Intergenerational Links between Parental Sleep Disorders and Child Sleep Health and Mental Well-Being
Article information
Abstract
Purpose
Emerging evidence highlights the intergenerational transmission of sleep disturbances and their potential influence on child mental health. However, few studies have examined these associations in Arabic-speaking populations. This study investigated the links between parental sleep disorders, child sleep behaviors, and child mental well-being, with particular attention to the mediating role of parental psychological distress.
Methods
A cross-sectional study was conducted with 200 parent–child dyads from Arabic-speaking communities. Parents completed validated Arabic versions of the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Depression Anxiety Stress Scales (DASS-21), while child outcomes were assessed using the Children’s Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ), and Revised Children’s Anxiety and Depression Scale (RCADS). Data were analyzed with Pearson correlations and multiple linear regression models.
Results
Parents reported high levels of sleep disturbance (PSQI, 8.18; ISI, 12.23), and children exhibited substantial sleep issues (CSHQ, 49.33). Psychological difficulties were also elevated (SDQ, 19.96; RCADS, 19.71). Parental distress (DASS-21) was strongly correlated with PSQI, ISI, CSHQ, SDQ, and RCADS, with coefficients (r) ranging from 0.992 to 0.994. Regression analyses revealed that parental mental health (β=0.413, P<0.001), insomnia severity (β=0.283, P<0.001), and child sleep problems (β=0.255, P<0.001) significantly predicted child mental health difficulties (R²=0.992, P<0.001).
Conclusion
Parental insomnia and psychological distress exert a strong influence on children’s emotional and behavioral health, underscoring the need for family-centered interventions and additional research into underlying causal pathways.
Introduction
Sleep is a fundamental biological process essential for physical health, cognitive functioning, and emotional regulation across the lifespan. In children, sufficient and good-quality sleep is particularly crucial, as inadequate or disrupted sleep has been linked to a wide range of adverse outcomes, including behavioral difficulties, impaired academic performance, and heightened risk for mental health conditions such as anxiety and depression [1]. Growing evidence suggests that sleep disturbances are not isolated occurrences but are influenced by familial and intergenerational factors, including parental sleep disorders and related behaviors [2].
Parental sleep health plays a central role in shaping children’s sleep patterns and overall well-being. Studies show that parents with sleep problems frequently report higher stress levels and more mental health challenges, which can subsequently affect their children’s sleep quality and emotional health [3]. For example, parental insomnia and irregular sleep schedules have been associated with more frequent sleep disturbances in children, reflecting the bidirectional interplay of sleep and mental health within family systems [4].
The intergenerational transmission of sleep disorders may be partly explained by parenting practices and environmental conditions. Harsh or inconsistent parenting, often exacerbated by parental sleep deprivation, has been linked to children’s sleep difficulties and related emotional and behavioral problems [5]. In addition, factors such as socioeconomic status, family routines, and neighborhood safety have been identified as significant contributors to children’s sleep health, indicating that broader contextual influences must be considered when exploring intergenerational sleep patterns [6].
Biological mechanisms, including epigenetic modifications, may further explain how parental sleep disorders affect child development. Research suggests that environmental stressors, such as chronic sleep deprivation, can produce epigenetic changes that alter gene expression related to stress responses and circadian rhythms, thereby shaping offspring’s vulnerability to sleep and mental health disorders [7]. These findings highlight the importance of adopting a multidisciplinary perspective to understand the complex interplay of genetic, environmental, and behavioral influences on the intergenerational transmission of sleep health [8].
Despite increasing recognition of these associations, relatively few comprehensive studies have examined the intergenerational links between parental sleep disorders and child sleep health and mental well-being [9]. Addressing this gap is particularly important for developing culturally tailored interventions and for clarifying how caregiver sleep health affects child development in Arabic-speaking populations [10].
Most research to date has been conducted in Western contexts, and little is known about these dynamics in Arabic-speaking populations. Given the cultural, environmental, and healthcare differences between regions, it is necessary to investigate whether intergenerational sleep patterns are similarly observed in non-Western, Arabic-speaking families. By integrating insights from psychology, neuroscience, and public health, this study seeks to examine the intergenerational links between parental sleep disturbances—including insomnia and poor sleep quality—and children’s sleep health and psychological well-being in Arabic-speaking families. It also explores the influence of parenting behaviors and environmental factors on these relationships, with an emphasis on evaluating the predictive role of parental sleep and mental health in shaping children’s emotional and behavioral outcomes. In doing so, the study aims to support the development of targeted, evidence-based interventions that encourage healthy sleep practices and foster mental well-being across generations.
