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Sleep education for healthcare providers: Addressing deficient sleep in Australia and New Zealand
Abstract
Deficient sleep has been recognized as a current health crisis in Australia and New Zealand, contributing to the increased prevalence and severity of chronic diseases and mental health issues. However, all healthcare disciplines currently receive limited training in addressing deficient sleep, which is contributing to the current health crisis. This narrative review considers the following: (1) the prevalence and burden of deficient sleep in Australia and New Zealand; (2) the limited sleep education in healthcare training programs; (3) healthcare providers' lack of knowledge and evidence-based clinical practice in sleep disorders; (4) sleep-focused education initiatives for healthcare providers; (5) an action agenda for improved sleep education for healthcare providers. Both domestic and international sleep initiatives are considered, as is the role of general practitioners (primary care physicians), pediatricians, psychologists, pharmacists, and nurses. Three key themes emerge and guide action: (1) relevant training for students from all healthcare disciplines; (2) continuing professional development for practicing healthcare providers; and (3) translation of evidence-driven best practice into clinical practice. To achieve this sleep education agenda, the sleep community must form and strengthen partnerships across professional associations, public health agencies, and education providers. By improving education and clinical practice in sleep, we will equip healthcare providers with the knowledge and skills needed to address deficient sleep in Australia and New Zealand.
... T here is a growing awareness of sleep disorders among primary care providers (Simon, 2016), but this has not translated to widespread integration of sleep education into nursing curricula (Gellerstedt et al., 2019;Meaklim et al., 2020) despite numerous recommendations put forth over the years (Colten & Altevogt, 2006;King et al., 2021;Lee et al., 2004;Meaklim et al., 2020;Ramar et al., 2021;Redeker & McEnany, 2011;Ye & Smith, 2015). Some studies have addressed sleep education in nursing curricula (Colvin et al., 2014;Gellerstedt et al., 2019;King et al., 2021;McIntosh & MacMillan, 2009;Meaklim et al., 2020;Redeker & McEnany, 2011;Ye & Smith, 2015), but consistent with the prior decade of research, advanced practice nurses continue to report little (two hours) to no education about sleep and sleep disorders (Sawyer et al., 2022). ...
... T here is a growing awareness of sleep disorders among primary care providers (Simon, 2016), but this has not translated to widespread integration of sleep education into nursing curricula (Gellerstedt et al., 2019;Meaklim et al., 2020) despite numerous recommendations put forth over the years (Colten & Altevogt, 2006;King et al., 2021;Lee et al., 2004;Meaklim et al., 2020;Ramar et al., 2021;Redeker & McEnany, 2011;Ye & Smith, 2015). Some studies have addressed sleep education in nursing curricula (Colvin et al., 2014;Gellerstedt et al., 2019;King et al., 2021;McIntosh & MacMillan, 2009;Meaklim et al., 2020;Redeker & McEnany, 2011;Ye & Smith, 2015), but consistent with the prior decade of research, advanced practice nurses continue to report little (two hours) to no education about sleep and sleep disorders (Sawyer et al., 2022). ...
... T here is a growing awareness of sleep disorders among primary care providers (Simon, 2016), but this has not translated to widespread integration of sleep education into nursing curricula (Gellerstedt et al., 2019;Meaklim et al., 2020) despite numerous recommendations put forth over the years (Colten & Altevogt, 2006;King et al., 2021;Lee et al., 2004;Meaklim et al., 2020;Ramar et al., 2021;Redeker & McEnany, 2011;Ye & Smith, 2015). Some studies have addressed sleep education in nursing curricula (Colvin et al., 2014;Gellerstedt et al., 2019;King et al., 2021;McIntosh & MacMillan, 2009;Meaklim et al., 2020;Redeker & McEnany, 2011;Ye & Smith, 2015), but consistent with the prior decade of research, advanced practice nurses continue to report little (two hours) to no education about sleep and sleep disorders (Sawyer et al., 2022). Furthermore, a recent narrative review to evaluate sleep education provided across health care provider training programs included 16 published studies, only one of which focused on sleep in nursing curricula (Meaklim et al., 2020). ...
Aim:
The aim of this study was to explore nurse practitioner (NP) students' perceptions of a sleep e-learning program.
Background:
Sleep assessment is uncommon as nursing curricula lack sleep education. By preparing NPs to conduct sleep assessment and screening and understand basic sleep diagnostics, sleep health is more likely to be part of the differential diagnosis.
Method:
The study is a qualitative descriptive study utilizing two focus groups. A directed content analysis, guided by the Kirkpatrick model, was used for analysis.
Results:
Twenty-four students participated in focus groups. Two overarching themes emerged: perceptions of course design and content. Asynchronous, case-based scenarios and quizzes were favorable. Students spoke of content relevance to themselves and patients and intentions to adopt sleep assessment practices.
Conclusion:
NP students embraced sleep education and declared intention to apply learned skills in practice. This study highlights the feasibility of increasing curricular exposure to sleep education and ensuring NPs have skills to recognize implications of poor and disordered sleep in patients.
... Despite the strong links among sleep, circadian rhythms, and mental health, sleep education has largely been neglected in mental healthcare training programs around the world [20]. In Australia, almost half of trainee psychologists receive no sleep education regarding assessment, diagnosis, or treatment for sleep and circadian rhythm disturbances during graduate school [21]. ...
... To address this curriculum oversight, the current study created and piloted a sleep education workshop, called the Sleep Psychology Workshop, targeting trainee psychologists in graduate school. In brief, the workshop was informed by a narrative review of the sleep education for healthcare provider literature [20], sleep education survey research with psychology trainees and educators [21], as well as published literature on other sleep education studies for a range of healthcare students and providers (e.g., psychologists, medical doctors, neurologists, nurses, pharmacists) [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. The learning objectives for the Sleep Psychology Workshop were to provide trainee psychologists with the introductory skills they need to assess, diagnose, and manage the sleep and circadian rhythm disturbances that are highly prevalent in mental health populations, such as insomnia (see Section 4.1 and Figures 2, 3 for workshop details). ...
... The content for the Sleep Psychology Workshop was designed by the research team, all registered psychologists with expertise in sleep and circadian rhythms, mental health, and/or clinical psychology. The development of the workshop was informed by the completion of a narrative review into sleep education for healthcare providers [20], a survey study into sleep education in graduate psychology programs in Australia [21], and other published sleep education for trainee psychologists and healthcare providers [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. In addition, resources and education guidelines from professional psychology and sleep organizations (e.g., Society for behavioral Sleep Medicine, Sleep Research Society, Australian Psychological Society, Australasian Sleep Association, American Academy of Sleep Medicine, European Sleep Research Society) were reviewed, along with Australian Psychological Accreditation Council guidelines, to ensure competency requirements for graduate clinical psychology students were met [47]. ...
Despite the strong links between sleep, circadian rhythms, and mental health, sleep education has been neglected in mental healthcare provider training programs. The current pilot study examined the potential efficacy and acceptability of a sleep education workshop for trainee psychologists, called the Sleep Psychology Workshop. Eleven students completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the Sleep Psychology Workshop as part of their Health Psychology course, delivered as three, two-hour lectures (total six hours). Trainees’ sleep psychology knowledge quiz scores (% correct) demonstrated significant improvement from pre- (M = 60%, SD = .09) to post-workshop (M = 79%, SD = .08), t (6) = -5.18, p = .002. Trainees also reported increased self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep and circadian rhythm disturbances, along with increased confidence to manage insomnia disorder in clinical practice (all p<.02). Trainees also endorsed the workshop as an acceptable sleep education program for trainee psychologists via a post-workshop feedback survey, focus group, and six-month follow-up survey. This pilot study provides preliminary evidence for the Sleep Psychology Workshop as an effective and acceptable sleep education program for trainee psychologists.
... O assunto não é incorporado e ocupa pouco espaço na grade curricular 7 , acarretando ausência de conhecimento e de habilidade em recémformados. 8,9 A falta de informação e treinamento em relação ao tema resulta na cultura de médicos que têm conhecimento limitado sobre o assunto e, consequentemente, maior chance de ter pacientes subdiagnosticados e subtratados. 10 Prova disso é que 60% dos pacientes da saúde primária possuem distúrbios do sono, mas devido à falta de conhecimento, muitos pacientes permanecem sem diagnóstico e tratamento. ...
... 10 Prova disso é que 60% dos pacientes da saúde primária possuem distúrbios do sono, mas devido à falta de conhecimento, muitos pacientes permanecem sem diagnóstico e tratamento. 8 No entanto é importante o reconhecimento de que o descuido com a saúde do sono é prejudicial tanto para o paciente quanto para o médico. A saúde do sono é multifacetada, possui associação com doenças e, por isso, deve ser abordada a fim de melhorá-la nos pacientes e daqueles que os tratam. ...
Introdução: O sono é essencial para a qualidade de vida e possui funções fundamentais para o funcionamento do corpo. Sua privação traz consequências negativas na homeostase corporal e na cognição. Essa privação pode tornar-se fator de risco para diversas doenças. Há deficiências no currículo de graduação médica acerca do conhecimento sobre a saúde do sono, acarretando subdiagnósticos e subtratamentos, além de ter consequências no sono para os próprios doutorandos e médicos, afetando assim na sua saúde e no seu desempenho profissional. Objetivo: Avaliar se a percepção do conhecimento do médico sobre o sono adquirido na graduação interfere na promoção da saúde do sono nas esferas pessoal e profissional. Métodos: Estudo observacional de abordagem quantitativa e recorte transversal através de formulário digital. Médicos e internos fizeram parte do estudo. O questionário teve as seguintes etapas: epidemiologia; avaliação subjetiva do conhecimento sobre saúde do sono; aplicação de conhecimentos na vida profissional e pessoal; avaliação da qualidade de sono através do Índice de Qualidade de Sono de Pittsburgh (PSQI). Resultados: A amostra foi de 103 participantes. A maioria concordou em ter adquirido conhecimentos sobre a saúde do sono durante a graduação. Durante a anamnese o sono foi o tema menos perguntado. As medidas que favorecem a higiene do sono mais relatadas foram dormir em ambiente adequado e praticar exercícios físicos. Já as desfavoráveis foram uso de eletrônicos no quarto. Não houve diferença significativa entre ano e nível de formação em relação a qualidade de sono. Os índices significativamente mais alterados do índice foram disfunções diurnas e uso de medicamentos para dormir. Conclusão: A importância da saúde do sono é bem estabelecida, porém a qualidade de sono entre médicos e internos é ruim. Portanto se faz necessário futuras mudanças na área de ensino, atuação e pesquisa.
... 21 Moreover, it has been reported that Australian health professionals receive limited training in providing sleep care. 22 For example, a study conducted in 2021 among postgraduate psychology students in Australia (n = 138) reported that students received a median of only one hour of sleep education training, with almost half (47%) receiving no training at all. 23 In summary, our study indicates that discussions about sleep are frequently initiated with health professionals, but this does not necessarily translate to the utilisation of first line treatment (CBTi). ...
... 23 In summary, our study indicates that discussions about sleep are frequently initiated with health professionals, but this does not necessarily translate to the utilisation of first line treatment (CBTi). The lack of translation to treatment may be attributed to multiple factors, including constraints in time and funding for individual general practitioners, insufficient referral pathways, 22 and the complexities associated with co-occurring mental health issues. 21 Health professionals face various barriers in providing sleep care and referring patients for CBTi, particularly among individuals with mental health conditions. ...
Background
Insomnia is a common issue among individuals with mental health conditions, yet the frequency of insomnia treatment remains unclear. The purpose of this study was to investigate the prevalence of probable insomnia, discussions regarding sleep with health professionals, and the utilisation of commonly delivered insomnia treatments in Australian adults diagnosed with mental health conditions.
Methods
This study represents a secondary analysis of data collected through a cross-sectional, national online survey conducted in 2019. A subset included participants (n = 624, age 18–85y) who self-reported a diagnosis of depression, bipolar disorder, anxiety, panic disorder, or post-traumatic stress disorder. Participants were classed as having probable insomnia based on self-reported symptoms and a minimum availability of 7.5 hours in bed.
Results
Among individuals with probable insomnia (n = 296, 47.4%), 64.5% (n = 191) reported discussing sleep with one or more health professionals, predominantly with general practitioners (n = 160, 83.8%). However, 35.4% (n = 105) of people with probable insomnia had not discussed their sleep with a health professional. Additionally, 35.1% (n = 104) used prescribed medication for sleep, while only 15.9% (n = 47) had used the first line recommended treatment of cognitive-behavioral therapy for insomnia in the last 12 months.
Conclusion
Although most participants who met the criteria for probable insomnia had engaged in discussions about sleep with health professionals, utilisation of first line recommended treatment was low. Interventions that promote routine assessment of sleep and first line treatment for insomnia by health professionals would likely benefit people with mental health conditions.
... Moreover, health care providers are appropriate disseminators and implementers of movement behaviour guidelines as primary care covers a spectrum of services devoted to the improvement of health outcomes [10,11]. In Canada and other developed, high-income countries, primary care is commonly delivered by physicians, nurses, and nurse practitioners [12,13]; however, family health teams may involve other providers, including pharmacists [12,14,15], dietitians [12,16], psychologists [15], registered psychotherapists [17], and social workers [10,12], who perform key roles in movement behaviour promotion. ...
... Moreover, health care providers are appropriate disseminators and implementers of movement behaviour guidelines as primary care covers a spectrum of services devoted to the improvement of health outcomes [10,11]. In Canada and other developed, high-income countries, primary care is commonly delivered by physicians, nurses, and nurse practitioners [12,13]; however, family health teams may involve other providers, including pharmacists [12,14,15], dietitians [12,16], psychologists [15], registered psychotherapists [17], and social workers [10,12], who perform key roles in movement behaviour promotion. ...
Background
Health care providers have reported low knowledge, skill, and confidence for discussing movement behaviours (i.e., physical activity, sedentary behaviour, and sleep), which may be improved with the use of tools to guide movement behaviour discussions in their practice. Past reviews have examined the psychometric properties, scoring, and behavioural outcomes of physical activity discussion tools. However, the features, perceptions, and effectiveness of discussion tools for physical activity, sedentary behaviour, and/or sleep have not yet been synthesized. The aim of this review was to report and appraise tools for movement behaviour discussions between health care providers and adults 18 + years in a primary care context within Canada or analogous countries.
Methods
An integrated knowledge translation approach guided this review, whereby a working group of experts in medicine, knowledge translation, communications, kinesiology, and health promotion was engaged from research question formation to interpretation of findings. Three search approaches were used (i.e., peer-reviewed, grey literature, and forward searches) to identify studies reporting on perceptions and/or effectiveness of tools for physical activity, sedentary behaviour, and/or sleep. The quality of included studies was assessed using the Mixed Methods Appraisal Tool.
Results
In total, 135 studies reporting on 61 tools (i.e., 51 on physical activity, one on sleep, and nine combining two movement behaviours) met inclusion criteria. Included tools served the purposes of assessment (n = 57), counselling (n = 50), prescription (n = 18), and/or referral (n = 12) of one or more movement behaviour. Most tools were used or intended for use by physicians, followed by nurses/nurse practitioners (n = 11), and adults accessing care (n = 10). Most tools were also used or intended to be used with adults without chronic conditions aged 18–64 years (n = 34), followed by adults with chronic conditions (n = 18). The quality of the 116 studies that evaluated tool effectiveness varied.
Conclusions
Many tools were positively perceived and were deemed effective at enhancing knowledge of, confidence for, ability in, and frequency of movement behaviour discussions. Future tools should guide discussions of all movement behaviours in an integrated manner in line with the 24-Hour Movement Guidelines. Practically, this review offers seven evidence-based recommendations that may guide future tool development and implementation.
... The semi-structured interview guide was informed by an extensive review of the literature and the practice expertise of the research team (Cheung et al., 2014;Espie, 2009;Meaklim et al., 2020;Sake et al., 2018Sake et al., , 2019. Prompts were used if required to guide the interview (e.g., when participants requested more explanation to better understand what the question was aiming to look at). ...
... As opposed to OSA, which was usually previously diagnosed and (Meaklim et al., 2020). Similar findings were observed with other health care professionals, such as GPs (suboptimal management of insomnia presentations) and pharmacists (oversupply of pharmacological sleep aids for acute insomnia concerns; Kippist et al., 2011;Sake et al., 2019). ...
Aims
To explore community nurses sleep health practices and their perspectives on improving sleep health care provision.
Design
An exploratory study utilizing the qualitative description methodology.
Methods
Semi‐structured interviews were conducted with community nurses from May 2019 – October 2021. Interviews were audio‐recorded, transcribed, and subjected to an inductive thematic analysis using a constructivist–interpretive paradigm.
