Religious involvement as a social determinant of sleep: an initial review and conceptual model

Religiosity, Religious Orientation, and a Good Night's Sleep: The Role of Anxiety and Depression

Religious belief can be beneficial to mental health, particularly in relation to anxiety and depression, both of which are strongly linked to poor sleep. This study aimed to investigate the role of anxiety and depression as mediators in the relationship between religiosity/religious orientation and sleep health in the Druze community in Israel. The cross-sectional study included 93 religious and 140 non-religious Druze adults who completed a questionnaire and a 2-week sleep diary. We tested the effects of religiosity (yes/no) and religious orientation (religion as end, means and quest) on sleep quality and efficiency. Next, we examined anxiety and depression as mediators in these relationships. Eighty-three (35.6%) respondents had borderline or clinical anxiety, while 24(10.3%) had borderline or clinical depression. Thirty (12.9%) reported poor sleep quality. In mediation models, anxiety fully mediated the relationship between religiosity and sleep quality (β = 0.195, 95% CI [0.109-0.296]); religiosity and sleep efficiency (β = 0.619, 95% CI [0.193-1.137]); religion as end and sleep quality (β = 0.091, 95% CI [0.046-0.150]); religion as end and sleep efficiency (β = 0.304, 95% CI [0.094-0.577]); religion as quest and sleep efficiency (β = -0.325, 95% CI [-0.575-0.086]). Additionally, anxiety partially mediated the relationship between religion as quest and sleep quality (β = -0.096, 95% CI [-0.152-0.052]). In all models, non-religious status, lower levels of religion as end, and higher levels of religion as quest predicted higher anxiety, which in turn predicted lower sleep quality and efficiency. Other models were non-significant for anxiety or depression. Anxiety plays a crucial role in the relationship between religiosity, religious orientation and sleep health. Religious individuals experience less anxiety and report better sleep quality.

Objectively-measured sleep characteristics and the associated factors among rural and urban in-school Nigerian adolescents

PURPOSE

Poor sleep is increasing worldwide but sleep studies, using objective measures, are limited in Africa. Thus, we described the actigraphy-measured sleep characteristics of Nigerian in-school adolescents and the differences in these sleep characteristics in rural versus urban-dwelling adolescents using actigraphy plus a sleep diary.

METHODS

This comparative, quantitative study involved 170 adolescents aged 13-19 attending six rural and six urban schools in southwestern Nigeria. Participants wore actiwatches and filled sleep diaries concurrently for one week. We ran a mixed model analysis with each sleep characteristic as a dependent variable in each model and the fixed effects of age, weekday versus weekend, rural versus urban residence, sex, and religion.

RESULTS

The adolescents were 54.1 % females with a mean age of 15.6 ± 1.3 years. Overall, adolescents' mean bedtime was 22.50 ± 0.85, mean waketime was 5.73 ± 0.68 and mean total sleep time (TST) was 06.07 ± 0.95 h. On both weekdays and weekends, urban adolescents had significantly later bedtimes, earlier waketimes, shorter time-in-bed (TIB) and TST (all p < 0.05) while rural adolescents had lower sleep efficiency, more frequent awakenings and WASO (all p < 0.05). In mixed-model analyses, older adolescents had later bedtimes (p = 0.035) and shorter TST (p = 0.047), urban adolescents had later bedtimes, earlier wake times, shorter TIB and TST than rural adolescents (all p < 0.05), and on weekdays, all adolescents had earlier bedtimes, waketimes, shorter TIB and TST than on weekends (all p < 0.05).

CONCLUSION

Adolescents, especially the urban ones, had insufficient sleep with a catch-up-sleep on weekends. Multipronged interventions, including controlling causes of late bedtimes and delaying school start-times are needed to improve sleep, especially among older and urban adolescents.

Religiosity and Mental and Behavioural Health Among Community-Dwelling Middle-Aged and Older Adults in Thailand: Results of a Longitudinal National Survey in 2015-2020

The aim of the study was to assess associations between religiousness (affiliation, and involvement) and five mental and five behavioural health indicators among middle-aged and older adults in a national longitudinal population survey in Thailand. The analytic sample consisted of 2863 participants, with two study assessments in 2015 and 2020. At baseline 91.5 percent were Buddhists and 8.2 percent were Muslims, and 42.6 percent a had high religious involvement. In the adjusted model, moderate and/or high religious involvement was negatively associated with four mental health and four behavioural health risk indicators. Furthermore, being a Buddhist was negatively associated with poor self-rated mental health status, depressive symptoms, insomnia symptoms and loneliness, and positively associated with alcohol use.

