Sleep hygiene in paramedics: What do they know and what do they do?

The Occurrence of Anxiety, Depression, and Distress among Professionals Working in Emergency Care

Maintaining mental health is essential for professions with higher stress levels and challenging environments, including emergency specializations. In this study, the occurrence of distress, anxiety, and depression among a group of ambulance and hospital emergency care professionals was assessed (n = 202). A cross-sectional, quantitative, descriptive online survey was conducted, including the internationally validated Beck depression inventory (BDI), the perceived stress scale (PSS-14), and the State-Trait Anxiety Inventory (STAI). Statistical analyses involved descriptive statistics, the χ2-test, Mann-Whitney U test, Kruskal-Wallis test, Dunn-Bonferroni test, logistic regression (LR), Cramer coefficient (Cramer's V), Kolmogorov-Smirnov test, and Spearman's rank correlation coefficient (rs). Based on the results, female professionals are more likely to have depressive symptoms (OR = 2.6, 95% CI = 1.3-5.1), perceived stress (OR = 1.2, 95% CI = 1.2-4.1), and anxiety (OR = 2.1, 95% CI = 1.0-4.1) than male professionals. Perceived stress levels decreased proportionally with increasing years spent working in healthcare (OR = 7.4, 95% CI = 7.1-8.3). Extended work shifts of 12 or 24 h increase the risk of perceived stress and anxiety in emergency care workers (p = 0.02). Customized stress management interventions are needed to mitigate the amplified mental strain associated with gender, working years, and longer shifts in the emergency care sector to sustain their mental health and well-being.

'It's satisfying but destructive': A qualitative study on the experience of bedtime procrastination in new career starters

BACKGROUND

Bedtime procrastination, the volitional delay of going to bed without any external circumstances causing the delay, is linked to multiple indicators of inadequate sleep. Intervening to reduce bedtime procrastination may be an important avenue to improve sleep outcomes, yet the phenomenon remains poorly understood in populations at risk for bedtime procrastination. New career starters, those who have graduated from tertiary education and started a new full-time job within the past 12 months, may be susceptible to problematic bedtime procrastination and are at an opportune time for a 'fresh start' to change behaviour.

AIMS

The objectives of this study were to understand how bedtime procrastination is experienced and perceived by new career starters, to identify the enablers and barriers to behaviour change in new career starters and to explore themes for future interventions.

MATERIALS & METHODS

Data were collected through in-depth semi-structured interviews with 28 participants.

RESULTS

Inductive thematic analysis was used to find seven themes: (1) negative feelings before and during bedtime procrastination; (2) wanting to versus knowing I shouldn't; (3) difficulty falling asleep; (4) influence of automatic processes; (5) consequences of bedtime procrastination; (6) lack of self-control and (7) technology captures late-night attention. Participants emphasised the need for me-time, self-negotiation to continue procrastinating and knowledge of the value of sleep.

DISCUSSION & CONCLUSION

Findings suggest that bedtime procrastination involves both reflective and automatic cognitive processes. Future interventions would benefit from a dual-process approach, using cognitive and behavioural techniques to reduce bedtime procrastination.

Healthy sleep practices for shift workers: consensus sleep hygiene guidelines using a Delphi methodology

STUDY OBJECTIVES

The unique requirements of shift work, such as sleeping and working at variable times, mean that current sleep hygiene guidelines may be inappropriate for shift workers. Current guidelines may also contradict fatigue management advice (e.g. advising against daytime napping). The present study utilized a Delphi methodology to determine expert opinion regarding the applicability of current guidelines for shift workers, the appropriateness of the term "sleep hygiene," and develop tailored guidelines for shift workers.

METHODS

The research team reviewed current guidelines and existing evidence to draft tailored guidelines. Seventeen individual guidelines, covering sleep scheduling, napping, sleep environment, bedtime routine, substances, light exposure, diet, and exercise were drafted. Experts from sleep, shift work, and occupational health fields (n = 155) were invited to review the draft guidelines using a Delphi methodology. In each round, experts voted on individual guidelines, with 70% agreement considered consensus. Where consensus was not reached, written feedback from experts was discussed and incorporated into subsequent iterations.

RESULTS

Of the experts invited, 68 (44%) agreed to participate, with 55 (35%) completing the third (final) round. Most experts (84%) agreed that tailored guidelines were required for shift workers. Consensus was reached on all guidelines after three rounds. One additional guideline (sleep inertia) and an introductory statement were developed, resulting in a final set of 18 individual guidelines, termed "healthy sleep practices for shift workers."

CONCLUSIONS

This is the first study to develop tailored sleep hygiene guidelines for shift workers. Future research should investigate the acceptability and effectiveness of these guidelines amongst shift workers.