Results
Twenty‐three Australian community nurses were interviewed. Participants frequently encountered sleep disturbances/disorders in their patients. Data analysis yielded three main themes: (1) Sleep health in the community serviced, (2) sleep health awareness and management, and (3) community nurses' A to Z of improving sleep health. The most common sleep disorder presentations were insomnia and sleep apnea. Although most community sleep apnea cases were appropriately managed, insomnia was often mismanaged. Participants described their sleep health knowledge as deficient, with the majority advocating for increased sleep‐related education tailored to their profession. Other important factors needed for improving sleep health provision were standardized patient treatment/referral pathways, increased interprofessional collaboration, and sufficient time for patient consults.
Conclusion
Community nurses service a patient population that requires increased sleep health care. However, they are currently underequipped to do so, leading to suboptimal treatment provision. Providing community nurses with the appropriate resources, such as increased sleep‐related education and standardized treatment frameworks, could enable them to better manage sleep disturbance/disorder presentations, such as insomnia.
Impact
Little is known about how community nurses care for patients with sleep disturbance/sleep disorders. This study found that contemporary sleep health care was lacking due to knowledge deficits, competing challenges, and a need for standardized care pathways. These findings can inform the development of targeted education/training and standardized guidelines for community nurses providing sleep health care to patients as well as the design of future practice models of care provision.
Patient or Public Contribution
Previous research by authors has involved extensive engagement with patients and health professionals, such as community pharmacists, general practitioners, and naturopaths who play a role in sleep health in the primary health care sector. These previous research projects built a significant understanding of the patient and health practitioner experience and have provided the background to the concept and design of this study.
... Particularly, the organization and structure of the healthcare assistance is another problem that demands attention. Training programs of healthcare personnel for assisting mental and sleep problems in the population could mitigate the resistance to helpseeking 47 . Several studies reinforced the need for a comprehensive approach that encompasses knowledge on sleep disorders diagnoses and therapeutics to general health professionals 47 . ...
... Training programs of healthcare personnel for assisting mental and sleep problems in the population could mitigate the resistance to helpseeking 47 . Several studies reinforced the need for a comprehensive approach that encompasses knowledge on sleep disorders diagnoses and therapeutics to general health professionals 47 . ...
Objective: This study aimed firstly to describe sleep-related and mental health symptoms before and during the COVID-19 pandemic in a national-wide sample and, secondly, to verify attitudes towards help-seeking to treat these symptoms.
Material and Methods: Data were collected through an online questionnaire sent through the Brazilian Sleep Association’s social media. The questionnaire included sociodemographic and sleep aspects questions currently and before the pandemic period. In addition, the survey addressed current and previous anxiety, depression, and burnout symptoms. The outcome help-seeking was addressed in the questionnaire as well by a single question asked when the participant reported mental or sleep problems.
Results: The study covered 6,360 participants, mean age 43.5 years (SD=14.3), 76.7% female and 63.7% with undergraduate or higher degree filled out the survey. Seventy percent of participants reported sleep disturbances and 80% reported symptoms of anxiety during the pandemic. Help-seeking behavior was found only in one third of them. Hours of sleep reduced from 7.12 to 6.2h, which can be related with the increase in 28.2% of dissatisfaction with sleep duration during the pandemic. The highest frequency of complaints related to sleep was difficulty to fall asleep three or more times a week (going from 27.6% before the pandemic to 58.9% during the pandemic; p
... Sleep difficulties can also worsen comorbid mental illness: increasing the likelihood of depression relapse [5]; prolonging the course of depression [6]; and blunting treatment effects [7]. As a consequence, mental health clinicians and physicians now consider the effective treatment of sleep disturbance to be a priority [8]. This greater awareness of the fundamental role sleep plays in maintaining physical and mental health, and the detrimental impact of sleep difficulties on mental health, underscores the need for effective psychological interventions that improve sleep quality. ...
Objective
This paper reviews the literature evaluating psychological treatments to improve sleep quality in young adult university students.
Method
Participants (N = 6179) were young adult (aged 18–30 years) university students. Databases (PubMed, PsychInfo, EMBASE and Medline) were searched for randomized controlled trials evaluating psychological treatments for sleep disturbance in university students. The search date was 20 September 2024.
Results
22 original trials met inclusion criteria. Meta-analysis showed that psychological interventions outperformed control groups (n = 14) on improving sleep quality (g = 0.50, 95%CI:0.26–0.73). There were significantly different effect sizes found between studies that evaluated cognitive behaviour therapy for insomnia (CBT-I; n = 6, g = 0.72, CI: 0.43–1.02) versus studies that evaluated mindfulness interventions (n = 5, g = 0.16, 95% CI: -0.18–0.51).
Conclusions
Psychological treatments improve sleep quality for young adult university students. While CBT-I showed larger effect sizes than interventions focused on mindfulness, further research is needed to verify if this reflects a true difference in the efficacy of the interventions.
... Regarding sleep, the intervention mirrored that of Mrs. A1, focusing on promoting rest periods and encouraging a division of tasks. For the newborn, emphasis was placed on establishing a somewhat consistent routine to provide a sense of predictability regarding sleep patterns, adaptation to the sleeping environment, and reinforcement of a safe sleeping position (McDonald et al., 2019;Meaklim et al., 2020;Torres et al., 2021). Additionally, both parents were encouraged to attend to the baby's needs calmly during nighttime, minimizing stimulation to help the baby return to sleep more easily. ...
RESUMO Introdução: Esta prática de enfermagem, orientada pela ontologia, foca-se na família como uma unidade, considerando também as necessidades individuais, promovendo um cuidado personalizado e inclusivo. Objetivo: Caraterizar o plano de cuidados de uma família em transição para a parentalidade, incluindo a integração do novo membro na família. Métodos: Estudo de caso, seguindo as diretrizes CARE para relatos de casos clínicos. Resultados: O plano de cuidados demonstra a autonomia da prática de enfermagem ao enfatizar a saúde individual e a importância dos processos familiares durante esta transição, promovendo a capacitação para o papel parental, a autorregulação, resiliência e cuidados inclusivos. Conclusão: É enfatizado o cuidado à família e seus indivíduos por parte do enfermeiro especialista em saúde comunitária na área de saúde familiar, destacando a interdependência da saúde individual e dos processos familiares durante esta transição, defendendo uma abordagem holística e flexível, apoiada por um sistema de informação em saúde que melhora a comunicação entre os profissionais de saúde e promove o bem-estar geral da família. Palavras-chave: estudo de caso; família; ontologia de enfermagem; transição ABSTRACT Introduction: This ontology-driven nursing practice focuses on the family as a unit while also considering individual needs and promoting personalized and inclusive care. Objective: To characterize the care plan for a family transitioning to parenthood, including integrating the new family member. Methods: Case report supported by the CARE guidelines for clinical case reporting. Results: The care plan demonstrates the autonomy of nursing practice by emphasizing individual health and the importance of family processes during the transition to parenthood while also empowering parental roles and promoting self-regulation, resilience, and inclusive care. Conclusion: The report highlights the role of community family nurse specialists in supporting individuals and families during the transition to parenthood, emphasizing the interconnection between personal health and family dynamics. It advocates for a holistic, flexible approach, supported by a health information system, fostering communication among healthcare professionals and improving family well-being.
... Healthcare providers' knowledge of sleep includes understanding the implementation of effective sleep evaluation techniques (Meaklim et al., 2020). Various tools are available for assessing sleep disorders, and the appropriate selection of these instruments is pivotal in evaluating sleep disruptions for researchers and clinicians (Luyster et al., 2015). ...
Aim
To identify sleep‐promoting nursing interventions in hospitalized adults and older people.
Background
Sleep is necessary for maintaining good physical and mental health, as well as a high quality of life. Hospitalization can significantly disrupt sleep patterns, which is an often‐overlooked issue. Nurses are the main participants in promoting sleep in hospitalized patients.
Methods
Systematic literature review based on the question: “What interventions can nurses implement to promote sleep in hospitalized adults and older people?”. The research was conducted on April 4, 2023, in CINAHL Complete, MEDLINE, Cochrane, Scopus, and Web of Science, filtering the articles published in the last 10 years. For a study to be included, it must feature adult or older participants, an intervention that aims to enhance sleep, and the research should have been conducted within a hospital setting. We followed the PRISMA flow diagram and analyzed the quality of the articles according to the Joanna Briggs Institute criteria for quality assessment. The results were subjected to a narrative synthesis.
Results or findings
Of the 712 articles found, 13 were selected. The sample encompasses 1975 participants. These selected articles emphasize educational and communicative interventions, dietary and sensory interventions, symptomatic and environmental control, daily activity planning, sleep assessment and documentation, and individualized nursing care.
Discussion
There is a need for a systematic approach incorporating physical, psychosocial, and relational dimensions within the care context.
Conclusion
It is necessary to raise the nurses’ awareness of the factors that affect sleep experience and empower them to promote sleep in partnership with hospitalized patients.
Implications for nursing and health policy
Sleep interventions can be promoted by implementing hospital policies, including environmental modifications in the design and refurbishment of facilities and restricting nighttime patient transfers to reduce noise and disturbances. Encouraging research studies that explore the effectiveness of these interventions will further support the development of evidence‐based policies aimed at improving sleep quality in hospitalized patients.
... This would encourage awareness of the implications of quality sleep health practices on the resident's overall health and well-being, which are often overlooked. Previous reports suggest that Australian health professionals have limited sleep health education in their curricula (Meaklim et al. 2020). Though our participant sample appeared to have some basic grounding in sleep medicine, a national sleep and circadian health training programme for Australian aged care staff with clear guidelines for managing sleep disturbances is recommended. ...
Aim
To explore the attitudes, beliefs and perspectives of registered nurses (RNs) regarding sleep health and sleep health management of residents living in aged care settings in Australia.
Design
Qualitative inductive thematic analysis of semi‐structured interviews.
Methods
Semi‐structured interviews were conducted with RNs working in residential aged care facilities using a topic guide between August 2021 and April 2022. Participants were recruited using a convenience‐based and snowball sampling approach. Interviews were audio‐recorded, transcribed verbatim and inductively analysed for emergent themes.
Results
Eighteen interviews were conducted with RNs working in aged care. Thematic analysis of the data derived three main themes: (i) Awareness and observations of sleep health, (ii) assessment and management of sleep disturbances and (iii) barriers to implementing evidence‐based sleep health management. It was found that the most common barrier to providing evidence‐based sleep health practices was related to workplace constraints. Participants detailed the limitations of the RN's professional role and ability to work autonomously in sleep health practices.
Conclusion
Despite the intentions of RNs to implement evidence‐based non‐pharmacological strategies for sleep health management, pharmacological interventions prevail. Systemic efforts to address organisational constraints in aged care may improve sleep disturbance management and assist with shifting the current attitudes around sleep health in aged care facilities.
Implications for the Profession and Patient Care
This study highlights that current sleep health management of residents in residential aged care is inadequate. Upskilling nurses in sleep health care techniques and improving organisational commitment to such care provision are issues urgently required to enhance the sleep health of residents.
Impact
Current sleep health practices are not evidence‐based in residential aged care. Optimising sleep practices in residential aged care that are person‐centred is likely to improve quality of life and healthy ageing.
Patient or Public Contribution
No patient or public contribution.
... However, given the variation in shiftwork arrangements (shift timing and length, roster configurations, variable work environments etc.), and the interindividual differences (age, gender, comorbidities etc.), there is no universally accepted approach to implementing these interventions. Instead, a stepped care model should be employed, with the most cost-effective and non-invasive strategies trialed first [15]. This often involves providing shiftworkers with education about sleep health through sleep hygiene advice [16]. ...
Background
Due to work commitments, shiftworkers often obtain inadequate sleep, consequently experiencing negative health, wellbeing, and safety outcomes. Given shiftworkers may have limited control over their work commitments, lifestyle and environmental factors within their control may present an intervention opportunity. However, such interventions require tailoring to ensure applicability for this sleep-vulnerable population.
Methods
A randomised waitlist control pilot trial investigated the effectiveness of mobile health application Sleepfit, which delivered a tailored sleep health intervention aimed at improving sleep health and sleep hygiene outcomes amongst paramedic shiftworkers. Outcome measures of self-reported sleep health (sleep need, duration, and quality, fatigue, Insomnia Severity Index, Fatigue Severity Scale, and Epworth Sleepiness Scale scores) and sleep hygiene (Sleep Hygiene Index score) were collected at baseline, post-intervention, and 3-month follow-up.
Results
Fifty-eight paramedics (aged 33.4 ± 8.0 years; 50% male) were recruited, and trialed Sleepfit for a 14-day intervention period between August 2021–January 2022. For all participants, there was a significant reduction in Insomnia Severity Index and Sleep Hygiene index scores after intervention engagement. Regression models demonstrated no significant intervention effect on sleep health or sleep hygiene outcomes (intervention versus waitlist control group). A high study drop-out rate (91.4%) prevented assessment of outcomes at 3-month follow-up.
Conclusions
Pilot trial findings demonstrate that Sleepfit may elicit improvements in sleep health and sleep hygiene outcomes amongst paramedic shiftworkers. However, low enrolment and retention means that findings should be interpreted with caution, further highlighting potential engagement challenges, especially among paramedics who are particularly in need of support for improved sleep.
Trial registration
Prospectively registered with the Australian New Zealand Clinical Trial Registry 24/01/2020 (reference no. ACTRN12620000059965).
... Sawyer et al. (2022) recently developed and tested an asynchronous online sleep education program among 149 primary care nurse practitioner students, and participants demonstrated a significant improvement in sleep health knowledge after the intervention (Sawyer et al. 2022). While there are other reports in the empirical literature on successful sleep health educational interventions among students in health care and psychology programs (Booker et al. 2020;Meaklim et al. 2020;Richardson et al. 2021); we cannot place our findings in the context of these interventions due to different outcome metrics. ...
Introduction: Social workers, the largest group of mental health clinicians in the United States, play a pivotal role in mental health promotion. Despite the importance of sleep for mental health, there is no empirical research on sleep education interventions for social workers. Method: We designed an online sleep health education intervention to equip social work students to promote healthy sleep practices among their clients. An interdisciplinary team of experts devised the 90 min intervention using an empirically supported behavioral change theoretical model (COM-B). The intervention discusses multi-level factors that impact sleep and emphasizes considerations for health disparities in populations commonly served by social workers (e.g., unhoused populations, clients with substance use disorders, etc.). We assessed sleep knowledge, sleep quality, and acceptability using survey and focus group data. Results: Ninety social work students (92.2% female, 38.8% non-Hispanic white) completed pre- and post-intervention assessments. Participants demonstrated significant improvements in sleep health knowledge and their personal sleep quality. Quantitative and qualitative data revealed perceived usefulness for social work practice. Conclusions: A short online sleep education intervention can improve sleep health knowledge, offering a practical method to expand social workers’ understanding of healthy sleep promotion that can be readily implemented in clinical training and practice.
... The overall result depicted that 50.00% of the residents sampled had serious or excessive sleepiness-related issues without them knowing. Furthermore, the result has shown that 50.00% of the residents have sleepiness problems which are either undetected or mismanaged, and this is in accord with the report of Meaklim et al (2020) and Grannakopoulos et al (2021), who independently reported that daytime sleepiness had caused behavioural problems, mood changes, memory lapses, impaired concentration and affected productivity. This view was further made by Janssen et al (2017) who reported the effectiveness of the Epworth scale in detecting daytime sleepiness in both adults and children. ...
The daytime sleepiness and youth dysfunctionality in the youth restive community in Diobu, Rivers State, Nigeria was investigated through EPWORTH and APGAR models. A convenience or purposivesampling technique was used to arrive at the sample size of 28. The youths sampled were those who have resided in the area for 4-20 years and above and engaged in different trades from bunkering to criminal activities. The EPWOTH scale result depicted that 14, 12, and 2 persons representing 50.00%, 42.86%, and 7.14% had normal, mild, and moderate sleep respectively. Furthermore, 50.00% of the residents have undetected or mismanaged sleepiness issues. However, there were no severe sleepiness-related issues. Again, the APGAR scale depicted that 8, 16, and 4 persons representing 28.57%, 57.14%, and 14.29% respectively were highly functional, but moderately dysfunctional, and severely dysfunctional. Thus, suggesting that the majority of the youths sampled were dysfunctional and could not relate well with their family without knowing it. The overall result has shown that the majority of the persons sampled had excessive daytime sleepiness which agreed with the high level of family dysfunctionality observed in the area. This situation, if not properly handled, can lead to behavioural problems, mode changes, and impaired concentration adversely affecting productivity.
... Despite the fact that clinical psychologists have the capacity to play a critical role in the assessment and treatment of sleep-related disorders, they also tend to have limited sleep training [18]. To address this gap in training, it is critical to gather information regarding the status of sleep training of Saudi clinical psychologists, as well as to obtain data on their potential role in sleep disorders management [19]. To the best of our knowledge, no research has previously been conducted to determine Saudi clinical psychologists' education or knowledge concerning sleep disorders. ...
