How religion affects sleep health: exploring the perspectives of religious Muslims and Jews in Israel.

Few empirical studies have explored the links between sleep and religion and no research has examined how religious individuals view these links. This article contributes to the literature by drawing on in-depth interviews with 31 midlife Israeli Muslims and Jews who describe themselves as religious or very religious. Findings indicate that respondents shared the view that sleep is important for health and wellbeing, as well as for religious practice and the proper worship of God. Their accounts clarified that religious observance entails a set of social rules and prescriptions as well as beliefs that may affect sleep behaviour and sleep outcomes. Traditional prayer times affected sleep duration for observant Muslims and Jews because respondents woke up early for prayer but could not always retire early enough so as to obtain a sufficient amount of sleep. Religion also dictated a preferred sleep position, to which participants became accustomed and found to be helpful. Respondents maintained that their deep faith in God and the practice of praying helped reduce stress, which contributed to sleep quality. However, among Muslims, missing prayers could arouse feelings of guilt and unease, thus affecting sleep quality. The article concludes that religion affects the sleep of both Muslims and Jews, but these effects vary by how individuals practice their religion and by how religiosity intersects with other social categories, such as gender. Future studies could enrich understanding of the social determinants of sleep by designing research inspired by lay persons' insights into the association between religion and sleep.

Sleep as a familial and communal matter: a qualitative study of social norms around sleep health in Israel.

BACKGROUND: A growing body of research has clarified that sleep is influenced not only by biological factors but also by social factors. While studies have shown that social norms can affect sleep behavior and sleeping arrangements, including when, where, how, and with whom people sleep, researchers still know relatively little about how social norms affect sleep health, especially among adults. The current study explores the association between social norms and sleep health in the Israeli context. METHODS: Data were drawn from semi-structured, in-depth interviews with 66 Israelis-including women and men, Arabs and Jews, and religious and non-religious persons-conducted between February 2020 and February 2022. This article focuses on responses to a set of questions about the comments people make or hear from others about their sleep. Exploring how people comment on the sleep of others highlights prevalent social norms around sleep. RESULTS: Findings indicate that how sleep is "done" is policed by family and community members who react to norm violations by commenting on what is perceived as "inappropriate" sleep behavior. Comments were made in jest or earnest in response to breaches of social norms regarding sleep timing, duration, continuity, and alertness/sleepiness, indicating that social norms and expectations shape each of these sleep health dimensions. CONCLUSIONS: This article expands the scholarly understanding of the social determinants of sleep health. The study concludes that since individuals may opt to conform to current social norms, which are enforced by members of the family and community, interventions aimed at promoting sleep health should target not only individuals but also the family and community.

Sleep, body work and bodily capital: Sleep discourse in the magazines Men's Health and Women's Health.

The subject of sleep has been receiving increasing attention in multiple arenas over the past decades, including in the social sciences and the media. However, only a few empirical studies have investigated how sleep is constructed within and by media discourses, and also whether and how these discourses are gendered. The present article explores how two popular lifestyle magazines, Men's Health and Women's Health, construct sleep. The analysis of online articles reveals that both magazines constitute sleep as a form of body work that enhances bodily capital, but they do so in gendered ways that reinforce patriarchal norms and expectations. This study shows that the magazines' discourse supports the neoliberal project, while also highlighting the malleability and adaptability of neoliberal discourses. The conclusion is that the ways in which the magazines' discourse constructs sleep might deepen both gender and class inequalities.

"You have to do something": Snoring, sleep interembodiment and the emergence of agency.

Although the sociology of sleep is a growing subfield, little is known about agency in the context of sleep. This article contributes to the sociological literature by showing how different types of agency emerge as a result of sleep interembodiment (i.e., experiencing sleep partners' bodies as intertwined). The study draws on qualitative data generated through in-depth interviews with 70 snorers and 20 sleep partners of snorers. Interviews were conducted in Israel and were analysed following constructivist grounded theory principles. Results indicate that two types of agency coexist and, in fact, co-constitute one another: The first type, herein termed material agency, reflects the post-humanist tradition, which conceptualizes agents as entities (whether human or nonhuman) that alter a state of affairs by making a difference in another agent's action. This type of agency exists in both wakefulness and throughout periods of sleep, as the snorer's body acts and interacts with a partner's body in ways that engender significant change in their lives, relationships, and actions. In contrast, the second type, herein termed reflexive agency, reflects the humanist tradition, which regards agency as individuals' creative and assertive capacities motivated by intentionality and reflexivity. This type of agency declines significantly during stages of deep sleep but re-emerges in response to partners' actions. The article adds to the literature by refining the concept of agency and elucidating its relationship to both accountability and interembodiment. In addition, the article provides much-needed empirical evidence showing how "personal responsibility" for health, as required by neoliberal discourses, is invoked within families, specifically with regard to sleep. This study therefore shows how certain macro-level structures of neoliberalism are enacted and reinforced within micro-level interactions.

