The effect of foot bath on sleep quality in the elderly: a systematic review

INTRODUCTION

Population aging is a problem that has affected most countries in the world. Poor-quality sleep is a common complaint among the elderly. Foot baths are a method of heat therapy and are performed as an independent nursing care in different departments. The present study was conducted with the aim of investigating the effects of foot baths with spa on improving the sleep quality of the elderly.

METHODS

This research is a systematic review. We systematically searched six databases, including Google Scholar, PubMed, Web of Science, Scopus, Embase, and the World Health Organization databases, to retrieve the related articles based on the keywords used in our search strategy from 2010 to March 2023.

RESULT

Finally, 10 articles were included in this study. All studies were randomized controlled trial (RCTs) and semi-experimental. In all 9 studies, the positive effects of the foot bath were reported. In 9 studies, the effect of foot baths with water above 40 degrees Celsius was reported. The PSQR questionnaire was used in most of the studies.

CONCLUSION

The total findings of this study showed that due to the high prevalence of sleep problems in the elderly, foot baths with warm water can be used as an easy, simple, and safe nursing intervention to improve sleep quality. Therefore, it can be used in nursing homes and hospitals. It is also a non-pharmacological and inexpensive nursing intervention that can be implemented by the elderly themselves after training by community health nurses.

The efficacy of earplugs and eye masks for delirium severity and sleep quality in patients undergoing coronary artery bypass grafting in cardiac intensive care units: A single-blind, randomised controlled trial

BACKGROUND AND PURPOSE

Delirium is a neuropsychiatric syndrome with a wide range of possible causes and multiple complications in patients admitted to intensive care units. It is, therefore, necessary to seek appropriate and safe strategies to prevent and manage delirium. This study is intended to examine the efficacy of eye masks and earplugs for delirium severity and sleep quality in patients with coronary artery bypass grafting in a cardiac intensive care unit.

MATERIALS AND METHODS

This single-blind, randomised controlled trial was conducted on 114 patients who were consecutively enrolled and randomly assigned to either the experimental group or the control group. The experimental group received routine care plus eye masks and earplugs, and the control group received only routine care. The delirium severity and sleep quality were measured with the Neelon and Champagne confusion scale and the Verran and Snyder-Halpern sleep scale.

RESULTS

The mean delirium severity score differed significantly between the two groups on the second, third, and fourth postoperative days (p < 0.001). Although the trend of changes in the mean delirium severity score from the first postoperative day (before the intervention) to the second, third, and fourth postoperative days was downward in the two groups (trending towards higher delirium severity), the control group experienced greater changes than the experimental group. An intragroup analysis of delirium severity detected a statistically significant difference in both the experimental and control groups (p < 0.001). The sleep quality domains (sleep disturbance, sleep effectiveness, sleep supplementation) showed a statistically significant difference between the two groups across the three intervention days (p < 0.001).

CONCLUSION

The overnight use of eye masks and earplugs were found to have positive effects on sleep quality domains (sleep disturbance, sleep effectiveness, sleep supplementation) and delirium severity in coronary artery bypass grafting patients admitted to the cardiac intensive care unit for several days. It was also found that a significant interaction effect between the sleep disturbance subscale and delirium severity exists.

CLINICAL TRIAL REGISTRATION NUMBER

(https://en.irct.ir): IRCT20210523051370N2.

"We're tough, but so is quitting." Barriers to Smoking Cessation: The Royal Malaysian Navy Perspective

INTRODUCTION

Tobacco kills half of its users. Despite this, there are over 1.1 billion smokers worldwide. Its harmful effects impair performance and readiness. Unfortunately, smoking has deeply ingrained in the military culture, as evidenced by the high prevalence. Hence, this study aims to identify the barriers to smoking cessation among this population.

METHODS

A study involving two groups of current smokers (commissioned officers and non-commissioned officers) was conducted using the modified nominal group technique (mNGT), a qualitative research method of judgmental decision-making involving four phases: Generating ideas, recording, evaluation, and prioritization. The mNGT was used to solicit respondents' barriers to smoking cessation.

RESULTS

The mNGT yielded seven main barriers to smoking cessation: (1) Addiction, (2) difficulty in staying focused without the usage of cigarettes, (3) smoking has been incorporated into an individual's lifestyle, (4) environmental influence, (5) coping mechanism, (6) the long-interval period between orders and duties exacerbates the desire to smoke, and (7) smoking has evolved into a permanent habit. Although nicotine addiction and habit were ranked as the most important barriers, the military working environment and nature of the job exposed them physically and mentally to unfavorable situations, complicating the quitting attempt. Furthermore, the acceptance of smoking in military culture leads to a positive smoker identity, further hindering cessation.

CONCLUSIONS

The findings indicate that in addition to barriers affecting the general population, military-specific barriers related to the nature of the job exist, complicating cessation. Hence, any intervention program should address these barriers to achieve positive outcomes.