A socioecological model of neighborhood disorder, religious attendance, and sleep efficiency

OBJECTIVES

Drawing on the socioecological model of sleep health, we formally examine the association between neighborhood disorder and sleep efficiency. While most studies focus on direct associations with neighborhood context, we also consider whether the relationship between religious attendance and sleep efficiency varies as a function of neighborhood disorder.

DESIGN

We use ordinary least squares regression to model cross-sectional survey data.

SETTING

The United States.

PARTICIPANTS

The All of Us Research Program is based on a nonprobability sample of 5168 adults aged 18 and over.

MEASUREMENTS

Our analyses include an index of perceived neighborhood disorder, a single-item measure of religious attendance, and an objective measure of sleep efficiency based on wrist actigraphy.

RESULTS

While perceptions of neighborhood disorder are inversely associated with sleep efficiency, religious attendance is positively associated with sleep efficiency. The association between religious attendance and sleep efficiency did not vary across levels of neighborhood disorder.

CONCLUSION

Our analyses add to a growing literature on the association of neighborhood disorder with objective indicators of sleep health. To our knowledge, we are among the first to observe any association between religious attendance and sleep efficiency. We extended the socioecological model of sleep health by framing neighborhood disorder as a moderator.

Crisis of Faith and Sleep Quality in the United States: A Literal Dark Night of the Soul?

A crisis of faith is an intrapersonal struggle with ultimate meaning that occurs when one's supramundane reality is called in question. We propose a theoretical model which suggests that a crisis of faith will contribute to poorer sleep quality by undermining a general sense of meaning and purpose in life, especially among women. We use national survey data from the Wave 5 of the Baylor Religion Survey United States (N = 1395). Ordinary least squares regression models with robust standard errors are utilized. Sobel-Goodman mediation techniques are used to test the proposed mediating pathway. Our results suggest that a crisis of faith is associated with lower sleep quality, and that this pathway is partially mediated by a lower sense of meaning and purpose in life. Finally, we found that the relationship between a crisis of faith and lower sleep quality was weaker for women. We discuss the implications of our results and suggest how future research may explore the relevance of a crisis of faith for well-being as well as other aspects of the human condition.

Job loss and mental disorders: International evidence from the early stages of COVID-19 outbreak

Using a rich individual level dataset from six countries, we examine the relationship between job loss and mental disorders during the first phase of the COVID-19 pandemic. We consider four indicators of mental disorders based on their severity, viz. anxiety, insomnia, boredom, and loneliness. We draw our conclusions based on two groups of countries that differ by the timing of their peak infections count. Using a logit and a two-stage least squares (TSLS) regression methods, we find that the people who lost their jobs due to the pandemic are more likely to suffer from mental disorders, especially insomnia and loneliness. Additionally, people with financial liabilities, such as housing mortgages, are among those vulnerable to anxiety. Women, urban residents, youth, low-income groups, and tobacco users are more prone to mental disorders. The findings from this research have significant policy implications on infectious disease control measures and mental health conditions due to lockdowns and social distancing.

Prevalence and predictors of insomnia and its treatment-seeking among older adults in India

BACKGROUND

Insomnia is a serious health problem among older adults and, if untreated, is linked to a high morbidity rate and decreased quality of life. There is limited empirical evidence on Insomnia and its treatment-seeking exclusively among older adults (60 plus years) using representative data in India. This study assesses the prevalence and predictors of Insomnia and its treatment-seeking among older adults.

METHODS

Data gathered through the nationally-representative Longitudinal Ageing Study in India (LASI); Wave 1 (2017-18) was used for the analysis. Specifically, information from older adults aged 60 and above for whom complete information on insomnia was available (n- 31,464) was considered for the analysis. Binary logistic regression was used to check the adjusted effects of insomnia's socio-demographic and economic predictors and its treatment-seeking status. Stata was used for the data analysis with a 5% significance level.