Sleep disorders comprise a range of medical conditions that interfere with regular sleep patterns. Despite the fact that clinical psychologists have the capacity to play a critical role in the assessment and treatment of sleep-related disorders, generally this population of professionals tend to have limited training in such conditions. The aim of this study was to assess the level of awareness, knowledge, and practice of sleep disorders among Saudi psychologists. A total of 92 Saudi psychologists participated in a cross-sectional online survey that consisted of 3 parts: (a) a section to obtain demographic data on the respondents, (b) items to assess respondents’ knowledge of sleep disorders, and (c) items to evaluate respondents’ perceptions of their own ability to treat various sleep disorders. Data were analyzed using IBM SPSS (Version 26). Males represented 52.17% of the participants and females represented 47.83%. The majority of participants (76.09%) reported they scan for sleep disorders during the initial diagnostic stage. One-third of participants reported that they skip formulating a treatment plan for sleep disturbances, and 30.43% of participants indicated they have no idea how to diagnose insomnia using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). Regarding the ability to diagnose and deal with sleep disorders, 44% of participants reported they perceive themselves as being some level of prepared. The responses of the majority of the psychologists indicated they perceive themselves as unprepared to deal with circadian rhythm disorders, narcolepsy, and parasomnia. Less-experienced psychologists showed greater knowledge of sleep disorders compared to more-experienced psychologists. The overall finding is that there is a lack of knowledge regarding sleep disturbances among Saudi psychologists. Future study is needed to provide psychologists with comprehensive training in evidence-based management guidelines for sleep disorders. The findings of this study emphasize the necessity for heightened pre- and in-service educational programs geared toward enhancing the proficiency of Saudi clinical psychologists in the application of evidence-based therapeutic approaches for sleep disorders.
... Although a relatively small number of children suffer from intrinsic sleep disorders that require specialist medical care (such as sleep apnea, restless legs syndrome, or narcolepsy) and in a more considerable number of cases sleep problems occur in children suffering from chronic health conditions or mental distress (e.g., depression and anxiety), most children experience insomnia and problems falling asleep linked to chronic insomnia, evening chronotype, and circadian misalignment during changes in daily routine, schedule, or stressful situations such as exams and competitions. These situations might be difficult to manage since most pediatricians and nurse practitioners are not trained about behavioral sleep problems [2,3]. ...
Sleeping problems are prevalent among children and adolescents, often leading to frequent consultations with pediatricians. While cognitive-behavioral therapy has shown effectiveness, especially in the short term, there is a lack of globally endorsed guidelines for the use of pharmaceuticals or over-the-counter remedies in managing sleep onset insomnia. An expert panel of pediatric sleep specialists and chronobiologists met in October 2023 to develop practical recommendations for pediatricians on the management of sleep onset insomnia in typically developing children. When sleep onset insomnia is present in otherwise healthy children, the management should follow a stepwise approach. Practical sleep hygiene indications and adaptive bedtime routine, followed by behavioral therapies, must be the first step. When these measures are not effective, low-dose melatonin, administered 30–60 min before bedtime, might be helpful in children over 2 years old. Melatonin use should be monitored by pediatricians to evaluate the efficacy as well as the presence of adverse effects.
Conclusion: Low-dose melatonin is a useful strategy for managing sleep onset insomnia in healthy children who have not improved or have responded insufficiently to sleep hygiene and behavioral interventions.
What is Known:
• Pediatric insomnia is a common disorder and impacts children's emotional, behavioral, and cognitive functioning, as well as parents' sleep and daytime functioning.
• There is no consensus in Europe on the management of sleep onset insomnia and the use of melatonin in typically developing children.
What is New:
• A group of European experts has compiled a set of recommendations for the management of insomnia, developing a step-by-step approach.
• Sleep hygiene, behavioral strategies, and finally low-dose melatonin represent valid strategies for managing sleep onset insomnia.
... Healthy sleep habits are also discussed by clinicians with their clients who have insomnia. However, changing sleep habits alone is not an effective treatment for people with insomnia (Meaklim et al., 2020;Mindell et al., 2011;Sake et al., 2019). Even though cognitive behavioral therapy (CBT) to change sleep behavior is evidence based and recommended by international guidelines as a first-line insomnia treatment, CBT is not easily accessible (Thomas et al., 2016). ...
Objectives:
Insomnia symptoms are common among medical students. This study explored the perspectives of medical students about which sleep management strategies to use.
Methods:
Medical students responded to an online survey on their thoughts about the use of various sleep management strategies.
Results:
Of the 828 respondents, 568 (69%) provided responses to questions about the most preferred strategies and 450 (54%) provided responses about their least preferred strategies. About 48.5% felt their insomnia symptoms were too mild to see a clinician and 23.9% did not think their symptoms warranted sleep medication. Over 40% of students could not avoid work before sleep, have consistent sleep/wake times, or engage in regular exercise because of their busy and inconsistent schedules. Approximately 40-60% could not improve their sleep environment (e.g. better heating and bed) because of the associated costs. Over 80% reported an inability to change their pre-sleep habits (e.g. using electronics close to bedtime, using bed for activities other than sleep or sex). Half of the students disliked relaxation techniques or felt they would not help. Around 30-50% did not believe that changing caffeine and/or alcohol intake would affect their sleep.
Conclusions:
Medical students may benefit from additional sleep education. Clinicians may need to discuss which strategies individual students prefer and modify their recommendations accordingly.
... 9 10 Despite this, it's estimated that only around one third to one half of people with sleep disorders seek help, 7 11 perhaps rooted in a lack of awareness about the importance of treating sleep problems. 12 In the past two decades, our understanding of the associations between sleep disorders and NCDs has grown. 2 -4 Researchers found that people with chronic insomnia lasting more than eight years had a 21% higher risk of hypertension and 51% increased risk of type 2 diabetes. 13 14 Moderate to severe sleep apnoea is associated with a 63% greater risk of type 2 diabetes and 30% higher risk of hypertension. ...
... Sleep has been identified as an area where healthcare providers require further training to address prevalent sleep deficiencies that have health and economic costs. 29 Our study demonstrates how it is important to consider poor sleep as a contributing factor to symptoms observed in a sibling of a child with DS as this may be modifiable if identified. We recommend that training and educational resources should include instruction around holistic healthcare that both seeks out siblings' voices and raises parents' awareness of sleep disruption symptoms and sleep health literacy, particularly around the benefits of addressing and seeking support for their child's sleep disruption, even if other causes are also at play. ...
Objective
Adverse effects of sleep disruption are identified in parents who live with a child with Down Syndrome (DS), yet there is no research on siblings’ experiences. This study addresses this knowledge gap.
Design
A qualitative research study using semi-structured interviews to understand the experiences of siblings of a child with DS and sleep difficulties from the perspectives of parents and siblings.
Participants
Eleven siblings aged 5-15 years old, and 11 parents, from 8 families with a child with DS in Australia.
Methods
Semi-structured sibling interviews explored what it was like to have a sibling with DS and sleep difficulties; the participant’s own sleep; how their sleep affected how they felt during the day; how sleep impacted their family; and advice that they would give to other siblings. Parent interviews included similar topics; here we report on excerpts in which parents reference siblings. Interviews were audio recorded, transcribed verbatim, and analyzed using a reflexive thematic analysis.
Results
Siblings and parents acknowledge sleep disruption for siblings; yet sleep disruption is normalized, viewed with acceptance and inevitability. Siblings report adverse effects from sleep disruption, view sleep in a relational way, and cope with sleep disruption. Parents can underestimate siblings’ sleep disruption and are uncertain whether siblings’ symptoms result from sleep disruption or other causes.
... Additionally, considering that improving sleep quality is associated with enhanced physical and mental health [47], future research should evaluate healthcare students' sleep knowledge and provide them with sleep education. This training must cover subjects including sleep and circadian science, sleep hygiene, and the clinical evaluation and treatment of sleep disturbances and disorders [48]. Some evidence of the effectiveness of sleep education programs in enhancing sleep hygiene knowledge, sleep hygiene behavior, and/or sleep quality when compared to traditional techniques has been documented by a comprehensive review of four interventional trials [49]. ...
Objectives:
Stress, anxiety, and depression among students have many negative health consequences and may predispose students to poor sleep quality; therefore, this research aimed to investigate the perceived stress, anxiety, and depression and their relation to the level of sleep quality among healthcare students.
Methods:
A cross-sectional study using a validated survey was conducted among Saudi healthcare students from different regions during the period from 26 September 2022 to 30 October 2022. The Pittsburgh Sleep Quality Index (PSQI) was utilized to assess sleep quality. PSPP Statistical Analysis Software version 1.2.0 was used for all statistical analyses.
Results:
701 respondents participated in this research; the response rate was 73.8%. About 60% of the study sample was female, and the average age was 20.9 years. 80.3% of students have poor sleep quality; the participants' mean sleeping hours per night was 6.81 ± 1.88 h. About three-quarters of students (72.9%) perceive themselves as stressed. A significant positive correlation was observed between sleep quality and perceived stress (r-value = 0.363), anxiety (r-value = 0.387), and depression (r-value = 0.347). Poor sleep quality was more likely among those with stress than those without stress (AOR = 1.79; 95% CI 1.07, 2.99) and two times more likely among students with cases of anxiety than those without anxiety (AOR = 2.07; 95% CI 1.10, 3.94).
Conclusions:
Our study highlights the high prevalence of poor sleep quality, anxiety, depression, and stress among healthcare students in Saudi Arabia. Students' reported stress, anxiety, and residence region were associated with poor sleep quality. These results imply the necessity of regular screening and appropriate intervention for sleep problems, stressors, and anxiety among healthcare students.
... A second barrier to CBT-I dissemination is that our mental healthcare providers lack general sleep and insomnia knowledge due to the limited sleep education taught within university-based healthcare training programs [52-54, 81, 93]. Sleep education is scarce in both medical and psychology programs due to limited time, space, and expertise in the curriculum [69,78,[94][95][96][97][98][99][100][101][102][103][104][105][106]. On average, medical students worldwide receive only 2.5 hours of sleep education across their medical degree [107], much less than, for example, the 19.6 hours for nutrition education [108,109]. ...
Study objectives:
Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) evaluation framework.
Methods:
Using a non-randomized waitlist control design, graduate psychology students attended a validated six-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months.
Results:
Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students' sleep knowledge and self-efficacy to manage sleep disturbances using Cognitive Behavioral Therapy for Insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p <.001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency.
Conclusion:
Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide.
... This study recruited PCPs, who are the target users of the Tool and User Guide. Eligible PCPs included those regularly involved in health promotion/health behaviour discussions with adults accessing care in a primary care setting in Canada [10,[37][38][39][40][41], including: physicians, residents, nurses, nurse practitioners, dietitians, pharmacists, social workers, and psychologists, and registered psychotherapists working in a family health team in Ontario, Canada. Our target sample size was 25 participants (i.e., five per each medicine, nursing, diet/nutrition, pharmacy, and psychology fields). ...
Background
Canada’s 24-Hour Movement Guidelines for Adults have shifted the focus from considering movement behaviours (i.e., physical activity, sedentary behaviour, and sleep) separately to a 24-h paradigm, which considers how they are integrated. Accordingly, primary care providers (PCPs) have the opportunity to improve their practice to promote all movement behaviours cohesively. However, PCPs have faced barriers to discussing physical activity alone (e.g., time, competing priorities, inadequate training), leading to low frequency of physical activity discussions. Consequently, discussing three movement behaviours may seem challenging. Tools to facilitate primary care discussions about physical activity have been developed and used; however, few have undergone usability testing and none have integrated all movement behaviours. Following a synthesis of physical activity, sedentary behaviour, and sleep tools for PCPs, we developed the Whole Day Matters Tool and User Guide that incorporate all movement behaviours. The present study aimed to explore PCPs’ perceptions on the usability, acceptability, and future implementation of the Whole Day Matters Tool and User Guide to improve their relevancy among PCPs.
Methods
Twenty-six PCPs were observed and audio–video recorded while using the Tool and User Guide in a think-aloud procedure, then in a near-live encounter with a mock service-user. A debriefing interview using a guide informed by Normalization Process Theory followed. Recordings were transcribed verbatim and analysed using content analysis and a critical friend to enhance rigour.
Results
PCPs valued aspects of the Tool and User Guide including their structure, user-friendliness, visual appeal, and multi-behaviour focus and suggested modifications to improve usability and acceptability. Findings are further discussed in the context of Normalization Process Theory and previous literature.
Conclusions
The Tool and User Guide were revised, including adding plain language, reordering and renaming sections, reducing text, and clarifying instructions. Results also informed the addition of a Preamble and a Handout for adults accessing care (i.e., patients/clients/service-users) to explain the evidence underpinning the 24-Hour Movement Guidelines for Adults and support a person-centered approach. These four resources (i.e., Tool, User Guide, Preamble, Handout) have since undergone a consensus building process to arrive at their final versions before being disseminated into primary care practice.
... For example, a barrier in the Australian context is that healthcare providers such as general practitioners and psychologists are often not aware that referral for insomnia treatment is a valid referral under the Better Access to Mental Healthcare initiative (Haycock et al., 2021). Another barrier to administration of CBT-I is a lack of screening for sleep disorders in clinical settings (Koffel et al., 2018) with recent Australian research finding that the majority of health professionals feeling under equipped to manage sleep disorders (Meaklim et al., 2020;Richardson et al., 2021). Further, when patients are referred for CBT-I there exists a shortage of trained clinicians for treatment delivery. ...
Objective
Insomnia, even when comorbid with other diagnoses is an independent health issue that warrants treatment. Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment. Although the science is clear that CBT-I supports outcomes for those with mental ill health, the routine use of CBT-I in mental health contexts is rare. Implementation research on CBT-I in the psychiatric context is urgently needed. This study evaluated group CBT-I as routinely delivered in a psychiatric hospital service.
Methods
Adult outpatients (N = 76; Mage = 50.20 years; female = 57; psychiatric comorbidity = 69.74%; using sleep medication = 76%) referred for insomnia treatment attended four sessions of group CBT-I. Standardised questionnaires were administered pre- and post-treatment.
Results
Intent-to-treat analysis revealed statistically significant and clinically meaningful improvements with large effect sizes in insomnia severity (d = 2.5, r = 0.8), depression (d = 1.4, r = 0.5), anxiety (d = 1.2, r = 0.5) and stress (d = 1.2, r = 0.5) symptoms, quality of life (d = 1.4, r = 0.6), and functional impairment (d = 2.2, r = 0.7). Regression analyses indicated pre-post changes in dysfunctional beliefs about sleep accounted for significant variance in post-treatment insomnia severity.
Conclusions
Results supported feasibility of implementation and real-world effectiveness of CBT-I in a psychiatric setting. Cognitive models of insomnia, emphasising the role of unhelpful beliefs about sleep in insomnia treatment were supported. Future directions include the dissemination of CBT-Insomnia to improve its uptake in psychiatric care.
... To date, efforts to embed sleep education in the undergraduate curriculum of healthcare workers have largely focused on medical clinicians and medical students. 26 Understanding the importance of sleep and strategies to achieve a good night's sleep is particularly important for nurses because it is often not common knowledge and strategies for non-shift workers are often publicised. Not all strategies to promote a good night's sleep are realistic or feasible for a person undertaking shift work. ...
Poor sleep among nurses (and other healthcare workers) is a growing area of concern that may have far-reaching consequences not just for themselves, but for their patients and the workforce. Fortunately, wellness programs are starting to integrate and highlight the importance of sleep for nurses, but this area of research still has a long way to go. Here, we discuss the importance of sleep for nurses, the challenges and future initiatives.
... 38 A recent review in 2020 by Meaklim et al. emphasised that sleep education in healthcare settings was inadequate in Australia and New Zealand and that sleep education must be improved for all healthcare students and currently registered/practicing healthcare providers. 39 Dental practitioners also have a role in the screening and management of OSA for certain adult and paediatric OSA patients. 40,41 However, dental sleep medicine education was also reported to be below optimal hours. ...
Introduction: Despite the serious health implications associated with obstructive sleep apnoea, the condition remains under-diagnosed. This study aims to evaluate the awareness of the condition amongst the Australian community.
Methods: A total of 2016 respondents recruited from a web-based panel completed an online questionnaire which assessed awareness and experience of obstructive sleep apnoea and sleep-disordered breathing. The association between the level of awareness and various socio-demographic variables was analysed using uni- and multivariate analyses.
