Symptoms of sleep problems and adherence to dietary guidelines in older women: evidence from the Australian Longitudinal Study on Women's Health.

OBJECTIVE: This study examined adherence to dietary guidelines and symptoms of sleep problems (e.g. taking a long time to fall sleep or waking up early) and their associations in a sample of older Australian women (68-73 years of age). DESIGN: This was a population-based cross-sectional study. Adherence to the dietary guidelines was measured using a validated FFQ and reported as a diet quality score. Symptoms of sleep problems were measured using five questions and a total score was derived. Multivariate linear regression was used to investigate the association between these outcomes, adjusted for the potential confounding influence of demographic (i.e. age and marital status) and lifestyle (i.e. physical activity, stress, alcohol intake, sleep medication use) variables. SETTING: Respondents from the 1946-1951 cohort of the Australian Longitudinal Study on Women's Health who completed Survey 9 were included. PARTICIPANTS: Data from n 7956 older women (mean age ± sd: 70·8 ± 1·5) were included. RESULTS: 70·2 % reported having at least one symptom and 20·5 % had between 3 and 5 symptoms of sleep problems (mean score ± sd: 1·4 ± 1·4, range 0-5). Adherence to dietary guidelines was poor with an average diet quality score of 56·9 ± 10·7 (range 0-100). Better adherence to dietary guidelines was associated with fewer sleep problem symptoms (ß: -0·065, 95 % CI: -0·012, -0·005) and remained significant after adjusting for confounding influences. CONCLUSIONS: These findings support the evidence that adherence to dietary guidelines is associated with symptoms of sleep problems in older women.

The Development and Validation of the Health Belief Model for Shift Workers (HBM-SW) Scale.

OBJECTIVE: Shift work is associated with circadian misalignment, sleep loss, and suboptimal health behaviors, which may contribute to longer term negative health outcomes. To inform future interventions for shift workers, the present study aimed to develop and evaluate the Health Belief Model for Shift Workers (HBM-SW) scale. METHODS: The HBM-SW development involved a seven-step process, including a literature review, expert panel analysis, cognitive interviews with shift workers, and a trial with a pilot sample of shift workers (n = 153). Utilizing exploratory factor analysis for factor identification and item reduction, the developed scale loaded on seven factors in line with the theoretical framework of the Health Belief Model: Perceived Threat, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-efficacy, and Health Motivation. Validation of the scale was conducted utilizing Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire, and Food Frequency Questionnaire. RESULTS: The pilot sample had an average age of 34.0 (18.0) years, was majority female (54.2%), with an average of 8.0 (11.0) years shift work experience. The HBM-SW showed good - excellent (α = 0.74-0.93) internal consistency and moderate - good (ICC = 0.64-0.89) test re-test reliability. Using health behavior outcome measures, the HBM-SW scale showed meaningful correlations with sleep quality, sleep duration, diet quality and leisure time physical activity, and acceptable validity and reliability. Further testing should be conducted in a larger sample to facilitate confirmatory factor analysis. CONCLUSIONS: The developed Health Belief Model for Shift Workers scale is likely beneficial for use in future studies of interventions for shift workers.

"I need to be alert at night to provide care": Factors associated with problematic sleep among young Australian caregivers.

OBJECTIVES: There is increased recognition that young people (<25 years) may occupy a carer role for family or others with health conditions or disability. This is often in addition to study and social activities. This means competing demands on time, and insufficient sleep. Our aim was to determine the contribution of caring duties to problematic sleep in young carers. METHODS: A survey of Australian carers was conducted, including questions on demographics, characteristics of the carer and care recipient, and sleep quality and quantity. Participants were eligible if they reported sleep time <7 hr or dissatisfaction with their sleep, and were aged 15-24 years. RESULTS: A total of 110 participants (71.8%_female = 79, 15-17 years = 62, 18-24 years = 48) were included in analysis; 55.5% (n= 61) reporting dissatisfaction with their sleep and 62.7% (n= 69) reporting typically less than 7 hr sleep per night. Sleep duration was significantly shorter for those who reported 1-2 or ≥3 awakenings to provide care, compared with no awakenings (p_< .05). Sleep quality, as described by scores on the Pittsburgh Sleep Quality Index (PSQI) was also significantly worse for those who were frequently awoken by their care recipient (p < .05). Worrying about the care recipient, being woken by the care recipient, and listening out for the care recipient were the most frequently identified factors impacting on sleep. CONCLUSION: Young carers experience reduced sleep duration and poor sleep quality. Strategies to alleviate the burden of care work on young carer's sleep would benefit the health and safety of this group.