Building on the growing body of evidence regarding the intergenerational transmission of sleep and emotional functioning, the present study addresses two central research questions. First, it examines the associations between parental sleep disturbances and children’s sleep health and mental well-being. Second, it investigates the extent to which parental sleep disorders and psychological distress predict child mental health outcomes. These questions aim to clarify potential pathways through which caregiver functioning may shape child development within families affected by disrupted sleep and psychological stress.
Materials and Methods
1. Study design
This study employed a cross-sectional design to examine the relationships between parental sleep disorders, child sleep health, and child mental well-being.
2. Participants
The study was conducted between January and March 2025. A total of 200 parent–child dyads were recruited through pediatric clinics, community health centers, schools, and social media platforms. Recruitment efforts emphasized enrolling parents with self-reported or clinically diagnosed sleep disorders. Strategies included digital flyers shared in insomnia and parenting forums, clinician referrals for patients with known sleep issues, and an initial screening questionnaire to confirm eligibility.
Eligibility criteria required parents (biological or primary caregivers) to be between 25 and 55 years old and to report a current or past diagnosis of a sleep disorder (e.g., insomnia) or meet screening thresholds on the Pittsburgh Sleep Quality Index (PSQI) or Insomnia Severity Index (ISI). Children were eligible if they were between 6 and 17 years old and resided in the same household.
Exclusion criteria were children with diagnosed developmental disorders (e.g., autism, severe intellectual disability) that substantially affect sleep, as well as families undergoing intensive medical treatment. Notably, more than half of the participating families (58.5%) were headed by single parents, reflecting broader demographic patterns within the clinical and community recruitment settings.
3. Parental sleep disorders
1) Pittsburgh Sleep Quality Index
The PSQI is a widely used self-administered instrument designed to evaluate subjective sleep quality and disturbances over the preceding month [11]. It consists of 19 items assessing seven domains: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Each domain is rated on a 0–3 scale, with a global score ranging from 0 to 21; higher scores indicate poorer sleep quality. A global score greater than 5 denotes clinically significant sleep impairment. Although the PSQI does not categorize severity (e.g., mild, moderate, severe), the >5 cutoff is broadly accepted in clinical and research contexts as a marker of poor sleep quality. The PSQI has been validated across diverse populations and translated into multiple languages, including Arabic. The Arabic version was translated and psychometrically validated, demonstrating strong reliability and cultural appropriateness for use in Arabic-speaking populations [12].
2) Insomnia Severity Index
The ISI is a brief self-report tool designed to measure the severity and functional impact of insomnia symptoms over the past 2 weeks [13]. It comprises seven items evaluating the nature, severity, and consequences of insomnia, including difficulties with sleep onset, sleep maintenance, early morning awakening, satisfaction with sleep, interference with daily functioning, observability of sleep problems by others, and distress associated with sleep difficulties. Items are rated on a 5-point Likert scale (0–4), yielding a total score between 0 and 28, with higher scores reflecting more severe insomnia. Severity categories are defined as follows: 0–7, no clinically significant insomnia; 8–14, subthreshold insomnia; 15–21, moderate clinical insomnia; and 22–28, severe clinical insomnia. The ISI is valued for its brevity, robust psychometric properties, and clinical utility. The Arabic version of the ISI has been translated and validated, showing acceptable reliability and validity for Arabic-speaking populations [14].
3) Child Sleep Health
Children’s sleep was measured using the Children’s Sleep Habits Questionnaire (CSHQ), a parent-reported instrument designed to assess sleep behaviors and identify potential sleep problems in children aged 4 to 12 years over a typical recent week [15]. The instrument contains 33 core items organized into eight subscales: bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, parasomnias, sleep-disordered breathing, and daytime sleepiness. Items are rated on a 3-point Likert scale (‘usually,’ ‘sometimes,’ ‘rarely’), with higher scores reflecting more problematic sleep behaviors. The CSHQ provides both subscale and total scores, with a total score ≥41 indicating clinically significant sleep disturbance. The Arabic version of the CSHQ was translated and psychometrically validated, confirming its reliability and cultural appropriateness for use among Arabic-speaking children and caregivers [16,17].
