Skip to main content
SpringerLink
Log in

Die Cortisol-Aufwachreaktion bei Müttern junger Kinder mit Schlafproblemen

Effekte eines internetbasierten Behandlungsprogramms (Mini-KiSS Online)

Cortisol awakening response in mothers of young children with sleep problems

Effects of an internet-based treatment program (Mini-KiSS Online)

  • Schwerpunkt
  • Published:
Somnologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Frühkindliche Schlafprobleme sind häufig und lösen bei den Eltern klinisch signifikanten Stress aus. Studien zeigen, dass eine Behandlung der kindlichen Schlafproblematik nicht nur den kindlichen Schlaf verbessern, sondern auch die mütterliche Stressbelastung reduzieren kann.

Ziel der Arbeit

In der vorliegenden Arbeit wird untersucht, ob sich die Stressbelastung von Müttern nach einem internetbasierten Behandlungsprogramm für frühkindliche Schlafprobleme (Mini-KiSS Online) reduziert. Geprüft wird außerdem, ob sich die Cortisol-Aufwachreaktion als Instrument zur Erfassung der zentralnervösen Stressreaktion für eine solche Veränderungsmessung eignet.

Material und Methode

Mütter (N = 23) von jungen Kindern (sechs Monate bis vier Jahre) mit Schlafproblemen wurden randomisiert zu einer Experimental- oder Wartelisten-Kontrollgruppe zugewiesen. Vor und nach der Intervention/Wartezeit wurde die Stressbelastung der Mütter subjektiv durch Fragebögen und physiologisch durch die Cortisol-Aufwachreaktion, das Schlafverhalten des Kindes durch ein Schlaftagebuch und das Schlafverhalten der Mütter durch einen Fragebogen erfasst.

Ergebnisse

Das Mini-KiSS-Online-Training führte teilweise zu einer Reduktion der subjektiven Stressbelastung und zu einer Verbesserung des kindlichen und mütterlichen Schlafs. Eine Reduktion der Cortisol-Werte wurde nicht signifikant. Veränderungen der subjektiven und physiologischen Stressbelastung korrelierten miteinander.

Diskussion

Die Cortisol-Aufwachreaktion scheint sich zur Erfassung der zentralnervösen Stressreaktion bei Müttern junger Kinder mit Schlafproblemen zu eignen. Größere Stichproben erscheinen jedoch notwendig, um Veränderungen signifikant abbilden zu können.

Abstract

Background

Sleep problems in young children are common and provoke clinically significant stress in their parents. Studies indicate that the treatment of the child’s sleep problem can simultaneously reduce maternal stress.

Objectives

In the present study we aimed to investigate, if maternal stress can be reduced by an Internet-based treatment program for sleep disturbances in young children (Mini-KiSS Online). The research also investigated whether the cortisol awakening response is a suitable tool for the detection of a central nervous stress response to such a change.

Materials and methods

Mothers (N = 23) of young children (six months to four years) with sleep problems were randomized to either the treatment or waiting-list control condition. Pre- and post-measurement assessed maternal distress by subjective questionnaires and physiologically by cortisol awakening response. The sleep behaviour of the child was assessed using a sleep-diary and the sleep behaviour of mothers using a questionnaire.

Results

Mini-KiSS Online partially reduced stress and improved child and maternal sleep. Reductions in cortisol level did not reach statistical significance. There was an association between reductions in subjective stress and cortisol level.

Conclusion

The cortisol awakening response seems to be an appropriate measure to detect stress in mothers of sleep-disturbed young children. However, larger sample sizes seem to be necessary to identify changes between measurement points.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Adam EK, Kumari M (2009) Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocrinology 34(10):1423–1436

    Article  CAS  PubMed  Google Scholar 

  2. Bayer JK, Hiscock H, Hampton A, Wake M (2007) Sleep problems in young infants and maternal mental and physical health. J Paediatr Child Health 43(1–2):66–73

    Article  PubMed  Google Scholar 

  3. Bhagwagar Z, Hafizi S, Cowen PJ (2005) Increased salivary cortisol after waking in depression. Psychopharmacology (Berl) 182(1):54–57