Results: The results of the questionnaire indicated that 50% and 70% of participants were unaware of adult and paediatric obstructive sleep apnoea. Socio-demographic variables including age, annual household income and education level significantly influenced a participant’s level of awareness. Approximately 8.3% of the participants had previously been diagnosed with obstructive sleep apnoea. However, 65% of participants exhibiting symptoms of daytime sleepiness had not sought health care. Paediatric sleep apnoea had been previously diagnosed in 7.1% of children residing in participant’s households but 49% of children with regular snoring had not been medically evaluated.
Conclusion: A deficiency exists in the awareness of sleep apnoea amongst the Australian general public. This is reflected in the discrepancy between the number of participants exhibiting potential symptoms and those who sought medical advice.
... Our participants noted a lack of preparation in healthy coping strategies for shift work and work stress, specifically in the prelicensure period. Indeed, prelicensure nursing curricula do not routinely teach about work stress and shift work management in a formal manner (Meaklim et al., 2020;Ye & Smith, 2015). Similarly, postlicensure continuing education and/or workplace wellness programs, such as mindfulness-based meditation or resilience training, are not uniform across organizations (Centers for Disease Control and Prevention [CDC], 2020). ...
Background
The COVID-19 pandemic put extreme stress on an already strained healthcare workforce. Suboptimal work organization, exacerbated by the pandemic, is associated with poor worker, patient, and organizational outcomes. However, there are limited qualitative studies exploring how the interconnections of work organization factors related to shift work, sleep, and work stress influence registered nurses and their work performance in the United States.
Purpose
We sought to understand how nurses perceive work organization factors that impact their performance. Knowledge in this area could direct efforts to implement policies and design tailored interventions to support nurses in the post-pandemic period.
Methods
We used a qualitative descriptive design with the Work, Stress, and Health framework as an overarching guide to understand the interconnectedness of work organization factors, work stress, and outcomes. Participants were randomly assigned to one of two anonymous, asynchronous virtual focus groups (i.e., threaded discussion boards) in 2019. Registered nurses (N = 23) working across the United States were recruited and engaged until data saturation was achieved. Directed content analysis was used to analyze the data.
Results
Findings aligned with the Work, Stress, and Health framework and revealed three themes: (1) “Our Voice Should Matter” (nurses’ desire to have their voices heard in staffing policies); (2) “Tired But Wired” (the harmful cycle of work stress, rumination, and poor sleep); and (3) “We’re Only Human” (nurses’ physical, emotional, and mental exhaustion linked to critical performance impairments).
Conclusion
These findings underscore that high work stress and poor sleep were present before the pandemic and impacted nurses’ perceptions of their performance. As leaders look forward to recovery and work redesign efforts, these findings can guide decision-making and resource allocation for optimal nurse, patient, and organization outcomes.
... Many sleep problems are either undetected or mismanaged (8). Night-time sleep deprivation in adolescents can cause daytime sleepiness, which in turn can cause impaired concentration, memory lapses, mood changes and behavioural problems. ...
Objective: Sleep disturbance is common among adolescents around the world. Our study aimed to determine the prevalence of sleeping disorders among in-school adolescents in Ilorin, Nigeria.Methods: With a cross-sectional design, sleep quality was assessed among 512 in-school adolescents using the Pittsburgh Sleep Quality Index (PSQI). A cut-off score of 5 was used. Data analysis was done with the Statistical Package for Social Sciences version 22.Results: Three out of every five adolescents were poor sleepers (PSQI global score > 5). Only a few respondents (19%) had optimal sleep (≥ 9 hours), and more than half had inadequate sleep (< 7 hours). Poor sleep was associated with male gender, being the first born and residence at home. Logistic regression analysis showed that living at home, as against hostel living, was predictive of poor sleep.Conclusion: Most respondents had inadequate sleep. Support from parents and other stakeholders could improve sleep among adolescents, as poor sleep is quite common in this age group. These concerted efforts would promote adolescent mental health in north-central Nigeria.
... Education about parent-infant sleep and mood could serve as an important form of anticipatory guidance to prevent PMADs during pregnancy and after childbirth. However, many clinicians lack sleep related training and education, suggesting that more emphasis on assessment of sleep and managing sleep problems in disciplinary curriculums and continuing education is required [87][88][89][90]. ...
Background
Although some women experience anger as a mood problem after childbirth, postpartum anger has been neglected by researchers. Mothers’ and infants’ poor sleep quality during the postpartum period has been associated with mothers’ depressive symptoms; however, links between mothers’ sleep quality and postpartum anger are unclear. This study aimed to determine proportions of women with intense anger, depressive symptoms, and comorbid intense anger and depressive symptoms, and to examine mothers’ and infants’ sleep quality as correlates of postpartum anger.
Methods
This cross-sectional survey study was advertised as an examination of mothers’ and babies’ sleep. Women, with healthy infants between 6 and 12 months of age, were recruited using community venues. The survey contained validated measures of sleep quality for mothers and infants, and fatigue, social support, anger, depressive symptoms, and cognitions about infant sleep.
Results
278 women participated in the study. Thirty-one percent of women ( n = 85) reported intense anger (≥ 90th percentile on State Anger Scale) while 26% ( n = 73) of mothers indicated probable depression (>12 on Edinburgh Postnatal Depression Scale). Over half of the participants rated their sleep as poor ( n = 144, 51.8%). Using robust regression analysis, income ( β = -0.11, p < 0.05), parity ( β = 0.2, p < 0.01), depressive symptoms ( β = 0.22, p < 0.01), and mothers’ sleep quality ( β = 0.10, p < 0.05), and anger about infant sleep ( β = 0.25, p < 0.01) were significant predictors of mothers’ anger.
Conclusions
Mothers’ sleep quality and anger about infant sleep are associated with their state anger. Clinicians can educate families about sleep pattern changes during the perinatal time frame and assess women’s mood and perceptions of their and their infants’ sleep quality in the first postpartum year. They can also offer evidence-based strategies for improving parent-infant sleep. Such health promotion initiatives could reduce mothers’ anger and support healthy sleep.
... There are still some instances where primary care physicians fail to recognise, make reliable diagnoses and refer high-risk individuals for further management [60]. Calculated measures need to be taken to equip primary care providers with the required skills and knowledge to competently manage OSA [61]. ...
Background
The current healthcare system is challenged with a large and rising demand for obstructive sleep apnoea (OSA) services. A paradigm shift in OSA management is required to incorporate the preferences of diagnosed patients and individuals at high risk of OSA.
Objectives
This study aimed to provide empirical evidence of the values and preferences of individuals diagnosed with OSA and high-risk populations regarding distinct OSA care pathway features.
Methods
A discrete choice experiment was undertaken in two groups: those with a formal diagnosis of OSA ( n = 421) and those undiagnosed but at high risk of having OSA ( n = 1033). Participants were recruited from a large cross-sectional survey in Australia. The discrete choice experiment approach used mixed-logit regression models to determine preferences relating to eight salient features of the OSA management pathway, i.e. initial assessment provider, sleep study setting, diagnosis costs, waiting times, results interpretation, treatment options, provider of ongoing care and frequency of follow-up visits.
Results
The findings indicate that all eight attributes investigated were statistically significant factors for respondents. Generally, both groups preferred low diagnostic costs, fewer follow-up visits, minimum waiting time for sleep study results and sleep specialists to recommend treatment. Management of OSA in primary care was acceptable to both groups and was the most preferred option by the high-risk group for the initial assessment, sleep study testing and ongoing care provision.
Conclusions
The discrete choice experiment results offer a promising approach for systematic incorporation of patient and high-risk group preferences into the future design and delivery of care pathways for OSA management.
Background:
This study aimed to evaluate the current status of dental sleep medicine education across dental schools in Australia and New Zealand and gain further insights into the educational background of dentists who have sat the Australasian Sleep Association Fellow of Dental Sleep Medicine examination in 2023.
Methods:
Online surveys were carried out, and descriptive statistics were used to analyse data.
Results:
All dental schools responded to the survey. Seventy per cent of the schools included dental sleep medicine as part of their curriculum, with an average total teaching time of 2.6 h. Dentists who sat the Fellow of dental sleep medicine examination spent on average 87 h preparing for the examination. All dental schools included discussion on pathophysiology of obstructive sleep apnoea and oral appliance therapy, but did not adequately discuss advanced sleep medicine topics, clinical aspects in treatment planning or contemporary dental sleep medicine topics, whereas dentists that completed the Fellow of dental sleep medicine examination gained knowledge in all aspects of the field.
Conclusion:
Findings from the study reveal that dental schools across Australia and New Zealand are not delivering adequate levels of education in dental sleep medicine, and hence the current dental sleep medicine curriculum needs to be reviewed and improved.
Inadequate sleep is a common problem among those receiving palliative care services, yet there is limited knowledge regarding nonpharmacological sleep interventions among staff. An educational online program was developed to address this deficit. This study assessed the extent of knowledge acquired following the online educational sleep program and determined the feasibility of using this intervention with palliative care professionals. Thirty-one participants (54.8% licensed nurses) completed the educational program. Most worked in either inpatient residential (38.7%) or home-based (35.5%) settings and had considerable experience working in palliative care. The total average pretest score was 67.5% (SD, 6.5%; range, 56.3%-79.2%) compared with the total average posttest score of 93.1% (SD, 6.0; range, 78.7%-100%). There was a significant mean difference in the scores as documented by a paired-sample t test ( t 30 = −21.9, P < .0001). The results did not differ between the disciplines and those working in each setting or by years of experience. The study had a 51.6% recruitment rate and an 88.6% retention rate. The significant increase in the palliative care professionals’ knowledge following the educational program suggests it is a useful tool for nurses, aides, social workers, and managers to improve direct care.
Introduction
Patients with breast cancer are 50% more likely to experience sleep disturbances during treatment. Sleep disturbances may affect physiological and psychological functions and even induce cancer recurrence. Screening, assessment, and management of sleep disturbances improves sleep quality in breast cancer patients.
Objectives
This project aimed to establish a care process for breast cancer patients with sleep disturbances in a cancer ward.
Methods
The project was implemented using the JBI Evidence Implementation Framework, which is grounded in audit and feedback. A baseline audit examined the existing care for sleep disturbances in breast cancer patients undergoing chemotherapy. Eight criteria were applied to evaluate compliance with best practice recommendations. A JBI Getting Research into Practice (GRiP) analysis was conducted, and five barriers to recommended practices were identified. Fourteen improvement strategies were then implemented and a follow-up audit was conducted to measure changes in practice.
Results
The baseline audit showed that the sleep screening rate was 71% (Criterion 1). However, for the remaining criteria (2–8), the compliance rate was 0%. After project implementation, all criteria improved. Thus, 100% of nurses received education on sleep disturbance; the screening rate increased to 90%; 100% of screened patients received comprehensive sleep assessment; and 100% of assessed patients received tailored, multimodal sleep management based on their assessment results.
Conclusions
This project improved compliance with evidence-based practices in caring for breast cancer patients with sleep disturbances. Process orientation, interdisciplinary collaboration, and leadership contributed to project success. Further studies in digitalized sleep assessment are needed to ensure the efficiency and sustainability of sleep care.
Spanish abstract
http://links.lww.com/IJEBH/A300
Objectives. This study explores the association between sleep quality, cumulative fatigue and occupational injuries among shift workers in Pakistan’s manufacturing industries. Methods. The study surveyed 200 shift workers using a self-administered questionnaire. Sleep quality was assessed with the Pittsburgh sleep quality index (PSQI), and fatigue with the standard shiftwork index (SSI). Statistical analyses included t tests, χ2 tests and logistic regression. Results. Night shift employees had higher odds of occupational injuries (odds ratio [OR] 3.591, 95% confidence interval [CI] [1.079, 11.944], p = 0.037) compared to day shift workers. Cumulative fatigue (OR 3.044, 95% CI [1.145, 8.089], p = 0.026) and PSQI global score (OR 1.249, 95% CI [1.002, 1.556], p = 0.048) also indicated an increased injury risk. Conclusion. Night shift workers experienced poorer sleep quality, higher fatigue and increased injuries than day shift workers. Employers should implement artificial intelligence to detect and manage fatigue, set strategic shift schedules for maximum sleep opportunities and train workers to improve sleep quality.
Objectives:
Technology has the potential to increase access to evidence-based insomnia treatment. Patient preferences/perceptions of automated digital cognitive behavior therapy for insomnia (CBTI) and telehealth-delivered CBTI remain largely unexplored among middle-aged and older adults. Using a qualitative approach, the current study describes patients' reasons for participating in the clinical trial, preferences for digital CBTI (dCBTI) versus therapist-led CBTI, patient attitudes toward dCBTI, and patient attitudes toward telehealth-delivered therapist-led CBTI.
Method:
Middle-aged and older adults (N = 80) completed a semi-structured interview before CBTI exposure. Qualitative responses were coded, and themes were inductively extracted.
Results:
Most (62.5%) of the participants expressed a preference for therapist-led CBTI to dCBTI. Convenience was the most commonly reported advantage of dCBTI (n = 55) and telehealth-delivered CBTI (n = 65). Decreasing transit time and pandemic-related health concerns were identified as advantages to dCBTI and telehealth-delivered CBTI. Lack of human connection and limited personalization were perceived as disadvantages of dCBTI. Only three participants reported technological barriers to dCBTI and telehealth-delivered CBTI.
Conclusion:
Findings suggest that, despite an overall preference for therapist-led treatment, most middle-aged and older adults are open to dCBTI. As both dCBTI and telehealth-delivered CBTI are perceived as convenient, these modalities offer the potential to increase access to insomnia care.
Purpose
To explore final-year medical students’ perceptions of sleep education during medical school to inform the development of a sleep curriculum.
Methods
Year 6 medical students on their final general practice placement in 2020 were invited to complete an online survey including questions regarding sleep education recalled during the medical programme.
Results
Responses were received from 51/71 (72%) students. Main learning topics recalled by participants were sleep apnoea (83%), sleep physiology (71%), and snoring (69%). Education in other topics was reported by <65% of students. Priority topics for students were treating common sleep disorders, taking a sleep history, and navigating shift work.
Conclusions
Whilst the majority of students recalled education on specific topics, many had no awareness of education relating to sleep assessment, insomnia, or shift work. Sleep education in the curriculum needs more emphasis and reinforcement given sleep’s relevance across many domains of health and morbidity. We propose that an identifiable sleep curriculum is required to ensure medical students have the necessary core education regarding sleep and sleep disorders both for patients and themselves. Further, we believe this is possible to achieve in a short timeframe within the constraints of an existing curriculum and propose some creative solutions.
Objectives:
Perfectionism is an important factor in insomnia development and maintenance. Previous studies exploring the relationship between perfectionism and insomnia have predominantly relied on self-reported sleep measures. Therefore, this study sought to assess whether actigraphy-measured sleep parameters were associated with perfectionism.
Methods:
Sixty adults (85% females, mean age 30.18 ± 11.01 years) were sampled from the Australian general population. Actigraphy-derived objective sleep measures, subjective sleep diary measures, the Frost Multidimensional Perfectionism Scale (FMPS), Hewitt-Flett Multidimensional Perfectionism Scale (HFMPS) and Depression, Anxiety and Stress Scale 21 (DASS-21) were collected.
Results:
High perfectionism levels were associated with poor sleep, but these relationships differed between objective and subjective measures. Perfectionism via FMPS total score and subscales of Concern over Mistakes, Doubts about Actions, Personal Standards and Self-oriented Perfectionism correlated with subjective sleep onset latency and sleep efficiency with moderate effects (r = .26 to .88). In contrast, perfectionism via HFMPS total score and subscales of Socially Prescribed Perfectionism and Parental Expectations predicted objective sleep onset latency and sleep efficiency. Additionally, stress mediated the relationships between objective sleep efficiency and Concern over Mistakes and Doubts about Actions.
Conclusions:
Perfectionism demonstrated stronger associations with subjective than objective sleep measures. Higher Parental Expectations and Socially Prescribed Perfectionism may increase one's vulnerability to objectively measured poor sleep. Therefore, perfectionism may be important in preventing and treating insomnia.
Introduction
A shortage of trained providers limits access to cognitive behavioral therapy for insomnia (CBTI). Supplementing traditional in-person, therapist-led CBTI with telehealth delivery and fully automated digital CBTI (dCBTI) can improve accessibility. Characterizing perceived advantages and disadvantages of distinct delivery modalities among patients with insomnia can inform targeted resource allocation and clinical rollout of CBTI. Thus, the current study aims to describe patients’ pre-treatment preferences for therapist-led (in-person and telehealth-delivered) and automated dCBTI, as well as patient-identified advantages and disadvantages of these modalities.
Methods
Participants (N = 80) 50 years and older (M age = 64.2, SD = 7.9; female = 85.2%) were randomly selected from the RESTING Study, an RCT evaluating a triaged stepped-care model for treating insomnia disorder (DSM-5), to undergo a semi-structured interview at baseline, prior to study treatment assignment and exposure. Interviews were recorded, transcribed, and coded by three raters (inter-rater reliability: 85.0–93.0%). Response themes were identified inductively via qualitative thematic analysis.