Conducting Joint Interviews With Couples: Ethical and Methodological Challenges.

Scholars have recently begun to discuss joint interviewing from a methodological perspective, generally presenting a favorable view of this mode of interviewing. In the present article, the author draws on her experiences with interviewing obstructive sleep apnea patients and their partners to shed further light on the methodological and ethical challenges of joint interviews. Specifically, it is shown that joint interviews may become a site in which one partner silences the other and enacts symbolic violence, with the interviewer as unwilling abettor, or alternatively may facilitate passivity. Joint interviewing may therefore prevent researchers from giving an equal voice to both partners, resulting in partial and fragmented data. In addition, the joint approach may generate tension between members of the couple and harm the quality of relationships, thus contravening the researcher's commitment to non-maleficence. The author points to a few possible solutions and suggests interviewing social partners as an alternative to couples.

'Whore stigma' as a transformative experience: altered cognitive expectations among Jewish-Israeli street-based sex workers.

While the scholarship on sex work is substantial, it neglects to explore whether sex work and associated stigma affect sex workers' cognitive expectations. Drawing on observations of street-based sex work as well as in-depth interviews with Jewish-Israeli sex workers, this study suggests that because stigma is a moral experience that threatens and often destroys what really matters to stigmatised individuals, it leads to recurrent disappointments, which, in turn, may alter sex workers' cognitive expectations. Sex workers learn to see certain life goals, including maintaining healthy social relationships and a workspace free of violence and humiliation, as unobtainable. However, they also begin to see other aspects of their lives, such as economic autonomy, as achievable through sex work. Tracing how whore stigma becomes a transformative experience allows us to add another layer to the heretofore suggested link between the structural, cultural and individual aspects of stigmatisation.

Sleep as a Gendered Family Affair: Snoring and the "Dark Side" of Relationships.

This study contributes to the emerging sociological literature on sleep, family, and gender by examining the experience and management of snoring within families. Drawing on in-depth interviews with Jewish-Israeli men and women who snore as well as their family members, this article suggests that sleep is a gendered family affair Family members attempt to face the challenges of snoring by using several management strategies to mend and sustain family ties, which are part of how they "do family." Nevertheless, men and women experience and manage snoring in different ways, thereby "doing gender" in their sleep management, only to find that "doing gender" and "doing family" often conflict. As a result, both the occurrence and management of snoring make relationships stressful, thereby affecting their quality. This research sheds light on the underexplored micro-processes involved in sleep management while providing unique insight into couple dyads and gender differences.

Contesting medicalisation, doubting the diagnosis: patients' ambivalence towards the diagnosis of Obstructive Sleep Apnoea.

Whereas social scientific studies have investigated the emergence of the category Obstructive Sleep Apnoea (OSA), the most commonly diagnosed sleep disorder, no study has examined whether and how the ways in which OSA emerged affect patients' reception of the diagnosis. This article fills this gap by drawing upon in-depth interviews with 65 Israelis who received a laboratory diagnosis of OSA. This study finds that many patients doubt the accuracy of their diagnosis, and argues that this scepticism derives from contested macro-level medicalisation processes that preceed and surround the development of OSA as a diagnostic category. Specifically, past and present controversies over the definitions of OSA and its precursor the 'Pickwickian syndrome' created images of 'OSA patients' as sleepy and obese. Consequently, patients whose self-perception conflicted with this image questioned their diagnosis. Other patients argued that one night of sleep at a laboratory could not reflect their quality of sleep at home, thereby implicitly criticising the ways in which OSA was medicalised. This study enhances our understanding of the underexplored dynamics between the macro and micro levels of medicalisation.

The pull into wakefulness: How sociocultural categories intersect to shape sleep opportunity and sleep ability in Israel.

OBJECTIVES: Prior studies have documented the existence of sleep disparities between social groups and have proposed possible reasons for these gaps. To extend these empirical findings, the current study elucidates whether and how intersections between sociocultural identities shape the lived experience and management of sleep and sheds light on the social factors that explain within-group heterogeneity. METHODS: This article draws on semi-structured interviews with 66 employed Israelis, aged 40-60, conducted between February 2020 and February 2022. Participants were selected using a non-probability purposeful sampling design that sought to include individuals with a wide range of sociodemographic backgrounds in terms of gender, ethnonationality, socioeconomic status, religion, and religiosity as well as the quality of sleep. RESULTS: The analysis shows that intersections of gender, socioeconomic status, ethnonationality, religion, and religiosity prompt qualitatively different understandings, experiences, and management of sleep, in a way that affects both sleep opportunity and sleep ability. CONCLUSIONS: This study contributes to the scholarly understanding of the social determinants of sleep by highlighting the significance of the intersections of sociocultural identities for sleep health and implementing a nuanced socioecological approach to understanding within-group variability. The results call for the design of tailored interventions that consider the sociocultural context.