RESULTS

37% of older adults had insomnia. Increasing age, female gender, living without a spouse, illiteracy, chronic health conditions, nutritionally underweight, physically inactive status, lack of exposure to mass media, Hindu religion, non-tribal status, and rural residence were significantly associated with insomnia. 3% of older adults sought treatment for insomnia. Not seeking treatment for insomnia was associated with male gender, exposure to mass media, physical activity, lack of chronic health issues, tribal status, living in a rural area, and being economically disadvantaged.

CONCLUSIONS

A sizable number of older adults have insomnia, and the prevalence varies by their socioeconomic, demographic, and health status. Many modifiable risk factors like low education, chronic health conditions, smoking, being underweight, physical inactivity, and lack of exposure to mass media are identified. Treatment-seeking for Insomnia is further inadequate, enhancing the older adult's vulnerability to various morbidities. Policy and program intervention to raise awareness about insomnia, including early identification and pharmacological and non-pharmacological treatment, will ensure better health and welfare of older adults. Estimations are based on self-report questionnaires; therefore, the possibility of recall bias and under-reporting cannot be ignored. Moreover, the estimation of insomnia may vary depending on various clinical definitions. However, a large sample size from a recent nationally representative survey with a robust sampling design is the strength of this study.

What's your religious coping profile? Differences in religious orientation and subjective sleep among religious coping groups in the United States

OBJECTIVES

To determine various profiles/subgroups of religious copers based on indices of positive and negative religious coping; and to determine whether religious copers differ in their religious orientations, subjective sleep characteristics, and strategies used to cope with sleep problems.

METHOD

Six hundred and ninety-five adults (77.3% female, 70.4% White) in the United States completed a 20-minute online questionnaire in January 2020.

RESULTS

Results of a latent profile analysis, based on 8 indicators of positive and negative religious coping, indicated a 5-class solution: (i) "Absent" (n = 101, 14.5%); (ii) "Anxious" (n = 122, 17.6%); (iii) "Ambivalent" (n = 101, 14.5%); (iv) "Secure" (n = 200, 28.8%); and (v) "Conflicted" copers (n = 171, 24.6%). Results of MANOVA tests indicated that Secure copers reported the least religious doubt and highest religious-based social support. Conflicted and Anxious copers had the worst sleep quality, while Secure, Ambivalent, and Absent copers had healthier sleep profiles. In terms of strategies used to cope with sleep problems, Secure and Conflicted copers reported the greatest use of prayer and meditation, while the use of technology was most prevalent among Conflicted and Anxious copers.

CONCLUSIONS

Individuals differ in their combined use of positive and negative religious coping, which is related to differences in their religious orientation, sleep characteristics, and strategies used to cope with sleep problems. Religious leaders should be mindful of the diverse ways in which religious coping strategies are harnessed to effectively cater to the unique religious and sleep needs of their members.

Relationship between sleep quality and marital satisfaction of working women during the premenopausal period

Sleep disorders can adversely affect physical, sexual, and marital health, particularly among middle-aged women. This study aimed to determine the relationship between sleep quality and marital satisfaction of working women during the premenopausal period. In this cross-sectional study, we selected 150 women working at Shiraz University of Medical Sciences in Iran was selected using random cluster sampling. A demographic information form, the Pittsburgh Sleep Quality Index (PSQI), and the Evaluation and Nurturing Relationship Issues, Communication, and Happiness (ENRICH) marital satisfaction scale were used for data collection. The Data were analyzed using SPSS.22 software at a significance level of P < 0.05. Multiple linear regression analysis was employed to predict sleep quality based on marital satisfaction. Our results showed that 79 (52.7%) of the participants had undesirable sleep quality, 87 (58%) had high marital satisfaction, and 32 (21.3%) had very high marital satisfaction. Regression analysis revealed that the total marital satisfaction score could not predict the sleep quality score of the participants. However, as dimensions of marital satisfaction, personality issues negatively (β = 0.327, P < 0.05) and ideological orientation positively (β = 0.336, P < 0.01) predicted the sleep quality score. Based on the prediction of the sleep quality score by personality issues and ideological orientations among the dimensions of marital satisfaction, it seems that life skills training, especially in these two dimensions, may improve the quality of sleep and, as a result, the physical and mental health of working women.

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.