Results
Approximately two-thirds of participants (n = 50, 62.5%) preferred therapist-led CBTI, delivered in-person or via telehealth, over automated dCBTI. The most common participant-identified advantage of dCBTI (n = 55; 68.8%) and telehealth-delivered CBTI (n = 65; 81.3%) was convenience. The most commonly reported disadvantages of dCBTI were limited customizability (n = 39, 38.75%) and lack of human connection (n = 40, 50.0%). However, some participants (n = 13, 16.30%) viewed lack of human connection as an advantage, citing the nonjudgmental nature of online programs and reduced social anxiety/fatigue. The main disadvantage identified for telehealth-delivered CBTi was loss of nonverbal communication (n = 20, 25%).
Conclusion
While participants identified advantages and disadvantages of both dCBTI and therapist-led CBTI, findings suggest a general preference for therapist-led treatment among middle-aged and older adults. This study is one of the first to examine participant preferences for and perceptions of CBTI delivery modalities prior to receiving study treatment(s). Findings can guide referring providers’ presentation of insomnia intervention options to patients and inform targeted discussions of perceived barriers to treatment. Moreover, results lay a foundation for future research examining the relationship between pre-treatment preferences/perceptions and longitudinal treatment adherence, engagement, and clinical outcomes.
Support (if any)
1R01AG057500
Insufficient sleep is associated with an increased risk for a range of negative physical and mental health outcomes. Causes of insufficient sleep involve many factors, and the consequences are not evenly distributed across populations. Indeed, stark sleep disparities disadvantage racial and ethnic minorities and those low in socioeconomic status, who are more readily affected by poor sleep than their White and high socioeconomic status comparators. Sleep is situated in the context of a socioecological model that recognizes societal, community, and individual factors that shape poor sleep and drive sleep-related outcomes. Policy opportunities address each level of the presented model and addressing these barriers should promote better sleep for those affected and potentially reduce sleep disparities.
Objectives:
Mental health care clinicians' training in treating sleep problems was investigated. We examined clinicians' (1) prior training in providing treatment for sleep problems, (2) interest in receiving training in treatment for sleep problems, and (3) perceptions of the importance of treating sleep problems and interest in incorporating sleep treatments into their practices.
Methods:
An online survey was completed by 137 clinicians.
Results:
The majority of clinicians (61.31%) reported receiving prior training in treating sleep problems, most commonly in the form of a workshop and after receiving a graduate degree. Most clinicians reported interest in receiving further training in treating sleep problems. Clinicians reported that the majority (66.67%) of their clients experience sleep problems, yet reported that they address sleep with fewer than half of clients. Addressing sleep in treatment was rated as "somewhat" to "very" important and most clinicians indicated further interest in receiving training in treating sleep.
Conclusions:
Mental health care clinicians receive limited training in treating sleep problems. As clinicians are interested in gaining further training to address sleep concerns within their clinical practice, training programs and continuing education programs should consider increasing the amount of programming in sleep treatment and assessment.
This book explores the different ways sleep medicine is practiced in the world by presenting information from multiple countries from all continents. The editors, all sleep medicine experts, dive into both clinical practice, and research keeping an eye on healthcare needs and disparities, before proposing solutions. The contributions also take into account the social, geographical and political situation of each country, along with demographic considerations such as income levels, adding a dimension of context to the contents. The book is meant to be a reference for sleep medicine practitioners who encounter diverse patients in their daily practice. It also serves as a good resource for anyone interested in the state of global health studies.
Objectives:
Despite the clear influence of poor sleep on mental health, sleep education has been neglected in psychology training programs. Here, we develop a novel behavioral sleep medicine (BSM) education workshop, the Sleep Psychology Workshop, designed for integration within graduate psychology programs. We also examined the potential efficacy and acceptability of the workshop to upskill trainee psychologists in sleep and insomnia management.
Methods:
The Sleep Psychology Workshop was developed using a modified Delphi Method. Eleven trainee psychologists completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the workshop, delivered as three, two-hour lectures (total of six hours). Sleep knowledge, attitudes, and practice assessments were completed pre-and post-intervention using the GradPsyKAPS Questionnaire. A focus group and 6-month follow-up survey captured feedback and qualitative data.
Results:
Trainees' sleep knowledge quiz scores (% correct) increased from 60% to 79% pre- to post-workshop (p = .002). Trainees' self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep disturbances increased, along with their confidence to manage insomnia (all p < .02). Participant feedback was positive, with 91% of trainees rating the workshop as "excellent" and qualitative data highlighting trainees developing practical skills in BSM. Six months post-intervention, 100% of trainees endorsed routinely asking their clients about sleep, with 82% reporting improvements in their own sleep.
Conclusions:
The Sleep Psychology Workshop is a potentially effective and acceptable introductory BSM education program for trainee psychologists, ready for integration within the graduate psychology curriculum.
Poor sleep health is consistently associated with the initiation of substance use, development of substance use disorders (SUDs), dropout from treatment, and return to use. Quality sleep health holds promise as a modifiable factor that can reduce the occurrence and severity of SUDs. Unfortunately, social workers typically receive little to no training in the assessment and evidence-based treatment of sleep disorders. This article, authored by an interdisciplinary team of clinicians and researchers, provides important sleep and SUD considerations for social workers. After providing a summary of the empirical literature surrounding the relationship between sleep and SUDs, we discuss the inclusion of the following in SUD treatment settings: (1) sleep health assessments, (2) psychoeducation on behaviors to promote healthy sleep, (3) referral to appropriate specialists when sleep disorders are suspected, (4) the promotion of a healthy sleep environment in residential treatment settings, and (5) evidenced-based behavioral interventions.
Insomnia is a highly prevalent sleep disorder, which has negative consequences on almost all aspects of physical and psychological health. The gold-standard treatment for insomnia disorder is cognitive behavioral therapy for insomnia (CBT-I). While CBT-I is efficacious, access to this therapy is limited. Digital forms of therapy for insomnia, including CBT-I and mindfulness-based therapy for insomnia are emerging, with growing evidence of their efficacy for reducing insomnia severity and other symptoms of the disorder (e.g., pre-sleep arousal) and improving mental health. This chapter describes the evidence for the effectiveness of these therapies, as well as factors that may influence response to treatment. The role of digital therapies for insomnia in stepped-care models is also discussed. Ultimately, digital therapeutics for insomnia will help address the poor sleep endemic faced by modern society, with potential positive flow-on effects for other aspects of health and well-being.
Background
Insomnia is a risk factor for affective disorders. This study examined whether individuals with insomnia symptoms early in the pandemic, either pre-existing or new-onset, were more vulnerable to anxiety and depressive symptoms over time than those who maintained normal sleep. Additionally, sleep-related factors such as pre-sleep arousal were assessed for their influence on clinically significant anxiety and depression risk.
Methods
Using a global online survey with 3-, 6-, and 12-month follow-ups between April 2020 and May 2021, data from 2069 participants (M = 46.16 ± 13.42 years; 75.3 % female) with pre-existing, new-onset, or no insomnia symptoms was examined using mixed-effects and logistic regression models.
Results
New-onset and pre-existing insomnia predicted persistent anxiety and depressive symptoms longitudinally (p's < 0.001), over other known risk factors, including age, sex, and previous psychiatric diagnoses. Despite decreasing from acutely elevated baseline levels, depressive symptoms in both insomnia groups remained above clinically significant thresholds at most time points, whereas normal sleepers remained subclinical. Pre-sleep arousal was found to increase the risk of clinically significant anxiety (OR = 1.05) and depressive symptoms (OR = 1.09) at 12-months. Sleep effort contributed to anxiety (OR = 1.06), whereas dysfunctional sleep-related beliefs and attitudes predicted clinically significant depression (OR = 1.22).
Limitations
Insomnia group categorization was based on self-report at baseline supported by a validated measure. High participant attrition was observed at 3-months (53 %; n = 971), but retention remained steady till 12-months (63 %, n = 779).
Conclusions
Insomnia is a modifiable risk factor for persistent anxiety and depressive symptoms. Additionally, pre-sleep arousal may be an important transdiagnostic process linking insomnia with affective disorders.
An illness is caused by many factors, such as the environment, lifestyle, genetic disposition, and disease agents. Preventive healthcare aims to eliminate its causes before individuals realise that they have been affected or the disease has worsened. Education to obtain knowledge about the cause of the illness and a suitable lifestyle is the primary step in preventive healthcare, the second one being self-management for recognising the health status. Healthcare support provided by trained medical specialists is a robust way to maintain a suitable health status. Recent developments in communication tools have enabled mobile health to successfully develop consistency with classical preventive healthcare. There is accumulating evidence regarding it for hypertension and diabetes. The development of technologies and services for mobile health will be continued and that of new parameters to satisfy one’s unmet needs are needed to expand the field of preventive healthcare.
Objective
Although clinical guidelines recommend Cognitive Behavioural Therapy for insomnia (CBTi) as the first-line treatment for insomnia, many people with insomnia do not have access to CBTi and are prescribed sedative-hypnotic medicines by medical health professionals. Psychologists have training in CBT and may be well placed to deliver behavioural therapy for insomnia. However, the current treatment of insomnia, amount of sleep-specific training and knowledge of CBTi among Australian psychologists remains unknown.
Method
This qualitative study conducted semi-structured interviews with Australian psychologists. Interviews included case study scenarios to provide an in-depth exploration of psychologists’ knowledge and skills in the management of insomnia. Interview transcripts were analysed using thematic analysis to identify themes.
Results
Twenty-six psychologists participated in this study. Four themes were identified in the data: 1) Sleep is important but rarely a treatment priority; 2) Confusion about funding pathways discourages treatment of insomnia; 3) A variety of approaches are used in the management of insomnia; 4) Psychologists with experience in CBTi are rare.
Conclusions
Most Australian psychologists are not well equipped to manage insomnia effectively with CBTi. Along with other primary health care professionals, psychologists need training in the delivery of evidence-based insomnia treatment.
Background
We have demonstrated the efficacy of a brief behavioral intervention for sleep in children with ADHD in a previous randomized controlled trial and now aim to examine whether this intervention is effective and cost‐effective when delivered by pediatricians or psychologists in community settings.
Methods
Translational, cluster‐randomized trial of a behavioral intervention versus usual care from 19th January, 2015 to 30th June, 2017. Participants (n = 361) were children aged 5–13 years with ADHD and parent report of a moderate/severe sleep problem who met criteria for American Academy of Sleep Medicine criteria for chronic insomnia disorder, delayed sleep–wake phase disorder, or were experiencing sleep‐related anxiety. Participants were randomized at the level of the pediatrician (n = 61) to intervention (n = 183) or usual care (n = 178). Families in the intervention group received two consultations with a pediatrician or a psychologist covering sleep hygiene and tailored behavioral strategies.
Results
In an intention‐to‐treat analysis, at 3 and 6 months respectively, the proportion of children with moderate to severe sleep problems was lower in the intervention (28.0%, 35.8%) compared with usual care group (55.4%, 60.1%; 3 month: risk ratio (RR): 0.51, 95% CI 0.37, 0.70, p < .001; 6 month: RR: 0.58; 95% CI 0.45, 0.76, p < .001). Intervention children had improvements across multiple Children's Sleep Habits Questionnaire subscales at 3 and 6 months. No benefits of the intervention were observed in other domains. Cost‐effectiveness of the intervention was AUD 13 per percentage point reduction in child sleep problem at 3 months.
Conclusions
A low‐cost brief behavioral sleep intervention is effective in improving sleep problems when delivered by community clinicians. Greater sample comorbidity, lower intervention dose or insufficient clinician supervisions may have contributed to the lack benefits seen in our previous trial.
Study Objectives
To estimate the economic cost (financial and nonfinancial) of inadequate sleep in Australia for the 2016–2017 financial year and relate this to likely costs in similar economies.
Methods
Analysis was undertaken using prevalence, financial, and nonfinancial cost data derived from national surveys and databases. Costs considered included the following: (1) financial costs associated with health care, informal care provided outside healthcare sector, productivity losses, nonmedical work and vehicle accident costs, deadweight loss through inefficiencies relating to lost taxation revenue and welfare payments; and (2) nonfinancial costs of loss of well-being. They were expressed in US dollars (45.21 billion. The financial cost component was 160 million for sleep disorders and 12.19 billion (0.61 billion premature death, 4.63 billion presenteeism); nonmedical accident costs of 0.41 billion; and deadweight loss of 27.33 billion.
Conclusions
The financial and nonfinancial costs associated with inadequate sleep are substantial. The estimated total financial cost of 27.33 billion represents 4.6 per cent of the total Australian burden of disease for the year. These costs warrant substantial investment in preventive health measures to address the issue through education and regulation.
Shift workers often experience reduced sleep quality, duration and/or excessive sleepiness due to the imposed conflict between work and their circadian system. About 20-30% of shift workers experience prominent insomnia symptoms and excessive daytime sleepiness consistent with the circadian rhythm sleep disorder known as shift work disorder. Individual factors may influence this vulnerability to shift work disorder or sleep-related impairment associated with shift work. This paper was registered with Prospero and was conducted using recommended standards for systematic reviews and meta-analyses. Published literature that measured sleep-related impairment associated with shift work including reduced sleep quality and duration and increased daytime sleepiness amongst healthcare shift workers and explored characteristics associated with individual variability were reviewed. Fifty-eight studies were included. Older age, morning-type, circadian flexibility, being married or having children, increased caffeine intake, higher scores on neuroticism and lower on hardiness were related to a higher risk of sleep-related impairment in response to shift work, whereas physical activity was a protective factor. The review highlights the diverse range of measurement tools used to evaluate the impact of shift work on sleep. Use of standardised and validated tools would enable cross-study comparisons. Longitudinal studies are required to establish causal relationships between individual factors and the development of shift work disorder.
Introduction
Insomnia is a common sleep complaint seen by Family Physicians (FP). Pharmacotherapy is most commonly used, even though Cognitive Behavioural Therapy for insomnia (CBT-i) has long term efficacy challenging ineffective behaviours/faulty sleep beliefs. Access to professionals providing these interventions is almost absent in rural communities in Australia. Training Practice Nurses to undertake a CBT-i intervention may provide an easily accessible and deliverable treatment. Practice Nurses play a key role in rural communities, enabling treatment adherence through education and support.
Methods
This pilot randomised wait-list controlled trial selected individuals attending their FP practices with an Insomnia Severity Score (ISI) of >14 randomising them to either an active or weight listed (delayed) intervention arm. Six Practice Nurses were trained to deliver CBT-i at 3 clinics in the Primary Healthcare Network of New England (NSW) with full support from the FP’s in that practice. Patients were seen individually over 4 sessions, facilitated by slides and a matching manual. All sessions were audio recorded and later evaluated by 2 assessors for accuracy of presentation. The ISI (primary outcome), mood and other questionnaire data were collected at 2, 4 & 6-months.
Results
N=26 were randomised (data available for 21 to date). There were no differences between the active and delayed groups at baseline for mood and sleep. At 2-months, CBT-i led to a significant fall in ISI (CBT-i vs Control -6.9, 95% CI -11.9 to -1.8, p=0.01). The Delayed group showed a similar fall in ISI after commencement of CBT-i. The effect appears sustained in both groups at 4-months post intervention. Assessment of the taped interviews/sessions suggests a high level of skill in these health professions who expressed considerable satisfaction in the intervention delivery.
Conclusion
This is the first full CBT-i intervention run by Practice Nurses compared with other studies using predominantly behavioural measures.This training appears to be an essential step in opening up CBT training to more rural communities.
Support (If Any)
This pilot study was supported by seed funding from the Centre for Integrated Research and the Understanding of Sleep (CIRUS).
Sleep disorders:
MORE ASSESSMENTS, SHORTER WAITS WITH COMMUNITY SLEEP SERVICE: A community-based service for common sleep disorders can provide rapid and easily accessed sleep assessment and treatment. A team led by Michael Hlavac and Michael Epton from Christchurch Hospital describe the creation of a sleep assessment service within the Canterbury district of New Zealand, in which initial assessments are conducted throughout the community by general practice teams under guidance and advice from sleep specialists at the region's largest hospital. Before the service, there were around 300 sleep assessments per year in all of Canterbury, a region with a population of around 510,000. Now, that number has more than tripled, with shorter waiting times for treatment, especially for people with severe sleep apnoea. The authors conclude that most patients can be assessed for a suspected sleep disorder without needing to visit a hospital's sleep unit.
Introduction
Up to 70% of children with attention-deficit/hyperactivity disorder (ADHD) experience sleep problems. We have demonstrated the efficacy of a brief behavioural intervention for children with ADHD in a large randomised controlled trial (RCT) and now aim to examine whether this intervention is effective in real-life clinical settings when delivered by paediatricians or psychologists. We will also assess the cost-effectiveness of the intervention.