Language disorder and internalizing mental health problems in youth offenders: A systematic review.

BACKGROUND: The prevalence of language disorder in youth offenders far exceeds rates reported in community samples. Youth involved in the justice system are also at increased risk of a range of psychiatric disorders, including internalizing mental health problems (i.e., anxiety, depression). However, the frequency with which these co-occur in this population is not known. Understanding the co-occurrence of language disorder with anxiety and depression in youth offenders may contribute to more coordinated and targeted support for these vulnerable youth. AIMS: To explore the co-occurrence of language disorder and anxiety and depression in youth offenders. METHODS & PROCEDURES: A systematic literature search of six databases (CINAHL, ERIC, Medline, PyscINFO, PubMED, Scopus) was conducted (September 2021) using key search terms relevant to the systematic review question. Study inclusion criteria were: (1) original research published in English; (2) youth up to 21 years of age involved in the justice system; and (3) reported outcomes on language and anxiety and/or depression. All included studies were appraised using the Joanna Briggs Critical Appraisal tool checklist relevant to study design. Due to the heterogeneity of included studies, data synthesis was narrative. MAIN CONTRIBUTION: Eight studies met the eligibility criteria. A range of measures was used to assess language abilities across samples. Only two studies directly addressed the relationship between language disorder and internalizing mental health problems; both found no significant correlation. CONCLUSIONS & IMPLICATIONS: Although the results did not support a significant relationship between language disorder and internalizing mental health problems in youth offenders, the two appear to occur comorbidly as evidenced by heightened rates of both in the included samples. This review highlights the need for more robust studies aimed to better understand this relationship. Stronger evidence may contribute to increased collaborative speech pathology and psychology services which might increase youth offenders' accessibility and engagement in intervention programmes (e.g., cognitive-behaviour therapy; interpersonal skills training; individual counselling). WHAT THIS PAPER ADDS: What is already known on this subject The markedly high rates of language disorder in youth involved in the justice system have been widely reported. It is also known that externalizing mental health problems often bring youth in contact with the justice system. Though there is some information about the prevalence of internalizing mental health problems in this population, the co-occurrence of language disorder and internalizing mental health problems has not been examined as widely. What this study adds to existing knowledge This study aimed to identify the frequency of co-occurrence of language disorder and anxiety and/or depression in youth offenders. Although the results did not support a significant relationship between language disorder and internalizing mental health problems in this population, results of the review provide evidence of heightened rates of both. This study also provides a summary of the various measures used to assess language and internalizing mental health in youth offenders across the eight studies included in this review. What are the potential or actual clinical implications of this work? It is possible that the tests and sub-tests used to identify language disorders and internalizing mental health problems were not sensitive enough to identify the full extent of youth offenders' needs. Identifying the presence of language disorders and internalizing mental health problems and recognizing the impact these may have on the communication and behaviours of an individual can better inform staff and therapists as they engage and interact with youth in the justice system.

A Deep Learning Approach to Classify Sitting and Sleep History from Raw Accelerometry Data during Simulated Driving.