The association between polluted fuel use and self-reported insomnia symptoms among middle-aged and elderly Indian adults: a cross-sectional study based on LASI, wave 1

BACKGROUND

Insomnia predisposes the aging population to reduced quality of life and poor mental and physical health. Evidence of the association between polluted fuel use and insomnia symptoms is limited and is non-existent for the Indian population. Our study aimed to explore the link between polluted fuel use and insomnia symptoms in middle-aged and older (≥ 45 years) Indian populations.

METHODS

We utilized data from nationally representative Longitudinal Aging Study in India (LASI) Wave 1. Participants with complete information on fuel use, insomnia symptoms, and covariates were included. Insomnia symptoms were indicated by the presence of at least one of three symptoms: difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), or early morning awakening (EMA), ≥ 5 times/week. Survey-weighted multivariable logistic regression analyses were conducted to evaluate the association between polluted fuel use and insomnia symptoms. We also assessed the interaction of association in subgroups of age, gender, BMI, drinking, and smoking status.

RESULTS

Sixty thousand five hundred fifteen participants met the eligibility criteria. Twenty-eight thousand two hundred thirty-six (weighted percentage 48.04%) used polluted fuel and 5461 (weighted percentage 9.90%) reported insomnia symptoms. After full adjustment, polluted fuel use was associated with insomnia symptoms (OR 1.16; 95%CI 1.08-1.24) and was linked with DIS, DMS, and EMA (OR 1.14; 95%CI 1.05-1.24, OR 1.12; 95%CI 1.03-1.22, and OR 1.15; 95%CI 1.06-1.25, respectively). No significant interactions for polluted fuel use and insomnia symptoms were observed for analyses stratified by age, sex, BMI, drinking, or smoking.

CONCLUSIONS

Polluted fuel use was positively related to insomnia symptoms among middle-aged and older Indians. Suggestions are offered within this article for further studies to confirm our results, to explore underlying mechanisms, and to inform intervention strategies.

Impact of a spiritual care program on the sleep quality and spiritual health of Muslim stroke patients: A randomized controlled trial

OBJECTIVES

Stroke patients often experience poor sleep quality and spiritual health due to complications and limitations. In this situation, implementing spiritual care may reduce these problems. Therefore, this study aimed to examine the effect of a spiritual care program on sleep quality and spiritual health of Muslim stroke patients.

METHODS

This was a two-group randomized clinical trial conducted in Hamadan, Iran, in 2021, with 117 stroke patients. The samples were selected by convenience sampling and assigned to experimental (N = 59) and control (N = 58) groups based on random permutation blocks. The data were collected using the demographic information form, the Pittsburgh Sleep Quality Index, the Paloutzian and Ellison Spiritual Well-Being Scale, and the Modified Rankin Scale before and one month after the intervention. The experimental group received five daily sessions of spiritual care for 45-60 min based on standard and local methods, including patient orientation and identification of spiritual needs, religious care, supportive spiritual care, and beneficial evaluations. Data were analyzed by chi-square test, Fisher's exact test, independent t-test, and paired t-test at 0.05 significance level in SPSS 21.

RESULTS

The socio-demographic characteristics were similar between the groups (p > 0.05). At baseline, there was no significant difference in sleep quality and spiritual health between the experimental and control groups (p > 0.05). However, after the intervention, the sleep quality and spiritual health of patients in the experimental group improved significantly compared with the control group (p < 0.05).

CONCLUSION

The spiritual care program improved sleep quality and spiritual health of stroke patients; therefore, nurses should consider these aspects to provide holistic care.

Godless owls, devout larks: Religiosity and conscientiousness are associated with morning preference and (partly) explain its effects on life satisfaction

The associations between morningness-eveningness, conscientiousness, and religiosity have not been investigated to date. The aim of the present research was to provide evidence for the relationships between these dimensions. Moreover, we tested whether the well-established link between morningness and life satisfaction could be explained by elevated religiosity of morning-oriented individuals and whether this relationship may be mediated by conscientiousness. The investigation was conducted on two independent samples of Polish adults (N = 500 and N = 728). Our results corroborated earlier findings that morningness was positively associated with both conscientiousness and satisfaction with life. We also found evidence for a significant positive association between morningness and religiosity. Moreover, controlling for age and gender, we obtained significant mediation effects showing that the association between morningness-eveningness and satisfaction with life might stem, at least in part, from the higher religiosity among morning-oriented individuals, also when conscientiousness was included in the model. It means that more morning-oriented individuals may benefit from higher psychological well-being thanks to both personality characteristics and attitudes towards religion.