Methods and analysis
Children aged 5–12 years with ADHD (n=320) are being recruited for this translational cluster RCT through paediatrician practices in Victoria and Queensland, Australia. Children are eligible if they meet criteria for ADHD, have a moderate/severe sleep problem and meet American Academy of Sleep Medicine criteria for either chronic insomnia disorder or delayed sleep–wake phase disorder; or are experiencing sleep-related anxiety. Clinicians are randomly allocated at the level of the paediatrician to either receive the sleep training or not. The behavioural intervention comprises 2 consultations covering sleep hygiene and standardised behavioural strategies. The primary outcome is change in the proportion of children with moderate/severe sleep problems from moderate/severe to no/mild by parent report at 3 months postintervention. Secondary outcomes include a range of child (eg, sleep severity, ADHD symptoms, quality of life, behaviour, working memory, executive functioning, learning, academic achievement) and primary caregiver (mental health, parenting, work attendance) measures. Analyses will address clustering at the level of the paediatrician using linear mixed effect models adjusting for potential a priori confounding variables.
Ethics and dissemination
Ethics approval has been granted. Findings will determine whether the benefits of an efficacy trial can be realised more broadly at the population level and will inform the development of clinical guidelines for managing sleep problems in this population. We will seek to publish in leading international paediatric journals, present at major conferences and through established clinician networks.
Trial registration number
ISRCTN50834814, Pre-results.
Study objectives:
To evaluate changes in rates of family physician (FP) management of insomnia in Australia from 2000-2015.
Methods:
The Bettering the Evaluation And Care of Health (BEACH) program is a nationally representative cross-sectional survey of 1,000 newly randomly sampled family physicians' activity in Australia per year, who each record details of 100 consecutive patient encounters. This provided records of approximately 100,000 encounters each year. We identified all encounters with patients older than 15 years where insomnia or difficulty sleeping was managed and assessed trends in these encounters from 2000-2015.
Results:
There was no change in the management rate of insomnia from 2000-2007 (1.54 per 100 encounters [95% confidence interval [CI]: 1.49-1.58]). This rate was lower from 2008-2015 (1.31 per 100 encounters [95% CI: 1.27-1.35]). There was no change in FP management: pharmacotherapy was used in approximately 90% of encounters; nonpharmacological advice was given at approximately 20%; and onward referral at approximately 1% of encounters. Prescription of temazepam changed from 54.6 [95% CI: 51.4-57.9] per 100 insomnia problems in 2000-2001 to 43.6 [95% CI: 40.1-47.0] in 2014-2015, whereas zolpidem increased steadily from introduction in 2000 to 14.6 [95% CI: 12.2-17.1] per 100 insomnia problems in 2006-2007, and then decreased to 7.3 [95% CI: 5.4-9.2] by 2014-2015.
Conclusions:
Insomnia management frequency decreased after 2007 in conjunction with ecologically associated Australian media reporting of adverse effects linked to zolpidem use. Australian FPs remain reliant on pharmacotherapy for the management of insomnia.
Aim:
To estimate prevalence and identify predictors and outcomes of reporting sleep problems in Māori and non-Māori of advanced age.
Method:
Participants were 251 Māori, and 398 non-Māori adults (79-90 years) from Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu. Life and Living in Advanced Age: A Cohort Study in New Zealand. Multiple logistic regression identified predictors of reporting a current sleep problem and investigated relationships between current sleep problems and physical and mental health.
Results:
26.3% of Māori and 31.7% of non-Māori reported a current sleep problem. Reporting a current sleep problem was associated with ethnicity (non-Māori, adjusted OR=0.52, 95% CI=0.30-0.90), and reporting a past sleep problem (adjusted OR=2.67, 95% CI=1.25-5.72). Sleep problems were related to poorer physical and mental health, and falling.
Conclusion:
Sleep problems are commonly reported and associated with poorer health. Early recognition and management of sleep problems could improve physical and mental health.
Background Obstructive sleep apnea (OSA) is a chronic sleep disorder associated with a varying degree of upper airway collapse during sleep. Left untreated, OSA can lead to the development of cardiovascular disease including risk of stroke and increased mortality. Pharmacists are the most accessible and underutilized healthcare resource in the community and can have a significant role in screening patients for OSA. The result may include an expedited referral to the patient’s general practitioners or sleep disorder specialists for further diagnostic assessment and therapeutic intervention. Aim of the review The primary aim of this review was to identify the current published evidence of pharmacists providing OSA screening services in a community pharmacy setting. Methods A literature search was conducted to identify evidence of pharmacists providing OSA screening services. The literature search including five databases [PubMed, (1946-January 2015), Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts (1970 to January 2015), Cochrane Database of Systematic Reviews and Google Scholar] with search terms of (“pharmacist or pharmacy”) AND (“obstructive sleep apnea”) AND (“sleep disorders”) AND (“continuous positive airway pressure—CPAP”) were used. Articles were limited to English and reported in humans. Results A total of seven publications (four Australia, two Switzerland and one France) were selected and evaluated. Pharmacists utilized validated screening tools in 6/7 (86 %) of clinical studies to assist in the identification of patients with sleep disorders in community pharmacies. A total of 1701 pharmacies encompassing 9177 patients were screened in the clinical studies. Pharmacists were able to identify between 21.4 and 67 % of patients that were at risk for developing OSA or required a referral to a general practitioner or sleep disorder specialist for further diagnostic testing. Conclusion Studies assessing the role of pharmacists performing OSA screening services remains limited due to the small number of studies available and differences in methodological assessment. More qualitative studies including randomized controlled trials are needed to better identify the value of pharmacists providing this novel service.
Purpose
. To assess the state of nutrition education at US medical schools and compare it with recommended instructional targets.
Method
. We surveyed all 133 US medical schools with a four-year curriculum about the extent and type of required nutrition education during the 2012/13 academic year.
Results
. Responses came from 121 institutions (91% response rate). Most US medical schools (86/121, 71%) fail to provide the recommended minimum 25 hours of nutrition education; 43 (36%) provide less than half that much. Nutrition instruction is still largely confined to preclinical courses, with an average of 14.3 hours occurring in this context. Less than half of all schools report teaching any nutrition in clinical practice; practice accounts for an average of only 4.7 hours overall. Seven of the 8 schools reporting at least 40 hours of nutrition instruction provided integrated courses together with clinical practice sessions.
Conclusions
. Many US medical schools still fail to prepare future physicians for everyday nutrition challenges in clinical practice. It cannot be a realistic expectation for physicians to effectively address obesity, diabetes, metabolic syndrome, hospital malnutrition, and many other conditions as long as they are not taught during medical school and residency training how to recognize and treat the nutritional root causes.
The aim of this study was to assess the undergraduate dental education in sleep medicine in Middle East universities as well as the students' knowledge in this field.
A cross-sectional observational study was carried out during the period from September 2013 to April 2014.Two different questionnaires were used. A self-administered questionnaire and a cover letter were emailed and distributed to 51 randomly selected Middle East dental schools to gather information about their undergraduate sleep medicine education offered in the academic year 2012-2013.The second questionnaire was distributed to the fifth-year dental students in the 2nd Sharjah International Dental Student Conference in April 2014, to assess their knowledge on sleep medicine. A survey to assess knowledge of sleep medicine in medical education (Modified ASKME Survey) was used.
Thirty-nine out of 51 (76%) responded to the first questionnaire. Out of the responding schools, only nine schools (23%) reported the inclusion of sleep medicine in their undergraduate curriculum. The total average hours dedicated to teaching sleep medicine in the responding dental schools was 1.2 hours. In the second questionnaire, 29.2% of the respondents were in the high score group, whereas 70.8% scored low in knowledge of sleep-related breathing disorders.
Dental students in Middle East universities receive a weak level of sleep medicine education resulting in poor knowledge in this field.
Insomnia is common in primary care. Cognitive behavioural therapy for insomnia (CBT-I) is effective but requires more time than is available in the general practice consultation. Sleep restriction is one behavioural component of CBT-I.
To assess whether simplified sleep restriction (SSR) can be effective in improving sleep in primary insomnia.
Randomised controlled trial of patients in urban general practice settings in Auckland, New Zealand.
Adults with persistent primary insomnia and no mental health or significant comorbidity were eligible. Intervention patients received SSR instructions and sleep hygiene advice. Control patients received sleep hygiene advice alone. Primary outcomes included change in sleep quality at 6 months measured by the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and sleep efficiency (SE%). The proportion of participants reaching a predefined 'insomnia remission' treatment response was calculated.
Ninety-seven patients were randomised and 94 (97%) completed the study. At 6-month follow-up, SSR participants had improved PSQI scores (6.2 versus 8.4, P<0.001), ISI scores (8.6 versus 11.1, P = 0.001), actigraphy-assessed SE% (difference 2.2%, P = 0.006), and reduced fatigue (difference -2.3 units, P = 0.04), compared with controls. SSR produced higher rates of treatment response (67% [28 out of 42] versus 41% [20 out of 49]); number needed to treat = 4 (95% CI = 2.0 to 19.0). Controlling for age, sex, and severity of insomnia, the adjusted odds ratio for insomnia remission was 2.7 (95% CI = 1.1 to 6.5). There were no significant differences in other outcomes or adverse effects.
SSR is an effective brief intervention in adults with primary insomnia and no comorbidities, suitable for use in general practice.
© British Journal of General Practice 2015.
Objective: To investigate the attitudes, practices and beliefs regarding children's sleep problems; their effect on the family; the actual treatment and beliefs of their efficacy; the basic knowledge of sleep and sleep disorders in children. Methods: A two-page questionnaire was sent to a representative sample of 8050 pediatricians (PED) and 1515 child neuropsychiatrists (ChNP). Questionnaire consisted of several questions on estimation of prevalence of sleep disordered patients, on beliefs about children's sleep difficulties, on the prescribed treatments, on reported effectiveness and on the overall effects of sleep problems on the family. A second questionnaire named Sleep Knowledge Questionnaire (SKQ) consisted of 30 true/false questions on sleep issues concerning 6 areas: developmental issues, sleep hygiene, parasomnias, sleep apnea, narcolepsy and miscellanea. Results: A total of 751 questionnaires were returned: 627 from PED and 120 from ChNP. PED indicated that 18.60% of their patients experienced sleep problems, a lower percentage than that indicated by ChNP (21.81%). Pharmacological treatment was prescribed by 58.54% of PED and by 61.21% of ChNP Among non-pharmacological treatment, the majority of PED and ChNP recommended the establishment of a bedtime routine while a low percentage recommended Ferber's method. Both categories of physicians scored low in all areas of sleep knowledge investigated and particularly in questions about narcolepsy, sleep apnea and parasomnias. Conclusions: Results of the present study supported the need for more education in sleep and sleep disorders among Italian physicians and the necessity to change the physicians' approach to childhood sleep problems.
Background
Community pharmacies may potentially assist in screening for chronic conditions such as sleep disorders, which remain both under-diagnosed and untreated. We aimed to compare a subjective risk-assessment-only questionnaire (RAO) for common sleep disorder screening against the same risk-assessment questionnaire plus a nasal flow monitor as an objective marker of possible underlying obstructive sleep apnea (OSA) (RA+) in a community pharmacy setting. The primary outcome was the number of participants identified in RAO or RA+ group who were likely to have and consequently be diagnosed with OSA. Further outcomes included the number of participants identified as being at risk for, referred for, taking-up referral for, and then diagnosed with OSA, insomnia, and/or restless legs syndrome (RLS) in either group.Methods
In a cluster-randomized trial, participants were recruited through 23 community pharmacies. Using validated instruments, 325 (RAO = 152, RA+ = 173) participants were screened for OSA, insomnia, and RLS.Findings218 (67%) participants were at risk of OSA, insomnia or RLS and these participants were referred to their primary physician. The proportion of screened participants identified as being at risk of OSA was significantly higher in the RA+ group (36% in RAO vs. 66% in RA+, OR 3.4, 95% CI (1.8-6.5), p
Background:
In Australia, certain pharmacies have undertaken a role in the management of the chronic sleep disorder, obstructive sleep apnea. The perspectives of pharmacy staff involved in this niche clinical service have never been formally collated on a national scale. The experiences of Australian pharmacies could provide a template for pharmacies in other health systems to adopt similar roles.
Objective:
To provide an overview of the perspectives of pharmacy staff involved in Continuous Positive Airway Pressure (CPAP) and sleep apnea-related services. Specifically, to describe clinical and structural elements, explore benefits and barriers, investigate viability, and gauge perspectives on future directions.
Setting:
Australian community pharmacies involved in CPAP and sleep apnea-related services.
Method:
Cross-sectional mail survey. A questionnaire designed to meet the study objectives was developed by the researchers and mailed to all pharmacies in Australia providing CPAP services during the period of study recruitment. Pharmacies were identified through the distributor lists of the major CPAP manufacturers and a comprehensive Internet search. Non-responders were contacted in two subsequent recruitment rounds.
Main outcome measure:
Self-reported sleep apnea service specifics.
Results:
A response rate of 55 % was achieved (n = 106 questionnaires valid for data entry). Benefits of providing a CPAP service included meeting patient and community needs, and professional satisfaction. Barriers included the cost of CPAP equipment to patients and lack of time. A majority of pharmacies (71 %) reported the service was financially viable despite most (63 %) not charging a 'fee for service.' Respondents expressed the view that CPAP provision should remain a specialist area of practice within the pharmacy profession. Key areas identified for improvement within the service were: (1) Staff training and knowledge (2) Promotion of the service and increasing public awareness (3) Infrastructure and expansion (4) Inter-professional collaboration and communication (5) Patient follow-up.
Conclusion:
The provision of CPAP and sleep apnea-related services can be a viable and rewarding experience for pharmacists. The role may need to remain a specialised area for those willing to invest significantly in the service--in time, staff, resources and finances.
Sleep deprivation within intensive care units (ICU) remains a recurring norm despite the extensive research highlighting a crucial need for sleep promotion. However, the degree to which sleep deprivation can be associated with the nurses' provision of care remains unclear. Therefore, this critical literature review aims to explore the nurses' knowledge and prioritisation of sleep whilst examining the nurses' use of sleep assessment skills and tools. The nurses' awareness and prioritisation of sleep promoting interventions and complimentary therapies will also be analysed.
The online databases Cochrane, CINAHL and Science Direct were searched for English language articles, published between 2003 and 2013 which were downloadable in full text format. A total of 378 articles were identified and 25 papers met all the inclusion criteria.
It appears that ICU nurses lack a complex understanding of the importance of sleep and the interventions needed to promote it. Indeed, studies suggest that inattention to sufficient training and a lack of structured protocol within practice makes the provision of sleep for the ICU patient impossible. Therefore, whilst further empirical research is required it may be noted that evidence informed education programmes and sleep assessment tools require development within the ICU environment.
This paper reports a qualitative pilot study exploring primary care health practitioners' perspectives on the management of insomnia following the extensive media coverage on the adverse effects of zolpidem in 2007-08. General practitioners and community pharmacists were recruited throughout metropolitan Sydney, New South Wales using a convenience sampling and snowballing technique. Demographic information was collected from each participant followed by a semistructured interview. In total 22 participants were interviewed, including eight general practitioners and 14 community pharmacists. Interview transcripts were analysed using 'framework analysis'. Participants' responses illuminated some of the key issues facing primary care practitioners in the management of insomnia. Practitioners perceived there to be an overreliance on pharmacotherapy among insomnia patients and inadequate support for directing patients to alternative treatment pathways if they require or prefer non-pharmacological management. Current prescribing trends appear to favour older benzodiazepines in new cases of insomnia whereas some successful sporadic users of zolpidem have continued to use zolpidem after the media coverage in 2007-08. The findings of this pilot study suggest the need to address the limitations in the management of insomnia within the current health care system, to revise and disseminate updated insomnia guidelines and to provide educational opportunities and resources to primary care practitioners concerning management options.
Limited information is available regarding sleep medicine education worldwide. Nevertheless, medical education has been blamed for the under-recognition of sleep disorders among physicians. This study was designed to assess the knowledge of Saudi undergraduate medical students about sleep and sleep disorders and the prevalence of education on sleep medicine in medical schools as well as to identify the obstacles to providing such education.
We surveyed medical schools that were established more than 10 years ago, asking fourth- and fifth-year medical students (men and women) to participate. Seven medical schools were selected. To assess knowledge on sleep and sleep disorders, we used the Assessment of Sleep Knowledge in Medical Education (ASKME) Survey, which is a validated 30-item questionnaire. The participants were separated into two groups: those who scored >=60% and those who scored <60%. To assess the number of teaching hours dedicated to sleep medicine in the undergraduate curricula, the organizers of the major courses on sleep disorders were contacted to obtain the curricula for those courses and to determine the obstacles to education.
