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Abstract

The discipline of nursing is concerned with human responses in illness and wellness at individual, family, and community levels of practice. Sleep and circadian rhythms are biological processes that can influence wellness and illness, or can be altered by illness and adverse environments. As yet, however, there is no established curriculum for sleep or chronobiology in undergraduate or graduate nursing education. This paper provides a consensus by expert nurses in the field of sleep and circadian rhythm disorders that can be used for undergraduate and graduate levels of nursing education as well as a basis for beginning research and practice on sleep and health consequences of sleep loss.

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... Therefore, we did a secondary analysis guided by the Conceptual Framework of Impaired Sleep (Lee et al., 2004) to investigate sleep disturbance in relation to various factors among this sample of Latinas in the US. The original framework posits that sleep is deprived by self-imposed sleep restriction and competing needs of family members, while sleep is disrupted by acute or chronic physical or mental health problems, substance use, sleep aid use, or past trauma. ...
... A total of 325 women completed the study but ten were later excluded after indicating they were not of Mexican descent. Three other women who worked night shift or variable shifts were excluded from analyses due to known sleep problems associated with shift work (Lee et al., 2004). The sample for this secondary analysis included 312 women. ...
... Conceptual Framework of Impaired Sleep holds that multiple roles and responsibilities may contribute to sleep deprivation (Lee et al., 2004) including role as parent (does/does not have children) and worker (employment status), marital/partner status, and living situation (living alone/with others). Because developmental transitions may disrupt sleep (Lee et al., 2004), childbearing status (pregnant, postpartum or neither) was also assessed as a deprivation factor. ...
Article
Aims: The aims were to identify the most useful parameters of acculturation in relation to self-reported sleep disturbance and describe risk factors for sleep disturbance in women of Mexican descent. Background: Little is known about acculturation as a factor for poor sleep in the context of other personal factors such as income or sense of resilience or mastery for Latinas in the United States. Design: This study was a secondary analysis of cross sectional survey data. Methods: Personal factors were incorporated into a modification of the conceptual framework of impaired sleep to guide our secondary analysis of self-reported sleep disturbance. Data were collected from a convenience sample of 312 women of Mexican descent of childbearing age (21-40 years) located in an urban California community were collected and previously analysed in relation to depressive symptoms and post-traumatic stress disorder. The general sleep disturbance scale (in English and Spanish) was used to assess sleep disturbance. Data was collected in 1998 from September through December. Results: Early socialization to the United States during childhood was the most useful acculturation parameter for understanding self-reported sleep disturbance in this sample. In a multivariate regression analysis, three factors (higher acculturation, lower income and higher depressive symptoms) were statistically significant in accounting for 40% of the variance in sleep disturbance. Conclusion: When low income Latinas of Mexican descent report sleep problems, clinicians should probe for environmental sleep factors associated with low income, such as noise, over-crowding and exposure to trauma and violence, and refer the woman to psychotherapy and counselling rather than merely prescribing a sleep medication.
... Other international studies report that less than 10% of medical school seniors scored >70% on questions in SM [25]. In another study only 2% of third and fourth year medical students, when tested, scored >66% in basic SM [26] and yet another study found second year medical students and physician specialists recorded an equally poor knowledge of SM [27]. Other medically related fields report a similar lack of education in the somnology. ...
... The increase in SM training in dental schools with more schools participating and more hours per program as compared to the Ivanhoe 2003 survey may build the confidence for increased multidisciplinary collaboration as members of a sleep medicine team, and ultimately better patient care outcomes. While it is noted that nursing [27] suggests 40 h of clinical rotation and more didactic experience for adequate training in their field, treatment competency beyond screening and co-diagnosis seems an unrealistic goal for the DDS curriculum, unless a major elective experience is provided. However, the authors believe it is the responsibility of DDS programs to establish a reasonable and a correct medical and dental basic science and clinical foundation upon which to build postdoctoral treatment experience with further training following graduation. ...
Article
Medical school surveys of pre-doctoral curriculum hours in the somnology, the study of sleep, and its application in sleep medicine/sleep disorders (SM) show slow progress. Limited information is available regarding dentist training. This study assessed current pre-doctoral dental education in the field of somnology with the hypothesis that increased curriculum hours are being devoted to SM but that competencies are still lacking. The 58 US dental schools were surveyed for curriculum offered in SM in the 2008/2009 academic year using an eight-topic, 52-item questionnaire mailed to the deans. Two new dental schools with interim accreditation had not graduated a class and were not included. Responses were received from 49 of 56 (87.5%) of the remaining schools. Results showed 75.5% of responding US dental schools reported some teaching time in SM in their pre-doctoral dental program with curriculum hours ranging from 0 to 15 h: 12 schools spent 0 h (24.5%), 26 schools 1-3 h, 5 schools 4-6 h, 3 schools 7-10 h, and 3 schools >10 h. The average number of educational hours was 3.92 h for the schools with curriculum time in SM, (2.96 across all 49 responding schools). The most frequently covered topics included sleep-related breathing disorders (32 schools) and sleep bruxism (31 schools). Although 3.92 h is an improvement from the mean 2.5 h last reported, the absolute number of curriculum hours given the epidemic scope of sleep problems still appears insufficient in most schools to achieve any competency in screening for SRBD, or sufficient foundation for future involvement in treatment.
... As pregnancy progresses, pregnant women experience more restless and fragmentary sleep which reduces sleep quality. Poor sleep quality is a crucial issue for pregnant women, because it affects physiological, cognitive/behavioral, social, and emotional health and total HRQOL (23,24). During the first trimester of conception, time spent sleeping increases; however, sleep quality decreases. ...
... The stated hypothesis three was rejected, because sleep quality components did not significantly, independently, and jointly influence social relationship domain of HRQOL among primigravidas in Ibadan. The findings of this study were supported by Lee (23) and Lee et al. (24). They observed that poor sleep quality was a crucial issue for expectant mothers, because it affected physiological, cognitive/behavioral, social, as well as emotional health. ...
Article
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Background and Objective: Pregnancy and childbirth are periods of great joy and delicate, interesting, and exciting aspects of women’s life. The study investigates whether sleep quality components will predict health-related quality of life (HRQOL) domains among primigravidas. Materials and Methods: The study employed descriptive research design. 768 primigravidas, attending antenatal care in nine purposively-selected government hospitals in Ibadan, Nigeria, which fulfilled the inclusion criteria participated in the study. A questionnaire consisting of demographic information of primigravidas, World Health Organization Quality of Life-BREF (WHOQOL-BREF), and Pittsburgh Sleep Quality Index (PSQI) with reliability coefficient of 0.89 and 0.85, respectively, were used to collect data. Six hypotheses were tested using multiple regression analysis (MRA) and analysis of variance (ANOVA). Results: Sleep quality components had a statistical, joint influence on HRQOL domains (physical health domain, F = 4.526, P < 0.01; psychological domain, F = 2.931, P < 0.05; and environment domain, F = 2.788, P < 0.05) of primigravidas in Ibadan. In addition, domains of HRQOL were significantly influenced by primigravidas’ marital status (F = 3.591, P < 0.05). Conclusion: Effective management of sleep quality components during pregnancy can improve HRQOL domains of primigravidas. Researchers recommended that antenatal care lectures for primigravidas should be reinforced with emphasis on the sleep quality and its influence on their HRQOL domains for better wellness of the primigravidas.
... The conceptual framework for this investigation was the model of impaired sleep 21 in which sleep loss associated with lifestyle factors (eg, employment demands, caregiving responsibilities, environmental stimuli) or health-related issues (eg, sleep-related breathing disorders, pain, pulmonary or gastrointestinal problems) increases a person's risk for adverse outcomes. Sleep loss associated with either inadequate or disrupted sleep increases the risk for adverse outcomes in physiological, cognitive-behavioral, emotional, and social responses 21 and affects the ability to engage in effective decision making. ...
... The conceptual framework for this investigation was the model of impaired sleep 21 in which sleep loss associated with lifestyle factors (eg, employment demands, caregiving responsibilities, environmental stimuli) or health-related issues (eg, sleep-related breathing disorders, pain, pulmonary or gastrointestinal problems) increases a person's risk for adverse outcomes. Sleep loss associated with either inadequate or disrupted sleep increases the risk for adverse outcomes in physiological, cognitive-behavioral, emotional, and social responses 21 and affects the ability to engage in effective decision making. This T he role of sleep loss and fatigue on cognitive performance has received increased attention recently. ...
Article
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Background: The effects of inadequate sleep on clinical decisions may be important for patients in critical care units, who are often more vulnerable than patients in other units. Fatigued nurses are more likely than well-rested nurses to make faulty decisions that lead to decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome. Objectives: To examine the association between selected sleep variables, impairment due to fatigue, and clinical-decision self-efficacy and regret among critical care nurses. Decision regret was the primary outcome variable. Methods A nonexperimental, descriptive design and extant measures were used to obtain data from a random sample of full-time nurses. Binary logistic regression models were used to examine the association between sleep variables, fatigue, and clinical-decision self-efficacy and regret. The discrimination of the models was compared with the C statistic, the area under the receiver operating characteristic curve. Results: A total of 605 nurses returned the questionnaires (17% response rate). Among these, decision regret was reported by 157 of 546 (29%). Nurses with decision regret reported more fatigue, more daytime sleepiness, less intershift recovery, and worse sleep quality than did nurses without decision regret. Being male, working a 12-hour shift, and clinical-decision satisfaction were significantly associated with decision regret (C statistic, 0.719; SE, 0.024). Conclusion: Nurses who experience impairments due to fatigue, loss of sleep, and inability to recover between shifts are more likely than unimpaired nurses to report decision regret.
... However, 80%–90% of adults with OSA are undiagnosed and untreated (Kapur et al., 2002). This underrecognition of adults at risk for OSA is probably because of the limited information primary care providers receive in their educational programs (Harding & Berner, 2002; Lee et al., 2004; Valerio, 2008a). ...
... Most healthcare professionals receive limited sleep information in their educational programs. Physicians reported 2.1 h of sleep education during medical school (Harding & Berner, 2002), and nurse educators reported limited sleep content in basic and advanced nursing programs (Lee et al., 2004). Valerio (2008a) found that nurse practitioners (NPs) in Illinois (n = 168) reported an average of 2.1 h of sleep education in their nursing programs, and 27.9% reported no sleep content. ...
Article
This study was conducted to determine the effects of an online educational program on nurse practitioner's (NP's) knowledge of identifying and evaluating adults at-risk for obstructive sleep apnea (OSA). Knowledge was assessed with a 15 question pre-test and post-test, after a 53 minute narrated PowerPoint educational session. Pre-test and post-test answers were compared to determine the change in knowledge. Fifty-four participants entered the study, and 38 (70.4%) completed. NPs that completed the entire OSA program (n = 38) had a significant improvement in post-test scores as compared to pre-test scores (p < .001, t(37 = -5.024). This was particularly evident (p = .05) in the areas of clinical prevalence, routine health evaluation, signs and symptoms, high risk situations and screening tools. After the educational session, 97.4% of participants indicated they were "very likely" or "likely" to evaluate their patients for OSA. NPs have limited formal education on sleep disorders, although are in a key position to make a significant impact on evaluating adults for OSA. Regular screening to identify adults with OSA would likely lead to improving the rate of diagnosis and reducing the associated chronic health problems.
... Nurses can contribute to new knowledge about sleep and health promotion, provide primary care, disseminate information to patients, and enhance patient compliance with treatment. 45 Curriculum recommendations for somnology and chronobiology education for nursing in undergraduate and graduate-level programs have been published, 45 and research now is within the domain of nursing. 46 -50 Coordination of medical and nursing education at fundamental levels may be possible, and research alliances can disseminate new knowledge quickly. ...