    Article  CAS  Google Scholar 

  4. Boergers J, Hart C, Owens JA, Streisand R, Spirito A (2007) Child sleep disorders: associations with parental sleep duration and daytime sleepiness. J Fam Psychol 21(1):88–94

    PubMed  Google Scholar 

  5. Böhmelt AH, Nater UM, Franke S, Hellhammer DH, Ehlert U (2005) Basal and stimulated Hypothalamic-pituitary-adrenal axis activity in patients with functional gastrointestinal disorders and healthy controls. Psychosom Med 67(2):288–294

    Article  PubMed  Google Scholar 

  6. Brandhorst I, Hautzinger M, Schlarb AA (2016) Improving psychosocial health, coping, and self-efficacy in parents of sleep-disturbed young children. J Psychol Psychother. doi:10.4172/2161-0487.1000249

    Google Scholar 

  7. Brandhorst I, Peters E, Hautzinger M, Schlarb AA (submitted) Telephone support in an Internet-Based Treatment for Sleep Problems in Early Childhood. Journal of Psychiatry

  8. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    Article  CAS  PubMed  Google Scholar 

  9. Byars KC, Yeomans-Maldonado G, Noll JG (2011) Parental functioning and pediatric sleep disturbance: an examination of factors associated with parenting stress in children clinically referred for evaluation of insomnia. Sleep Med 12(9):898–905

    Article  PubMed  Google Scholar 

  10. Chida Y, Steptoe A (2009) Cortisol awakening response and psychosocial factors: A systematic review and meta-analysis. Biol Psychol 80(3):265–278

    Article  PubMed  Google Scholar 

  11. Clow A, Thorn L, Evans P, Hucklebridge F (2009) The awakening Cortisol response: methodological issues and significance. Stress 7(1):29–37

    Article  Google Scholar 

  12. Davison GC, Neale JM, Hautzinger M (2007) Klinische Psychologie, 7. Aufl. Beltz, Weinheim

    Google Scholar 

  13. Dockray S, Bhattacharyya MR, Molloy GJ, Steptoe A (2008) The cortisol awakening response in relation to objective and subjective measures of waking in the morning. Psychoneuroendocrinology 33(1):77–82

    Article  CAS  PubMed  Google Scholar 

  14. Eckerberg B (2004) Treatment of sleep problems in families with young children: effects of treatment on family well-being. Acta Paediatr 93:126–134

    Article  CAS  PubMed  Google Scholar 

  15. Federenko I (2004) Free cortisol awakening responses are influenced by awakening time. Psychoneuroendocrinology 29(2):174–184

    Article  CAS  PubMed  Google Scholar 

  16. Gaylor EE, Burnham MM, Goodlin-Jones BL, Anders TF (2005) A longitudinal follow-up study of young children’s sleep patterns using a developmental classification system. Behav Sleep Med 3(1):44–61

    Article  PubMed  PubMed Central  Google Scholar 

  17. Giallo R, Rose N, Vittorino R (2011) Fatigue, wellbeing and parenting in mothers of infants and toddlers with sleep problems. J Reprod Infant Psychol 29(3):236–249

    Article  Google Scholar 

  18. Herrmann B (2008) Nichtakzidentelle Kopfverletzungen und Schütteltrauma. Rechtsmedizin 18(1):9–16

    Article  Google Scholar 

  19. Hiscock H, Wake M (2002) Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ 324(7345):1062–1065

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Hiscock H, Cook F, Bayer J, Le HND, Mensah F, Cann W et al (2014) Preventing early infant sleep and crying problems and postnatal depression: a randomized trial. Pediatrics 133(2):e346–e354

    Article  PubMed  Google Scholar 

  21. Hughes A, Gallagher S, Hannigan A (2015) A cluster analysis of reported sleeping patterns of 9‑month old infants and the association with maternal health: results from a population based cohort study. Matern Child Health J 19(8):1881–1889