A total of 348 students completed the survey (54.9% male). Among the participants, 27.7% had a specific interest in sleep medicine. More than 80% of the study sample had rated their knowledge in sleep medicine as below average. Only 4.6% of the respondents correctly answered >=60% of the questions. There was no difference in the scores of the respondents with regard to university, gender, grade-point average (GPA) or student academic levels. Only five universities provided data on sleep medicine education. The time spent teaching sleep medicine in the surveyed medical schools ranged from 0-8 hours with a mean of 2.6 +/-2.6 hours. Identified obstacles included the following: (1) sleep medicine has a lower priority in the curriculum (53%) and (2) time constraints do not allow the incorporation of sleep medicine topics in the curriculum (47%).
Medical students in the surveyed institutions possess poor knowledge regarding sleep medicine, which reflects the weak level of education in this field of medicine. To improve the recognition of sleep disorders among practicing physicians, medical schools must provide adequate sleep medicine education.
Although sleep disturbances are comorbid with most psychiatric disorders and both intensify and exacerbate psychiatric distress, graduate clinical psychology programs provide little training in the assessment of sleep and the treatment of sleep disorders in general practice. To address this, a curriculum for a 10-week, 15-module online course on sleep is presented, including rationale for the chosen content and representative learning experiences. Enrolled students were graduate students in doctoral programs in a professional school of psychology. Students' attitudes toward the topic, their self-efficacy to provide assessment and treatment for sleep complaints, and their knowledge about sleep were evaluated prior to and following the course. A matched comparison group of graduate students completed the same measures. All students completed a skills measure demonstrating their assessment and intervention strategy in response to a complex clinical vignette. Enrolled students' knowledge and self-efficacy significantly increased, and after course completion, enrolled students scored significantly higher than comparison participants in appreciation for the role of sleep in mental and physical health, and in confidence in their ability to assess sleep and apply the techniques taught in the course. They also demonstrated greater knowledge and scores on several domains of the skills assessment. We hope that this course provides a template for generalist training in sleep for students and working professionals.
Background
The objective of this study was to assess the prevalence of education about sleep and sleep disorders in pediatric residency programs and to identify barriers to providing such education.
Methods
Surveys were completed by directors of 152 pediatric residency programs across 10 countries (Hong Kong, India, Indonesia, Japan, Singapore, South Korea, Thailand, United States-Canada, and Vietnam).
Results
Overall, the average amount of time spent on sleep education is 4.4 hours (median = 2.0 hours), with 23% responding that their pediatric residency program provides no sleep education. Almost all programs (94.8%) offer less than 10 hours of instruction. The predominant topics covered include sleep-related development, as well as normal sleep, sleep-related breathing disorders, parasomnias, and behavioral insomnia of childhood.
Conclusions
These results indicate that there is still a need for more efforts to include sleep-related education in all pediatric residency programs, as well as coverage of the breadth of sleep-related topics. Such education would be consistent with the increased recognition of the importance of sleep and under-diagnosis of sleep disorders in children and adolescents.
Short (≤6 hours) and long (>9 hours) sleep durations are risk factors for mortality and morbidity. To investigate whether the prevalences of short and long sleep durations have increased from the 1970s to the 2000s, we analyzed data from repeated cross-sectional surveys of 10 industrialized countries (38 nationally representative time-use surveys; n = 328,018 adults). Logistic regression models for each country were used to determine changes in the prevalence of short and long sleep durations over time, controlling for sampling differences in gender, age, number of weekend days included, and season of data collection. Over the periods covered by data, the incidence of short sleep duration increased in Italy (adjusted odds ratio = 2.64, 95% confidence interval (CI): 2.41, 2.89) and Norway (adjusted odds ratio = 2.33, 95% CI: 1.77, 3.08) but decreased in Sweden, the United Kingdom, and the United States. The prevalence of long sleep duration increased in Australia (adjusted odds ratio = 1.14, 95% CI: 1.05, 1.25), Finland (adjusted odds ratio = 1.30, 95% CI: 1.14, 1.48), Sweden (adjusted odds ratio = 1.51, 95% CI: 1.35, 1.69), the United Kingdom (adjusted odds ratio = 2.03, 95% CI: 1.68, 2.46), and the United States (adjusted odds ratio = 1.50, 95% CI: 1.36, 1.65) but decreased in Canada and Italy. No changes were observed in Germany or the Netherlands. Limited increases in short sleep duration challenge the claim of increasingly sleep-deprived societies. Long sleep duration is more widespread than is short sleep duration. It has become more prevalent and thus should not be overlooked as a potential contributor to ill health.
Sleep is a pillar of health, alongside adequate nutrition and exercise. Problems with sleep are common and often treatable. Twenty years ago, UK medical school education on sleep disorders had a median teaching time of 15 min; we investigate whether education on sleep disorders has improved. This is a cross‐sectional survey, including time spent on teaching sleep medicine, subtopics covered and forms of assessment. Thirty‐four medical degree courses in the UK were investigated via a questionnaire. We excluded responses not concerned with general undergraduate education (i.e. optional modules). Twenty‐five (74%) medical schools responded. Time spent teaching undergraduates sleep medicine was: median, 1.5 hr; mode, <1 hr; mean, 3.2 hr (SD = 2.6). Only two schools had a syllabus or core module (8%) and five (22%) were involved in sleep disorders research. Despite the above, half of the respondents thought provision was sufficient. Free‐text comments had recurring themes: sleep medicine is subsumed into other specialties, obstructive sleep apnea dominates teaching, knowledge of sleep disorders is optional, and there is inertia regarding change. A substantial minority of respondents were enthusiastic about improving provision. In conclusion, little has changed over 20 years: sleep medicine is neglected despite agreement on its importance for general health. Sleep research is the exception rather than the rule. Obstacles to change include views that “sleep is not a core topic” or “the curriculum is too crowded”. However, there is enthusiasm for improvement. We recommend establishment of a sleep medicine curriculum. Without better teaching, doctors will remain ill‐equipped to recognize and treat these common conditions.
Aims:
To examine the longitudinal effects of individual characteristics on the change pattern of insomnia and the association of occupational stress with insomnia over time in newly graduated nurses.
Background:
The association between individual factors and insomnia in nurses is inconclusive. Longitudinal research on insomnia in newly graduated nurses is limited.
Methods:
This prospective longitudinal study included 200 participants generating 800 observations of insomnia severity during their first year of nursing. We employed growth mixture modeling for data analyses. Both time-varying covariate (occupational stress) and time-invariant covariates (nurses' characteristics) were entered into the model simultaneously.
Results:
Nurses had a homogeneous insomnia trajectory during the whole year of survey. The educational level significantly predicted the growth rate of insomnia severity among nurses. Occupational stress at each time point was significantly associated with worse insomnia across time points (all p < 0.001).
Conclusions:
Nurses with a baccalaureate degree were more resilient to the development of severe insomnia. Additional studies should investigate the reason for the effects of the educational level on the pattern of insomnia.
Implications for nursing management:
Considering nurses' occupational stress and educational level would to lead more effective management of stress and insomnia in newly graduated nurses.
Objectives:
Determine the current rate of patient-provider sleep discussions and identify factors associated with occurrence of these discussions.
Design:
Secondary cross-sectional analysis of self-report data collected during the Sleep and Healthy Activity Diet Environment and Socialization study. Logistic regressions were used.
Setting:
Urban and suburban Southeastern Pennsylvania PARTICIPANTS: A total of n = 998 adults (aged 22-60), 38.6% female, racially and socioeconomically diverse, from urban and suburban Southeastern Pennsylvania.
Measurements:
Outcome measures were responses to 3 questions: (1) ever discussed sleep with a provider, (2) a provider ever discussed importance of sleep schedule, and (3) a provider ever discussed importance of enough sleep. Descriptive/independent variables included demographic factors and a wide range of patient-reported measures of health and sleep habits.
Results:
About a third of individuals have ever discussed sleep with a provider. Factors associated with higher odds of sleep-related discussions included sleep medication use, worse insomnia severity, race (Black/African American, Hispanic, Latino, other/multiracial), female sex, higher education, higher body mass index, and worse depression severity. Factors associated with lower odds were Asian race and low income. Sleep discussions were not associated with certain factors indicative of sleep disorders: sleep duration, snoring, shift work schedule, not working, and anxiety.
Conclusions:
Low rates of patient-provider sleep discussions and factors associated (or not) with their occurrence indicate missed opportunities for improved health outcomes.
Background
Sleep is a basic human need and is considered important for maintaining health. It is even more important during illness due to its impact for example on our immune system. Nurses have an important role in identifying sleep deprivation. They are also in a unique position to promote and address sleep among patients. However, it is essential that they are provided with the appropriate knowledge during training.
Aim
To explore and describe nursing students' perceptions of preparedness to adress and support patients' sleep during hospitalization and to apply sleep-promoting interventions in a clinical context. Furthermore, the aim was to investigate if, and how, the topic of sleep is explicitly incorporated in nursing education programs.
Design
A descriptive study based on a mixed method approach.
Methods
Quantitative and qualitative data were collected from program and course syllabuses and intended learning outcomes from three universities. Twenty-one nursing students from the same universities were interviewed during their final year of education.
Results
The results of both quantitative and qualitative data consistently show that education regarding sleep and patients' sleep is limited and, in some respects, absent in the Bachelor of Science Nursing programs investigated.
Conclusion
This study indicates that education about sleep and patients' sleep in the nursing programs studied is insufficient and limited. This gap in knowledge may lead to prospective registered nurses using their own experiences instead of evidence-based knowledge when assessing, supporting and applying sleep-promoting interventions.
Physicians are among the few professionals who are expected to work extended duty shifts of 24 hours or more, often with little opportunity for rest. The physiological factors regulating sleepiness, including circadian rhythms, sleep homeostasis, and sleep inertia, are pushed to their limits when meeting the demands of training programmes and patient care. Sleep-deprived physicians experience reduced clinical performance and vigilance, putting patients at risk. Tired physicians are more likely to make both cognitive errors (e.g. diagnostic reasoning) and technical errors (e.g. surgical complications). Over recent decades, regulations have promulgated that limit physician hours in Europe and the United States. Studies of their impact have generally shown improvements in patient and physician outcomes, though have also revealed concerns about education and training which must also be addressed. As medicine evolves to meet our 24-hour on-demand society, physicians and patients will need to embrace new approaches to high-quality and safe care delivery.
Objectives/background:
This paper outlines the current state of Canadian training, clinical services, research, and advocacy initiatives related to non-respiratory sleep disorders, with a specific focus on insomnia, the most common sleep problem in children.
Methods:
Information for this narrative review was collected from peer-reviewed publications, web-resources, and personal communications and experiences.
Results:
It is estimated that approximately one-third of Canadian children and youth present with insomnia, and that this is impacting their physical and mental health, as well as learning in school. Training in pediatric sleep is limited and highly inconsistent within and across disciplines. While there are some publicly and privately funded pediatric sleep services available, these are mostly focused on respiratory sleep problems and are not equally accessible across the country.
Conclusions:
Pediatric assessment and treatment services for non-respiratory sleep disorders needs to be more integrated into the Canadian health care system.
Objective:
To present (1) justification for earmarking sleep medicine education as an essential component of all medical school curricula and (2) various avenues to incorporate sleep medicine exposure into medical school curricula through (primarily) neuroscience and neurology courses.
Methods:
Per consensus of a team of leading neurology and sleep medicine educators, an evidence-based rationale for including sleep medicine across a 4-year medical school curriculum is presented along with suggested content, available/vetted resources, and formats for delivering sleep medicine education at various points and through various formats.
Results:
Growing evidence has linked sleep disorders (e.g., sleep-disordered breathing, chronic insufficient sleep) as risk factors for several neurologic disorders. Medical educators in neurology/neuroscience are now strongly advocating for sleep medicine education in the context of neurology/neuroscience pre and post graduate medical education. Sleep medicine education is also a critical component of a proactive strategy to address physician wellness and burnout. The suggested curriculum proposes a sleep educational exposure time of 2-4 hours per year in the form of lectures, flipped-classroom sessions, clinical opportunities, and online educational tools that would result in a 200%-400% increase in the amount of sleep medicine exposure that US medical schools currently provide. The guidelines are accompanied by the recommendation for use of technological education, to facilitate more seamless curricular incorporation.
Conclusion:
Even in this era with limited flexibility to add content to an already packed medical school curriculum, incorporating sleep medicine exposure into the current medical school curriculum is both justified and feasible.
Objective:
To assess the current state of sleep medicine educational resources and training offered by North American psychiatry residency programs.
Methods:
In June 2013, a 9-item peer-reviewed Sleep Medicine Training Survey was administered to 39 chief residents of psychiatry residency training programs during a meeting in New York.
Results:
Thirty-four percent of the participating programs offered an elective rotation in sleep medicine. A variety of innovative approaches for teaching sleep medicine were noted. The majority of the chief residents felt comfortable screening patients for obstructive sleep apnea (72%), half felt comfortable screening for restless legs syndrome (53%), and fewer than half were comfortable screening for other sleep disorders (47%).
Conclusions:
This is the first report in the last decade to provide any analysis of current sleep medicine training in North American psychiatry residency training programs. These data indicate that sleep medicine education in psychiatry residency programs is possibly in decline.
Study objectives:
Insomnia is a widespread issue among United States adults and rates of insomnia among veterans are even higher than the general population. Prior research examining primary care provider (PCP) perspectives on insomnia treatment found that: sleep hygiene and pharmacotherapy are the primary treatments offered; PCPs tend to focus on perceived causes of insomnia rather than the insomnia itself; and neither patients nor providers are satisfied with insomnia treatment options. Although insomnia complaints are typically first reported to primary care providers, little research has focused on perspectives regarding insomnia treatment among PCPs working in the largest integrated health care system in the United States-the Veterans Affairs (VA) health care system. This study was conducted to examine VA PCP perceptions of the availability of insomnia treatments, identify specific strategies offered by PCPs, and examine perceptions regarding the importance of treating insomnia and the role of comorbid conditions.
Methods:
A survey was conducted within the VA health care system. Primary care providers completed surveys electronically.
Results:
A high percentage of veterans (modal response = 20% to 39%) seen in VA primary care settings report an insomnia complaint to their provider. Almost half of respondents do not consistently document insomnia in the medical record (46% endorsed "sometimes," "rarely," or "never"). PCPs routinely advise sleep hygiene recommendations for insomnia (ie, avoid stimulants before bedtime [84.3%], and keep the bedroom environment quiet and dark and comfortable [68.6%]) and many are uncertain if cognitive behavioral therapy for insomnia is available at their facility (43.1%).
Conclusions:
Findings point to the need for systems-level changes within health care systems, including the adoption of evidence-based clinical practice standards for insomnia and PCP education about the processes that maintain insomnia.
Background
Sleep disorders are prevalent in children and are associated with significant comorbidity.
Objective
To assess the training, knowledge, attitudes and practices of Canadian health care providers (HCPs) regarding sleep disorders in children.
Method
A 42-item survey, designed to collect information on frequency of paediatric sleep disorders-related screening and diagnosis, implementation of evidence-based interventions and related knowledge base, was completed by HCPs.
Results
Ninety-seven HCPs completed the survey. One per cent obtained training in paediatric sleep during undergraduate training and 3% obtained such training during their residencies, yet 34.9% estimated that 25 to 50% of their patients suffered from sleep disorders. Most HCPs thought that sleep disorders significantly impacted children’s health and daytime function. Most HCPs screened for developmental sleep issues, but not consistently for sleep disorders. Most recommended evidence-based behavioural interventions for behavioural sleep disorders, but some also reported behavioural interventions that were not first-line or recommended. Inadequate knowledge regarding melatonin use was evident. Most participants reported rarely/never ordering a sleep study for a child with suspected obstructive sleep apnea (OSA). Most were familiar with surgical and weight loss management options for OSA; many were unfamiliar with benefits of continuous positive airway pressure. Participants’ knowledge scores were highest on developmental and behavioural aspects of sleep, and lowest on sleep disorders.
Conclusions
HCPs exhibit significant gaps in their knowledge, screening, evaluation and treatment practices for paediatric sleep disorders. Training at the undergraduate, graduate and postgraduate levels, as well as Continuing Medical Education are needed to optimize recognition, treatment and follow-up of paediatric sleep disorders.
Objective:
To measure the prevalence and social impacts of sleep problems in Australia.
Design:
Cross-sectional national adult online survey.
Setting:
Community-based sample.
Participants:
Australian adults ≥18 years, n=1011.