... Nurses can contribute to new knowledge about sleep and health promotion, provide primary care, disseminate information to patients, and enhance patient compliance with treatment. 45 Curriculum recommendations for somnology and chronobiology education for nursing in undergraduate and graduate-level programs have been published, 45 and research now is within the domain of nursing. 46 -50 Coordination of medical and nursing education at fundamental levels may be possible, and research alliances can disseminate new knowledge quickly. ...
Article
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There is now a new pathway and examination for sleep medicine, sponsored by the American Board of Internal Medicine, and a number of accredited sleep medicine fellowship programs through the Accreditation Council for Graduate Medical Education. This review takes an historical approach to discuss the process of education for sleep physiology and disorders not only in the postgraduate period but also at all levels of instruction. In reality, there is a continuum of knowledge that needs to be reinforced up and down the educational system, of which Sleep Medicine subspecialty training is just one part. Although progress has been made at all educational levels up to this point, the future of training and education will depend on a sustained effort at several levels from undergraduate to postgraduate continuing medical education and will be facilitated by professional societies and other specialties who will collectively promote the value of and outcomes for clinical sleep medicine.
... Nurses may have more sleep disturbances when compared with those in the general population (Cheung & Yip, 2015;Tsai et al., 2017). Poor sleep quality in nurses adversely affects their daily mental and physical functioning (Lee et al., 2004;Scott et al., 2014), increases the likelihood of cognitive difficulties (Kaliyaperumal et al., 2017), and reduces work quality and productivity (Lawson & Lee, 2018;Stimpfel et al., 2020). Previous studies have also found that nurses frequently report back pain (Guan et al., 2019;Ibrahim et al., 2020;Katsifaraki et al., 2019), musculoskeletal pain (Freimann et al., 2016;Zhang et al., 2020), neck pain (Freimann et al., 2016;Zhang et al., 2020), stomach pain (Katsifaraki et al., 2019), and headaches (Freimann et al., 2016;Guan et al., 2019;Katsifaraki et al., 2019). ...
Article
Objective: Poorer sleep quality and insufficient sleep increase the risk of physical pain. The current study examined the daily associations between sleep and physical pain symptoms and tested the moderating role of trait and state mindfulness in this relationship. Methods: Sixty hospital nurses (Mage=35.4 ± 11.8 years) completed 14-day ecological momentary assessment (EMA) and sleep actigraphy. EMA measured physical pain frequency and interference (1×/day) and state mindfulness (3×/day). Multilevel modelling was used to examine the associations at the between-person and within-person levels. Results: After nights with poorer sleep quality, lower sleep sufficiency, and more insomnia symptoms, the frequency of physical pain symptoms and pain interference were greater than usual. Overall, those with poorer sleep quality, lower sleep sufficiency, and more insomnia symptoms reported more physical pain symptoms and greater pain interference. Higher state mindfulness buffered the negative within-person association between sleep efficiency and physical pain frequency. There was evidence that the joint moderating effects of trait and state mindfulness yielded more protective benefits in the relationship between sleep quality and physical pain than trait or state mindfulness alone. Conclusion: Even without mindfulness training, one's mindfulness may be protective against the adverse effects of poor sleep quality on physical pain.
... [16] This is relevant for many specialties and subspecialties, such as general medicine, neurology, neurosurgery, psychiatry, family medicine, otorhinolaryngology, and anesthesiology. Besides nurses can contribute to knowledge about sleep and health promotion, provide primary care, disseminate information to patients, and enhance patient compliance with treatment [17] Hence, it is imperative that teaching curriculum for nurses at undergraduate and postgraduate levels should include the hitherto neglected fields of OSA and other sleep disorders. ...
Article
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Obstructive sleep apnoea (OSA) syndrome is an established and modifiable but under recognized risk factor for common disorders like stroke and hypertension. To assess awareness level of health care practitioners and medical students about OSA as a risk factor for stroke and hypertension. Questionnaire based survey with multiple response type and fill in the blanks type questions. The data was compiled and analyzed using SPSS version 19. 180 participants completed the survey questionnaire. Only 24 (13.3%) identified OSA as a reversible risk factor for ischemic stroke. 11 (6%) participants only could answer OSA as an identified risk factor for hypertension as per Seventh Joint National Committee report. This study reveals dismal level of awareness, among health professionals and medical students, about OSA being an established and modifiable risk factor for hypertension and ischemic stroke.
... Development of improved nursing education curricula to address these potential shortcomings began in 2000 and culminated in 2004, with an Association of Professional Sleep Societies Nursing Task Force publishing their "Recommendations for Nursing Education." 22 Undergraduate sleep education and specifi c sleep training for NPs were encouraged, but CBT-I was not highlighted as an integral part of the training. Including CBT-I training as a regular offering in nursing curricula will allow greater numbers of providers to be trained while improving visibility and awareness of this treatment. ...
Article
Despite the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in treating chronic insomnia, it remains underutilized. Lack of appropriately-trained CBT-I providers is a major reason. Master's-level practitioners (MLPs) may, in addition to doctoral-level psychologists, be uniquely positioned to fill this role, based not only on "goodness of professional fit" but also given a handful of studies showing these individuals' care outcomes meet or exceed standard outcomes. However, the ability of MLPs to provide CBT-I will be significantly restricted until a clear pathway is established that extends from training opportunities to credentialing. Further questions remain about how to attract and incorporate MLPs into established practices. Fields BG; Schutte-Rodin S; Perlis ML; Myers M. Master's-level practitioners as cognitive behavioral therapy for insomnia providers: an underutilized resource. J Clin Sleep Med 2013;9(10):1093-1096.
... A conceptual model adapted from the model of the health consequences of sleep loss by Lee et al. forms the theoretical framework for this study. 17 The model posits that lack of adequate sleep, due to sleep deprivation and sleep disruption, leads to adverse health outcomes and daytime consequences such as impaired function, fatigue, impaired short-term memory and problem solving, and impaired social and family interactions. A child with disrupted sleep may be excessively tired during the day, leading to poor accomplishment of daily life habits and lower participation level in typical daily activities. ...
Article
Objectives: The goal of this study was to describe sleep patterns and accomplishment of daily life habits in children with Down syndrome (DS) and to investigate the relationship between subjective indicators of sleep disturbance with functional outcomes in daily life. Design: Cross-sectional study with an Internet sample. Setting: Online survey filled out at home. Participants: 110 parents of children with DS and 29 parents of children with typical development (TD), age 5 to 18 years. Interventions: N/A. Measurements and results: Children's Sleep Habits Questionnaire was employed to collect information about sleep disturbances in 8 domains (subscales) and a total score. The Life Habits (Life-H) questionnaire sampled information about daily life habits in 11 domains. Multivariable regression modeling was used to assess the associations between sleep disturbances and the accomplishment of daily life habits. Sleep disordered breathing (SDB) was a significant explanatory factor in 10 of 11 daily life habits and the total Life-H score. Sleep anxiety and parasomnias significantly influenced the accomplishment of life habits in children with DS as compared to children with typical development. When evaluated in multivariable models in conjunction with the other 7 domains of sleep disturbances, SDB was the most dominant explanatory factor for accomplishment of life habits. Conclusions: Sleep disturbances are negatively related to accomplishment of daily life functions. Prevention and treatment of sleep problems, particularly sleep disordered breathing, in children with DS may lead to enhanced accomplishment of daily life habits and activities.
... Development of improved nursing education curricula to address these potential shortcomings began in 2000 and culminated in 2004, with an Association of Professional Sleep Societies Nursing Task Force publishing their "Recommendations for Nursing Education." [16] Undergraduate sleep education and specific sleep training for NP's were encouraged, but CBT-I was not highlighted as an integral part of the training. Including CBT-I training as a regular offering in nursing curricula will allow greater numbers of providers to be trained while improving visibility and awareness of this treatment. ...
Article
Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective treatment for chronic insomnia, but it remains underutilized. Lack of appropriately-trained CBT-I providers is a major reason. Nurse Practitioners (NPs) may, in addition to psychologists, be uniquely positioned to fill this role, based not only on their professional training but also given a handful of studies showing these individuals’ care outcomes meet or exceed standard outcomes. Questions as to how to attract NPs to the field, credential them, and incorporate them into established practices remain unanswered.
... Poor sleep is also associated with daytime impairment [7]. After a stroke, restorative sleep is essential to gain physical and psychological energy, but it must be taken into consideration that age and numbers of medical condition influence patients' sleep quality [8] [9]. ...
Article
Full-text available
This study describes the pattern of day and night sleep and explores relationships between these patterns and sociodemographic and clinical factors as well as sleep environmental context and the patient's subjective sleep quality. Data from 110 patients with first-ever stroke was collected by structured interview surveys, medical record, and objective estimated sleep data from wrist actigraphy. The variability in estimated sleep is large. Half the patients slept either <6 hours or >8 hours per night, and 78% had more than nine awakenings per night. Men slept less than women, and patients sleeping at home had fewer awakenings than those who slept in hospital. It was estimated sleep during daytime in all, except 4, patients. Longer stay in hospital was related to more daytime sleep, and the subjective sleep quality correlated with estimated sleep time, wake time, and wake percentage.
... However, a deeper understanding of the concepts underpinning chronotherapy and exposure to newly emerging data is not included in most undergraduate pharmacy programs. This may be linked to the novelty of the sleep and circadian medicine field itself, which is only now being introduced in nursing and medical education in a meaningful manner [19,20]. ...
Article
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Chronotherapy involves altering the timing of medication administration in coordination with the body's circadian rhythms to improve the overall control of disease and to minimise treatment side effects. Training on chronotherapy requires students to map different topics learnt in earlier years of their professional degree and apply these concepts clinically. This requires strategic educational design. Therefore, the aim of the study was to develop, implement and evaluate an educational intervention focusing on the application of chronotherapy for final-year undergraduate pharmacy students. An educational intervention utilizing multiple learning strategies for enhancing chronotherapy related awareness was designed and implemented in the final year undergraduate pharmacy cohort at the University of Sydney Australia (2013). A custom-designed questionnaire measuring awareness about (13 items scored 0 or 1), and attitudes (12 items scored on a Likert scale of 1–5) towards chronotherapy was administered pre and post intervention to evaluate its impact. The pre-intervention mean total awareness and attitude scores were 6.5 ± 2.0 (score range 0–13) and 47.4 ± 6.9 (score range 12–60) respectively. The mean total post-intervention scores were significantly higher for total awareness (10.1 ± 1.9) and attitude (54.0 ± 6.0). Carefully designed educational interventions utilising pedagogic principles for pharmacy students can improve awareness of and enhance positive attitudes toward pharmacists' roles in optimizing drug therapy using chronotherapy.
... Most participants in the study were enthusiastic about learning more about chronotherapy and reported being willing to provide their patients with appropriate advice about the optimal time for them to administer their medications. Many nursing and medical schools are recommending a conceptual framework for enhancing an understanding of sleep and circadian rhythms for nursing students and medical graduates [66,67]. Education and training in pre-registration of pharmacy and continuing professional training could address the awareness gap about circadian rhythms and chronotherapy and would allow community pharmacists to deal with encounters in a way that allows better patient outcomes. ...