Association of Religious Service Attendance and Neuropsychiatric Symptoms, Cognitive Function, and Sleep Disturbances in All-Cause Dementia

Commonly reported in dementia, neuropsychiatric symptoms (NPS), cognitive decline, and sleep disturbances indicate dementia progression. With the growing dementia burden, identifying protective factors that may slow dementia progression is increasingly essential. Religion and spirituality are associated with better mental and physical health, yet few studies have been reported in older adults with dementia. This study examines associations between religious service attendance and symptoms of dementia progression. Using data from the Health and Retirement Study in 2000, 2006, and 2008 and the sub-study, Aging, Demographics, and Memory Study in 2001-2003, 2006-2007, and 2008-2009, we examined the association of religious attendance with neuropsychiatric symptoms, cognitive function, and sleep disturbances among U.S. older adults aged 70 years and older with all-cause dementia (N = 72) using Spearman's partial Rho correlation controlling for social interaction. Significant associations were identified for religious attendance and NPS (r_s (97) = -0.124, 95% CI [-0.129, -0.119], p < 0.0005); cognitive function, r_s (97) = -0.018, 95% CI [-0.023, -0.013], p < 0.001); and sleep disturbances, r_s (97) = -0.275, 95% CI [-0.280, -0.271], p < 0.0005). Beyond adjusting for social interaction, increased religious attendance was associated with lower NPS, better cognitive function, and fewer sleep disturbances. Clinical trials and longitudinal studies with a larger sample size examining religion and spirituality factors with dementia progression are warranted.

The associations between paranormal beliefs and sleep variables

Previous studies have found significant associations between paranormal beliefs and sleep variables. However, these have been conducted on a small scale and are limited in the number of sleep variables investigated. This study aims to fill a gap in the literature by investigating paranormal beliefs in relation to a wide range of sleep variables in a large sample. Participants (N = 8853) completed a survey initiated by the BBC Focus Magazine. They reported on their demographics, sleep disturbances and paranormal beliefs. Poorer subjective sleep quality (lower sleep efficiency, longer sleep latency, shorter sleep duration and increased insomnia symptoms) was associated with greater endorsement of belief in: (1) the soul living on after death; (2) the existence of ghosts; (3) demons; (4) an ability for some people to communicate with the dead; (5) near-death experiences are evidence for life after death; and (6) aliens have visited earth. In addition, episodes of exploding head syndrome and isolated sleep paralysis were associated with the belief that aliens have visited earth. Isolated sleep paralysis was also associated with the belief that near-death experiences are evidence for life after death. Findings obtained here indicate that there are associations between beliefs in the paranormal and various sleep variables. This information could potentially better equip us to support sleep via psychoeducation. Mechanisms underlying these associations are likely complex, and need to be further explored to fully understand why people sometimes report "things that go bump in the night".

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.

Factors that protect against poor sleep quality in an adult lifespan sample of non-Hispanic Black and non-Hispanic White adults during COVID-19: A cross-sectional study

Introduction

Stress in relation to the Coronavirus disease 19 pandemic (i.e., COVID-19, COVID stress) may be linked with poor sleep quality. The association between stress that is specific to the COVID-19 pandemic and sleep quality has been understudied, particularly in racially diverse people across the adult lifespan. Here, we investigated self-reported sleep quality in relation to COVID stress and factors that may protect against experiencing poor sleep quality from high COVID stress, including social support and religiosity.

Method

We recruited non-Hispanic Black (n = 73) and non-Hispanic White (n = 178) participants across the adult lifespan (18-76 years) using an online, cross-sectional design during the COVID-19 pandemic (March 2021-June 2021). We asked participants to report information regarding demographics (age, race/ethnicity, years of education), sleep (sleep quality, sleep habits), and positive (social support, religious activities) and negative (events of discrimination, depression, general stress, COVID stress) psychosocial factors.

Results

Across age and racial groups, better sleep habits were associated with better sleep quality, and higher COVID stress was linked to poorer sleep quality. Black participants reported higher quality sleep than White participants (p = 0.006). They also endorsed greater private and internal religiosity (p's < 0.001). Across racial groups, moderation analyses revealed a protective effect of religiosity against poor sleep (p's < 0.006). Specifically, individuals with high religious activity and high COVID stress did not experience poor sleep quality, but individuals with low religious activity and high COVID stress demonstrated poor sleep quality. These results remained significant when controlling for general stress.