Residents' choice of a placement in periphery hospitals in Israel: The significance of personal/family and professional considerations.

Physician maldistribution affects remote and rural population health indicators and as such constitutes a major concern for health systems. Various countries, including Israel, have sought to remedy this problem, often by implementing more than one intervention simultaneously. In this paper, we explored the considerations that motivated Israeli residents to opt for a position in the periphery, as well as potential factors that could facilitate their retention in these underserved areas. We found that the motivation driving young physicians to specialize in a specific hospital includes personal- and family-oriented considerations (proximity to the nuclear family, perceived quality of life and lifestyle) as well as professional considerations (prior acquaintance with a hospital and a specific hospital department, department characteristics, availability of a residence position in a preferred specialty, prospective professional advancement). We therefore argue that the key to recruitment and retention of young physicians in remote areas lies in tailored interventions that take personal, professional and regional issues into account, preferably in consultation with the physicians themselves. The prominence of personal issues in the interviews with young physicians suggests that effective interventions should support a work-life balance. Hence success in attracting residents as a first step towards correcting physician maldistribution hinges upon coordinating policies in the medical field with policies in non-medical arenas - education, welfare, local authorities.

The trajectory of "medical cannabis" in Israel: Driving medicalization in different directions.

BACKGROUND: Although researchers, laypersons and policymakers have been debating about the "medicalization of cannabis" for years, few have attempted to unpack this phrase and clarify what it actually means. The present qualitative research addresses this issue by tracing the trajectory of "medical cannabis" (MC) in Israel. METHODS: This article draws on multiple sources, including in-depth interviews, parliamentary protocols, conference observations, policy documents, and media coverage. RESULTS: The analysis shows that while patients, growers, and certain physicians advocated for a more inclusive type of cannabis medicalization, other physicians and sick funds strove to curtail this medicalization; for its part, the Ministry of Health (MoH) attempted to find a pathway that would bridge their conflicting standpoints. In the first phase of medicalization patients' and regulators' trajectories coincided; however, they diverged in the second phase as regulators sought to transform MC into a standardized medication in line with the biomedical model. Patients and physicians criticized the new policy reform and highlighted some of its negative effects on patient care. The trajectories of patients and regulators then intersected in a way that led to some alterations in the MC trajectory. CONCLUSION: This study enhances our understanding of how MC was, and is still being, incorporated into medicine in Israel. The study illuminates the plurality of meanings that have been assigned to the concept of medicalization and the contingent nature of MC. Additionally, this study sheds light on the under-investigated role of regulators as drivers of the medicalization of "solutions," and it shows how different engines of medicalization may drive the process in diverging directions.

Delaying and seeking care for obstructive sleep apnea: The role of gender, family, and morality.

Social scientists have proposed various theories as to when, why, and how people come to seek medical care for multiple conditions. Yet, there is still little empirical research to illustrate the pathways into and out of care, especially for chronic illness. This article contributes to this body of work by exploring individuals' reasons for delaying and seeking care for obstructive sleep apnea, which despite being the most diagnosed sleep disorder, has been largely neglected by social scientists. Drawing upon in-depth interviews with 65 Jewish-Israeli obstructive sleep apnea patients, this study shows how intersections of gender, family, and morality shape and are shaped by care-seeking behavior. The analysis reveals that married men claim they do not do health, thereby reaffirming their masculinity, but they maintain moral status because their wives do much of their illness work for them. Unmarried men, however, claim to be more vigilant in their pursuit of health and present it as one of their responsibilities. Women acknowledge they have the double burden of protecting their own health as well as that of their loved ones, and often feel that they are incapable of meeting these social expectations. However, men and women are able to maintain moral status by explaining their neglect of health as resulting from their attempts to care for significant others. Finally, married women differ from men and unmarried women in their motivations for seeking care. In keeping with their gender roles, married women emphasize disturbance to others whereas men stress disturbance to self.

Rhetorical and regulatory boundary-work: The case of medical cannabis policy-making in Israel.

Recent studies have explored how professionals draw boundaries to reach workable solutions in conflictual and contested areas. Yet they neglected to explore the relationships and dynamics between how boundaries are demarcated in rhetoric and in policy. This article examines these relationships empirically through the case of medical cannabis (MC) policy-making in Israel. Drawing on interviews with key stakeholders in the MC policy field, formal policy documents, and observations of MC conferences, this article sheds light on the dynamics between rhetorical boundary-work and what we term regulatory boundary-work, namely setting rules and regulations to demarcate boundaries in actual practice. Results show how certain definitions of and rationales for a discursive separation between "medical" and "recreational" cannabis and between cannabis "medicalization" and "legalization" prevailed and were translated into formal policy, as well as how stakeholders' reactions to this boundary-work produced policy changes and the shifting of boundaries. Both rhetorical and regulatory boundary-works emerge as ongoing contested processes of negotiation, which are linked in a pattern of reciprocal influence. These processes are dominated by certain actors who have greater power to determine how and why specific boundaries should be drawn instead of others.