Article
Background: Optimising the time of drug administration in alignment with circadian rhythms to enhance the clinical effect or minimise/avoid adverse effects is referred to as chronotherapy. Pharmacists have a key role in providing medicine related information, including counselling about the optimal time for medication administration. Where applicable, the principles of chronotherapy should underlie this aspect of medication counselling. Despite significant developments in the science of chronotherapy for specific pharmacological treatments, the perspective of pharmacists about their understanding and application of these principles in practice has not been explored. Objective: To explore community pharmacist's viewpoints about and experience with the application of chronotherapy principles in practice. Setting: Community pharmacies within metropolitan Sydney in New South Wales, Australia. Methods: Semi-structured, face to face interviews with a convenience sample of community pharmacists were conducted. All interviews were audio-recorded, transcribed verbatim and thematically analyzed using a 'grounded theory' approach, given the novelty of this area. Main outcome measure Community pharmacists' awareness, current practice and future practice support requirements about the principles of chronotherapy. Results: Twenty-five semi-structured interviews were conducted. Most participants reported encountering cases where clinical decision making about suggesting appropriate times of drug administration to patients was needed. Their approach was mainly pragmatic rather than based on theoretical principles of circadian variation in drug disposition or on current or emerging evidence; thus there was an evidence practice chasm in some cases. However, most participants believed they have an important role to play in counselling patients about optimal administration times and were willing to enact such roles or acquire skills/competence in this area. Conclusion: Community pharmacists contribute to the safe and effective use of medications in providing the patients with information on optimal timing of drug administration during counselling. Further education, practical training and access to information may help pharmacists in translating principles of chronotherapy into the practice.
... The latter study found that less than 2 hours of sleep education was typically provided during medical school and approximately 30% of schools provided no formal education. Furthermore, surveys of practicing physicians and pediatricians find greatly limited sleep knowledge, therefore further emphasizing the need for education on sleep and sleep disorders during medical education [18][19][20]. ...
Article
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Introduction: Egyptian medical education system awards students the bachelor degree of medicine after six academic years and a rotating house officer year. There are no structured sleep educative programs in Egypt. Aim of work: This study aimed to assess the knowledge of Egyptian final year medical students and house officers about normal sleep and sleep disorders. Subjects and methods: Medical schools distributed throughout Egypt were surveyed asking sixth-year medical students (males and females) and house-officers to participate. Seven faculties of medicine were selected. To screen for knowledge on normal sleep and sleep disorders, the Assessment of Sleep Knowledge in Medical Education Survey was used; the participants were classified to low scorers versus high scorers depending upon their ability to answer 60% of the questions correctly. The participants were separated into comparative groups (males vs. females). Sixth-year students vs. house officers and according to their faculty location. Results: A total of 726 participants completed the survey (52.8% males, 78.9% were 6th year medical students and 21.1% were house-officers). There was a statistically significant difference in the scores of the participants with regard to their Faculty location and gender, while no statistically significant difference was found with regards to the study year. Conclusion and recommendation: Medical students in the screened Egyptian faculties possess poor knowledge about sleep medicine, which reflects the deficient educative processes in this field of medicine. Medical faculties should provide better sleep medicine education through a formal sleep medicine degree-awarding program.
... Other factors affected may include the inflammatory system, fat/glucose metabolism, social/professional relationships, cognitive functions, mental/mood states, and overall health-related quality of life. 7,9 In the first trimester of pregnancy, total sleep time increases but sleep quality is disturbed. The amount of reported sleep begins to decrease in the second trimester, and sleep disturbances (restless legs syndrome and nightly nocturnal awakenings) reach the highest rates in the third trimester. ...
Article
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The aim of this study was to investigate sleep quality and health-related quality of life in pregnancy. In a cross-sectional design, 492 women (292 pregnant and 200 nonpregnant healthy controls) were included in this study between November 2014 and June 2015. Participants completed a survey on sociodemographic characteristics, the Pittsburgh Sleep Quality Index (PSQI), and the European Quality of Life-5 Dimensions (EQ-5D). The PSQI total and EQ-5D scores of pregnant women were significantly worse than the controls (P = .017 and P < .001, respectively). Linear regression analysis showed that only pregnancy status was related to PSQI scores (β = .117; P = .009). Compared with the first trimester, the risk of poor sleep quality increased 2.11-fold in the second trimester (P = .048) and 1.86-fold in the third trimester (P = .054). Compared with the first trimester, EQ-5D scores significantly decreased in the second (P = .038) and third (P < .001) trimesters. Sleep quality and health-related quality of life of pregnant women were worse than those of nonpregnant healthy controls. Healthcare professionals need to be aware of deteriorations in sleep quality and health-related quality of life of pregnant women.
... Lee and Ward (2005) have recently published an impressive article that focuses on critical components of sleep assessment for clinical practice. Another group of nurses from the American Academy of Nursing (Lee et al., 2004) has provided an exceptional document on sleep and chronobiology, focusing their work on content of interest and concern to nurses. Thanks to the work of these leaders and others, the science of sleep is advancing in our discipline. ...
... Whether chronic sleep losses are the result of deprivation or disruption, these losses increase a person's risk of adverse physical, cognitive, and emotional outcomes (Dinges, Rogers, & Baynard, 2011;Lee et al., 2004). Adverse physical responses can include alterations in immune functioning (von Känel et al., 2006), alterations in metabolic or endocrine functioning (Moldofsky, 1995), and increases in comorbidities such as hypertension (von Känel et al., 2006) and depression (Hamilton, Nelson, Stevens, & Kitzman, 2007). ...
Article
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Purpose/objectives: To describe the sleep characteristics of family caregivers of individuals with a primary malignant brain tumor (PMBT). Design: Cross-sectional, correlational design using baseline data from a longitudinal study. Setting: Neuro-oncology and neurosurgery clinics at an urban tertiary medical center in the United States. Sample: 133 family caregivers recruited one to two months following diagnosis of family member's PMBT. Methods: Subjective and objective measures of sleep were obtained via self-report and the use of accelerometers (three nights). Main research variables: Sleep characteristics including sleep latency, total sleep time, wake after sleep onset, number of naps, number of arousals, sleep-wake cycle, and sleep quality. Findings: Sleep latency in caregivers was, on average, 35 minutes (SD = 34.5)-more than twice as long as the norm of 15 minutes (t[113]) = 6.18, p < 0.01). Caregivers averaged a total sleep time of 5 hours and 57 minutes (SD = 84.6), significantly less than the recommended 7 hours (t[113] = -8, p < 0.01), and were awake in the night 15% of the time, significantly more than the norm of 10% (t[111] = 5.84, p < 0.01). Caregivers aroused an average of 8.3 times during nocturnal sleep (SD = 3.5, range = 2-21), with about 32% reporting poor or very poor sleep quality. Conclusions: Caregivers experienced sleep impairments that placed them at risk for poor mental and physical health, and may compromise their ability to continue in the caregiving role. Implications for nursing: Nurses need to assess sleep in caregivers of individuals with PMBT and implement interventions to improve sleep. Knowledge translation: Sleep deprivation is common in family caregivers during the early stages of care for individuals with a PMBT. A single-item sleep quality question could be an easy but valuable tool in assessing sleep disturbances in family caregivers of individuals with a PMBT. The health trajectory of family caregivers warrants further longitudinal study, in addition to the examination of the bidirectional relationship of health status of care recipients and their family caregiver.
... Education Berger et al. (2005) listed specific implications for nursing education related to sleep-wake disturbances. A high priority is for nursing education to include information on sleep and circadian rhythms (Lee et al., 2004). Only one publication was found that described implementation of these recommendations by an academic institution. ...
Article
To update the state of the science on sleep-wake disturbances in adult patients with cancer, focusing on insomnia in the areas of prevalence, mechanisms and models, measurement, interventions, and implications for practice, health policy, education, and research. Published articles, books, book chapters, MEDLINE, CINAHL, and PsycINFO computerized databases. Since the 2004 conference on Sleep-Wake Disturbances in People With Cancer and Their Caregivers, an increased focus has existed on the prevalence and distress experienced by patients with cancer with sleep-wake disturbances, particularly insomnia. Evidence suggests that altered physiology directly related to the cancer process may play a prominent role in disrupting sleep, circadian rhythms, and hypothalamic-pituitary-adrenal axis-regulated processes. Reliable and valid objective and subjective measurements for screening and assessing sleep-wake disturbances are ready for use in clinical and research settings, and an increasing amount of intervention studies have reported sleep-wake outcomes in adult patients with cancer. Cognitive behavioral therapy interventions are likely to be effective, but effectiveness has not been established for complementary, education or information, or exercise interventions. Multidisciplinary research teams should test the effectiveness of interventions to reduce sleep-wake disturbances in adult patients with cancer. Settings should create the infrastructure to initiate and sustain evidence-based oncology nursing practice, clinicians should educate the public about sleep, and public policies should promote adoption of healthy sleep patterns and early diagnosis and treatment of sleep disorders.
... Also, many strategies to assist sleep complement existing nursing skills and responsibilities. Despite this, education of nurses has historically neglected sleep and sleep disturbance (Cohen et al. 1992, Stores 2001, Lee et al. 2004, Pelayo et al. 2004). The familiarity of sleep has caused it to be discounted and casually approached by health professionals, with symptom control the main treatment rather than investigation of underlying issues (Stores 2001). ...
Article
To evaluate nurses' knowledge of adolescent sleep and sleep disturbance and the strategies they employ to facilitate sleep in adolescent patients. Sleep disturbance in adolescents is common and associated with potentially devastating outcomes and co-morbidities. Despite this, little literature exists that reports nursing interventions related to facilitating sleep, and no literature could be located that explored what Australian nurses know about adolescent sleep and sleep disturbance. Qualitative. Eight nurses routinely involved in the care of adolescent patients were interviewed via email and instant messaging over a five month period. Explored was the formation and extent of knowledge held by these nurses about adolescent sleep and sleep disturbance and the strategies they used to facilitate sleep in adolescent patients. Data were analysed thematically. Three main themes were identified: 'A patchwork of experiences', 'Traditional remedies, personal beliefs and commonsense' and 'Drugs, doctors and disempowerment'. Despite a lack of formal education about adolescent sleep and sleep disturbance, through life and professional experience the nurses in this study had formulated effective strategies to assist the sleep of adolescent patients. RELEVANCE TO CLINICAL PRACTICE; There is a need for nursing education regarding adolescent sleep issues. Providing rationales for nursing strategies would afford nurses greater confidence to strongly advocate for a more non-pharmacological approach to managing certain types of sleep disturbance. Initiating routine assessment of adolescent sleep in both hospital and community settings could be beneficial to detecting a range of difficulties adolescent patients may be experiencing.
... Nurses have an influential role in improving the general level of health in the society (12) and are the most important people who can convey the required knowledge and information to the society (13). Nurses are in a specific and unique position to help with new knowledge about sleep and health promotion (14). ...
... The purpose of this study was to examine the predictive and longitudinal association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women. The rationale and theoretical basis for this study were based on the conceptual model of impaired sleep ( Lee et al., 2004 ). The model of impaired sleep illustrates that an inadequate amount of sleep and fragmented sleep can result in sleep loss, with negative impacts on physiological, cognitive/behavioral, emotional, and social domains of health. ...