Results:
Self-reported inadequate sleep, of either duration or quality, and its daytime consequences affect 33%-45% of adults. Diagnosed sleep apnea is reported by 8%, significant insomnia by 20%, and restless legs by18% of adults. Besides specific clinical sleep disorders, poor sleep habits were common. Average reported sleep time is 7 hours, although 12% sleep less than 5½hours and 8% over 9 hours. Three-quarters (76%) of those who sleep less than 5½hours report frequent daytime impairment or sleep-related symptoms. Frequent, loud snoring is reported by 24% of men and 17% of women. Among these, 70% report daytime impairment or other sleep-related symptoms. Twenty-six percent report Internet use most or every night just before bed and frequent sleep difficulties or daytime impairments. Similarly, 16% of working adults do work just before bed and also have frequent sleep difficulties or daytime sleep-related symptoms. Younger adults (18-34 years) sleep around 1 hour longer before non-work days than working days compared with 18 minutes in older age groups. In the past 3 months, 29% of adults report making errors at work due to sleepiness or sleep problems. Driving while drowsy at least every month is reported by 29% of people, 20% have nodded off while driving, and 5% have had an accident in the past year because they dozed off.
Conclusion:
Sleep problems and daytime consequences are endemic among Australian adults. A focus on healthy sleep at a policy level as well as increased clinician and public awareness may be warranted.
Background and objective:
Insomnia is one of the most prevalent and costly sleep disorders presenting in general practice, and when left untreated, has major health consequences. However, studies are limited on how general practitioners respond to this health issue, especially since the reconceptualization of insomnia in DSM 5. Therefore, the aim of this study was to explore how insomnia is diagnosed and treated in Australian general practices.
Participants:
Twenty-four (54% male) general practitioners were recruited throughout the greater Sydney metropolitan area in New South Wales using the professional network of research team members and snowballing technique.
Methods:
Participants were interviewed using a semi-structured interview guide. The audio-taped interviews were transcribed verbatim and a framework approach was used for analysis of transcribed data.
Results:
Participant's responses highlighted that despite being a frequent presentation, insomnia is often trivialized with a low recognition rate in general practices. Lack of support and clear and effective management guidelines for general practitioners are the perceived barriers to early recognition of insomnia in general practices. Treating the underlying causes and initiating the treatment with general practitioners to manage insomnia. Medications including off-label antidepressants are often prescribed based on perceived patient expectation for a prescription.
Conclusion:
Findings of this exploratory study suggest the need for clearly contextualized guidelines that include information about a patient's insomnia experience and treatment expectations. Another significant implication of this study is the need to develop and evaluate a model of collaborative sleep health services in general practice.
Chronotherapy involves the administration of medication in coordination with the body’s circadian rhythms to maximise effectiveness and/or minimise/avoid adverse effects. A deeper understanding of the concepts underpinning chronotherapy and emerging applications in pharmacy practice would be an important addition to the scope of education in future graduates. This study aimed to assess baseline awareness level and attitude towards the principles of chronotherapy among final-year pharmacy students at the University of Sydney and to uncover underlying ‘gaps’ in their knowledge of the evidence-based information on chronotherapy in practice. A cross-sectional survey instrument was utilised. A questionnaire was designed to establish the knowledge base and attitudes toward principles of chronotherapy. Out of 216 students, 212 students completed the questionnaire resulting in a response rate of 98 %. Mean total awareness and attitude scores were 6.6 ± 2.0 (score range 0–13) and 47.4 ± 6.9 (score range 12–60), respectively. The study indicated that the final-year pharmacy students have a positive attitude and willingness to apply principles of chronotherapy in future practice despite having a lack of awareness regarding circadian rhythms and evidence-based information on chronotherapy. The finding points to the need for an educational intervention based on the principles of chronotherapy in pharmacy schools.
Despite the obvious link between sleep chronobiology and psychology and the emerging evidence demonstrating the importance of sleep psychology, there is little in the way of education about sleep and sleep disorders in the current psychology curriculum, at both the undergraduate and postgraduate level. The aim of this chapter is primarily to provide a platform from which the reader can identify points at which sleep can be integrated into the psychology curriculum, either in part or as a stand-alone module. The chapter begins with an overview of the benefits, to both psychology and sleep research, of having sleep incorporated into the curriculum and then goes on to discuss the current situation with regard to undergraduate and postgraduate teaching and learning, including vocational opportunities such as placements and rotations. The chapter ends with ideas and examples of how sleep education has been translated within this context and what a sleep psychology curriculum could look like with reference to some of the resources that are available.
Behavioural therapies are recommended as the first-line treatment of insomnia; however, sedatives and hypnotics constitute the main treatment modality used in primary care. Community pharmacies provide a unique conduit for identifying and providing appropriate treatment for those with insomnia either purchasing prescription sedatives or seeking over-the-counter treatments. A feasibility study using a cluster-randomized controlled trial, testing the efficacy of trained pharmacists providing behavioural interventions such as stimulus control and sleep restriction to patients with insomnia, in improving insomnia severity was conducted. The intervention involved three pharmacy visits (baseline, 1 and 3 months follow-up). The control group received usual care and information sheets on insomnia. The primary outcome was the Insomnia Severity Index. Twelve community pharmacists (five control, seven intervention) in New South Wales, Australia were recruited and trained. These pharmacists, in turn, recruited 46 patients (22 control, 24 intervention (mean age 53.7 ± 18.4, 72% females) and delivered a brief behavioural therapy intervention. The overall decrease in Insomnia Severity Index from baseline to the 3-month follow-up in the intervention group, n = 17 (7.6 ± 4.3 points), was significantly greater than for the control group, n = 19 (2.9 ± 8.8 points) (mean difference 4.6, 95% confidence interval: 0.005-9.2, P = 0.05). However, when the effect of clustering was taken into account using a mixed-effects model, the estimated difference in Insomnia Severity Index (change from baseline to visit 3) between the intervention and control groups was not significant (group difference in Insomnia Severity Index change = 3.78, 95% confidence interval: -0.81 to 8.37, P = 0.11; intracluster correlation = 0.18). The study highlights the use of a novel venue to deliver brief behavioural therapies for insomnia using trained non-psychologist health professionals. Although, when cluster effect was taken into account, the difference in Insomnia Severity Index reduction between the intervention versus control groups was non-significant, the results highlight that reductions in insomnia severity can be gained using trained pharmacists providing brief behavioural interventions. Future research in this area is warranted, with appropriately sized studies using the conventional, robust randomized trial design.
© 2015 European Sleep Research Society.
This clinical practice guideline, intended for use by primary care clinicians, provides recommendations for the diagnosis and management of obstructive sleep apnea syndrome (OSAS).
The Section on Pediatric Pulmonology of the American Academy of Pediatrics selected a subcommittee composed of pediatricians and other experts in the fields of pulmonology and otolaryngology as well as experts from epidemiology and pediatric practice to develop an evidence base of literature on this topic. The resulting evidence report was used to formulate recommendations for the diagnosis and management of childhood OSAS.
The guideline contains the following recommendations for the diagnosis of OSAS: 1) all children should be screened for snoring; 2) complex high-risk patients should be referred to a specialist; 3) patients with cardiorespiratory failure cannot await elective evaluation; 4) diagnostic evaluation is useful in discriminating between primary snoring and OSAS, the gold standard being polysomnography; 5) adenotonsillectomy is the first line of treatment for most children, and continuous positive airway pressure is an option for those who are not candidates for surgery or do not respond to surgery; 6) high-risk patients should be monitored as inpatients postoperatively; 7) patients should be reevaluated postoperatively to determine whether additional treatment is required.
This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with OSAS. Rather, it is designed to assist primary care clinicians by providing a framework for diagnostic decision-making. It is not intended to replace clinical judgment or to establish a protocol for all children with this condition and may not provide the only appropriate approach to this problem.
To compare the use of sleep diagnostic tests, the risks, and cofactors, and outcomes of the care of Indigenous and non-indigenous Australian adults in regional and remote Australia in whom sleep related breathing disorders have been diagnosed.
A retrospective cohort study of 200 adults; 100 Aboriginal and Torres Strait Islander and 100 non-indigenous adults with a confirmed sleep related breathing disorder diagnosed prior to September 2011 at Alice Springs Hospital and Cairns Hospital, Australia.
Results showed overall Indigenous Australians were 1.8 times more likely to have a positive diagnostic sleep study performed compared with non-indigenous patients, 1.6 times less likely in central Australia and 3.4 times more likely in far north Queensland. All regional and remote residents accessed diagnostic sleep studies at a rate less than Australia overall (31/100,000/y (95% confidence interval, 21-44) compared with 575/100,000/y).
The barriers to diagnosis and ongoing care are likely to relate to remote residence, lower health self-efficacy, the complex nature of the treatment tool, and environmental factors such as electricity and sleeping area. Indigeneity, remote residence, environmental factors, and low awareness of sleep health are likely to affect service accessibility and rate of use and capacity to enhance patient and family education and support following a diagnosis. A greater understanding of enablers and barriers to care and evaluation of interventions to address these are required.
Copyright © 2015 American Academy of Sleep Medicine. All rights reserved.
Sleep disorders represent an under-recognised public health problem and are reported to be under-diagnosed in general practices.
To examine general practitioners' (GPs) attitude, knowledge and practice behaviour and identify barriers to detection, diagnosis and treatment of sleep disorders encountered in the Australian primary care setting.
Using mixed methods, quantitative data from the Dartmouth Sleep Knowledge Questionnaire (DSKQ) were analysed using MS Excel 2007. Qualitative data were obtained from one focus group and eight interviews. Data were thematically analysed.
15 GPs participated; seven in a focus group and eight in interviews. Scores from DSKQ suggest gaps in GPs' knowledge. Qualitative analysis revealed that patients frequently presented with sleep disorders underpinned by mental health disorders. GPs agreed that prescribing pharmacological interventions was undesirable and behavioural interventions were preferred. Barriers included limited training for GPs, lack of resources, patient expectations and willingness to engage in lifestyle changes, and consultation time constraints.
Greater flexibility to investigate sleep related problems within the standard consultation and improved access to educational activities could assist GPs. Patient factors, such as adherence to management strategies, are paramount to successful management of sleep disorders; however, these obstacles to clinical practice may be difficult to overcome.
Providing education for GPs about sleep disorders, greater flexibility within consultations may improve patient care and patient engagement in management strategies may assist, yet a critical success factor in disease management includes patient engagement in management strategies.
Poor sleep imparts a significant personal and societal burden. Therefore, it is important to have accurate estimates of its causes, prevalence and costs to inform health policy. A recent evaluation of the sleep habits of Australians demonstrates that frequent (daily or near daily) sleep difficulties (initiating and maintaining sleep, and experiencing inadequate sleep), daytime fatigue, sleepiness and irritability are highly prevalent (20%-35%). These difficulties are generally more prevalent among females, with the exception of snoring and related difficulties. While about half of these problems are likely to be attributable to specific sleep disorders, the balance appears attributable to poor sleep habits or choices to limit sleep opportunity. Study of the economic impact of sleep disorders demonstrates financial costs to Australia of 270 million for health care costs for the conditions themselves, 4.3 billion largely attributable to associated productivity losses and non-medical costs resulting from sleep loss-related accidents. Loss of life quality added a substantial further non-financial cost. While large, these costs were for sleep disorders alone. Additional costs relating to inadequate sleep from poor sleep habits in people without sleep disorders were not considered. Based on the high prevalence of such problems and the known impacts of sleep loss in all its forms on health, productivity and safety, it is likely that these poor sleep habits would add substantially to the costs from sleep disorders alone.
Insomnia is common leading to patients with sleep problems often presenting to primary care services including general practice, community pharmacies and community mental health teams. Little is known about how health professionals in primary care respond to patients with insomnia.
We aimed to explore health professionals' and patients' experiences and perceptions of the management of insomnia in primary care.
We used a qualitative design and thematic approach.
Primary care in Nottinghamshire and Lincolnshire.
We undertook focus groups and one-to-one interviews with a purposive sample of health professionals and adults with insomnia.
We interviewed 28 patients and 23 health professionals. Practitioners focused on treating the cause of insomnia rather than the insomnia itself. They described providing stepped care for insomnia, but this focused on sleep hygiene which patients often disregarded, rather than cognitive behavioural therapy for insomnia (CBT-I). Practitioners were ambivalent towards hypnotic drugs but often colluded with patients to prescribe to avoid confrontation or express empathy. Patients sometimes took hypnotics in ways that were not intended, for example together with over-the-counter medication. Practitioners and patients were sometimes but not always concerned about addiction. Practitioners sometimes prescribed despite these concerns but at other times withdrew hypnotics abruptly without treating insomnia. Both patients and practitioners wanted more options and better training for the management of insomnia in primary care.
A better understanding of the current approaches and difficulties in the management of insomnia will help to inform more therapeutic options and health professional training.
Little is known about CPAP services offered in the Australian primary care pharmacy setting, despite the potential influence of service quality on patient adherence. The objective of this study was to provide an overview on a nationwide scale of the range and quality of CPAP and sleep apnea-related services in Australian pharmacies.
A paper-based questionnaire was developed and mailed to all pharmacies in Australia that currently provide CPAP services (as identified by manufacturer's distributor lists or Internet search). A point system was devised to score participants on the quality of their CPAP service. Pharmacies were rated against a list of 23 criteria that were determined by consensus, with one point allocated for each criterion met, allowing for a maximum score of 23.
The study response rate was 55% (110/199), and representation was obtained from all eight Australian states and territories. The mean number of criteria met (total score) for pharmacies was 15.7 ± 3.4 (15.7/23 = 68.3%; score range 2-22). Variability was evident in the range of services offered. Eighty-seven percent of respondents believed that pharmacies supplying CPAP should adhere to a formalised set of professional guidelines.
The accessibility of pharmacies may make them a valuable venue for CPAP service provision. However, models of care to guide practice and standardise the variability in services are required. Implementation of such models could improve patient access to quality treatment in the primary care setting.
To evaluate the current state of sleep medicine educational resources and training offered by US neurology residency programs.
In 2010, a 20-item peer reviewed Sleep Education Survey (SES) was sent to neurology residency program directors surveying them about sleep medicine educational resources used in teaching residents. Pearson product momentum correlation was used to determine correlation of program attributes with resident interest in pursuing a career in sleep medicine.
Of the programs completing the survey, 81% listed a formal sleep rotation and 24% included a forum for sleep research. A variety of innovative approaches for teaching sleep medicine were noted. Program directors noted that 5.7% residents entered sleep medicine fellowship training programs in the preceding 5 years. Programs that had a more substantial investment in sleep medicine teaching resources were more likely to report residents entering a sleep medicine training program.
This is the first report providing an analysis of the current state of sleep medicine training in US Neurology Residency Programs. Our data provide evidence that investment by the residency program in sleep education may enhance the ultimate decision by the neurology trainee to pursue a career in sleep medicine.
Avidan AY; Vaughn BV; Silber MH. The current state of sleep medicine education in us neurology residency training programs: where do we go from here? J Clin Sleep Med 2013;9(3):281-286.
Importance Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea. With appropriate training and simplified management tools, primary care physicians are ideally positioned to take on a greater role in diagnosis and treatment.
Objective To compare the clinical efficacy and within-trial costs of a simplified model of diagnosis and care in primary care relative to that in specialist sleep centers.
Design, Setting, and Patients A randomized, controlled, noninferiority study involving 155 patients with obstructive sleep apnea that was treated at primary care practices (n=81) in metropolitan Adelaide, 3 rural regions of South Australia or at a university hospital sleep medicine center in Adelaide, Australia (n = 74), between September 2008 and June 2010.
Interventions Primary care management of obstructive sleep apnea vs usual care in a specialist sleep center; both plans included continuous positive airway pressure, mandibular advancement splints, or conservative measures only.
Main Outcome and Measures The primary outcome was 6-month change in Epworth Sleepiness Scale (ESS) score, which ranges from 0 (no daytime sleepiness) to 24 points (high level of daytime sleepiness). The noninferiority margin was −2.0. Secondary outcomes included disease-specific and general quality of life measures, obstructive sleep apnea symptoms, adherence to using continuous positive airway pressure, patient satisfaction, and health care costs.
Results There were significant improvements in ESS scores from baseline to 6 months in both groups. In the primary care group, the mean baseline score of 12.8 decreased to 7.0 at 6 months (P < .001), and in the specialist group, the score decreased from a mean of 12.5 to 7.0 (P < .001). Primary care management was noninferior to specialist management with a mean change in ESS score of 5.8 vs 5.4 (adjusted difference, −0.13; lower bound of 1-sided 95% CI, −1.5; P = .43). There were no differences in secondary outcome measures between groups. Seventeen patients (21%) withdrew from the study in the primary care group vs 6 patients (8%) in the specialist group.
Conclusions and Relevance Among patients with obstructive sleep apnea, treatment under a primary care model compared with a specialist model did not result in worse sleepiness scores, suggesting that the 2 treatment modes may be comparable.
Trial Registration anzctr.org.au Identifier: ACTRN12608000514303