Sleep-Scheduling Strategies in Hospital Shiftworkers.

INTRODUCTION: Shiftwork causes circadian disruption and results in impaired performance, sleep, and health. Often, individuals on non-standard shifts cannot modify work schedules. At-home sleep schedules are a potentially modifiable point of intervention, yet sleep-scheduling strategies remain relatively understudied. Specifically, the adoption of multiple strategies and the employment of strategies for not only night shifts, but also early starts on days, have yet to be formally examined to our knowledge. We studied how adoption of specific and/or multiple sleep-scheduling strategies for day and night shifts relates to measures of adaptation to shiftwork, self-reported on-shift sleepiness, and individual characteristics (eg, age, chronotype, education in circadian and sleep health). We hypothesized: 1) strategies would differ by shift type, 2) individuals would adopt multiple strategies, 3) strategies better aligned with circadian principles would relate to measures of adaptation, and 4) individual characteristics, such as having dependents, would relate to strategy selection. METHODS: A retrospective, online questionnaire (including items from the Survey of Shiftworkers and items related to sleep-scheduling strategies) was administered to both permanent and rotating hospital staff in four wards working 12-h day and/or night shifts (n=89). Additionally, reasons for strategy selection were explored. RESULTS: Level of adaptation varied by sleep-scheduling strategy, with the least adaptation for those utilizing the Incomplete Shifter strategies. For night shifts, Night Stay and Switch Sleeper-N strategies were related to lower mid-shift sleepiness. Many night workers reported using strategies that restricted sleep, and most reported using multiple strategies, both of which also related to lower adaptation. Domestic considerations were the most common rationale for strategy selection. Strategies varied by several individual characteristics, including chronotype, dependents, and level of sleep education. DISCUSSION: Future work should investigate sleep strategies and circadian interventions to help mitigate the effects of circadian and sleep disruption in hospital staff.

Implementation of interventions designed to promote healthy sleep and circadian rhythms in shiftworkers.

Shiftwork is a significant risk factor for a host of negative health and safety outcomes, which have been at least partly attributed to disturbances of the circadian timing system. As a result, an entire sub-field of chronobiology has been devoted to developing and evaluating countermeasures for circadian misalignment, sleep disruption, fatigue, and other issues associated with shiftwork. Much of this research takes place under highly controlled laboratory conditions due to the necessity of accurately characterizing individual rhythms, both for intervention design and assessment of efficacy. Applied studies of interventions for shiftworkers are, by their nature, more complicated, often demonstrating less consistent findings. While this, in part, reflects execution under less rigorously controlled conditions, it may also stem from variability in implementation approaches. A systematic review of published studies (through May 2017) of interventions designed to enhance circadian health in shiftworkers was conducted to determine the frequency and quality of the assessment of implementation as well as barriers and enablers to implementation. A search of PubMed, PsychINFO, Web of Science, and CINAHL databases yielded a total of 5368 unique references. After a title and abstract screen, 323 proceeded to full-text review; 68 of those met final criteria for data extraction. Implementation was assessed to some degree in 60.3% of those 68 articles. Where it was assessed, the mean quality score on a scale from 1 to 5 (1 = very little, 3 = moderate, 5 = very in-depth) was 2.56. One or more enablers were identified in just 17 of the 68 studies (25.0%), and barriers in just 18 (26.5%). Implementation of these interventions is a critical but seldom-acknowledged component of their uptake and effectiveness, and we highly recommend that future shiftworker intervention research make an effort to incorporate formalized assessments of implementation and/or hybrid effectiveness-implementation approaches.

Long-Term Outcomes of Service Women Injured on Combat Deployment.

Sex- and gender-based health disparities are well established and may be of particular concern for service women. Given that injured service members are at high risk of adverse mental and behavioral health outcomes, it is important to address any such disparities in this group, especially in regard to patient-reported outcomes, as much of the existing research has focused on objective medical records. The current study addressed physical and mental health-related quality of life, mental health symptoms, and health behaviors (i.e., alcohol use, sleep, and physical activity) among a sample of service women injured on deployment. Results indicate that about half of injured service women screened positive for a mental health condition, and also evidenced risky health behaviors including problematic drinking, poor sleep, and physical inactivity. Many of the mental and behavioral health variables demonstrated statistically significant associations with each other, supporting the relationships between psychological health and behaviors. Results provide additional evidence for the importance of access to integrated and effective mental healthcare treatment for injured service women and the need for screening in healthcare settings that address the multiple factors (e.g., mental health symptoms, alcohol use, poor sleep) that may lead to poor outcomes.