Prolonged sitting and inadequate sleep can impact driving performance. Therefore, objective knowledge of a driver's recent sitting and sleep history could help reduce safety risks. This study aimed to apply deep learning to raw accelerometry data collected during a simulated driving task to classify recent sitting and sleep history. Participants (n = 84, Mean ± SD age = 23.5 ± 4.8, 49% Female) completed a seven-day laboratory study. Raw accelerometry data were collected from a thigh-worn accelerometer during a 20-min simulated drive (8:10 h and 17:30 h each day). Two convolutional neural networks (CNNs; ResNet-18 and DixonNet) were trained to classify accelerometry data into four classes (sitting or breaking up sitting and 9-h or 5-h sleep). Accuracy was determined using five-fold cross-validation. ResNet-18 produced higher accuracy scores: 88.6 ± 1.3% for activity (compared to 77.2 ± 2.6% from DixonNet) and 88.6 ± 1.1% for sleep history (compared to 75.2 ± 2.6% from DixonNet). Class activation mapping revealed distinct patterns of movement and postural changes between classes. Findings demonstrate the suitability of CNNs in classifying sitting and sleep history using thigh-worn accelerometer data collected during a simulated drive. This approach has implications for the identification of drivers at risk of fatigue-related impairment.

The Discrepancy between Knowledge of Sleep Recommendations and the Actual Sleep Behaviour of Australian Adults.

Introduction: Inadequate sleep is a major public health concern, with large economic, health, and operational costs to Australia. Despite the implementation of public sleep health campaigns, approximately 40% of Australian adults do not obtain the recommended 7-9 hours of sleep. Thus, while people may know how much sleep is required, this knowledge may not be adequately translated to actual sleep behavior. Consequently, this study aims to examine the discrepancy between knowledge of sleep recommendations and self-reported sleep behaviors.Methods: A sample of 1265 Australian adults (54% female, aged 18-65) completed a phone interview as part of the 2017 National Social Survey and were asked questions about their knowledge of sleep guidelines and their actual sleep behavior. Binary logistic regression was used to determine the factors associated with awareness of sleep recommendations and whether this corresponded with reported sleep duration.Results: The final sample size was 998. Although 94% of the sample were aware of current sleep recommendations, 23% of participants did not self-report regularly obtaining 7-9 h sleep per night. These participants were less likely to want to obtain more sleep, less likely to view sleep as a priority before stressful events, and less likely to self-report good health.Conclusion: Although a majority of the sample were aware of sleep recommendations, almost a quarter of the participants' behavior did not align with their knowledge. Future sleep health campaigns should consider options beyond education, including emphasis on practical strategies and modifiable lifestyle factors to assist individuals to obtain the recommended amount of sleep.

Move the night way: how can physical activity facilitate adaptation to shift work?

Shift work, involving night work, leads to impaired sleep, cognition, health and wellbeing, and an increased risk of occupational incidents. Current countermeasures include circadian adaptation to phase shift circadian biomarkers. However, evidence of real-world circadian adaptation is found primarily in occupations where light exposure is readily controlled. Despite this, non-photic adaptation to shift work remains under researched. Other markers of shift work adaptation exist (e.g., improvements in cognition and wellbeing outcomes) but are relatively unexplored. Timeframes for shift work adaptation involve changes which occur over a block of shifts, or over a shift working career. We propose an additional shift work adaptation timeframe exists which encompasses acute within shift changes in markers of adaptation. We also propose that physical activity might be an accessible and cost-effective countermeasure that could influence multiple markers of adaptation across three timeframes (Within Shift, Within Block, Within Work-span). Finally, practical considerations for shift workers, shift work industries and future research are identified.

Calibrated to drive: Measuring self-assessed driving ability and perceived workload after prolonged sitting and sleep restriction.