Discussion

Protective factors, such as religiosity, may mitigate the negative associations between high COVID stress and poor sleep quality.

Religious Involvement and Sleep Among Older African Americans

Objective: This study sought to determine whether religious involvement is associated with sleep quality in a nationally representative sample of older African Americans. Methods: The analytic sample included African American respondents aged 55+ from the National Survey of American Life-Reinterview (N = 459). Religious involvement variables included service attendance, reading religious texts, watching religious television programs, listening to religious radio programs, prayer, and subjective religiosity. Sleep outcomes were restless sleep and sleep satisfaction. Multiple linear regression analysis was used. Results: Watching religious television programs was associated with more restless sleep. Respondents who attended religious services less than once a year, at least once a week, or nearly every day reported greater sleep satisfaction than respondents who never attended religious services. Subjective religiosity was associated with lower sleep satisfaction. Discussion: The findings demonstrate the importance of examining a variety of religious involvement domains, which could point to different explanatory pathways between religious involvement and sleep.

The Efficacy of Integrating Spirituality into Prenatal Care on Pregnant Women’s Sleep: A Randomized Controlled Trial

Objective. The study is aimed at determining the efficacy of spiritual content counselling on improving the sleep quality and insomnia severity of pregnant women. Methods. This randomized controlled trial was carried out on 40 pregnant women recruited at five health centres of Abhar, Iran, 2020. The eligible women were allocated into two intervention and control groups according to the randomized blocking method. Group counselling with spiritual content was carried out in eight sessions at 16 to 20 weeks of gestation. The control group only received routine care. Data were collected using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) questionnaires in three stages, before the intervention, at 28, and 36 weeks of gestation. Statistical analysis was performed using repeated measure ANOVA test, chi-square, and independent $t$ -tests. $P<0.05$ was considered significant statistical level. Results. In the counselling group, the mean (SD) of a total score of sleep quality before the intervention was 9.45 (2.30) which decreased to 5.40 (1.56) in 36 weeks of gestational age, while in the control group was increased from 9.26 (2.15) to 11.47 (1.54). After the intervention based on the repeated measure ANOVA test, the mean total score of the insomnia severity, sleep quality, and its components decreased statistically in the second and third trimesters compared to the first trimester in the intervention group compared to the control group ( $P=0.001$ ). Conclusion. The results showed that counselling with spiritual content could effectively ameliorate sleep quality and reduce insomnia severity in pregnant women. It seems that the approach is an acceptable basis to design intervention programs in this field that can be considered by midwives. Clinical Trial Registry and Registration Number. The study was registered at the Iranian Registry of Clinical Trials under the IRCT20150731023423N15.

International study of the prevalence and factors associated with insomnia in the general population

OBJECTIVES

Insomnia is a public health problem with many repercussions. It affects a significant proportion of the general population worldwide, but the estimated prevalences in different countries are difficult to compare due to the use of heterogeneous methodologies. The objectives of the study were to compare the prevalence of insomnia in the general population in different sites around the world and to identify sociodemographic and mental health associated factors, using the same tool and within a single study.

METHODS

This multicenter cross-sectional study is based on the Mental Health in the General Population survey (MHPG). It included several sites in France and 12 countries around the world with a representative sampling of the general population. The prevalence of short-term insomnia disorder was estimated by the occurrence within one month of at least one symptom, at a minimum frequency of three per week, with repercussions on everyday life.

RESULTS

Out of the 57,298 participants, 11.3% had a diagnosis of short-term insomnia disorder, with significant differences in prevalence between sites, ranging from 2.3% to 25.5%. Insomnia was significantly related to having mood disorders, anxiety disorders, substance use disorders and psychotic disorders. Insomnia was also more common among women, older adults, working participants and those who practice a religion.

CONCLUSIONS

The prevalence of insomnia was highly variable between sites, but the predictors appeared to be the same everywhere. Insomnia seemed to be more related to the presence of mood and anxiety disorders than a site-specific effect and thus may be a good indicator of mental health.

