Sleep hygiene - What do we mean? A bibliographic review.

There is no consensus on the definition of sleep hygiene and its components. We examined the definition of sleep hygiene based on its use in published studies. Four databases (Medline, EMBASE, PsycINFO and CINAHL) were searched from inception until December 31, 2021 for the phrase 'sleep hygiene' in the title or abstract. We identified 548 relevant studies in adults: 250 observational and 298 intervention studies. A definition of sleep hygiene was provided in only 44% of studies and converged on three themes: behavioural factors, environmental factors, and an aspect of control. Sleep hygiene components were explicitly defined in up to 70% of observational studies, but in only 35% of intervention studies. The most commonly considered components of sleep hygiene were caffeine (in 51% of studies), alcohol (46%), exercise (46%), sleep timing (45%), light (42%), napping (39%), smoking (38%), noise (37%), temperature (34%), wind-down routine (33%), stress (32%), and stimulus control (32%), although the specific details of each component varied. Lack of consistency in definitions of sleep hygiene and its components may hinder communication between researchers, clinicians, and the public, and likely limits the utility of sleep hygiene as an intervention.

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.

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

OBJECTIVES: Shift workers routinely obtain inadequate sleep, which has major health and well-being consequences. Sleep hygiene describes a range of behaviors, lifestyle and environmental factors that can support optimal sleep. To date, limited research has examined sleep hygiene in shift workers. This study aimed to 1) assess the knowledge and understanding of sleep hygiene amongst shift working paramedics, as well as the perceived impact on sleep, and 2) investigate paramedics engagement with sleep hygiene practices. STUDY DESIGN: Participants completed an online, cross-sectional survey. PARTICIPANTS: Queensland Ambulance Service paramedics (n = 184) who work shift work. MEASURES: The online survey included questions from the Standard Shiftwork Index and Sleep Hygiene Index. RESULTS: Most participants reported little or no understanding or knowledge of "sleep hygiene" as a concept. Participants reported that sleep scheduling and bedroom environment (temperature, light, and noise) were the most impactful on sleep. Few participants reported nicotine and alcohol consumption, or daytime napping, whereas caffeine consumption and mentally-stimulating bedtime activities were more common. Participants who were young, single, and worked all shift types (day, afternoon, and night) as part of their regular rosters, demonstrated less knowledge regarding sleep hygiene, and were more likely to be exhibiting poor sleep hygiene engagement. CONCLUSIONS: Paramedics demonstrated a limited level of understanding of sleep hygiene as a concept, and varied knowledge about the impacts of individual sleep hygiene factors. Further, paramedics demonstrated varied engagement with individual sleep hygiene practices. Future research should focus on the development of sleep hygiene interventions to optimize sleep in paramedics.

Go to bed! A systematic review and meta-analysis of bedtime procrastination correlates and sleep outcomes.

Bedtime procrastination is defined as the volitional delay of going to bed, without any external circumstances causing the delay, and is associated with inadequate sleep. Alleviating bedtime procrastination is an important target for interventions promoting adequate sleep, yet the correlates of bedtime procrastination are poorly understood. This study examined (1) correlates of bedtime procrastination, and (2) strength and direction of the association between bedtime procrastination and sleep outcomes. Six databases (CINAHL, EMBASE, PsychINFO, PubMed, Scopus, Web of Science) were searched from inception to September 2021 against pre-determined eligibility criteria. Forty-three studies were included (GRADE = low). Meta-analysis revealed that bedtime procrastination had a moderate negative association with self-control (z = -0.39; CI: -0.45, -0.29) and a moderate positive association with evening chronotype (z = 0.43; CI: 0.32, 0.48). Furthermore, bedtime procrastination was moderately negatively associated with sleep duration (z = -0.31; CI: -0.37, -0.24), sleep quality (z = -0.35; CI: -0.42, -0.27) and moderately positively associated with daytime fatigue (z = 0.32; CI: 0.25, 0.38). Further high-quality studies are needed to identify causal relationships between bedtime procrastination and correlates, as well as bedtime procrastination and sleep. Future work will guide the development of interventions targeting bedtime procrastination for improved sleep outcomes. STUDY REGISTRATION: PROSPERO registration number CRD42021248891.

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.

Sleep hygiene in shift workers: A systematic literature review.

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.

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

OBJECTIVES: Shift workers routinely obtain inadequate sleep, which has major health and wellbeing consequences. Sleep hygiene describes a range of behaviours, lifestyle and environmental factors that can support optimal sleep. To date, limited research has examined sleep hygiene in shift workers. This study aimed to 1) assess the knowledge and understanding of sleep hygiene amongst shift working paramedics, as well as its perceived impact on sleep, and 2) investigate paramedics' engagement with sleep hygiene practices. STUDY DESIGN: Participants completed an online, cross-sectional survey. PARTICIPANTS: Queensland Ambulance Service paramedics (n = 184) who engage in shift work. MEASURES: The online survey included questions from the Standard Shiftwork Index and Sleep Hygiene Index. RESULTS: Most participants reported little or no understanding or knowledge of 'sleep hygiene' as a concept. Participants reported that sleep scheduling and bedroom environment (temperature, light, and noise) were the most impactful on sleep. Few participants reported nicotine and alcohol consumption, or daytime napping, whereas caffeine consumption and mentally-stimulating bedtime activities were more common. Participants who were young, single, and worked varying shift types (day, afternoon, and night) as part of their regular rosters demonstrated less knowledge regarding sleep hygiene, and were more likely to be exhibiting poor sleep hygiene engagement. CONCLUSIONS: Paramedics demonstrated a limited level of understanding of sleep hygiene as a concept, and varied knowledge about the impacts of individual sleep hygiene factors. Further, paramedics demonstrated varied engagement with individual sleep hygiene practices. Future research should focus on the development of sleep hygiene interventions to optimise sleep in paramedics.