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Wu JY, Li H, Shuai JK, He Y, Li PC. Evidence summary on the non-pharmacological management of sleep disorders in shift workers. Sleep Breath 2024; 28:909-918. [PMID: 37587356 PMCID: PMC11136795 DOI: 10.1007/s11325-023-02901-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE This study aimed to evaluate, and integrate the relevant evidence on the non-pharmacological management of sleep disorders in shift workers to provide a reference for improving sleep of shift workers. METHODS According to the "6S" pyramid model of evidence, a comprehensive search was conducted in evidence-based databases, including BMJ-Best Practice, UpToDate, DynaMed, Cochrane Library, and Joanna Briggs Institute (JBI); clinical practice guideline websites, such as the Guidelines International Network; professional association websites, such as the World Sleep Society; and literature databases, including PubMed, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Biology Medicine disc (CBM) from inception to November 30, 2022. Two researchers independently evaluated the literature in accordance with the evaluation standards; conducted the extraction, classification, and synthesis of the evidence; and evaluated its grade and recommendation grade. RESULTS A total of 18 studies were included, including 2 clinical decisions, 2 guidelines, 3 expert consensuses, and 11 systematic reviews. In total, 25 pieces of evidence were summarized from 6 aspects: sleep assessment, sleep scheduling, sleep hygiene, light therapy, workplace intervention, and other managements. CONCLUSION This study summarized the best evidence for the non-pharmacological management of sleep disorders in shift workers. Shift workers should reasonably arrange their sleep time and develop good sleep hygiene. Additionally, work organizations should jointly promote sleep to improve the sleep conditions of shift workers and promote their physical and mental health.
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Affiliation(s)
- Jin-Yu Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
- West China School of Nursing, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
| | - Hui Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
- West China School of Nursing, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
| | - Jun-Kun Shuai
- Department of Emergency Medicine, Affiliated Hospital of Chengdu University, No.82, North 2nd Section, 2nd Ring Road, Chengdu, 610081, Sichuan, China
| | - Yue He
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
- West China School of Nursing, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
| | - Peng-Cheng Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China.
- West China School of Nursing, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China.
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2
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McAlpine T, Mullan B, Clarke PJF. Re-considering the Role of Sleep Hygiene Behaviours in Sleep: Associations Between Sleep Hygiene, Perceptions and Sleep. Int J Behav Med 2023:10.1007/s12529-023-10212-y. [PMID: 37672195 DOI: 10.1007/s12529-023-10212-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Sleep hygiene behaviours are a suggested set of behaviours people can engage in to improve sleep. However, there are numerous issues relating to the measurement of sleep hygiene, primarily, the lack of consensus as to which behaviours impact sleep and should therefore be included in scales. METHOD Cross-sectional correlational methods were used to assess the association between sleep quality, a highly inclusive range of sleep hygiene behaviours, and individual perceptions of those behaviours in a non-clinical sample of 300 participants. RESULTS Of the 35 sleep hygiene behaviours assessed, 18 were independently associated with sleep quality. Post-hoc factor analysis revealed that behaviours clustered together across four factors. A 'routine' factor included behaviours such as going to bed and waking up at the same time each night, and were important predictors of sleep quality, as were behaviours belonging to the 'perseverative cognition' and 'negative emotionality' factor. Other behaviours related to physiological processes like exposure to sunlight during the day and going to bed hungry were also significantly associated with sleep. Negative perceptions moderated the relationship between daytime exposure to sunlight and sleep. CONCLUSIONS Although certain behaviours were significantly related to sleep, almost half were not, supporting the need to examine the association between sleep and behaviours used for sleep hygiene recommendations more critically. Reframing sleep hygiene recommendations into a condensed set of shared underlying mechanisms may be of benefit for the development of sleep hygiene scales and interventions in non-clinical populations.
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Affiliation(s)
- Thomas McAlpine
- enAble Institute, Curtin University, Bentley, WA, 6102, Australia
- School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Barbara Mullan
- enAble Institute, Curtin University, Bentley, WA, 6102, Australia.