Passion for an activity: a new predictor of sleep quality

STUDY OBJECTIVES

The present research examines the relationship between people's frequent involvement in an activity they like and find important (i.e., a passion) and the quality of their sleep. Research on the dualistic model of passion has widely documented the relationship between individuals' type of passion-harmonious versus obsessive-and the quality of their mental and physical health. However, research has yet to examine the relationship between passion and sleep quality. Building on prior research has shown that obsessive (vs harmonious) passion is related to depressive mood symptoms-an important factor associated with sleep problems-we hypothesized that obsessive passion would be associated with overall worse sleep quality, whereas harmonious passion would predict better sleep quality.

METHODS

A sample of 1,506 Americans filled out an online questionnaire on sleep habits and passion. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Hierarchical linear regressions and mediation analyses were carried out with results confirming our hypotheses.

RESULTS

Obsessive passion for an activity was associated with worse sleep quality, whereas harmonious passion was associated with better sleep quality, adjusting for demographics, the type of passionate activity and its self-reported importance, alcohol and tobacco consumption, BMI, self-reported health, and diagnosed health conditions. The relationship between both types of passion and sleep quality was mediated by depressive mood symptoms.

CONCLUSIONS

Our study presents evidence of a strong relationship between sleep quality and passion, opening the door for future research to create new interventions to improve people's sleep and, consequently, their well-being.

Resilience factors, race/ethnicity and sleep disturbance among diverse older females with hypertension

BACKGROUND

This study examined the relationships between resilience and sleep disturbance in a diverse sample of older women with a history of hypertension and whether this relationship is moderated by individuals' race/ethnicity.

METHODS

Sample includes 700 females from a community-based study in Brooklyn, New York with a mean age of 60.7 years (SD=6.52). Of the participants, 28.1% were born in the U.S.; 71% were African-descent, 17.4% were European and 11.6% were Hispanics descents. Data were gathered on demographics and sleep disturbance using the Comprehensive Assessment and Referral Evaluation (CARE) and the Stress Index Scale (SIS). Resilience Factors were assessed with both the Index of Self-Regulation of Emotion (ISE) and religious health beliefs. Chi-Square, Anova, Student t-tests, and multilinear regression analysis were conducted to explore associations between resilience factors and sleep disturbance. Associations between resilience factors and sleep disturbance were examined using stratified multilinear regression analysis in three models by race/ethnicity. Regression models was conducted examining the interaction between resilience factors and stress RESULTS: Resilience factor, ISE emerged as the strongest independent predictor of sleep disturbance [B(SE) = -0.368(0.008); p < .001] for African descents. ISE was not a significant predictor of sleep disturbance among Hispanic participants [B(SE) = -0.218(0.022);p = .052], however interaction effect analysis revealed that stress level moderates significantly the relationship between ISE, and their sleep disturbance [B(SE) = 0.243(0.001);p = .036].

CONCLUSIONS

Results of our study suggest that resilience factors might be a more important protective factor for sleep disturbance among diverse older females.

Effect of diurnal fasting on sleep during Ramadan: a systematic review and meta-analysis

PURPOSE

The current meta-analysis aimed to obtain a more stable estimate of the effect size of Ramadan diurnal intermittent fasting (RDF) on sleep duration and daytime sleepiness.

METHODS

Databases (Scopus, ScienceDirect, ProQuest Medical, PubMed/MEDLINE, Web of Science, EBSCOhost, Cochrane, CINAHL, and Google Scholar) were searched from database inception to the end of June 2019. The sleep quality measures analyzed were excessive daytime sleepiness (EDS) measured by the Epworth sleepiness scale (ESS) and total sleep time (TST). Subgroup analyses for age, sex, and levels of physical activity were conducted.

RESULTS

We identified 24 studies (involving 646 participants, median age 23.7 years, 73% men) conducted in 12 countries from 2001 to 2019. The results revealed that TST decreased from 7.2 h per night [95% confidence interval (CI) 6.7-7.8] before Ramadan to 6.4 h (95% CI 5.3-7.5) during Ramadan, while the ESS score increased slightly from 6.1 (95% CI 4.5-7.7) before Ramadan to 7.0 (95% CI 5.2-8.8) during Ramadan. Effect sizes on sleep quality measures during RDF demonstrated a moderate reduction in TST (number of studies, K = 22; number of subjects, N = 571, Hedges' g value of -0.43, 95% CI - 0.64 to -0.22, Q = 90, τ² = 0.15, I² = 78%, P < 0.001), while ESS score showed negligible effect on EDS (K = 9, N = 362, Hedges' g value of -0.06, 95% CI -0.43 to 0.28, Q = 21, τ² = 0.13, I² = 76%, P value = 0.001).