Article
Background : Sleep disturbances are one of the most frequent chief complaints brought to the healthcare professionals during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide with women more likely to be affected than men. However, limited studies have prospectively investigated the association between sleep disturbances and longitudinal risk of depression in pregnant women, with no studies using actigraphy to objectively estimate daytime and nighttime sleep duration and the extent of sleep disruption. Objectives To examine the predictive and longitudinal association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women. Design A prospective observational cohort study. Methods : 204 first-trimester pregnant women recruited from a university-affiliated hospital provided socio-demographic and health information, wore a wrist actigraph for 7 days, and completed Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies - Depression Scale, and Epworth Sleepiness Scale. Identical data collection procedures were implemented again in the second and third trimester, with each data collection scheduled at least 8 weeks apart. We estimated unadjusted and multivariable adjusted odds ratios and 95% confidence intervals to evaluate various types of sleep disturbances at 1st trimester and risk of depression at follow-ups. Results : 121 (59.3%) first-trimester women had a sleep efficiency of < 85% by actigraphy, and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores > 5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency < 85% was associated with 2.71-, 3.87-, and 5.27-fold increased odds having risk of depression at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively. Conclusions : Healthy pregnant women experience both objective and subjective sleep disturbances during the early trimester, with a substantial proportion of them also having high depressive symptoms throughout the pregnancy. Objectively assessed poor sleep quality in the 1st trimester, but not self-reported characteristics of disturbed sleep, may play a role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether an early intervention aiming at improving sleep may help reduce high depressive symptom risk and lower depression rate in women during pregnancy. Tweetable abstract: Objectively assessed poor sleep efficiency in the 1st trimester predicts both elevated and persistent high depressive symptoms in pregnancy.
... Integrating the science of sleep into nursing practice, education and research is an admirable goal and more work is to be done to forward it (McEnany & Redeker, 2013). As an example, the literature has decried the lack of a formalized curriculum regarding sleep in undergraduate and graduate nursing studies (Dambrosio & Mazanec, 2013;Lee et al., 2004). As detailed in McEnany & Redeker (2013), a survey of practicing nurses (n = 539) found that 70% had five hours or less of sleep-related education in their entire educational preparation. ...
Article
Given that approximately 70 million Americans suffer from sleep–wake disorders and their under-recognized role in practice, psychiatric nurses may see, or may be already seeing, patients with undiagnosed sleep disorders. Assessment of sleep–wake disorders can and should be a part of psychiatric nursing education and practice. Many practicing clinicians lack formal training regarding sleep–wake issues and treatment. Even as sleep disturbances are common concerns among psychiatric populations, sleep–wake issues may go unrecognized. The article presents a stylized progression of care to enable clinicians to identify, address, and treat underlying sleep–wake disorders in psychiatric settings. The article recommends instituting screening procedures for sleep–wake issues and follow-up assessments, particularly overnight pulse oximetry and polysomnograms. Just as clinicians already screen for physical conditions that would affect psychiatric care, practitioners can evaluate patients for potential sleep–wake disorders as part of their existing practice and intake procedures. Further, the piece details implications for psychopharmacology as well as evidence from clinical practice. Psychiatric nurses should stay awake to the importance of sleep medicine and aware of how sleep–wake disorders can affect psychiatric populations.
... Inadequate sleep can adversely affect all aspects of a child's biopsychosocial health. 1 Studies have focused on children's sleep in relation with obesity 2-4 and behavioral problems. [5][6][7][8] Gregory 5 reported that sleep problems may forecast behavioral/emotional problems. ...
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It is known that sleep problems impact children's health, learning, and school performance. The purpose of this paper is to examine the association between sleeping habits and social competence development. Three hundred and nine caregiver-child dyads participated in this study, which was conducted as part of a Japan Science and Technology Agency (JST) project. The caregivers answered some questionnaires about sleeping habits when the child was 9 months and 18 months old. Caregiver-child interaction was observed when the child was 30 months old, and the features of the interaction were examined using the Interaction Rating Scale (IRS) as a measure of social competence. The caregivers' attitude toward sleeping in the 9-month period was found to be significantly correlated with the children's social competence at 30 months. Moreover the caregivers' attitude toward sleeping in the 9-month period significantly correlated with the children's sleeping habits at 9 and 18 months. These findings show that the caregivers' attitude toward sleeping is an important factor influencing the development of children's social competence.
... and efficacy of a hospital-based sleep hygiene intervention, modified from prior sleep behavior intervention strategies to improve sleep among pregnant and postpartum women in their home environment. 22,23 This intervention approach was based on the Theory of Symptom Management 24 and Model of Impaired Sleep, 25 and was designed to combine patient education, hospital staff education, and provision of specific items and visual cues to provide more immediate improvement in sleep within the hospital setting. It was hypothesized that the hospital-based intervention would be feasible, and that antepartum patients who received the intervention would adhere to the protocol and have better sleep during hospitalization compared with similar patients who did not receive the intervention. ...
Article
Study objectives: To evaluate feasibility and efficacy of a hospital-based protocol for improving sleep in high- risk antepartum patients. Methods: Sleep measures were compared during 1 week of hospitalization before and after implementing a Sleep Improvement Protocol for Antepartum Patients (SIP-AP). A non-randomized convenience sample of usual care controls was compared to a subsequent intervention sample after the protocol was implemented. Women were eligible if they spoke English, were medically stable, pregnant for at least 20 weeks, and hospitalized at least 24 hours; 25 pregnant women had sufficient data for analyses (11 controls, 14 intervention). Sleep was assessed in 3 ways: the Pittsburgh Sleep Quality Index was completed after obtaining consent to estimate sleep quality prior to hospital admission; sleep diary completed each hospital day; and General Sleep Disturbance Scale completed at 7 days or prior to hospital discharge. Symptoms that could affect sleep were assessed with the Memorial Symptom Assessment Scale. Results: Both groups recorded similar sleep duration (7 hours) but the intervention group had fewer symptoms and significantly (P = .015) lower sleep disturbance scores (53.1 ± 14.5) than controls (71.9 ± 18.8). Participant feedback about the intervention was positive, although adherence to components of the intervention protocol was variable. Conclusions: This pilot study provides evidence of the feasibility and preliminary efficacy of the SIP-AP intervention for reducing symptoms and improving sleep of antepartum patients during hospitalization. Further detailed evaluation of specific components of this protocol is warranted, and other types of hospitalized patients may benefit from unit-based modifications to this SIP-AP protocol.
... Nurses have an influential role in improving the general level of health in the society (12) and are the most important people who can convey the required knowledge and information to the society (13). Nurses are in a specific and unique position to help with new knowledge about sleep and health promotion (14). ...
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Background: Sleep-deprivation in children decreases the quality of life and endangers health. Increasing mother’s level of awareness can help improve the children’s sleep schedule and avoid many associated problems. Objectives: This study aimed to investigate the effect of SMS-based education on the level of sleep knowledge in mothers with 7 - 12 years old children. Methods: In this single-blind randomized controlled trial, 13 governmental primary schools in Tabriz (Iran) in 2016 (7 girls’ schools and 6 boys’ schools) were randomly selected among the primary schools, using cluster sampling approach. Then, the mothers of sleep-deprived students were randomly divided into intervention and control groups by using RAS. Both of the groups took a pretest on sleep knowledge by PSKI and then, mothers in the intervention group received education through sending SMS. Finally, all of the participants took again the posttest in two time intervals including a week and three months after the intervention. A number of 92 mothers (experiment = 47, control = 45) completed all of the three phases of the research and the data were analyzed using SPSS ver13. Results: The results showed that the difference between the scores obtained in the first and the second measurements of sleep knowledge in the experimental group was significantly different from that of the control group [mean between-group difference of 5.98 within 95% CI of 3.56 to 8.41 (P < 0.001)]. The difference of sleep knowledge scores between the third and first measurements in the experimental group was also significantly different from that of the control group [mean between-group difference of 4.09 within 95% CI of 1.44 to 6.74 (P < 0.003)]. Conclusions: The use of SMS-based education is a constant and efficient educational approach for increasing mothers’ level of knowledge about children’s sleep health.
... A n estimated 50 to 70 million adults in the United States have sleep deficiency, 1 which is a deficit in the quantity or quality of sleep obtained and a major public health concern. 2 Left untreated, it can lead to cardiovascular morbidity, metabolic dysfunction, work-related injuries, and daytime deficits (eg, daytime sleepiness, fatigue, mood), all of which place patients at risk for adverse health outcomes and increased healthcare utilization. 2,3 Psoriasis occurs in 7.5 million adults in the United States and has been identified as a potential risk factor for sleep deficiency. [4][5][6][7] In 2013, psoriasis treatment was estimated at $51e$63 billion in the United States, 8 and sleep deficiency may contribute to these costs. ...
Article
Adults with psoriasis experience sleep deficiency due to poor sleep habits, underlying sleep disorders (obstructive sleep apnea, insomnia), and symptoms of pruritus and pain. This article aims to provide an overview of (1) psoriasis, (2) sleep deficiency in psoriasis, (3) sleep assessment, and (4) the clinical implications of sleep deficiency in psoriasis. Routine assessment and treatment of sleep deficiency in clinical practice may improve quality of life, facilitate disease management, and decrease health care utilization.
... Page 11 of 39 curricular elements and clinical experiences about sleep for all undergraduate and graduate nursing programs ( Lee et al., 2004). They provided a conceptual model of impaired sleep and important learning objectives and expected competencies for undergraduate nursing students and advanced practice graduate nursing students (e.g., nurse practitioners or clinical nurse specialists). ...
Article
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.
... Further, sleep is critical to brain and body development [15][16][17]. Inadequate sleep can adversely affect all aspects of a child's biopsychosocial health [18]. Many reports have examined the link between sleep and behavioral problems [19][20][21][22][23][24] in children. ...
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Background Many reports argue that sleep is important for children’s health, learning, and academic performance. The purpose of this longitudinal study was to examine the association between sleep and the development of social competence in infants. Methods This study was conducted as part of a Japan Science and Technology Agency (JST) project. Caregivers responded to the Japan Children’s Study Sleep Questionnaire when children were 18 months old. The interactions of caregivers and children were observed when children were 18, 30, and 42 months old, and rated with the Interaction Rating Scale, which is a measure of social competence. Results Nocturnal sleep duration of more than 10 h and an earlier bed time than 22:00 were significantly correlated with two trajectory groups (low point and high point transition groups) of children’s social competence at 18, 30, and 42 months. Further, total sleep duration of more than 12.25 h and an earlier bed time than 22:00 were significantly correlated with the trajectory of children’s social competence at 18, 30, and 42 months. Conclusions Sleep duration and sleep onset time are important factors in children’s development of social competence. Trial registration The ethics committee of the JST approved this study on March 19, 2001. The registration number is 356-1.
Article
Sleep is a basic activity of living. Its restorative properties in healthcare settings--both hospital and community--should be considered by healthcare workers. Its significance in gerontological nursing should not be underestimated. As older people are prone to multiple pathology, disease processes may mask their need for effective sleep and rest. "Sleep architecture" is a term that applies to the mechanics of sleep or its stages and clinicians may fail to identify when this is disrupted. "Sleep hygiene" refers to measures or interventions used to promote sleep and a person-centred approach is necessary, with support from specialist agencies to achieve effective sleep hygiene. The need for long periods of sleep may diminish owing to ageing. However, the quality of the sleep experiences, i.e. feeling rested and refreshed, should be the same. Several factors have been identified in the causation of insomnia. In healthcare settings, environmental factors such as noise and light pollution are the commonest features. Other issues that may be present in both healthcare and community settings are related to varied perspectives, such as physiological, psychological and spiritual-religious. Providing a climate conducive to health sleep in all settings becomes a requisite in the planning of care.
Article
Sleep disturbance is a prevalent and complex issue within the family caregiver population that affects the overall health of the caregivers themselves and their care recipients. However, there is limited evidence to support the efficacy of current practice and a lack of consensus regarding the optimal treatment protocol. This article will provide an overview of sleep research in family caregivers. It explores current trends in sleep research and identifies relevant conceptual and methodological issues, suggesting implications for further research and highlighting the need to improve sleep quality in the caregiver population.