Self-assessed driving ability may differ from actual driving performance, leading to poor calibration (i.e., differences between self-assessed driving ability and actual performance), increased risk of accidents and unsafe driving behaviour. Factors such as sleep restriction and sedentary behaviour can impact driver workload, which influences driver calibration. This study aims to investigate how sleep restriction and prolonged sitting impact driver workload and driver calibration to identify strategies that can lead to safer and better calibrated drivers. Participants (n = 84, mean age = 23.5 ± 4.8, 49 % female) undertook a 7-day laboratory study and were randomly allocated to a condition: sitting 9-h sleep opportunity (Sit9), breaking up sitting 9-h sleep opportunity (Break9), sitting 5-h sleep opportunity (Sit5) and breaking up sitting 5-h sleep opportunity (Break5). Break9 and Break5 conditions completed 3-min of light-intensity walking on a treadmill every 30 min between 09:00-17:00 h, while participants in Sit9 and Sit5 conditions remained seated. Each participant completed a 20-min simulated commute in the morning and afternoon each day and completed subjective assessments of driving ability and perceived workload before and after each commute. Objective driving performance was assessed using a driving simulator measuring speed and lane performance metrics. Driver calibration was analysed using a single component and 3-component Brier Score. Correlational matrices were conducted as an exploratory analysis to understand the strength and direction of the relationship between subjective and objective driving outcomes. Analyses revealed participants in Sit9 and Break9 were significantly better calibrated for lane variability, lane position and safe zone-lane parameters at both time points (p < 0.0001) compared to Sit5 and Break5. Break5 participants were better calibrated for safe zone-speed and combined safe zone parameters (p < 0.0001) and speed variability at both time points (p = 0.005) compared to all other conditions. Analyses revealed lower perceived workload scores at both time points for Sit9 and Break9 participants compared to Sit5 and Break5 (p = <0.001). Breaking up sitting during the day may reduce calibration errors compared to sitting during the day for speed keeping parameters. Future studies should investigate if different physical activity frequency and intensity can reduce calibration errors, and better align a driver's self-assessment with their actual performance.

Stress and the gig economy: it's not all shifts and giggles.

Gig work is a type of contingent work which has increased markedly in recent times, and is characterised by uncertainty, unpredictability, and instability of both schedules and income earned. Gig workers are also likely to work for multiple platforms and/or employers. These work characteristics mean that performing gig work is associated with higher rates of stress than the general population (Madden et al. Pers Rev 2017). However, it is not currently known which strategies gig workers use to cope with this stress - including which strategies are likely to be effective. The aim of this study was to understand the relationship between coping strategies, number of employers and stress in gig workers. An online survey was completed by 49 gig workers. Validated questionnaires were administered to measure coping strategies (Brief COPE) and stress (Perceived Stress Scale-14). Approach coping strategies (active, planning, and social support) were associated with reduced stress (p<0.05), whereas the avoidant coping strategy of self-blame was associated with increased stress (p<0.05). No differences in stress were seen between gig workers with one employer and those with multiple employers. Findings suggest that some coping strategies may lower stress in gig workers, though long-term outcomes should be considered in future research.

How do infant feeding method, sleeping location, and postpartum depression interact with maternal sleep quality?

New mothers generally experience poor and/or disrupted sleep. A range of infant care and mental health factors may impact new mothers' sleep quality. A cross-sectional online survey was completed by a sample of 101 Australian new mothers with children under 12 months (M = 5.52 months, SD = 3.29 months) to examine the relationship between infant feeding method, infant sleeping location, and postpartum depression with maternal sleep quality. Subjective maternal sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and postpartum depression was measured using the Edinburgh Postpartum Depression Scale (EPDS). Overall, new mothers experienced poor subjective sleep quality, with high average PSQI scores, above the cut-off of 5 (M = 9.63, SD = 4.07). The majority of new mothers did not experience postpartum depression, with an average EPDS score below the cut-off of 11 (8.66, SD = 5.20). Mothers who breastfed their infants experienced significantly better subjective sleep quality than mothers who bottle-fed, with a medium effect size (ηp2 = 0.458). Subjective maternal sleep quality did not differ based on infant sleeping location. Poor subjective maternal sleep quality was a significant predictor of postpartum depression. While poor sleep was common in this sample of Australian new mothers, this study demonstrated that new mothers who breastfeed may experience slightly better subjective sleep quality than other feeding methods. Further research into, and better services for the education and advocation of, new mothers' sleep quality will be beneficial to both new mothers and clinicians.

