, but the reported treatment efficacy of different studies was not consistent. This study intended to evaluate the efficacy and safety of Wuling capsule for insomnia disorder, so as to provide evidence for clinical application.
Eight databases (MEDLINE, EMBASE, Ovid, Cochrane Library, Chinese National Knowledge Infrastructure, VIP information database, Chinese Biomedical Database and Wanfang) were searched from inception to September 14, 2021. Randomized controlled trials (RCTs) comparing Wuling capsule with controls in adults with insomnia disorder were eligible. The primary outcome was sleep quality assessed by Pittsburgh Sleep Quality Index (PSQI), and the secondary outcomes were severity of insomnia disorder measured by Sleep Dysfunction Rating Scale (SDRS) and adverse events. This study was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0.
Nineteen RCTs with a total of 1850 participants were included. In terms of sleep quality assessed by PSQI, Wuling capsule significantly lowered PSQI score (MD: −1.92, 95% CI: [−2.34, −1.50], P < 0.00001, I² = 95%) compared to controls, and the effect of Wuling capsule was significantly better than control no matter when Wuling capsule as monotherapy (MD: −1.71, 95% CI: [−2.33, −1.09], P < 0.00001, I² = 97%) or as adjunctive therapy (MD: −2.10, 95% CI: [−2.66, −1.55], P < 0.00001, I² = 90%). Wuling capsule was more effective for the treatment duration lasted 8 weeks (MD: −2.57, 95% CI: [−3.52, −1.62], P < 0.00001, I² = 93%) than 4 weeks (MD: −1.68, 95% CI: [−2.13, −1.22], P < 0.00001, I² = 95%). In terms of severity of insomnia disorder measured by SDRS, Wuling capsule significantly reduced SDRS score (MD: −4.21, 95% CI: [−4.95, −3.46], P < 0.00001, I² = 0%) compared to benzodiazepines. Wuling capsule significantly reduced adverse events compared to controls (RR: 0.47, 95% CI: [0.34, 0.65], P < 0.00001, I² = 43%).
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Complementary and alternative medicine mind-body approaches used among racially and ethnically diverse adolescents
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The aim of this paper is to examine complementary and alternative medicine (CAM) use among racially and ethnically diverse adolescents. Greater understanding of CAM use among this group is warranted to better inform health care providers in delivering a culturally relevant health promotion approach.
A secondary data analysis was conducted using the 2012 Child Complementary and Alternative Medicine Supplement of the National Health Interview Survey (CAM-NHIS) data, which was collected from a national sample of adolescents aged 12–17 years. A logistic regression test was employed to investigate the predictors associated with CAM use among racially and ethnically diverse adolescents.
While Black and Hispanic adolescents were the least likely to use CAM compared to their White counterparts, families with higher incomes, higher education attainment, and adolescents who experienced pain were more likely to use CAM.
Findings suggest the need for future research to gain a greater understanding of CAM use among racially and ethnically diverse adolescents, and insights into how health disparities impact CAM use. Greater understanding of how CAM use intersects with health beliefs and outcomes is also warranted.
Based on the CAM-NHIS survey, few racially and ethnically diverse adolescents have reported use of CAM. Development of culturally appropriate instruments and methods to assess CAM use among racially and ethnically diverse adolescents may yield specific data for this population. Informed health care providers can advocate for improved access to CAM for minority adolescents and alter disparate use.
Medicinal seeds Ziziphus spinosa for insomnia: A randomized, placebo-controlled, cross-over, feasibility clinical trial
2021, Complementary Therapies in Medicine
Citation Excerpt :
People with insomnia often initiate self-help activities,12,13 as well as using complementary and alternative therapies such as herbal medicine, massage and relaxation techniques.14–16 Herbal medicines have been traditionally used for centuries for treatment of many health conditions, including insomnia, and continue to be utilized over-the-counter or through practitioner prescribing in Western and Asian countries.17–19 Ziziphus spinosa (ZS) seeds are a potential candidate for the treatment of insomnia and are one of the most commonly used herbs in Chinese medicine.20
To evaluate the feasibility of implementing a clinical trial protocol of the herbal seeds Ziziphus spinosa (ZS) for people with insomnia.
A randomized, double-blind, placebo controlled, cross-over feasibility trial in Melbourne, Australia.
After two-week run-in participants were randomized to either ZS (encapsulated granules; 2 g daily) or placebo for four weeks. After four-weeks wash-out, participants swapped to the other treatment for four weeks.
Sleep quality assessed by the Insomnia Severity Index and Pittsburgh Sleep Quality Index (PSQI). Quality of life, mood, functional impairment and sleep parameters were also assessed.
Twelve participants were randomized and completed both periods of cross-over (six in each sequence). Feasibility endpoints were acceptable. Improvements for sleep quality measured on the PSQI were statistically significant during the ZS treatment periods compared to placebo (t = −2.276, df = 10, 95 % CI −3.3 to −0.04, p = 0.046). There was no evidence of any significant carryover effects. However, there were period effects. Other outcomes showed no statistically significant difference between the treatments. Subjective sleep parameters measured on sleep diaries showed improvements after ZS in terms of total sleep time, sleep efficiency and sleep onset latency, but not after placebo. ZS was well tolerated with only minor adverse events.
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Physician Office Visits That Included Complementary Health Approaches in U.S. Adults: 2005-2015
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View full text

Original ArticleFactors associated with insomnia and complementary medicine use in children: results of a national survey

Highlights

Abstract

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Study population

Patient characteristics

Discussion

Conclusions

Disclosures

Odds, prevalence and predictors of sleep problems in school-age normal children

J Sleep Res

Prevalence and course of sleep problems in childhood

Sleep

Sleep disorders and behavioural problems among 8-to 11-year-old children

Prevalence of sleep disorders in school children between 11 and 15 years of age

Wien Klin Wochenschr

Sleep problems of elementary school children: a community survey

Arch Pediatr Adolesc Med

Prospective longitudinal associations between persistent sleep problems in childhood and anxiety and depression disorders in adulthood

J Abnorm Child Psychol

Behavioral treatment of bedtime problems and night wakings in infants and young children

Sleep

Pharmacologic management of insomnia in children and adolescents: consensus statement

Pediatrics

Medication use in the treatment of pediatric insomnia: results of a survey of community-based pediatricians

Pediatrics

Complementary and alternative medicine

Usage and attitudes towards natural remedies and homeopathy in general pediatrics

Glob Pediatr Heal

Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 national health interview survey data

Arch Intern Med

Complementary and alternative medicine use by children with pain in the United States

Acad Pediatr

Complementary and alternative medicine use among adults and children: United States, 2007

Natl Health Stat Report

Original Article
Factors associated with insomnia and complementary medicine use in children: results of a national survey