4. Child mental well-being
1) Strengths and Difficulties Questionnaire
The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioral screening instrument used to evaluate psychological adjustment in children and adolescents aged 3 to 17 years [18]. It consists of 25 items divided into five subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Each item is rated on a 3-point scale (‘not true,’ ‘somewhat true,’ ‘certainly true’). Subscale scores can be summed to yield a total difficulties score (excluding prosocial behavior). Established thresholds for the total difficulties score are 0–13 (normal), 14–16 (borderline), and 17–40 (abnormal), which aid in identifying children with possible psychological difficulties. The SDQ has multiple versions tailored to different age groups and informants, including parent-, teacher-, and self-report formats. Its brevity, robust psychometric properties, and versatility contribute to its widespread use in clinical and research contexts. The Arabic version was translated and validated, and is available through the official SDQ website, demonstrating good reliability and cultural sensitivity for Arabic-speaking populations [19].
2) Revised Children’s Anxiety and Depression Scale
The Revised Children’s Anxiety and Depression Scale (RCADS) is a comprehensive self-report tool designed to assess symptoms of anxiety and depression in children and adolescents aged 8 to 18 years, based on Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria [20]. It contains 47 items measuring six subscales: separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and major depressive disorder. Items are rated on a 4-point Likert scale (‘never‘ to ‘always’), allowing calculation of individual subscale scores as well as a total internalizing score. Interpretation is typically based on T-scores: scores below 65 are considered normal, 65–69 are borderline clinical, and 70 or higher indicate clinically significant anxiety or depression. The RCADS has demonstrated strong psychometric validity and is widely employed in both clinical and research settings for early detection and monitoring of emotional disorders in youth. The Arabic version was translated and validated, confirming its reliability and construct validity in Arabic-speaking populations [21].
5. Demographic and covariate data
A structured demographic questionnaire was used to collect data on child and parent age, gender, education level, employment status, and socioeconomic status. Additional variables included family composition, screen time, and physical activity levels. Parental mental health history was assessed using the Depression Anxiety Stress Scales (DASS-21). The DASS-21, developed by Lovibond and Lovibond [22], is a 21-item self-report measure assessing depression, anxiety, and stress. It is a shorter form of the original 42-item scale and is widely used in both research and clinical practice. The Arabic version of the DASS-21 was translated and validated by Ali and colleagues, who confirmed its reliability and suitability for Arabic-speaking populations through psychometric evaluation [23].
6. Procedure
Data collection was conducted online via secure survey platforms (e.g., Qualtrics), with optional in-person support provided at selected clinics for families requiring assistance. All survey instruments were validated and age-appropriate. Participation was voluntary, and participants could withdraw at any time without penalty.
7. Data analysis
Data were analyzed using SPSS version 26 (IBM Co., Armonk, NY, USA). Statistical procedures included descriptive analyses to summarize participant characteristics and scores across all measures. Pearson correlation coefficients were used to examine associations between parental sleep disorders, child sleep health, and child mental well-being. Multiple regression analyses were then used to test whether parental sleep predicts child mental health outcomes while controlling for demographic covariates. Statistical significance was set at P<0.05 for all analyses.
8. Ethical considerations
Ethical approval was obtained from the Institutional Review Board of Faculty of Nursing Mansoura University (MFN-IRB No. 2025-01-2337). Recruitment materials were distributed online and in partnering clinics and schools. Interested participants completed an online screening form, followed by informed consent and assent procedures.
All study procedures adhered to ethical guidelines for research involving human participants. Participants were informed of the study’s purpose, confidentiality of data, and their right to withdraw at any stage. Informed consent (and child assent) was obtained electronically. Any cases of severe psychological distress identified during data collection were referred to appropriate clinical services.