Sleep hygiene strategies for individuals with chronic pain: a scoping review.

OBJECTIVES: Up to a quarter of the world's population experience chronic pain, which, in addition to interfering with daily activities and waking function, is often associated with poor sleep. Individuals experiencing poor sleep are often encouraged to implement sleep hygiene strategies. However, current sleep hygiene strategies have not been developed considering the unique challenges faced by individuals with chronic pain and therefore they might not be as effective in this population. The aim of this scoping review is to map the state of the existing literature examining sleep hygiene strategies in individuals with chronic pain. DESIGN: This scoping review included a search of four online databases (Medline, Embase, PsycINFO and CINAHL) to identify articles examining the use of sleep hygiene strategies in populations with chronic pain. RESULTS: Thirty articles investigated at least one sleep hygiene strategy in individuals with chronic pain, with improvements to sleep reported for six sleep hygiene strategies (education, exercise, limiting alcohol use, limiting tobacco use, prebed state and sleep environment). However, the timing of these strategies was often not reported which limits the degree to which these strategies can be generalised for use as a presleep strategy. CONCLUSION: This scoping review examined the existing literature focusing on sleep hygiene strategies for people with chronic pain. There are limitations to the methodology of the existing literature and gaps in our understanding of sleep hygiene strategies in some chronic pain conditions that must be addressed in future research before the effectiveness of these strategies can be understood.

"Mars Bar and a Tin of Red Bull Kept Me and My Patients Alive": Exploring Barriers to Healthy Eating through Facebook Comments of Shiftworkers.

The negative impact of an unhealthy diet on the shiftworker population has been well-documented. However, little evidence exists on the underlying reasons for unhealthy eating behaviours and the existing barriers to healthy eating withinshiftwork environments. This qualitative study investigated the dietary behaviours reported by shiftworkers through Facebook comments. Comments were collected if they were on public shiftworker-relevant posts pertaining to dietary news or dietary information on Facebook and were posted by self-identified shiftworkers, relatives of shiftworkers, or partners of shiftworkers. A thematic analysis of the 144 comments collected generated four categories that can be used to understand the motivations for eating behaviour on-shift: what shiftworkers eat, where food is sourced from, when food is eaten, and why certain foods are chosen. Results reveal motivations, attitudes, and both internal and external barriers to healthy eating behaviours, as well as similarities and differences across shiftwork industries. Recommendations for future research include further explorations on the link between scheduled eating (e.g., time-restricted eating) and shiftwork, the impact of a rotating shift arrangements on dietary health behaviours, and the impact of interpersonal relationships on shiftworker dietary choices. Understanding these motivations will inform strategies to promote healthy eating and help understand barriers for shiftworkers.

Can we put the first night effect to bed? An analysis based on a large sample of healthy adults.

The 'first night effect' refers to individuals experiencing poorer sleep during their first night in a laboratory. The effect is attributed to sleeping in a new environment, as well as wearing electrodes on the head and face, and is often cited as a reason for including an adaptation night in sleep research protocols. However, in the time since the 'first night effect' was initially reported, the conditions and equipment used in modern sleep laboratories have changed considerably, which may reduce the 'first night effect.' The aim of this study was to examine the impact of the 'first night effect' on sleep in a sample of healthy adults. Participants (n = 124; 22.7 ± 3.6 years) were given a 9-hour sleep opportunity (23:00-08:00 h) on two consecutive nights in a time-isolated sleep laboratory with sleep measured via polysomnography. Differences in dependent sleep variables between Night 1 and Night 2 were examined using paired t-tests. There was no difference in sleep onset latency (p = .295), total sleep time (p = .343), wake after sleep onset (p = .410), or sleep efficiency (p = .342) between Nights 1 and 2. However, participants spent more time in stage one (p = .001), and less time in stages two (p = .029) and three (p = .013) on Night 1 compared with Night 2. This suggests that, where primary sleep variables are the focus and not sleep architecture or arousals (e.g., where sleep is used as an independent variable), including an adaptation night may not be necessary.