    Article  PubMed  Google Scholar 

  22. Kudielka BM, Gierens A, Hellhammer DH, Wüst S, Schlotz W (2012) Salivary Cortisol in ambulatory assessment – some dos, some don’ts, and some open questions. Psychosom Med 74(4):418–431

    Article  CAS  PubMed  Google Scholar 

  23. Marcus MT, Fine M, Möller G, Khan MM, Pitts K, Swank PR et al (2003) Change in stress levels following mindfulness-based stress reduction in a therapeutic community. Addict Disord Their Treat 2(3):63–68

    Article  Google Scholar 

  24. Martin JL, Ancoli-Israel S (2008) Sleep disturbances in long-term care. Clin Geriatr Med 24(1):39–vi

    Article  PubMed  PubMed Central  Google Scholar 

  25. Martin J, Hiscock H, Hardy P, Davey B, Wake M (2007) Adverse associations of infant and child sleep problems and parent health: an Australian population study. Pediatrics 119(5):947–955

    Article  PubMed  Google Scholar 

  26. Mason JW (1968) A review of psychoendocrine research on the pituitary-adrenal cortical system. Psychosom Med 30(5):576–607

    Article  Google Scholar 

  27. Meltzer LJ, Mindell JA (2007) Relationship between child sleep disturbances and maternal sleep, mood, and parenting stress: a pilot study. J Fam Psychol 21(1):67–73

    PubMed  Google Scholar 

  28. Meltzer LJ, Mindell JA (2014) Systematic review and meta-analysis of behavioral interventions for pediatric insomnia. J Pediatr Psychol 39(8):932–948

    Article  PubMed  Google Scholar 

  29. Mindell JA, Kuhn B, Lewin DS, Meltzer LJ, Sadeh A (2006) Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep 29(10):1263–1276

    PubMed  Google Scholar 

  30. Mindell JA, Du Mond CE, Sadeh A, Telofski LS, Kulkarni N, Gunn E (2011) Efficacy of an internet-based intervention for infant and toddler sleep disturbances. Sleep 34(4):451–458

    PubMed  PubMed Central  Google Scholar 

  31. Mindell JA, Sadeh A, Kwon R, Goh DYT (2013) Cross-cultural differences in the sleep of preschool children. Sleep Med 14(12):1283–1289

    Article  PubMed  Google Scholar 

  32. Pruessner JC, Wolf OT, Hellhammer DH, Buske-Kirschbaum A, von Auer K, Jobst S et al (1997) Free cortisol levels after awakening: A reliable biological marker for the assessment of adrenocortical activity. Life Sci 61(26):2539–2549

    Article  CAS  PubMed  Google Scholar 

  33. Rabung S, Harfst T, Kawski S, Koch U, Wittchen H, Schulz H (2009) Psychometrische Uberprüfung einer verkürzten Version der „Hamburger Module zur Erfassung allgemeiner Aspekte psychosozialer Gesundheit für die therapeutische Praxis“ (HEALTH-49). Z Psychosom Med Psychother 55(2):162–179

    PubMed  Google Scholar 

  34. Rensing L, Koch M, Rippe B, Rippe V (2005) Mensch im Stress: Psyche, Körper, Moleküle. Springer, Berlin

    Book  Google Scholar 

  35. Satow L (2012) Stress- und Coping-Inventar (SCI): Test- und Skalendokumentation. Leibniz Zentrum für Psychologische Information und Dokumentation (ZPID), Trier

    Google Scholar 

  36. Schlarb AA, Brandhorst I, Hautzinger M (2011) Mini-KiSS – ein multimodales Gruppentherapieprogramm für Eltern von Kleinkindern mit Schlafstörungen. Z Kinder Jugendpsychiatr Psychother 39(3):197–206

    Article  PubMed  Google Scholar 

  37. Schlarb AA, Brandhorst I (2012) Mini-KiSS Online: an Internet-based intervention program for parents of young children with sleep problems – influence on parental behavior and children’s sleep. Nat Sci Sleep 4:41–52