- School of Population Health, Curtin University, Bentley, WA, 6102, Australia.
| | - Patrick J F Clarke
- enAble Institute, Curtin University, Bentley, WA, 6102, Australia
- School of Population Health, Curtin University, Bentley, WA, 6102, Australia
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Mantua J, Ritland BM, Naylor JA, Simonelli G, Mickelson CA, Choynowski JJ, Bessey AF, Sowden WJ, Burke TM, McKeon AB. Physical sleeping environment is related to insomnia risk and measures of readiness in US army special operations soldiers. BMJ Mil Health 2023; 169:316-320. [PMID: 34301851 DOI: 10.1136/bmjmilitary-2021-001801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND US military service members have characteristically poor sleep, even when 'in garrison' or at one's home base. The physical sleeping environment, which is often poor in military-provided housing or barracks, may contribute to poor sleep quality in soldiers. The current study aimed to assess whether the sleeping environment in garrison is related to sleep quality, insomnia risk and military readiness. METHODS Seventy-four US army special operations soldiers participated in a cross-sectional study. Soldiers were queried on their sleeping surface comfort and the frequency of being awakened at night by excess light, abnormal temperatures and noise. Subjective sleep quality and insomnia symptoms were also queried, via the Pittsburgh Sleep Quality Index and Insomnia Severity Index, respectively. Lastly, measures of soldier readiness, including morale, motivation, fatigue, mood and bodily pain, were assessed. RESULTS Soldiers reporting temperature-related and light-related awakenings had poorer sleep quality higher fatigue and higher bodily pain than soldiers without those disturbances. Lower ratings of sleeping surface comfort were associated with poorer sleep quality and lower motivation, lower morale, higher fatigue and higher bodily pain. Each 1-point increase in sleeping surface comfort decreased the risk for a positive insomnia screen by 38.3%, and the presence of temperature-related awakenings increased risk for a positive insomnia screen by 78.4%. Those living on base had a poorer sleeping environment than those living off base. CONCLUSION Optimising the sleep environment-particularly in on-base, military-provided housing-may improve soldier sleep quality, and readiness metrics. Providers treating insomnia in soldiers should rule out environment-related sleep disturbances prior to beginning more resource-intensive treatment.
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Affiliation(s)
- Janna Mantua
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - B M Ritland
- Human Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - J A Naylor
- 75th Ranger Regiment, Ft. Benning, Georgia, USA
| | - G Simonelli
- Department of Psychology, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Department of Psychology, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - C A Mickelson
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - J J Choynowski
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - A F Bessey
- Department of Psychology, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - W J Sowden
- Department of Behavioral Health, Tripler Army Medical Center, Tripler Army Medical Center, Hawaii, USA
| | - T M Burke
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - A B McKeon
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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van den Berg NH, Michaud X, Pattyn N, Simonelli G. How Sleep Research in Extreme Environments Can Inform the Military: Advocating for a Transactional Model of Sleep Adaptation. Curr Psychiatry Rep 2023; 25:73-91. [PMID: 36790725 DOI: 10.1007/s11920-022-01407-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 02/16/2023]
Abstract
PURPOSE OF REVIEW We review the literature on sleep in extreme environments. Accordingly, we present a model that identifies the need for mitigating interventions to preserve sleep quality for military deployments. RECENT FINDINGS Situational factors that affect sleep in extreme environments include cold temperatures, isolated and confined areas, fluctuating seasonality, photoperiodicity, and extreme latitudes and altitudes. Results vary across studies, but general effects include decreased total sleep time, poor sleep efficiency, and non-specific phase delays or phase advances in sleep onset and sleep architecture. Considering habitability measures (e.g., light or temperature control) and individual differences such as variable stress responses or sleep need can mitigate these effects to improve mood, cognition, and operational performance. Although the situational demands during military missions inevitably reduce total sleep time and sleep efficiency, mitigating factors can attenuate sleep-related impairments, hence allowing for optimal mission success and personnel safety.
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Affiliation(s)
- N H van den Berg
- Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord de l'Île-de-Montréal, Montreal, Quebec, Canada.,School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - X Michaud
- Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord de l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Psychology, Faculty of Arts and Science, Université de Montréal, Montreal, Quebec, Canada
| | - N Pattyn
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Human Physiology Department (MFYS), Vrije Universiteit Brussel, Brussels, Belgium.,VIPER Research Unit, Royal Military Academy, Brussels, Belgium
| | - G Simonelli
- Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord de l'Île-de-Montréal, Montreal, Quebec, Canada. .,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada. .,Department of Neuroscience, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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Abanes JJ, Ridner SH, Dietrich MS, Hiers C, Rhoten B. Acupuncture for Sleep Disturbances in Post-Deployment Military Service Members: A Randomized Controlled Trial. Clin Nurs Res 2021; 31:239-250. [PMID: 34229475 DOI: 10.1177/10547738211030602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This RCT and mixed-methods study examined the difference between two groups receiving the following interventions: (1) brief manual standardized stress acupuncture (MSSA) combined with an abbreviated Cognitive Behavioral Therapy (ACBT) versus (2) ACBT alone. Three study aims: Aim (1): Insomnia Severity Index (ISI) and Pittsburg Sleep Quality Index (PSQI) scores were analyzed using descriptive summaries, linear regression, and reliable change index (RCI). Aim (2): Journal entries were analyzed using content analysis. Aim (3): Acupuncture Expectancy Scale (AES) scores were analyzed using paired t-test and RCI. Aim (1): Both groups demonstrated similar improvements in the ISI scores (p = .480). Aim (2): The ACBT/MSSA group reported greater benefits in sleep and in other life areas including mental, physical, and social functioning. Aim (3): The AES showed that 21.6% had a clinically meaningful increase in expectations in the effect of acupuncture for stress (p = .965). The study was registered in ClinicalTrials.gov (NCT04031365) at https://clinicaltrials.gov/ct2/show/NCT04031365 on July 24, 2019.