The impact of a truncated competition on the sleep and wellness of sub-elite netballers.

BACKGROUND: Sleep and wellness outcomes have been explored in elite netball athletes, but research examining these outcomes in sub-elite athletes is lacking despite high participation rates at the sub-elite level. The aim was to investigate the impact of the scheduling of games over consecutive days during a truncated four-round netball competition on the sleep and wellness outcomes of sub-elite netballers. METHODS: A total of 12 female, sub-elite netball players were examined via sleep outcomes, stress, fatigue, mood, muscle soreness, and overall wellness on the night before, the night of, and for two nights after games during a four-round truncated competition. Linear mixed models examined changes for variables across days around game day. RESULTS: Bedtime (P=0.038), wake time (P=0.001), fatigue (P=0.003), and muscle soreness (P<0.001) differed according to game status (i.e., pre-game days, game days, and post-game days). Bedtime was later on game days compared to pre-game days, and wake-up time was later on post-game days than pre-game days. Fatigue and muscle soreness were greater the day after the game, compared to days before the game. Over the four rounds, bedtime (P=0.027) and wake-up time (P<0.001) tended to be later, while wellness did not change. CONCLUSIONS: These data may help guide coaching staff to plan training and travel arrangements during truncated multi-week competitions.

Does breaking up sitting in office-based settings result in cognitive performance improvements which last throughout the day? A review of the evidence.

Sedentary behavior at work contributes to detrimental cognitive outcomes (e.g., decreases in attention). The length of time that cognitive performance benefits are sustained following bouts of breaking up sitting (e.g., using sit-stand desks or walking) is not known. A narrative review of the literature was conducted using a systematic search strategy, with keywords related to breaking up sitting interventions in office-based environments and cognitive performance outcomes in the period immediately post the cessation of the breaking up sitting intervention. Three types of office-based breaking up sitting interventions were identified; 1) sit-stand desks, 2) walking desks and 3) cycling desks. From the eight studies which met the criteria, the impacts of these interventions on cognitive performance outcomes were mixed, with significant benefits in some studies and others reporting no benefit. Of the cognitive domains assessed, working memory, attention, and psychomotor function showed significant sustained improvement for up to 30 minutes post intervention. While there are benefits to a key set of cognitive performance domains following breaking up sitting interventions in office-based settings, no studies have evaluated whether benefits to cognitive performance persist for longer than 30 minutes after the breaking up sitting intervention. Furthermore, specific applications of these cognitive benefits to tasks outside of work (e.g., driving home from work) are unknown.

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.

A Time to Rest, a Time to Dine: Sleep, Time-Restricted Eating, and Cardiometabolic Health.

Cardiovascular disease (CVD) poses a serious health and economic burden worldwide. Modifiable lifestyle factors are a focus of research into reducing the burden of CVD, with diet as one of the most investigated factors. Specifically, the timing and regularity of food intake is an emerging research area, with approaches such as time-restricted eating (TRE) receiving much attention. TRE involves shortening the time available to eat across the day and is associated with improved CVD outcomes compared with longer eating windows. However, studies that have examined TRE have not considered the impact of sleep on CVD outcomes despite recent evidence showing that sleep duration can influence the timing and amount of food eaten. In this article, we argue that as TRE and sleep influence each other, and influence the same cardiometabolic parameters, experiencing inadequate sleep may attenuate any positive impact TRE has on CVD. We examine the relationship between TRE and CVD, with sleep as a potential mediator in this relationship, and propose a research agenda to investigate this relationship. This will provide necessary evidence to inform future interventions aimed at reducing the burden of CVD.

Sleep disturbance in caregivers of individuals with Parkinsonism: a systematic review and meta-analysis.