CONCLUSION

During the month of Ramadan, there is approximately a 1 hour reduction in TST and nearly a 1 point increase in the ESS score.

Sleep quality among college students: exploring the role of a divine locus of sleep control

OBJECTIVES

To explore (a) how perceptions of personal and divine control over one's sleep schedule combine in distinct ways to predict sleep quality among college students and (b) whether health behaviors and psychological distress mediate the associations between perceptions of sleep control and sleep quality.

METHODS

We surveyed 1251 students attending a public university in South Texas. All measures were derived from self-reports. Binary logistic regression techniques were used to predict the odds of reporting high-quality sleep in the past month. Mediation analyses were used to decompose the estimated effects of perceptions of sleep control on sleep quality via smoking, drinking, and psychological distress.

RESULTS

Compared to participants who reported both low personal control and low divine control over their sleep schedules, students who reported both high personal control and high divine control exhibited 148% greater odds of reporting high-quality sleep (odds ratio = 2.48; 95% confidence interval = 1.434-4.294). These same participants also showed the highest predicted probabilities of reporting high-quality sleep (22%) compared to students with other sleep control orientations. Mediation analyses indicated that reduced psychological distress partially accounted for these differences, whereas smoking and drinking behaviors did not.

CONCLUSION

College students who felt they and God both shared full control over their sleep schedules reported the highest quality sleep, which was partially explained by their lower average levels of psychological distress.

The Relationship Between Sleep Quality and Internet Addiction Among Female College Students

BACKGROUND

Over 40% of Taiwanese College students experience sleep problems that not only impair their quality of life but also contribute to psychosomatic disorders. Of all the factors affecting the sleep quality, internet surfing is among one of the most prevalent. Female college students are more vulnerable to internet-associated sleep disorders than their male counterparts. Therefore, this study aims to investigate (1) the relationship between internet addiction and sleep quality, and (2) whether significant variations in sleep quality exist among students with different degrees of internet use.

METHODS

This structured questionnaire-based cross-sectional study enrolled students from a technical institute in southern Taiwan. The questionnaire collected information on the following three aspects: (1) demography, (2) sleep quality with Pittsburgh Sleep Quality Index (PSQI), and (3) severity of internet addiction using a 20-item Internet Addiction Test (IAT). Multiple regression analysis was performed to examine the correlation between PSQI and IAT scores among the participants. Logistic analysis was used to determine the significance of association between PSQI and IAT scores.

RESULTS

In total, 503 female students were recruited (mean age 17.05 ± 1.34). After controlling for age, body mass index, smoking and drinking habits, religion, and habitual use of smartphone before sleep, internet addiction was found to be significantly associated with subjective sleep quality, sleep latency, sleep duration, sleep disturbance, use of sleep medication, and daytime dysfunction. Worse quality of sleep as reflected by PSQI was noted in students with moderate and severe degrees of internet addiction compared to those with mild or no internet addiction. Logistic regression analysis of the association between scores on IAT and sleep quality, demonstrated significant correlations between quality of sleep and total IAT scores (odds ratio = 1.05:1.03 ∼ 1.06, p < 0.01).

CONCLUSION

The results of this study demonstrated significant negative association between the degree of internet addiction and sleep quality, providing reference for educational institutes to minimize adverse effects associated with internet use and improve students' sleep quality.

SleepOMICS: How Big Data Can Revolutionize Sleep Science

Sleep disorders have reached epidemic proportions worldwide, affecting the youth as well as the elderly, crossing the entire lifespan in both developed and developing countries. "Real-life" behavioral (sensor-based), molecular, digital, and epidemiological big data represent a source of an impressive wealth of information that can be exploited in order to advance the field of sleep research. It can be anticipated that big data will have a profound impact, potentially enabling the dissection of differences and oscillations in sleep dynamics and architecture at the individual level ("sleepOMICS"), thus paving the way for a targeted, "one-size-does-not-fit-all" management of sleep disorders ("precision sleep medicine").