Article
This study explored the knowledge and educational experiences of student nurses regarding sleep and its promotion in hospitals. Nurses have a key role to play in sleep promotion, with the knowledge of sleep an important component of skilled patient care. From a review of the literature, minimal research was found on what student nurses know, or how they learn about, sleep and its promotion. A mixed method approach was used. 1. Questionnaires were completed by student volunteers in the last six months of their nursing programme(n = 120) from four Higher Education Institutions.2. Semi-structured interviews were carried out with a sample of the students (n = 26). The students lacked a complete knowledge about basic sleep physiology. Their knowledge of sleep disruption and sleep promoting factors was more evident, although this was generally not based on empirical evidence. The students viewed knowledge of sleep and its promotion positively, but reported that their educational programmes did not prepare them in this respect. The students felt that they had learnt most about sleep promotion through clinical experience, from staff, patients and their own life experiences, though this learning was unstructured. These findings highlight the need to address the acquisition of knowledge and skills for the promotion of sleep in a structured learning framework in pre-registration nursing programmes. Academic and clinical staff need to be proactive in this respect.
Article
: Sleep disturbance is a significant health issue in pregnant women. Although previous studies contribute to an understanding of the multifactorial nature of pregnancy-related sleep disturbance, objective measures of sleep were not included, and so data may be subject to recall and potential participant self-report bias. : The aim of this study was to identify sociodemographic, lifestyle, and health-related factors associated with poor sleep quality in women during their third trimester of pregnancy. : This prospective study included 30 nulliparous women who wore a wrist actigraph to objectively monitor sleep for 7 consecutive days and completed the Pittsburgh Sleep Quality Index. : Fifteen women (50%) had a Pittsburgh Sleep Quality Index global score of >5, indicating poor sleep quality. Mean actigraphic sleep efficiency was only 80.05% ± 6.27%. There were significant differences (p < .01) in sleep offset time and total nocturnal sleep time between weekdays and weekends. Later sleep onset time was associated with poorer sleep, including longer sleep latency, and reduced total nocturnal sleep time and sleep efficiency. : Nulliparous women experience both objective and subjective sleep disturbances, and their sleep patterns differ between weekdays and weekends during their third trimester of pregnancy. Results suggest that maternal sleep pattern may be improved by maintaining a regular and earlier bedtime so women have more opportunity to obtain sufficient nocturnal sleep and improved sleep quality.
Article
Studies indicate that extended shifts worked by hospital staff nurses are associated with higher risk of errors. Long work hours coupled with insufficient sleep and fatigue are even riskier. Although other industries have developed programs to reduce fatigue-related errors and injury, fatigue countermeasures program for nurses (FCMPN) are lacking. The objective of this study was to evaluate the feasibility of an FCMPN for improving sleep duration and quality while reducing daytime sleepiness and patient care errors. Selected sleep variables, errors and drowsy driving, were evaluated among hospital staff nurses (n = 47) before and after FCMPN implementation. A one-group pretest-posttest repeated-measures approach was used. Participants provided data 2 weeks before the FCMPN, 4 weeks after receiving the intervention, and again at 3 months after intervention. Most of the nurses experienced poor sleep quality, severe daytime sleepiness, and decreased alertness at work and while operating a motor vehicle. After the FCMPN, significant improvements were noted in sleep duration, sleep quality, alertness, and error prevention. Although significant improvements were not found in daytime sleepiness scores, severity of daytime sleepiness appeared to decrease. Despite improvements in fatigue management, nurses reported feelings of guilt when engaging in FCMPN activities, especially strategic naps and relieved breaks. Initial findings support the feasibility of using an FCMPN for mitigating fatigue, improving sleep, and reducing errors among hospital staff nurses. In future investigations, the acceptability, efficacy, and effectiveness of FCMPNs can be examined.
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This study compared the occurrence rates for and severity ratings of sleep disturbance in patient-family caregiver (FC) dyads. In total, 102 dyads were recruited from two radiation therapy (RT) departments. Patients and their FCs completed the Pittsburgh Sleep Quality Index (PSQI) and the General Sleep Disturbance Scale (GSDS) and wore wrist actigraphs to obtain subjective and objective measures of the occurrence and severity of sleep disturbance at the initiation of RT. Match paired t tests were used to evaluate for dyadic differences. No differences were found in the occurrence of clinically significant levels of sleep disturbance between patients and their FCs that ranged between 40% and 50% using subjective and objective measures. Few differences were found in the severity of any of the sleep-wake parameters between patients and FCs using both the subjective and objective measures of sleep disturbance. The findings from this study suggest that patients with cancer and their FCs experience similar levels of sleep disturbance and that both groups could benefit from interventions that aim to promote restful sleep. In addition to routine and systematic assessment of sleep disturbance by oncology clinicians, interventions are needed that take into account the specific needs of the patient and the FC as well as the potential for partners' sleep patterns to influence one another.
The purpose of palliative care is to alleviate noxious symptoms and promote quality of life in patients and families facing life-threatening illness. Although research in palliative care has made advances in evidenced-based practice, research into sleep disturbances in the context of advanced disease has remained very limited. This research deficit is critical given that sleep disturbance can have a significant impact on quality of life. The purpose of this article is to explore relationships between sleep disturbance and palliative care as reflected in the literature. From this perspective, the author concludes with issues of relevance to nursing care of patients with advanced disease.
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Purpose: Shift work disrupts the synchronization between the human biological clock and the environment. Sleep disturbances are common for shift work nurses, and may threaten patient safety. This study was done to investigate the sleep characteristics and medication errors (ME) of intensive care unit (ICU) nurses who work shifts, and ascertain if there is an association between these factors. Methods: Data were collected using a self-report questionnaire from 126 ICU nurses on three shifts. Collected data included their sleep characteristics including sleep patterns and sleep disturbances, and ME for the past 2 weeks. Results: There were significant differences in sleep duration and sleep latency according to shift. Day shift nurses had the shortest sleep duration, and their sleep latency was the longest (about 49 minutes) compared to nurses on evening and night shifts; 54% reported sleep disturbances, 16% experienced ME, and among these nurses 50% were on the night shift. Logistic regression analysis revealed significant associations between nurses' sleep duration and ME (adjusted OR 0.52 [95% CI 0.32-0.85]). Conclusions: The results confirmed that shift worknurses in the ICUs experience sleep disturbance, and that less sleep is associated with ME.
Article
Objectives: This study aimed to investigate the prevalence of symptoms of shift work disorder (SSWD) and its related factors in rapidly rotating three-shift nurses. Methods: We enrolled 344 nurses (mean age, 28.7 years) without prior history of sleep disturbance before starting shift work in a university-affiliated hospital. SSWD were defined using self-reported sleep questionnaires (insomnia severity index >14 and/or Epworth Sleepiness Scale ≥10) and without any sleep problem before shift work. Sleep pattern in each of the three shifts was measured using the Munich Chronotype Questionnaire for Shift-Workers. Mood (anxiety, depression) and job stress were also measured using self-reported questionnaires. Results: Our results showed that 62.2% of the participants presented SSWD. Compared to the non-SWD group, the SSWD group showed worse sleep hygiene, lower total sleep time (TST) during workdays, higher anxiety and depressive mood, and higher job stress. In the SSWD group, the evening chronotype individuals presented the shortest TST during day shifts, while the morning chronotype individuals presented the shortest TST during evening shifts. Conclusions: SSWD is highly prevalent in fast rotating three-shift nurses. This study suggests that intensive education on sleep hygiene and appropriate scheduling of shift work while considering individual chronotypes may improve sleep patterns and sleep quality of shift workers and minimize SSWD.
Article
The need to educate the future nursing workforce to increase understanding of healthy sleep practices, adverse health consequences of impaired sleep, and common sleep disorders is pressing. Unfortunately, education about sleep and sleep disorders has not been part of established undergraduate nursing curricula. This study developed a sleep education program for college nursing students and tested its effect on knowledge about sleep and sleep disorders. With a total time commitment of 10 hours, this program included three sequential components: traditional in-classroom teaching, guided online virtual self-learning, and interactive simulation-based discussion. This innovative education program was implemented in a core course offered to senior nursing students in spring 2013, and demonstrated its effectiveness in improving knowledge about sleep and sleep disorders. Translating into undergraduate nursing curriculum, it will lay a foundation for improving health care of patients and decreasing the health risks of nurses as care providers. [J Nurs Educ. 2015;54(9):532-535.]. Copyright 2015, SLACK Incorporated.
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Sleep deprivation in midwives may decrease clinical competence by impeding communication, critical thinking skills, cognitive knowledge, as well as professional behaviour. Improving sleep hygiene, stress management and having a balanced lifestyle can ultimately improve client care.
Article
Current workforce shortages may cause some neonatal nurses and Neonatal Nurse Practitioners (NNPs) to schedule and work more hours than their normal hours, leading to inadequate sleep and recovery. Sleep related fatigue of neonatal nurses, including NNPs, is a serious but common health issue that can lead to personal and patient safety problems if not effectively addressed. Elements contributing to sleep disturbances and related fatigue are multifactorial, and include personal, work group, and organizational and administrative factors. Improving individual knowledge and accountability while working collaboratively with employers and regulatory bodies to address these issues can improve safety and quality of care for patients and improve the health and wellbeing of neonatal nurses and NNPs.
Article
Work-family conflict is challenging for workers and may lead to depression, anxiety, and overall poor health. Sleep plays an important role in the maintenance of mental health; however, the role of sleep in the association between work-family conflict and mental health is not well-studied. Questionnaires were collected from 650 nursing assistants in 15 nursing homes. Multivariate linear regression modeling demonstrated that increased work-family conflict was associated with lower mental health scores (β = −2.56, p < .01). More work-family conflict was correlated with more job demands, less job control, less social support, and longer work hours. Poor sleep quality, but not short sleep duration, mediated the association between work-family conflict and mental health. Workplace interventions to improve nursing assistants’ mental health should increase their control over work schedules and responsibilities, provide support to meet their work and family needs, and address healthy sleep practices.
Article
Introduction: Depression has been identified as the leading cause of disability worldwide. Nurses report higher rates of depression than the general public. Work-family conflict is challenging for nurses and may lead to depression and poor health. However, the mechanisms for the effect of work-family conflict on depression haven't been well understood. Aim: The objective is to use a cross-sectional design to examine the role of sleep disturbances in the association between work-family conflict and depressive symptoms in nurses. Methods: Questionnaires, measuring working conditions, work-family conflict, sleep disturbances, and depressive symptoms, were collected from 397 nurses at a not-for-profit community hospital in the northeastern United States. Results: We observed a significant association between work-family conflict and depressive symptoms (β=2.22, p<.001) among nurses. Sleep disturbances partially mediated this association by 40.54%. Discussion: Sleep disturbances play an important role in translating work-family conflict into depressive symptoms. Implications: Evidence-based interventions to promote healthy sleep practices should be evaluated for their effectiveness in addressing the impact of work-family conflict on mental health. Organizations should include sleep education and training as a component of workplace health promotion and employee assistance programs to mitigate the effect of work-family conflict and promote overall health in nurses. This article is protected by copyright. All rights reserved.
Article
Objective: The aim of this study is to explore the relationship of night-shift napping on fatigue. Background: Nurses' fatigue, especially at night, interferes with quality of life and job performance and impacts safety and health. Methods: Night-shift nurses completed the Brief Fatigue Inventory and a demographic information sheet to determine differences in fatigue between nurses who napped during their night shift as compared with nurses who did not nap. Results: No statistically significant differences in global fatigue were found; differences in rotating shift, age, and, gender were identified. Rotating shifts, a 2nd job, and caring for family predicted fatigue. Conclusions: Based on this pilot study, further investigations of fatigue among night-shift nurses are needed as well as evidence-based support to promote sleep.