Results
Table 1 summarizes the sociodemographic and familial characteristics of the 200 participants included in the study on intergenerational links between parental sleep disorders and child sleep health and mental well-being. The parental cohort was predominantly female (61%) and largely between 25 and 44 years old (63.5%). Most parents had post-secondary education (74.5%), indicating a sample with relatively high educational attainment and likely health awareness. Employment status varied: 15.0% were unemployed, 15.5% were homemakers, and 21.5% were retired, reflecting diverse caregiving demands and potential implications for parenting practices and sleep routines. A history of mental health diagnoses (depression or anxiety) was reported by 34% of parents, suggesting a possible pathway for intergenerational transmission of sleep and psychological vulnerabilities. Household income was distributed across a wide range, with 35.5% earning ≥20,000 monthly and 18.5% earning <5,000, illustrating the intersection of economic stressors with sleep and mental health. Children were nearly evenly distributed by gender (52.5% female) and predominantly aged 6 to 14 years (80.5%). Educational distribution showed 35.5% in primary school (ages 6 to 11), 33.5% in preparatory school (ages 12 to 14), and 31.0% in secondary school (ages 15 to 17). Family structure was characterized by a high prevalence of single-parent households (58.5%), with 19.5% in extended family arrangements. Children’s lifestyle data revealed substantial screen time exposure, with 70.5% reporting 1 to 4 hours daily and 18% exceeding 4 hours. Physical activity levels were mixed, with 25% engaging in ≥5 hours weekly and 24% engaging in <1 hour. These contextual findings provide a comprehensive background for interpreting the intergenerational links between parental and child sleep health and mental well-being.
Sociodemographic and family characteristics of the sample (n=200)
Table 2 presents descriptive statistics for the psychometric tools used to assess parental sleep, child sleep, and psychological functioning. Parents reported a mean±standard deviation PSQI score of 8.18±3.22, above the clinical cutoff of 5, indicating widespread poor sleep quality. The ISI mean score was 12.23±5.35, consistent with subthreshold to moderate insomnia, further supporting the presence of sleep disturbances among parents.
Descriptive statistics of sleep and mental health measures among parents and children (n=200)
For child sleep assessment, the CSHQ had a mean score of 49.33±7.59, well above the established clinical cutoff of 41, indicating a high prevalence of sleep problems among the child sample. This pattern highlights the potential for intergenerational transmission of sleep disturbances, particularly in households affected by parental sleep dysfunction.
With regard to child psychological well-being, the SDQ yielded a mean score of 19.96±6.45, reflecting elevated emotional and behavioral difficulties that frequently co-occur with poor sleep health. The RCADS had an average total score of 19.71±9.18, while the DASS-21—used to evaluate parental emotional distress—showed a markedly high mean score of 63.44±10.59, indicating considerable psychological strain among parents.
Table 3 demonstrates robust and statistically significant positive correlations between parental sleep disturbances, parental distress, child sleep problems, and child mental health outcomes. The DASS-21 was strongly correlated with parental sleep quality (PSQI, r=0.992) and insomnia severity (ISI, r=0.993), as well as with child mental health indicators (SDQ, r=0.994; RCADS, r=0.994). These associations highlight the strong interdependence between caregiver well-being and child psychosocial outcomes. Correlations between RCADS and ISI (r=0.995) and between DASS-21 and SDQ (r=0.994) were particularly striking, suggesting close alignment between parental insomnia and child anxiety–depressive symptoms, and between caregiver stress and child behavioral difficulties. Additionally, the CSHQ was highly correlated with all parental sleep and mental health measures (r=0.987 to 0.990), underscoring the reciprocal vulnerabilities within family sleep–mental health dynamics.
Pearson correlation coefficients among parental sleep measures, psychological distress, and child mental health outcomes (n=200)
Table 4 reports the results of multiple linear regression examining predictors of child mental health difficulties (SDQ total score). Independent variables included parental sleep quality (PSQI), insomnia severity (ISI), parental psychological distress (DASS-21), child sleep health (CSHQ), household income, and family composition. The overall model was statistically significant (F(6,193)=3,922.48, P<0.001), explaining an exceptionally high proportion of variance in child difficulties (R²=0.992). Within the model, parental psychological distress (β=0.413, P<0.001), insomnia severity (β=0.283, P<0.001), and child sleep problems (β=0.255, P<0.001) were significant positive predictors, indicating that higher parental distress, more severe insomnia symptoms, and greater child sleep disturbances were each associated with increased child mental health difficulties. By contrast, parental sleep quality (PSQI), household income, and family composition were not significant predictors. These findings highlight the central role of parental insomnia and psychological distress in shaping child emotional and behavioral health, reinforcing the intergenerational nature of sleep and mental well-being.