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Affiliation(s)
| | | | - Mary S Dietrich
- Vanderbilt University School of Nursing, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Cynthia Hiers
- James H. Quillen VA Medical Center, Sevierville, TN, USA
| | - Bethany Rhoten
- Vanderbilt University School of Nursing, Nashville, TN, USA
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Mantua J, Pirner MC, Doyle ST, Bessey AF, Naylor JA, Ritland BM, Sowden WJ, Burke TM, McKeon AB. Sleep and occupational well-being in active duty special operations soldiers: A replication and expansion. Sleep Health 2021; 7:500-503. [PMID: 33685830 DOI: 10.1016/j.sleh.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the relationship between sleep quality and occupational well-being in active duty military Service Members. DESIGN Longitudinal prospective analysis. SETTING An annual military training event. PARTICIPANTS US Army special operations Soldiers (n = 60; 100% male; age 25.41 ± 3.74). INTERVENTION None. MEASUREMENTS The Pittsburgh Sleep Quality Index (PSQI) was administered prior to the training event, and the Emotional Exhaustion Scale, the Role Overload Scale, the Walter Reed Army Institute of Research Soldier-Specific Functional Impairment Scale, and the Perceived Stress Scale were administered after the event. Linear regression models were used to assess the relationship between sleep and occupational wellness measures, and the outcome measures of "good" and "poor" sleepers (per the PSQI scoring criteria) were compared with Student's t tests. RESULTS Higher (poorer) PSQI Global Scores predicted poorer occupational wellness of all measures (emotional exhaustion: B = 1.60, P < .001, R2 = 0.25; functional impairment: B = 0.29, P = .03, R2 = 0.14; role overload: B = 0.28, P = .008, R2 = 0.12; and perceived stress: B = 0.34, P = .004, R2 = 0.20). There were additional relationships between specific PSQI component scores and occupational wellness measures, which is a replication of This team's previous work. Furthermore, emotional exhaustion (t(58) = -4.18, P < .001), functional impairment (t(59)= -3.68, P = .001), role overload (t(58) = -3.20, P = .002), and perceived stress (t(58) = -2.43, P = .02) were all higher in poor sleepers. CONCLUSIONS The findings of this study suggest that US Army special operations Soldiers who have poorer sleep quality may be at increased risk for having poorer occupational well-being.
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Affiliation(s)
- Janna Mantua
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
| | - Maddison C Pirner
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Scott T Doyle
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Alexxa F Bessey
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA; Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Jacob A Naylor
- 75th Ranger Regiment Headquarters, Ft. Benning, Georgia, USA
| | - Bradley M Ritland
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Walter J Sowden
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA; Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Tina M Burke
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Ashlee B McKeon
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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Sleep hygiene in shift workers: A systematic literature review. Sleep Med Rev 2020; 53:101336. [PMID: 32593135 DOI: 10.1016/j.smrv.2020.101336] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/21/2022]
Abstract
In response to demand for the '24/7' service availability, shift work has become increasingly common. Given their non-traditional working hours, shift workers sleep at non-traditional times, with significant research undertaken to understand shift worker sleep. However, sleep hygiene in shift workers has been paid little research attention. To investigate shift worker engagement with sleep hygiene, a systematic review using the databases Sage, ScienceDirect, and Scopus was undertaken. The search terms utilised were: shift work, shiftwork, shift-work, sleep hygiene, sleep routine, and sleep habit. Sixteen studies were included for review. Findings show that shift workers frequently report caffeine consumption and daytime napping, in line with best-practice fatigue-management strategies, but contrary to existing sleep hygiene recommendations. Shift workers also altered their bedroom environment to optimise sleep. Diet, exercise, alcohol and nicotine consumption were investigated minimally from a sleep hygiene perspective. Given that shift workers are engaging in practices in-line with current fatigue-management strategies, but contrary to sleep hygiene recommendations, further research is required. Specifically, assessment of the applicability of current sleep hygiene guidelines to shift workers (particularly caffeine and napping recommendations) is required, in addition to the development of shift work-specific sleep hygiene guidelines and interventions for this sleep-vulnerable population.
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