OBJECTIVES: The global prevalence of Parkinsonism continues to rise given ageing populations. Individuals with Parkinsonism who have moderate or severe symptoms typically require a high level of care, including assistance with activities of daily living. This care is often provided across the 24-hour period by a family member or friend. It is likely that providing care significantly impacts the sleep duration and quality of the caregiver given overnight caring responsibilities, in addition to worry and stress associated with the caregiving role. The aim of this systematic review and meta-analysis was to investigate whether providing care to an individual with Parkinsonism was associated with disturbed caregiver sleep, and to identify associated factors that may contribute to disturbed sleep in this population. SETTING: Five databases were electronically searched on 30 June 2021 including CINAHL, PubMed, PsycINFO, CENTRAL and EMBASE. PARTICIPANTS: Eligibility criteria included a population of caregivers whose care recipient has a form of Parkinsonism. PRIMARY AND SECONDARY OUTCOME MEASURES: To be included in this systematic review, outcome measures of caregiver sleep (eg, sleep duration, sleep quality) were required. RESULTS: Eighteen studies (n=1998) were included. Findings indicated that caregivers of individuals with Parkinsonism typically experience poor sleep quality (mean (95% CI): 5.6 (4.8 to 6.4) points on the Pittsburgh Sleep Quality Index), increased sleep latency and poor sleep efficiency. CONCLUSIONS: The degree of poor sleep quality was clinically significant. However, further investigation of sleep outcomes is required using sleep measurement tools tailored for this population (eg, measures that capture overnight sleep disruption by care recipient/s). Additionally, there is a need for appropriate individual and societal-level interventions to improve caregiver sleep. PROSPERO REGISTRATION NUMBER: CRD42021274529.

On-call work and sleep: the importance of switching on during a callout and switching off after a call.

Due to the unpredictable nature of working time arrangements, on-call workers experience regular disruption to sleep, particularly if woken by calls. Sleep disruption can impact long term physical and mental health, next day performance, and importantly, performance immediately after waking. To reduce the impact of performance impairments upon waking (i.e., reducing sleep inertia), research has investigated strategies to promote alertness (e.g., bright light, caffeine, and exercise). This review puts forth on-call workers who are likely to return to sleep after a call, it is also important to consider the impact of these sleep inertia countermeasures on subsequent sleep. Future research should build on the preliminary evidence base for sleep inertia countermeasures by examining the impact on subsequent sleep. This research is key for both supporting alertness and performance during a call ("switching on") and for allowing the on-call worker to return to sleep after a call ("switching off").

Interventions to improve sleep in caregivers: A systematic review and meta-analysis.

Unpaid caregivers often experience sleep impairments as an unintended consequence of providing care. This systematic review and meta-analysis investigated the efficacy of interventions to improve sleep in unpaid caregivers. Six databases were searched from journal inception to 7-Sep-2021 to identify randomised controlled trials. Random-effects meta-analyses estimated mean differences (MD) at end-of-intervention. Twenty-one studies were identified (15 eligible for meta-analysis). Compared to control, interventions improved sleep quality (Pittsburgh Sleep Quality Index; 12 studies, 1153 participants, MD = -1.66, 95% CI [-2.91, -0.41], p = 0.009, I2 = 90.51%, GRADE = low), and total sleep time (hours; two studies, 122 participants, MD = 0.45, 95% CI [0.42, 0.48], p = 0.003, I2 = 0.00%, GRADE = low), but not sleeping problems (sleep item on Symptom Distress Scale of the Omega Screening Questionnaire; two studies, 529 participants, MD = -0.06, 95% CI [-0.69, 0.58], p = 0.458, I2 = 0.01%, GRADE = low). There is low quality evidence that interventions improve sleep quality in unpaid caregivers compared to control. Limitations include the lack of evidence for specific intervention modes and limited use of objective sleep measures. Future research should explore potential effect modifiers such as care recipient condition (CRD42021278670).