Discussion
The present results strongly align with and further substantiate the existing literature on intergenerational associations between parental sleep disturbances and child sleep and mental health outcomes. Elevated PSQI and ISI scores in the parental cohort—indicating poor sleep quality and clinically significant insomnia symptoms—are consistent with prior research documenting the high prevalence of sleep disorders among adults, particularly those with caregiving responsibilities. Previous studies have shown that parental sleep problems compromise caregivers’ own psychological functioning and also influence child sleep behaviors and emotional well-being through both biological and psychosocial pathways [24].
It is noteworthy that a majority of participants in this study (59%) were from single-parent households, a distribution not fully representative of the broader population. This overrepresentation raises the possibility of selection bias and may limit the generalizability of the findings to families with different structures. Single-parent households face unique stressors and sleep-related challenges, which may have contributed to both parental and child outcomes observed in the present study.
The elevated CSHQ scores among children—well above the clinical threshold—are consistent with prior research showing that children of parents with insomnia or poor sleep quality are at higher risk of developing maladaptive sleep patterns. These associations may reflect mechanisms such as learned behaviors, inconsistent bedtime routines, increased household stress, or shared genetic vulnerabilities [25]. Similarly, elevated SDQ and RCADS scores support existing evidence linking poor child sleep to higher risk of emotional and behavioral difficulties, including anxiety, depression, and attentional problems [26].
High DASS-21 scores among parents further reinforce the well-established bidirectional relationship between sleep disturbances and psychological distress in adults [27]. Such strains create stressful home environments that can intensify child sleep disturbances and mental health difficulties, perpetuating a feedback loop of dysfunction across generations.
Overall, these findings support and expand the growing body of research advocating for a biopsychosocial model of intergenerational sleep and mental health transmission [28]. This model conceptualizes sleep and psychological health as interconnected family processes, rather than isolated issues of individuals, while acknowledging that questions of causality and directionality remain unresolved [29]. A holistic approach is increasingly promoted in the literature as essential to breaking the cycle of intergenerational transmission of sleep and psychological disorders.
The exceptionally high correlations observed between parental sleep disturbances, psychological distress, and child outcomes highlight the intergenerational synchrony of sleep and emotional functioning. In particular, the near-perfect correlations between parental insomnia (ISI) and child anxiety–depressive symptoms (RCADS; r=0.995), and between parental psychological distress (DASS-21) and child behavioral difficulties (SDQ; r=0.994), point to substantial co-occurrence. However, these values require cautious interpretation due to possible methodological influences such as shared method variance or multicollinearity. The findings are consistent with work by Wang and colleagues, who reported that reduced parental well-being predicted greater child psychological difficulties, with child sleep disturbances mediating the association—especially under conditions of elevated stress [30]. Similarly, Merrill and Slavik [31] demonstrated strong associations between parental stress and sleep problems in both parents and children, supporting the notion that sleep disturbances function in a bidirectional, mutually reinforcing manner within families.
Beyond correlational evidence, intervention-focused research increasingly identifies parental sleep health as a central determinant of child mental health trajectories. For example, Palagini et al. [32] showed that chronic caregiver insomnia is associated with greater emotional dysregulation and suicidality, particularly in parents of children with psychiatric conditions. Blunden et al. [33] compared responsive versus extinction-based sleep interventions in mother–infant dyads and found that while both approaches improved sleep, responsive interventions were less detrimental to maternal mental health and caregiver–child bonding. Such findings emphasize the importance of context-sensitive, relational approaches to sleep management that recognize emotional co-regulation within families. The magnitude of associations observed in the present study—frequently exceeding (r=0.99)—may reflect heightened risk amplification in families experiencing concurrent psychosocial stressors, providing empirical support for transactional and systems-based models of development [34]. Collectively, these findings underscore the need for integrative, family-centered clinical frameworks that conceptualize sleep as a shared biopsychosocial resource vital to the emotional and developmental health of both parents and children [34].