Article
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.
Article
Introduction: Health professionals have been subject to increased levels fatigue when compared to population norms. It remains unknown if physiotherapists report high levels of sleep deprivation. This paper explores levels of sleep deprivation, and its potential impact on professional performance. Methods: A survey was distributed through the Irish Society of Chartered Physiotherapists. The survey explored work characteristics, sleep quality using the Pittsburgh Sleep Quality Index, daytime sleepiness using the Epworth Sleepiness Scale, and the professional and non-professional causes of sleep deprivation in the profession. Pearson correlation and independent t-tests were used on SPSS to explore relationship between variables. Results: There was a total of 559 valid respondents. Females accounted for 82% and public sector employees accounted for 63% of respondents. Over half (50.1%) of respondents said they felt sleep deprivation impacted on their practice. Most physiotherapists (63.3%) of respondents said they did not feel that their practice impacted sleep. The PSQI global score was 5.6 indicating “poor” quality of sleep. The ESS global score was 6.0 indicating ‘higher normal daytime sleepiness’. Potential causes of sleep deprivation included professional issues relating to burnout and work-life balance, and non-professional reasons such as parenthood. Discussion and Conclusion: A mismatch exists between self-reported sleep deprivation and validated measurements of sleep indicating poor self-awareness of the impact of sleep in optimising professional performance. A work-life balance is needed to facilitate a safe and efficient workforce. Individual and organizational efforts should be made to improve sleep quantity and quality to reduce personnel fatigue and enhance physiotherapists professional performance.
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I. Introduction II. Characteristics and Causal Mechanisms of 24-h Rhythms of Glucose Regulation in Normal Young Subjects A. 24-h variations in glucose tolerance B. Causal mechanisms III. Alterations of 24-h Rhythms of Glucose Regulation in Normal Aging A. Daytime variations in glucose tolerance B. Nighttime variations in glucose tolerance C. Respective roles of sleep and time of day D. Significance and clinical implications IV. Diurnal Variations of Glucose Regulation in Obesity A. Daytime variations in glucose tolerance B. Nighttime variations in glucose tolerance C. Significance and clinical implications V. Alterations in 24-h Rhythmicity of Glucose Regulation in Non-Insulin-Dependent Diabetes Mellitus (NIDDM) A. Alterations in daytime variations in glucose tolerance B. Alterations in nighttime variations in glucose levels during fasting C. Significance and clinical implications VI. Alterations in 24-h Rhythmicity of Glucose Regulation in Insulin-Dependent Diabetes Mellitus (IDDM) A. Alterations in dayt...
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To the Editor: Popular wisdom holds that not getting enough sleep increases the propensity of catching a cold or other ailments. In America, sleep duration has steadily declined from nearly 9 hours in 1960 to less than 7 hours today 1, 2. Although adverse effects of sleep deprivation on immune parameters have been documented, the possible clinical implications are unclear. Here we show a marked decrease in the response to influenza vaccination in young healthy individuals immunized after 4 days of sleep curtailment as compared to subjects with unrestricted sleep. Methods: Two groups of healthy young men (23 ± 1 years) consented to participate in a protocol approved by the Institutional Review Board. Selection criteria included bedtime between 23:00 and 01:00, wake time between 07:00 and 09:00 and time in bed of 8 hours ± 30 min. None of the subjects had been immunized against influenza during the preceding 3 years. A group of eleven subjects had their bedtime restricted to 4 hours (01:00-05:00) for 6 nights and then extended to 12 hours per night for 7 nights to recover from sleep loss 3. On the morning following the 4rth short night, they were immunized against influenza between 09:00 and 10:00 (intra-muscular injection of 0.5 ml, Influenza Virus Vaccine, Trivalent Types A and B, Fluogen, Parke-Davis, Morris Plains, NJ 07950, 1996-97 influenza season). A second group of 14 subjects served as controls and maintained their usual bedtimes prior to receiving the same vaccine under the same conditions. The two groups were recruited from the same pool of subjects, fulfilled the same inclusion criteria and did not differ in terms of age, body mass index and ethnic distribution. To assess anti-influenza IgG antibody titers throughout the major phases of the antibody response, a morning blood sample was taken immediately before vaccination (baseline), as well as 10 days (log phase - antibody titer increases logarithmically) and 21-30 days (plateau phase - antibody titer stabilizes) after vaccination. Antibody titers were measured in all samples using an ELISA assay with the vaccine used to immunize the subjects as the antigen 4. All subjects were seropositive for anti-influenza IgG antibody at baseline and mean titers were similar in both groups (mean ± SEM; control group 0.09.106 ± 0.02.106; experimental group 0.07. 106 ± 0.03.106). Results: Ten days post vaccination, mean antibody titers in subjects who were immunized in a state of sleep debt were less than half those measured in the subjects with normal sleep times (0.50.106 ± 0.14.106 versus 1.15.106 ± 0.27.106; p<0.03 by Mann-Whitney test; Figure 1). Three to 4 weeks post vaccination, differences in antibody titers between the group who had been sleep-restricted prior to vaccination and the control subjects were no longer significant. Thus, sleep deprivation at the time of vaccination reduced the response during the log phase of antibody production despite a prolonged period of sleep recovery post-vaccination. Repeated measures analysis of variance of natural log-transformed antibody titers with sleep condition as factor revealed a significant (p=0.0425) impact of sleep duration. Comment: These results indicate that the response to influenza vaccination is likely to be impaired in individuals who suffer from chronic partial sleep restriction. Because adults who show poorer responses to vaccines and other antigenic challenges also experience higher rates of clinical illness 5, our findings support the concept that adequate amounts of sleep are needed to maintain resistance to infectious challenge. References 1. Kripke DF, Simons R, Garfinkel L, Hammond E. Short and long sleep and sleeping pills. Is increased mortality associated? Archives of General Psychiatry 1979;36(1):103-16. 2. National Sleep Foundation (NSF). 2000 omnibus sleep in America poll. 2000. 3. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet 1999;354(9188):1435-9. 4. Kiecolt-Glaser JK, Glaser R, Gravenstein S, Malarkey WB, Sheridan J. Chronic stress alters the immune response to influenza virus vaccine in older adults. Proc. Natl. Acad. Sci. USA 1996;93:3043-47. 5. McGlone FB, Arden NH. Impact of influenza in geriatrics and action plan for prevention and treatment. Am. J. Med. (Suppl. A) 1987;82:55-57.
Book
This authoritative guide to sleep medicine is also available as an e-dition, book (ISBN: 1416003207) plus updated online reference! The new edition of this definitive resource has been completely revised and updated to provide all of the latest scientific and clinical advances. Drs. Kryger, Roth, and Dementand over 170 international expertsdiscuss the most recent data, management guidelines, and treatments for a full range of sleep problems. Representing a wide variety of specialties, including pulmonary, neurology, psychiatry, cardiology, internal medicine, otolaryngology, and primary care, this whos who of experts delivers the most compelling, readable, and scientifically accurate source of sleep medicine available today. Includes user-friendly synopses of important background information before all basic science chapters. Provides expert coverage of narcolepsy * movement disorders * breathing disorders * gastrointestinal problems * neurological conditions * psychiatric disturbances * substance abuse * and more. Discusses hot topics such as the genetic mechanisms of circadian rhythms * the relationship between obesity, hormones, and sleep apnea * sleep apnea and arterial hypertension * and more. Includes a new section on Cardiovascular Disorders that examines the links between sleep breathing disorders and cardiovascular abnormalities, as well as the use of sleep related therapies for congestive heart failure. Provides a new section on Womens Health and Sleep Disorders that includes information on the effects of hormonal changes during pregnancy and menopause on sleep. Features the fresh perspectives of 4 new section editors. Employs a more consistent chapter organization for better readability and easier navigation.
Article
Complaints of insomnia are common in patients with Parkinson's disease (PD). Melatonin has been shown to improve insomnia in some populations but has not been well studied in patients with PD. The primary aims of this pilot study were to assess endogenous melatonin secretion in PD patients by determining the time of dim-light melatonin onset (DLMO), and to compare the effect of exogenous melatonin (5 mg) therapy with placebo on nocturnal sleep in patients who complained of insomnia. A double-blind, placebo-controlled, cross-over trial was employed. Subjects (n=8) with PD and no evidence of depression, cognitive impairment, or primary sleep disorders participated in the 4-week protocol. During a 1-week treatment period, subjects took melatonin (5 mg) or placebo capsules (administered in random order) 30 minutes before bedtime, with a 1-week washout between treatments. DLMO was determined by RIA of blood samples. Nocturnal sleep was assessed by actigraphy. Subjective sleep quality was assessed with daily diaries and a weekly questionnaire. The mean DLMO was 21:05. During the melatonin treatment week there was a nonsignificant decrease in nocturnal waketime (20 minutes) and an increase in sleep efficiency (3%). Six subjects (75%) reported that they slept better during the melatonin treatment week. Results of this pilot study do not indicate that melatonin administration improves objective sleep in PD patients who complain of insomnia.
Article
Women between the ages of 40 and 59 years were classified as pre-, peri-, and postmenopausal, with and without hot flash symptoms, for comparison of somnographic sleep variables. Few differences in sleep variables were noted between the groups. However, peri- and postmenopausal women experiencing hot flashes (symptomatic) tended to have lower sleep efficiencies than those not experiencing hot flashes. As well, rapid-eye-movement (REM) latency was longer (p less than 0.05) in the symptomatic women (means = 94.2 min) than in the nonsymptomatic women (means = 71.4 min). Although an age difference existed between the menopausal status groups, it was less than a decade and a main group effect for sleep efficiency and REM latency was seen while controlling for age and/or depression.
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Insomnia is a prevalent health complaint in older adults. Behavioral and pharmacological treatments have their benefits and limitations, but no placebo-controlled study has compared their separate and combined effects for late-life insomnia. To evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for late-life insomnia. Randomized, placebo-controlled clinical trial, at a single academic medical center. Outpatient treatment lasted 8 weeks with follow-ups conducted at 3, 12, and 24 months. Seventy-eight adults (50 women, 28 men; mean age, 65 years) with chronic and primary insomnia. Cognitive-behavior therapy (stimulus control, sleep restriction, sleep hygiene, and cognitive therapy) (n = 18), pharmacotherapy (temazepam) (n = 20), or both (n = 20) compared with placebo (n = 20). Time awake after sleep onset and sleep efficiency as measured by sleep diaries and polysomnography; clinical ratings from subjects, significant others, and clinicians. The 3 active treatments were more effective than placebo at posttreatment assessment; there was a trend for the combined approach to improve sleep more than either of its 2 single components (shorter time awake after sleep onset by sleep diary and polysomnography). For example, the percentage reductions of time awake after sleep onset was highest for the combined condition (63.5%), followed by cognitive-behavior therapy (55%), pharmacotherapy (46.5%), and placebo (16.9%). Subjects treated with behavior therapy sustained their clinical gains at follow-up, whereas those treated with drug therapy alone did not. Long-term outcome of the combined intervention was more variable. Behavioral treatment, singly or combined, was rated by subjects, significant others, and clinicians as more effective than drug therapy alone. Subjects were also more satisfied with the behavioral approach. Behavioral and pharmacological approaches are effective for the short-term management of insomnia in late life; sleep improvements are better sustained over time with behavioral treatment.