A Hybrid Effectiveness-Implementation Study of a Multi-Component Lighting Intervention for Hospital Shift Workers.

Simple lighting solutions may mitigate the harmful effects of shiftwork. This hybrid effectiveness-implementation study evaluated a multi-component lighting intervention in hospital nurses that included 6500 K architectural lighting in the nurses' station plus optional behavioral components (a lightbox, blueblocker glasses, eyemasks) with instruction about appropriately timed usage. Selective improvements from baseline were observed in on-shift performance, sleep quality, and caffeine consumption in day workers (all p < 0.05); off-shift sleepiness scores improved for night workers (p < 0.05). Further, self-reported measures of quality of life improved for both groups (p < 0.05). Preliminary implementation data from interviews and questionnaires suggest perceived benefits and high acceptability of the intervention.

Reported light in the sleep environment: enhancement of the sleep diary.

BACKGROUND: Light is the primary synchronizing cue for the circadian timing system, capable of exerting robust physiological effects, even with very dim and/or brief photic exposure. Mammals, including humans, are particularly susceptible to light at night. As such, measures of light in the sleeping environment are critical for evaluating sleep health. Sleep diaries provide inexpensive measures of sleep, but do not typically include light information. METHODS: Four questions probing visual perception of light in the bedtime and waking environments were added to the Consensus Sleep Diary for Morning administration. As part of a lighting intervention study, 18 hospital Labor and Delivery Department personnel completed the sleep diary for 1 week in each of two experimental conditions while wearing Actiwatch devices equipped with photosensors. Diary responses were evaluated against photosensor values from the beginning and end of each rest interval (n=194 rest intervals), as well as against sleep measures, utilizing linear mixed models. RESULTS: Responses to light questions were related to actual light measures at bedtime, controlling for shift type and experimental condition. In addition, subjective light information at bedtime and waking was related to both objective and subjective sleep parameters, with data generally indicating poorer sleep with light in the sleeping environment. CONCLUSION: Questions addressing perception of light in the sleeping environment may provide a crude yet affordable metric of relative photic intensity. Further, as responses relate to sleep outcomes, subjective light information may yield valuable insights regarding mechanisms and outcomes of clinical significance in sleep and circadian research.

Parenting Stress After Deployment in Navy Active Duty Fathers.

Military fathers are being deployed, and leaving their families, for greater lengths of time and more frequently than ever before. The purpose of this study was to examine the impact of recent deployment on parenting stress in U.S. Navy fathers with young children. Of the 111 participants who completed the one-time study questionnaire at a large military outpatient clinic on the Eastern seaboard, 67.6% had returned from a ship-based deployment. Regression analyses were performed, using the Parenting Stress Index as the outcome variable, deployment elements (such as time away from home in the past 5 years) as predictors, and adjusting for other factors such as post-traumatic stress disorder (PTSD) and depression. Higher perceived threat and greater warfare exposure were both associated with increased parenting stress (p < 0.05) in the unadjusted model. These associations were greatly attenuated and no longer significant after adjustment for depression. In addition, rates of positive screens for PTSD and depression (17.1%) in this sample were higher than in other recent studies. In summary, these data indicate that various deployment factors are associated with increased parenting stress in Navy fathers back from deployment within the past year; these relationships are largely explained by depressive symptoms. Clinical implications are discussed.

Hard is Normal: Military Families' Transitions Within the Process of Deployment.

US military deployments have become more frequent and lengthier in duration since 2003. Over half of US military members are married, and many also have children. The authors sought to understand the process of deployment from the perspective of the military family. After a thorough search of the literature, 21 primary research reports of 19 studies with an aggregate sample of 874 were analyzed using qualitative metasynthesis. The deployment process was experienced in four temporal domains. The military family as a whole shared the pre-deployment transition: all family members felt uncertain about the future, needed to complete tasks to "get ready" for deployment, and experienced a sense of distancing in preparation for the upcoming separation. The AD member went through the deployment transition independently, needing to "stay engaged" with the military mission, building a surrogate family and simultaneously trying to maintain connection with the family at home. In parallel, the home front family was going through a transposement transition, moving forward as an altered family unit, taking on new roles and responsibilities, and trying to simultaneously connect with the deployed member and find support from other military families. In post-deployment, the family went through the "reintegration" transition together, managing expectations, and readjusting family roles, all needing understanding and appreciation for their sacrifices during the recent separation. Effective family communication was important for military family well-being after deployment but unexpectedly challenging for many. Clinical, research, and policy recommendations are discussed.