A preliminary framework for managing sleep inertia in occupational settings

Sleep inertia, the temporary period of impairment experienced upon waking, is a safety hazard that has been implicated in serious work-related incidents resulting in injuries as well as the loss of life and assets. As such, sleep inertia warrants formal management in industries where personnel are required to undertake their role soon after waking (e.g. emergency services, engineers, and health care). At present, there is a lack of practical, evidence-based guidance on how sleep inertia could be formally managed at an organizational level. We propose a preliminary framework for managing sleep inertia based on the translation of research findings into specific work procedure modifications/control mechanisms. Within the framework, work procedure modifications/control mechanisms to manage sleep inertia are organized into three levels: (1) modifications/controls that eliminate the chance of sleep inertia, (2) modifications/controls that reduce sleep inertia severity, and (3) modifications/controls that manage the risk of errors during sleep inertia. Practical considerations, limitations, and areas of further research are highlighted for each modification/control to help determine how readily each control measure could be implemented by industries at present. A guide for organizations to use this preliminary framework of sleep inertia management is put forward, as well as the next research priorities to strengthen the utility and evidence base of the framework. This paper is part of the Sleep and Circadian Rhythms: Management of Fatigue in Occupational Settings Collection.

Effect of Work-Related Behavior and Experience Patterns on Sleep Quality in Emergency Medical Service Personnel

OBJECTIVE

The aim of this study was to examine the influence of work-related behavior and experience patterns on sleep quality in emergency medical service personnel.

METHODS

From the total sample of 508 emergency medical service workers who took part in the Germany-wide online survey, 368 respondents completed the questionnaires on sleep characteristics (Pittsburgh Sleep Quality Index [PSQI]) and work-related behavior and experience pattern. Three hundred sixty-seven of the 368 participants also finished the Regensburg Insomnia Scale.

RESULTS

Based on their work-related behavior and experience pattern results, individuals were categorized into one of the four following patterns: two risk patterns (A, B) and two healthy behavior and experience patterns (G, S). Participants that were classified into risk-pattern A and B (33.85%) scored significantly higher in both PSQI and Regensburg Insomnia Scale overall score and all PSQI components implicating a poorer sleep quality. A total of 78.5% of the individuals with pattern A and B were considered bad sleepers whereas only 43.4% of individuals with pattern G and S were scored as bad sleepers.

CONCLUSIONS

Work-related behavior and experience patterns showed a strong association to sleep characteristics and may therefore be used to identify appropriate preventative measures.

Sleep and mental health in recruit paramedics: a 6-month longitudinal study

STUDY OBJECTIVES

To explore potential relationships and longitudinal changes in sleep and mental health in recruit paramedics over the first 6 months of work, and whether sleep disturbances pre-emergency work predict future mental health outcomes.

METHODS

Participants (N = 101, 52% female, Mage = 26 years) completed questionnaires prior to (baseline), and after 6 months of emergency work to assess for symptoms of insomnia, obstructive sleep apnea, post-traumatic stress disorder (PTSD), depression, anxiety, and trauma exposure. At each timepoint, participants also completed a sleep diary and wore an actigraph for 14 days to assess sleep patterns. Correlations between baseline sleep and mental health were conducted and changes in these variables across timepoints were examined using linear mixed models. Hierarchical regressions assessed whether sleep at baseline predicted mental health at follow-up.

RESULTS

Insomnia and depression symptoms, and total sleep time increased while sleep onset latency decreased across the first 6 months of emergency work. Participants experienced an average of 1 potentially traumatic event during the 6-month period. Baseline insomnia predicted increased depression symptoms at the 6-month follow-up, while baseline wake after sleep onset predicted follow-up PTSD symptoms.

CONCLUSION

Results highlight an increase in insomnia and depression across the initial months of emergency work, while sleep disturbances before emergency work were identified as potential risk factors for the development of depression and PTSD among paramedics in their early career. Screening and early interventions targeting poor sleep at the beginning of emergency employment may assist in reducing the risk of future mental health outcomes in this high-risk occupation.

Does knowledge of sleep hygiene recommendations match behaviour in Australian shift workers? A cross-sectional study

OBJECTIVES

Shiftworkers routinely obtain inadequate sleep, which has major health consequences. Sleep hygiene describes a range of behaviours, lifestyle and environmental factors that can improve sleep. To date, limited research has examined sleep hygiene in shiftworkers. This study aimed to assess the sociodemographic and behavioural correlates of sleep hygiene knowledge and engagement with sleep hygiene practices in Australian shiftworkers.

STUDY DESIGN

An online, cross-sectional survey.

SETTING AND PARTICIPANTS

Australian adults from across multiple industries (n=588) who work shift work.

MEASURES

The online survey included questions regarding sleep hygiene knowledge and questions from modified versions of the Pittsburgh Sleep Quality Index and Sleep Hygiene Index.

RESULTS

Of the 588 participants, 52.9% reported having heard of 'sleep hygiene'. Of these participants, 77.5% reported understanding the term moderately, extremely or very well. Engagement with each sleep hygiene practice was varied. Common sleep hygiene practices were controlling the bedroom environment (eg, a cool, dark and quiet bedroom). Less common practices were avoiding light as bedtime approaches. Logistic regressions revealed that shiftworkers who had heard of sleep hygiene were more likely to engage in sleep hygiene practices and had better sleep quality compared with those who had not heard of sleep hygiene. Increased engagement in sleep hygiene practices did not predict the likelihood of individuals reporting better sleep quality.

CONCLUSIONS

Shiftworkers demonstrated varied knowledge, understanding and engagement with individual sleep hygiene practices. Future research should focus on the development of sleep hygiene interventions that accommodate the unique challenges of shift work to optimise sleep.