The findings of the present study are consistent with prior research on intergenerational associations between parental sleep disturbances and child mental health. Results from the regression analysis indicate that parental psychological distress (DASS-21), insomnia severity (ISI), and child sleep problems (CSHQ) were all significantly associated with child mental health difficulties, as measured by the SDQ. These results align with earlier studies showing that parental anxiety and depressive symptoms are linked to heightened emotional and behavioral concerns in children [35]. Likewise, the observed relationship between parental insomnia and child outcomes supports previous evidence that caregiver sleep difficulties are associated with less effective parenting practices and increased risk for child psychological problems [36]. The role of child sleep problems is also consistent with broader evidence that inadequate or disturbed sleep functions both as a symptom and as a correlate of internalizing and externalizing difficulties in youth [24].
Interestingly, the study found that parental sleep quality (PSQI), household income, and family composition did not significantly predict child mental health outcomes. This contrasts with some earlier findings suggesting that socioeconomic status and family structure are important contextual factors [37]. However, the current results may indicate that psychological and sleep-specific variables exert a stronger influence on child mental health in this sample. Notably, using insomnia severity (ISI) rather than global sleep quality (PSQI) may have produced more precise associations, suggesting that specific dimensions of sleep disturbance are more directly related to child outcomes than overall sleep quality measures. Taken together, these findings underscore the complex interplay between parental psychological functioning and child well-being. They highlight the importance of addressing both parental mental health and sleep within family-centered interventions designed to improve child psychological outcomes.
While this study provides valuable insights into intergenerational associations between parental sleep disturbances, child sleep health, and child psychological well-being, several important avenues remain for future investigation. Longitudinal studies are particularly needed to move beyond correlational evidence and clarify the temporal and potentially causal pathways underlying the transmission of sleep and mental health difficulties across generations. The cross-sectional design employed here precludes determination of directionality—whether parental sleep disruptions contribute to child psychological problems, whether child difficulties impair parental functioning, or whether the relationship is reciprocal. Tracking parent–child dyads across key developmental stages would offer a more nuanced understanding of these dynamics and could help identify optimal periods for targeted intervention.
To better understand intergenerational patterns in sleep and mental health, future research should adopt designs capable of distinguishing genetic predispositions from environmental influences, such as longitudinal, twin, or adoption studies. Although the present findings demonstrate strong associations between parental insomnia, psychological distress, and child outcomes, it remains unclear whether these links are primarily driven by inherited traits (e.g., circadian gene expression, stress reactivity) or by environmental conditions such as parenting practices, household routines, or psychosocial stress. Incorporating physiological and objective sleep measures—such as actigraphy, cortisol levels, or inflammatory biomarkers—alongside observational and self-report data would facilitate a more comprehensive analysis and help differentiate between biological and modifiable contextual factors.
In addition to unidirectional models, future work should examine reciprocal influences within the parent–child sleep relationship. Emerging evidence indicates that child sleep disturbances can contribute to increased parental stress and impaired sleep quality, creating feedback loops that exacerbate mental health challenges within family systems. Analytical approaches such as cross-lagged panel models or structural equation modeling could enable more precise examination of these bidirectional processes and enhance understanding of mutual risk amplification.
Another critical direction involves expanding the cultural and contextual scope of intergenerational sleep research. The present study was conducted in a specific socio-cultural context, which may limit generalizability. Because sleep behaviors and perceptions of mental health are deeply embedded in cultural norms and socioeconomic conditions, comparative studies across diverse populations would clarify how contextual factors shape intergenerational sleep–health transmission. Furthermore, examining the roles of social support, family routines, and culturally specific parenting practices may identify protective or risk-enhancing influences unique to different communities.
Future studies should also broaden the range of caregivers included. Most family-based sleep research has focused on mothers, yet fathers, grandparents, and other non-traditional caregivers also play significant roles in child development. Emerging evidence suggests that paternal sleep and psychological health may exert distinct influences on child well-being. Excluding these caregivers risks an incomplete understanding of intergenerational processes.
Finally, intervention-based research is urgently needed to test whether improving parental sleep and mental health can directly ameliorate child outcomes. Trials incorporating cognitive-behavioral therapy for insomnia, mindfulness-based stress reduction, or structured sleep hygiene education for parents may provide effective strategies to disrupt the cycle of intergenerational distress. The integration of wearable technologies and ecological momentary assessment methods could further enrich these interventions by generating real-time, ecologically valid data on family sleep and mental health.