Article
Pain and fatigue are two of the most common problems experienced by oncology patients. This study evaluated 24 oncology patients who were receiving radiation therapy for bone metastases to (1) describe the patterns of pain intensity and fatigue severity over a 48-hour period; (2) evaluate for sleep disturbances; (3) describe the relationships between these symptoms and various treatment characteristics; and (4) describe the self-care strategies used by patients to manage pain and fatigue. Patients reported moderate amounts of pain and fatigue. Average pain scores did not vary significantly over a 48-hour period. However, patients reported significantly lower fatigue scores in the morning compared to the evening. In addition, patients experienced significant sleep disturbances, with a mean sleep efficiency index of 70.7% (estimated using wrist actigraphy). Patients with lower Karnofsky Performance Status scores reported more sleep disturbances. In addition, patients who had received a higher percentage of their radiation treatment reported more sleep disturbances. Patients used a variety of self-care strategies to manage pain and fatigue. Additional research is warranted to describe more completely the patterns of pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy.
Article
Providing care to a family member with dementia has significant psychological and physical consequences. Sleep quality is likely affected by caregiving, yet this domain has received surprisingly little empirical study. In this study, sleep complaints were examined in 90 older women who were family caregivers of adults with dementia. Caregivers reported more sleep complaints than similarly aged healthy adults on all seven components of the Pittsburgh Sleep Quality Index, and a similar level of sleep complaints to those of sleep-impaired women and depressives on 6 and 4 components, respectively. Sleep medication was used by 38% of caregivers in the past month. The most common sleep complaints that occurred at least weekly were waking up in the night or early morning (84%), bathroom needs (83%), and sleep onset difficulties (41%). Sixty percent of the sample reporting nighttime care recipient disruptions stated that these disruptions occurred 3 or more times per week. Caregiver relationship and care recipient diagnosis were unrelated to sleep complaints. Lower levels of education, less internalized anger, care recipient disruptions, and psychological distress were related to poorer overall sleep quality. Sleep complaints are a common yet understudied problem in family caregivers.
Article
To describe sheltered battered women's sleep patterns and resulting daytime fatigue. The model for symptom management framed this study to describe one component of the model--symptom experience. Beginning evidence suggests that sheltered battered women experience disturbed sleep and fatigue that can interfere with vital activities. Descriptive using a convenience sample of 50 ethnically diverse women residing at least 21 days in battered women's shelters located in one western U.S. city. The study was done in 1997. The Pittsburgh Sleep Quality Index (PSQI), the Mini Motionlogger Actigraph, a sleep diary, the Visual Analogue Scale for Fatigue, and an open-ended interview were used to collect data. Descriptive and inferential statistics were used to analyze the quantitative data. Qualitative data were analyzed to determine patterns and themes. Seventy percent of the women had global PSQI scores of greater than five indicating poor sleep and 17 (34%) had a sleep efficiency index of 80% or less. Fourteen (28%) of the women went to bed very fatigued (> 66 mm) and 20 (40%) woke up very fatigued (> 33 mm). The majority of sheltered battered women experienced disturbed sleep and daytime fatigue. Both personal and environmental variables were found to significantly affect sleep patterns. Sheltered battered women can benefit from information about sleep disturbances and sleep enhancing self-care strategies.
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To describe changes in women's sleep patterns from prepregnancy to postpartum. Polysomnography was done in women's homes for 2 consecutive nights. Forty-five women were studied during the follicular and luteal phases of their menstrual cycles, and 33 conceived and were studied during each trimester of pregnancy. Twenty-nine were studied at 1 and 3 months postpartum. Compared with prepregnant sleep characteristics, significant changes in sleep patterns were evident by 11-12 weeks' gestation, with a significant increase in total sleep time but less deep sleep and more awakening during sleep. By the third month postpartum, there was improvement in sleep characteristics; however, sleep efficiency remained significantly lower than baseline prepregnancy values. Sleep disturbance was greatest during the first postpartum month, particularly for first-time mothers.
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To examine patterns of and relationships between activity, sleep, symptom distress, health status, and fatigue during and following adjuvant breast cancer chemotherapy with doxorubicin and cyclophosphamide. Prospective, descriptive, repeated measures. Midwestern, urban, oncology clinics. 14 women, ages 32-69 (X = 52.4), with stage I or II breast cancer receiving four cycles of chemotherapy. Wrist actigraph, modified Morin Sleep Diary, Symptom Experience Scale, Medical Outcomes Study-Short Form 36, and Piper Fatigue Scale were used to collect data two days prior to and during the 21-day cycle 3, and for three days at three weeks and two months following treatment 4. Activity, sleep, symptom distress, health status, and fatigue. Fluctuating patterns of lowered activity, disturbed sleep, mild-to-moderate symptom distress, and moderate fatigue were identified. Mean activity levels ranged from 65%-80% of norms during and following treatments. Patterns of sleep (total rest, sleep latency, wake after sleep onset, and sleep efficiency) differed from established norms. Patients experienced the highest levels of fatigue and symptom distress during the first four days after treatment 3. Correlates of fatigue were greater symptom distress, lower activity, and poorer physical and social health status; variables representing disturbed sleep trended toward associations with fatigue. Activity, sleep, symptom distress, and health status cluster in patterns associated with either lower or higher fatigue. Efforts to manage symptoms, remain active, and obtain quality sleep, especially in women with poorer health status, may assist in modifying fatigue.
Article
A cross-sectional, correlational design was used to describe and explore the relation between caregiver sleep and depression. For the study, 51 caregivers were recruited from two sites in southern California. Caregivers were primarily white (84%), female (80%), spouses (61%), or adult children (29%), who had provided care for a mean of 16 hours per day for an average of 2 years. The Center for Epidemiological Studies-Depression (CES-D)and the Pittsburgh Sleep Quality Index (PSQI) were used to measure caregiver depression and sleep, respectively. Most of the caregivers (95%) expressed severe sleep problems, and more than half of them were experiencing depressive symptoms at a level that would suggest risk for clinical depression. Correlations were strongest between caregiver depression and the sleep subscales of overall quality (r = 0.70; p < 0.001), habitual sleep efficiency (r = 0.54; p < 0.001), and daytime dysfunction (r = 0.59; p < 0.001). The final regression model, which included these subscales, predicted 63.6% of the variance in depression scores (F = 27.32; p < 0.001). These findings, which are consistent with results from other studies, suggest that caregivers of persons with terminal illness are at risk for clinical depression. It is critical for nurses to be cognizant of the relation between sleep problems and depression, and to explore interventions that would allow the caregivers to obtain needed sleep without diminishing their ability to function in their role as caregiver.
Article
Difficulties with sleep and daytime sleepiness are common complaints among adults in the United States. During the past decade, the use of herbal preparations among adults increased from 2.5% to 12.4%. This article presents relevant aspects of the 1994 Dietary Supplements Health and Education Act that stimulated the proliferation of herbal medicinals and reviews the pharmacological properties of the most commonly available herbal wake-promoting and sedating products. Given the rapid increase in use of herbals, health care professionals need to educate themselves and their patients about the use of these preparations.
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Changes in the health care system have resulted in a shift of cancer care from the in-patient arena to ambulatory and home settings. This shift has likewise translated into increased family involvement in the day-to-day care of the person with cancer. Cancer patients have multifaceted needs, including disease and treatment monitoring, symptom management, medication administration, emotional support, assistance with personal care, and assistance with instrument care. Family caregivers may be ill prepared to assume these tasks, requiring information on the disease and treatment, as well as instruction in technical and care skills. Moreover, caregiving must be balanced against already established roles and role responsibilities. In addition, family caregivers have their own emotional responses to the patients' diagnosis and prognosis, and may require coaching and emotional support themselves. The health care system can facilitate positive outcomes by embracing the family caregiver as a partner in the health care team, providing instruction and guidance to the caregiver as he/she assumes this role, and evaluating the home care situation. Research to date has only scratched the surface of testing interventions that meet the needs of the cancer caregiver. A research agenda is proposed to more fully elucidate the cancer caregiver's experience throughout the illness and treatment trajectory, and identify the means to effecting positive outcomes for the person with cancer, their family caregiver, and the health care system.
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Heart rate variability (HRV) measurement is an important tool in cardiac care that can provide clinicians and researchers with a 24-hour noninvasive measure of autonomic nervous system activity. Sleep and wake have profoundly different effects on HRV patterns and therefore significant implications for HRV interpretation. This article provides a brief overview of the processes underlying HRV, the standard measures of HRV, a basic overview of wake and sleep, the HRV patterns associated with different sleep and wake states, and the patterns of HRV exhibited in common cardiac conditions. The article concludes with an overview of some general health history factors that are important to consider when interpreting HRV patterns in the clinical and research setting.
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Synthesis of studies of sleep and aging show major increases occur in nighttime awakening and major decreases occur in sleep depth over the life span. Fatigue and drowsiness during the day, with increased napping, and earlier bedtimes, are also prevalent in the elderly. Interventions that impact these sleep variables, as well as sleep variables that change less dramatically, are needed. All indications are that the promotion of restorative sleep and daytime well-being in older adults will continue to be an important part of nursing practice affecting even more people as the population ages. Although nurses have only begun to identify and study interventions that promote sleep in nursing environments, nursing is in a position to make major contributions to the health and well-being of older adults who experience sleep disruption, especially sleep disruptions secondary to illness and aging.
Article
Naturally fluctuating hormones (menstrual cycle, through pregnancy or menopausal transition) are not related to marked sleep disturbances in women. It is likely, however, that subsets of women will display a central nervous system vulnerability to hormonal fluctuations so that sleep disturbances manifest as a part of a complex of discomforting symptoms. Sleep is impacted directly through the circadian system or brain sleep regulation or through the development of concurrent functional changes and symptoms. Women are susceptible to sleep-related disorders that are also common in men, such as primary insomnia and SBD although the contributing factors and manifestations may not be the same.
Article
Sleep disorders are common in childhood, and may affect multiple aspects of a child's life and the lives of other family members. A sleep disorder assessment should begin with detailed sleep history and a review of interrelated health issues. Factors contributing to disturbed sleep may be discovered or confirmed by a thorough physical examination. Thereafter, appropriate ancillary testing can provide support for a specific clinical diagnosis. The spectrum of childhood sleep disorders includes OSA, narcolepsy, RLS/PLMD, sleep onset association disorder, and parasomnias. Diagnosing sleep disorders in children remains a challenge; however, a multidisciplinary approach may provide an opportunity for productive collaboration and, thereby, more effective patient management. Centers treating pediatric sleep disorders may include providers from a variety of disciplines in pediatric healthcare, such as child psychology, pulmonology, neurology, psychiatry, nursing, and otolaryngology. Over the last decade, research in pediatric sleep disorders has expanded greatly, paralleled by an increased awareness of the importance of adequate, restorative sleep in childhood.
Article
Patients with persistent insomnia are long-suffering and in dire need of treatment. These individuals can be a challenge to treat. Duration and severity of the problem, current and prior use of sleeping medications, medical and psychiatric conditions, and experience with rebound insomnia are just some of the factors that affect treatment. Most of the insomnia problems that nurses encounter are secondary to a medical or psychiatric condition. Knowledge of assessment methods and implementation of nonpharmacological interventions can make a substantial contribution to the quality of life of persons with insomnia.
Article
The timing and synchronization of human circadian rhythms is important for health and well-being. Some individuals, for reasons that remain unclear, display less resilience or flexibility in their ability to synchronize to the 24-hour world and are thus diagnosed with a circadian schedule disorder. The objective of this article is to briefly introduce concepts about human circadian timing and to review what is known about chronic, long-term circadian schedule disorders such as delayed sleep phase syndrome, advanced sleep phase syndrome, irregular sleep-wake patterns, and non-24-hour sleep-wake disorder. Practical considerations for the clinician caring for these individuals are discussed.