Medical cannabis: An oxymoron? Physicians' perceptions of medical cannabis.

BACKGROUND: Medical cannabis policies are changing in many places around the world, and physicians play a major role in the implementation of these policies. The aim of this study was to gain a deeper understanding of physicians' views on medical cannabis and its possible integration into their clinic, as well as to identify potential underlying factors that influence these perceptions. METHODS: Qualitative narrative analysis of in-depth interviews with twenty-four Israeli physicians from three specialties (pain medicine, oncology and family medicine). FINDINGS: Physicians disclosed contrasting narratives of cannabis, presenting it as both a medicine and a non-medicine. These divergent positions co-existed and were intertwined in physicians' accounts. When presenting cannabis as a non-medicine, physicians drew on conventional medicine and prohibition as narrative environments. They emphasized the incongruence of cannabis with standards of biomedicine and presented cannabis as an addictive drug of abuse. In contrast, physicians drew upon unconventional medicine and palliative care as narrative environments while presenting cannabis as a medicine. In this narrative, physicians emphasized positive hands-on experiences with cannabis, and pointed to the limits of conventional medicine. CONCLUSION: Physicians did not have a consolidated perspective as to whether cannabis is a medicine or not, but rather struggled with this question. The dualistic narratives of cannabis reflect the lack of a dominant narrative environment that supports the integration of cannabis into medical practice. This may in turn indicate barriers to the implementation of medical cannabis policies. An awareness of physicians' views and the different levels of their willingness to implement medical cannabis policies is essential for policy developments in this evolving field.

Ambivalent Adherence and Nonadherence to Continuous Positive Airway Pressure Devices: A Qualitative Study.

STUDY OBJECTIVES: Continuous positive airway pressure (CPAP) therapy is considered the front-line treatment for moderate-severe obstructive sleep apnea (OSA). However, nonuse rates are very high, such that adherence to CPAP has become a major concern. Although the literature on CPAP use is vast, further research is required to understand patients' experiences of CPAP use and nonuse. This is the goal of this study. METHODS: This study draws on in-depth interviews with 61 Jewish-Israeli patients with OSA who received a recommendation to use a CPAP device. The sample includes both patients who started using CPAP devices as well as patients who rejected this course of treatment. It follows principles of constructivist-grounded theory in both sampling and analysis. RESULTS: The study shows that regardless of patients' status of adherence, their attitudes toward CPAP devices are characterized by ambivalence. Users of CPAP expressed ambivalent adherence, pondering whether they should stop using the device; and patients who rejected the CPAP expressed ambivalent nonadherence, wondering whether they should give the CPAP another chance. This study identifies the experiences involved in using, as well as not using, CPAP devices that produce patients' ambivalence. CONCLUSIONS: Both adherence and nonadherence to CPAP are dynamic processes that are characterized by patients' ambivalence and contingent upon diverse factors. These findings have practical implications as they suggest that all patients, regardless of their initial adherence status, would benefit from a close follow-up.

What's at stake? Genetic information from the perspective of people with epilepsy and their family members.

Substantial progress has been made in identifying genes that raise risk for epilepsy, and genetic testing for some of these genes is increasingly being used in clinical practice. However, almost no empirical data are available from the perspective of people with epilepsy and their family members about the impact of genetic information and potential benefits and harms of genetic testing. To address this gap we conducted in-depth qualitative interviews with 40 individuals (22 with epilepsy, 18 unaffected) in the USA from families containing multiple affected individuals who had participated in epilepsy genetics research. The interviews were coded and analyzed using the principles of grounded theory. Several major themes emerged from these interviews. Participants expressed "personal theories of inheritance" that emphasized commonalities among relatives and the idea that disease risk is most shared by family members who share physical or personality traits. Most participants said they would have genetic testing if it were offered. They cited many potential benefits, including learning what caused epilepsy in their family, being better able to care and advocate for children at risk, reducing guilt and blame, providing an increased sense of control, and relieving anxiety in unaffected individuals who test negative. The influence of genetic information on reproduction was a particularly salient theme. Although respondents believed genetic testing would be useful for informing their reproductive choices, they also expressed fear that it could lead to external pressures to modify these choices. Other concerns about the potential negative impact of genetic information included increased blame and guilt, increased stigma and discrimination in employment and insurance, self-imposed limitations on life goals, and alterations in fundamental conceptions of "what epilepsy is." Consideration of the perspectives of people with epilepsy and their family members is critical to understanding the implications of contemporary epilepsy genetic research and testing.