In summary, advancing this field will require longitudinal, mechanistic, culturally inclusive, and intervention-focused designs that capture the complexity and bidirectionality of family sleep and psychological dynamics. Although the present study highlights associations primarily from parents to children, reciprocal effects are equally plausible: children’s sleep difficulties may exacerbate parental distress and sleep disruption, reinforcing a cyclical family dynamic. Addressing these complexities will not only refine theoretical models but also inform the development of targeted, evidence-based interventions that foster holistic family well-being.
Despite the valuable contributions of this study to understanding intergenerational dynamics between parental sleep disturbances and child mental health, several limitations should be acknowledged. First, the cross-sectional design precludes any conclusions about causality or temporal directionality. Although significant associations were found between parental insomnia severity, psychological distress, and child mental health outcomes, it remains unclear whether these parental factors precede or result from child sleep and behavioral difficulties. Longitudinal or prospective cohort designs are needed to disentangle these bidirectional effects and to map developmental trajectories of sleep and psychological functioning across generations.
Second, the study relied exclusively on self-reported parental data, which introduces the risk of shared method variance and response bias. Parents’ reports of their own sleep and psychological functioning, as well as perceptions of their child’s sleep and behavior, may have been influenced by their own stress levels, sleep quality, or subjective interpretations. Incorporating multi-informant assessments—such as child self-reports, teacher evaluations, or objective sleep measures (e.g., actigraphy, polysomnography)—would strengthen the validity and reliability of future studies.
Another limitation pertains to the sample characteristics and generalizability of the findings. The study was conducted within a specific cultural and geographic context, and although efforts were made to capture diverse family compositions and socioeconomic backgrounds, the results may not be fully representative of broader populations. Cultural norms regarding sleep practices, parenting roles, and mental health stigma could moderate the observed relationships and should be systematically examined in cross-cultural comparative studies.
Additionally, the regression model yielded a remarkably high proportion of explained variance (R²=0.992). While statistically noteworthy, such a result raises concerns about possible model overfitting or multicollinearity. Although variance inflation factors were within acceptable thresholds, future studies should apply model validation techniques, such as cross-validation or independent replication samples, to confirm the robustness and generalizability of these predictive relationships.
Finally, the study did not include potentially important moderating factors such as parenting style, child temperament, marital conflict, or digital media exposure—all of which are associated with sleep and psychological outcomes in existing literature. Omitting these variables may have limited a more nuanced understanding of the intergenerational mechanisms at play. Future research would benefit from adopting an ecological framework that integrates multiple layers of family dynamics and environmental influences.
In conclusion, this study provides compelling evidence for intergenerational links between parental sleep disturbances, parental psychological distress, and children’s sleep and mental health outcomes in Arabic-speaking families. Elevated rates of insomnia, poor sleep quality, and psychological distress among parents were strongly associated with heightened emotional and behavioral difficulties in their children, underscoring the critical role of caregiver well-being in child development.
Importantly, parental insomnia severity, parental psychological distress, and child sleep problems emerged as the strongest predictors of child mental health difficulties, whereas socioeconomic status and family structure were not significant predictors in the final model. These findings highlight the importance of family-centered interventions targeting both parental sleep health and emotional functioning as strategies for improving child psychological outcomes. Given that most participating families were single-parent households, further research is needed to examine whether these patterns generalize across more diverse family structures and socioeconomic contexts. Longitudinal studies will be particularly valuable in clarifying causal pathways and exploring the biological, behavioral, and environmental mechanisms underlying intergenerational associations.
Overall, this study adds to the growing body of literature emphasizing the interconnectedness of sleep, mental health, and family dynamics. It reinforces the importance of supporting parental sleep health not only for caregivers’ own well-being but also as a fundamental factor in promoting children’s emotional resilience and developmental health.
Notes
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contribution
Conceptualization: AMA and HMS. Data curation: AMA, HSM, FAH, and HMS. Formal analysis: AMA, HSM, FAH, and HMS. Methodology: FAH. Project administration: AMA. Visualization: AMA, HSM, and FAH. Writing - original draft: FAH. Writing - review & editing: AMA, HSM, and FAH.