Article
Sleep is a complex behavior; adequate sleep is essential for healthy functioning and even for survival. Poor sleep quality and insufficient sleep have been linked to increased risk for various illnesses, as well as with an increased prevalence of excessive daytime sleepiness and reduced quality of life. Daytime sleepiness can lead to dangerous outcomes associated with drowsy driving and has become an important public health issue. Routine health examinations that include questions about sleep habits, daytime sleepiness, and problems with sleep at night can help to educate people about the importance of good sleep habits. They provide a way to identify sleep disorders so that appropriate therapies can be instituted or proper referrals to a sleep specialist can be given.
Article
Limited data are available on the relationship between self-reported sleep quality, fatigue, and behavioral sleep patterns in women with fibromyalgia (FM). To compare self-reported sleep quality, fatigue, and behavioral sleep indicators obtained by actigraphy between women with FM and sedentary women without pain, and to examine relationships among these variables. Twenty-three women with FM (M = 47.3, +/- 6.7 years) and 22 control women (M = 43.5, +/- 8.2 years) wore an actigraph on the nondominant wrist for 3 consecutive days at home. Each day women reported bedtimes, rise times, and ratings of sleep quality and fatigue in a diary. Self-reported sleep quality, fatigue, and indicators of sleep quality obtained from actigraphy (e.g., total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and fragmentation index) were averaged. The Mann Whitney U test was used to assess group differences. Pearson Product Moment Correlation was used to evaluate relationships between sleep quality and fatigue, and among sleep quality, fatigue, and actigraphy sleep indicators. Women with FM reported poorer sleep quality and more fatigue compared to controls (both p <.001). Actigraphy sleep indicators were not different between groups. In women with FM but not in controls, self-reported sleep quality was directly related to actigraphy indicators of total sleep time (r =.635, p <.01) and inversely related to sleep fragmentation (r = -.46, p <.05). Fatigue in women with FM was directly related to actigraphy indicators of wake after sleep onset (r =.57, p <.01), and inversely related to sleep efficiency (r = -.545, p <.01). Self-reported sleep quality and fatigue are associated with behavioral indicators of sleep quality at home in women with FM. Actigraphy is a useful objective measure of improved sleep outcomes in intervention studies.
Article
Although nocturnal voiding is frequently attributed to urologic disorders, nocturia and enuresis are also important symptoms of sleep-disordered breathing. However, polyuria can be elicited by obstructive sleep apnea as well as bedrest, microgravity and other experimental conditions where the blood volume is shifted centrally to the upper body. The nocturnal polyuria of sleep apnea is an evoked response to conditions of negative intrathoracic pressure due to inspiratory effort posed against a closed airway. The mechanism for this natriuretic response is the release of atrial natriuretic peptide due to cardiac distension caused by the negative pressure environment. This cardiac hormone increases sodium and water excretion and also inhibits other hormone systems that regulate fluid volume, vasopressin and the rennin-angiotensin-aldosterone complex. Treatment of sleep apnea and airway compromise has been shown to reverse nocturnal polyuria and thereby reduce or eliminate nocturia and enuresis. Thus, careful evaluation of nocturia and enuresis for evidence of nocturnal polyuria can increase the diagnostic certainty of referring primary care providers and sleep specialists. In addition, the resolution of these bothersome symptoms after treatment can contribute to patient satisfaction as well as reinforce treatment compliance.
Article
Many patients with Parkinson's disease (PD) experience sleep-related symptoms. Studies in other populations indicate that melatonin can increase sleep efficiency, decrease nighttime activity, and shorten sleep latency, but there has been little research on the use of melatonin in PD. The purpose of this study was to compare the effects of two doses of melatonin to placebo on sleep, daytime sleepiness, and level of function in patients with PD who complained of sleep disturbances. A multi-site double-blind placebo-controlled cross-over trial was employed; 40 subjects completed the 10-week protocol. There was a 2-week screening period, 2-week treatment periods, and 1-week washouts between treatments. Nocturnal sleep was assessed by actigraphy and diaries, whereas daytime sleepiness and function were assessed by the Epworth Sleepiness Scale (ESS), Stanford Sleepiness Scale (SSS), and General Sleep Disturbance Scale (GSDS). Repeated measures analysis of variance revealed a significant improvement in total nighttime sleep time during the 50 mg melatonin treatment compared to placebo. There was significant improvement in subjective sleep disturbance, sleep quantity, and daytime sleepiness during the 5 mg melatonin treatment compared to placebo as assessed by the GSDS. Although we found a statistically significant improvement in actigraphically measured total sleep time on 50 mg melatonin compared to 5 mg or placebo, this small improvement (10 min) may not be clinically significant. However, the significant improvement found in subjective sleep disturbance suggests that these modest effects may be clinically relevant in this patient population.
Narcolepsy: The nurse's role in assessment and management
  • A Rogers
  • K A Lee
  • C Guilleminault
Rogers A, Lee KA, Guilleminault C. Narcolepsy: The nurse's role in assessment and management. American Academy of Sleep Medicine Web site. Available at: http:// www.aasmnet.org/MEDSLeepprogram.htm.
Restless legs syndrome and periodic limb movement disorder
  • K Parker
  • K A Lee
  • C Guilleminault
Parker K, Lee KA, Guilleminault C. Restless legs syndrome and periodic limb movement disorder. American Academy of Sleep Medicine Web site. Available at: http://www. aasmnet.org/MEDSLeepprogram.htm.
Critical care nursing: Diagnosis and management
  • Kc Richards
  • L Sleep Disorders Thelan
  • M Urden
  • K Lough
  • K Stacy
Richards KC. Sleep disorders. In: Thelan L, Urden M, Lough K, Stacy K, Eds. Critical care nursing: Diagnosis and management (4th ed). St. Louis, MO: Mosby, 2001.
Managing sleep and waking behaviors and the symptom of fatigue
  • Shaver
Shaver JLF. Managing sleep and waking behaviors and the symptom of fatigue. In: Hindshaw AS, Feethman SL, Shaver JLF, Eds. Handbook of clinical nursing research. Thousand Oaks, CA: Sage Publications; 1999. p. 435-58.
Excessive daytime sleepiness in older adults Geriatric nursing protocols for best practice
  • Mg Umlauf
  • Er Chasens
  • Te Weaver
Umlauf MG, Chasens ER, Weaver TE. Excessive daytime sleepiness in older adults. In: Mezey M, Fulmer T, Abraham I, Eds. Geriatric nursing protocols for best practice. (2nd ed).
The effect of bright light therapy on the sleep-wake rhythm in institutionalized patients with Alzheimer's disease (AD)
  • G A Dowling
  • E Hubbard
  • J Mastick
  • J Luxenberg
  • Van Someren
  • J W Eus
Dowling GA, Hubbard E, Mastick J, Luxenberg J, Van Someren, Eus JW, et al. The effect of bright light therapy on the sleep-wake rhythm in institutionalized patients with Alzheimer's disease (AD). International Psychogeriatrics 2003;15(Suppl 2):330 -1.
Study of insomnia and sleep loss Symptom Research: Methods and Opportunities (interactive, Web-based textbook) National Institute of Dental and Craniofacial Research
  • J Shaver
  • B Mitchell
  • Md Max
  • J Lynn
Shaver J. Study of insomnia and sleep loss. In: Mitchell B, Max MD, Lynn J, Eds. Symptom Research: Methods and Opportunities (interactive, Web-based textbook). National Institute of Dental and Craniofacial Research, National Institutes of Health. Available at: http://symptomresearch. nih.gov/.
Compliance and CPAP treatment for sleep apnea
  • T E Weaver
  • K A Lee
  • C Guilleminault
Weaver TE, Lee KA, Guilleminault C. Compliance and CPAP treatment for sleep apnea. American Academy of Sleep Medicine Web site. Available at: http://www.aasmnet. org/MEDSLeepprogram.htm.
National institutes of Health NHLBI Website: Available at
National Center on Sleep Disorders Research 2003 Sleep Research Plan. National institutes of Health NHLBI Website: Available at: http://www.nhlbi.nih.gov/about/ ncsdr/research/research-a.htm.
Overview of sleep disorders for primary care
  • C A Landis
  • K A Lee
  • C Guilleminault
Landis CA, Lee KA, Guilleminault C. Overview of sleep disorders for primary care. American Academy of Sleep Medicine Web site. Available at: http://www.aasmnet.org/ MEDSLeepprogram.htm.
Rest and sleep Fundamentals of contemporary nursing practice
  • Ka Lee
  • Chapter
Lee KA. Chapter 18: Rest and sleep. In: Lindeman C, McAthie M, Eds. Fundamentals of contemporary nursing practice. Philadelphia, PA: WB Saunders Co; 1999. p. 723-44.
  • D R Epstein
  • R R Bootzin
  • Insomnia
Epstein DR, Bootzin RR. Insomnia. Nurs Clin North Am 2002;37:611-31.
  • K Parker
Parker K. Sleep and Dialysis. (Vol. Ed). Amer Nephrology Nurs Assoc (ANNA), 1997:24.
  • D Epstein
Epstein D. Sleep Disorders (Vol. Ed.). Nurs Clin North Am 2002;37:xiii.
Sleep loss in health and illness: An overview for nurses
  • K A Lee
  • C A Landis
  • C Guilleminault
Lee KA, Landis CA, Guilleminault C. Sleep loss in health and illness: An overview for nurses. American Academy of Sleep Medicine Web site. Available at: http://www.aasmnet. org/ MEDSLeepprogram.htm.
The nurse's role in assessment and management
  • A Rogers
  • K A Lee
  • C Guilleminault
  • Narcolepsy
Rogers A, Lee KA, Guilleminault C. Narcolepsy: The nurse's role in assessment and management. American Academy of Sleep Medicine Web site. Available at: http:// www.aasmnet.org/MEDSLeepprogram.htm.
Philadelphia: WB Saunders Co
  • K A Lee
Lee KA. Chapter 20: Impaired Sleep. In: Carrieri-Kohlman V, Lindsay AM, West CM, Eds. Pathophysiological phenomena in nursing. (3rd ed). Philadelphia: WB Saunders Co; 2003. p. 363-85.
Fundamentals of nursing: Concepts, process and practice
  • S L Merritt
  • Sleep
Merritt SL. Sleep. In: Potter P, Perry A, Eds. Fundamentals of nursing: Concepts, process and practice. St. Louis, MO: CV Mosby; 1997. p. 1128-52.
  • D Epstein
Epstein D. Sleep Disorders (Vol. Ed.). Nurs Clin North Am 2002;37:xiii.
Geriatric nursing protocols for best practice
  • M G Umlauf
  • E R Chasens
  • T E Weaver
Umlauf MG, Chasens ER, Weaver TE. Excessive daytime sleepiness in older adults. In: Mezey M, Fulmer T, Abraham I, Eds. Geriatric nursing protocols for best practice. (2nd ed). New York, NY: Springer Publishing Company; 2003.
Symptom Research: Methods and Opportunities (interactive, Web-based textbook). National Institute of Dental and Craniofacial Research
  • J Shaver
Shaver J. Study of insomnia and sleep loss. In: Mitchell B, Max MD, Lynn J, Eds. Symptom Research: Methods and Opportunities (interactive, Web-based textbook). National Institute of Dental and Craniofacial Research, National Institutes of Health. Available at: http://symptomresearch. nih.gov/.
Roles of circadian rhythmicity and sleep in glucose regulation. Review
  • Van Cauter