    Article  PubMed  PubMed Central  Google Scholar 

  38. Schlotz W, Hellhammer J, Schulz P, Stone AA (2004) Perceived work overload and chronic worrying predict weekend – weekday differences in the Cortisol awakening response. Psychosom Med 66(2):207–214

    Article  CAS  PubMed  Google Scholar 

  39. Schweisthal O (2007) Der Cortisol Awakening Response in der Diagnostik stressbezogener Erkrankungen. Dissertation, Trier

    Google Scholar 

  40. Scott G, Richards M (1990) Night waking in infants: effects of providing advice and support for parents. J Child Psychol Psychiatry 31(4):551–567

    Article  CAS  PubMed  Google Scholar 

  41. Sharkey KM, Iko IN, Machan JT, Thompson-Westra J, Pearlstein TB (2015) Infant sleep and feeding patterns are associated with maternal sleep, stress, and depressed mood in women with a history of major depressive disorder (MDD). Arch Womens Ment Health. doi:10.1007/s00737-015-0557-5

    PubMed  Google Scholar 

  42. Stalder T, Evans P, Hucklebridge F, Clow A (2010) State associations with the cortisol awakening response in healthy females. Psychoneuroendocrinology 35(8):1245–1252

    Article  CAS  PubMed  Google Scholar 

  43. Thorndike FP (2009) Commentary: Interest in internet interventions – an infant sleep program as illustration. J Pediatr Psychol 34(5):470–473

    Article  PubMed  Google Scholar 

  44. Wake M, Morton-Allen E, Poulakis Z, Hiscock H, Gallagher S, Oberklaid F (2006) Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: prospective community-based study. Pediatrics 117(3):836–842

    Article  PubMed  Google Scholar 

  45. Wiater A, Scheuermann P (2007) Diagnostik von Schlafstörungen. Monatsschr Kinderheilkd 155(7):600–607

    Article  Google Scholar 

  46. Wiggs L, Stores G (2001) Behavioural treatment for sleep problems in children with severe intellectual disabilities and daytime challenging behaviour: Effect on mothers and fathers. J Health Psychol 6(3):257–269

    CAS  Google Scholar 

  47. Wolfram M, Bellingrath S, Kudielka BM (2011) The cortisol awakening response (CAR) across the female menstrual cycle. Psychoneuroendocrinology 36(6):905–912

    Article  CAS  PubMed  Google Scholar 

  48. Wüst S, Federenko I, Hellhammer DH, Kirschbaum C (2000) Genetic factors, perceived chronic stress, and the free cortisol response to awakening. Psychoneuroendocrinology 25(7):707–720

    Article  PubMed  Google Scholar 

  49. Wüst S, Wolf J, Hellhammer D, Federenko I, Schommer N, Kirschbaum C (2000) The cortisol awakening response – normal values and confounds. Noise Health 2(7):79–88

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mathematisch-Naturwissenschaftliche Fakultät, Fachbereich Psychologie, Universität Tübingen, Tübingen, Deutschland

    Isabel Brandhorst,  Carolin Bernhardt &  Martin Hautzinger

  2. Fakultät für Psychologie und Sportwissenschaften, Universität Bielefeld, Postfach 10 01 31, 33501, Bielefeld, Deutschland

    Angelika A. Schlarb

Authors
  1. Isabel Brandhorst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carolin Bernhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Hautzinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Angelika A. Schlarb
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angelika A. Schlarb.

Ethics declarations

Interessenkonflikt

I. Brandhorst, C. Bernhardt, M. Hautzinger und A. A. Schlarb geben an, dass kein Interessenkonflikt besteht.

Die vorliegende Untersuchung wurde nach den Richtlinien der Deklaration von Helsinki durchgeführt und von der lokalen Ethikkommission der medizinischen Fakultät Tübingen genehmigt (185/2014BO1).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brandhorst, I., Bernhardt, C., Hautzinger, M. et al. Die Cortisol-Aufwachreaktion bei Müttern junger Kinder mit Schlafproblemen. Somnologie 21, 53–66 (2017). https://doi.org/10.1007/s11818-016-0070-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11818-016-0070-8

Schlüsselwörter

Keywords

Search

Navigation