Sleep, Activity, and Nutrition Among an Army Sample: Strengths, Deficits, and Demographic Differences

Sleep, activity, and nutrition (SAN) are key components in overall health, and an individual's knowledge about and self-confidence to engage in healthy SAN behaviors can have an impact on their actions. This evaluation examined SAN knowledge, self-confidence, and behaviors among U.S. Army Soldiers prior to participating in a health promotion program. Baseline surveys from participating Soldiers provide evidence in this evaluation. U.S. Army Soldiers (N = 11,485) participating in a health promotion program completed surveys. Participants completed an online survey assessing SAN knowledge, self-confidence, and behaviors (among other constructs). We examined the common patterns of SAN behaviors, the associations between them, and the differences based on gender and rank. Knowledge, self-confidence, and behaviors were correlated within each of the three SAN domains. Men reported more aerobic exercise (d = .48) and more resistance training (d = .34) per week than women. Officers reported greater self-confidence in their ability to consume a post-exercise snack (i.e., refuel; d = .38), greater refueling behaviors (d = .43), greater activity knowledge (d = .33), and greater self-confidence in their ability to achieve activity goals (d ranging from .33 to .39), compared to enlisted Soldiers. Finally, greater confidence in one's ability to achieve healthy sleep correlated with getting more sleep, both during workweek (r = .56, p < .001) and weekend (r = .25, p < .001). These baseline data support the need for health promotion of SAN behaviors among these Soldiers.

Physical sleeping environment is related to insomnia risk and measures of readiness in US army special operations soldiers

BACKGROUND

US military service members have characteristically poor sleep, even when 'in garrison' or at one's home base. The physical sleeping environment, which is often poor in military-provided housing or barracks, may contribute to poor sleep quality in soldiers. The current study aimed to assess whether the sleeping environment in garrison is related to sleep quality, insomnia risk and military readiness.

METHODS

Seventy-four US army special operations soldiers participated in a cross-sectional study. Soldiers were queried on their sleeping surface comfort and the frequency of being awakened at night by excess light, abnormal temperatures and noise. Subjective sleep quality and insomnia symptoms were also queried, via the Pittsburgh Sleep Quality Index and Insomnia Severity Index, respectively. Lastly, measures of soldier readiness, including morale, motivation, fatigue, mood and bodily pain, were assessed.

RESULTS

Soldiers reporting temperature-related and light-related awakenings had poorer sleep quality higher fatigue and higher bodily pain than soldiers without those disturbances. Lower ratings of sleeping surface comfort were associated with poorer sleep quality and lower motivation, lower morale, higher fatigue and higher bodily pain. Each 1-point increase in sleeping surface comfort decreased the risk for a positive insomnia screen by 38.3%, and the presence of temperature-related awakenings increased risk for a positive insomnia screen by 78.4%. Those living on base had a poorer sleeping environment than those living off base.

CONCLUSION

Optimising the sleep environment-particularly in on-base, military-provided housing-may improve soldier sleep quality, and readiness metrics. Providers treating insomnia in soldiers should rule out environment-related sleep disturbances prior to beginning more resource-intensive treatment.

Operation early-bird: Investigating altered light exposure in military barracks on sleep and performance-a placebo-controlled study

The manipulation of light exposure in the evening has been shown to modulate sleep, and may be beneficial in a military setting where sleep is reported to be problematic. This study investigated the efficacy of low-temperature lighting on objective sleep measures and physical performance in military trainees. Sixty-four officer-trainees (52 male/12 female, mean ± SD age: 25 ± 5 years) wore wrist-actigraphs for 6 weeks during military training to quantify sleep metrics. Trainee 2.4-km run time and upper-body muscular-endurance were assessed before and after the training course. Participants were randomly assigned to either: low-temperature lighting (LOW, n = 19), standard-temperature lighting with a placebo "sleep-enhancing" device (PLA, n = 17), or standard-temperature lighting (CON, n = 28) groups in their military barracks for the duration of the course. Repeated-measures ANOVAs were run to identify significant differences with post hoc analyses and effect size calculations performed where indicated. No significant interaction effect was observed for the sleep metrics; however, there was a significant effect of time for average sleep duration, and small benefits of LOW when compared with CON (d = 0.41-0.44). A significant interaction was observed for the 2.4-km run, with the improvement in LOW (Δ92.3 s) associated with a large improvement when compared with CON (Δ35.9 s; p = 0.003; d = 0.95 ± 0.60), but not PLA (Δ68.6 s). Similarly, curl-up improvement resulted in a moderate effect in favour of LOW (Δ14 repetitions) compared with CON (Δ6; p = 0.063; d = 0.68 ± 0.72). Chronic exposure to low-temperature lighting was associated with benefits to aerobic fitness across a 6-week training period, with minimal effects on sleep measures.

How Sleep Research in Extreme Environments Can Inform the Military: Advocating for a Transactional Model of Sleep Adaptation

PURPOSE OF REVIEW

We review the literature on sleep in extreme environments. Accordingly, we present a model that identifies the need for mitigating interventions to preserve sleep quality for military deployments.

RECENT FINDINGS

Situational factors that affect sleep in extreme environments include cold temperatures, isolated and confined areas, fluctuating seasonality, photoperiodicity, and extreme latitudes and altitudes. Results vary across studies, but general effects include decreased total sleep time, poor sleep efficiency, and non-specific phase delays or phase advances in sleep onset and sleep architecture. Considering habitability measures (e.g., light or temperature control) and individual differences such as variable stress responses or sleep need can mitigate these effects to improve mood, cognition, and operational performance. Although the situational demands during military missions inevitably reduce total sleep time and sleep efficiency, mitigating factors can attenuate sleep-related impairments, hence allowing for optimal mission success and personnel safety.

Combat exposure and behavioral health in U.S. Army Special Forces

Although combat has been found to be associated with adverse health outcomes, little is known about the impact of specific combat exposures, particularly among specialized personnel. This study examined the association of different types of combat exposures with behavioral health outcomes, and whether these associations differed by Army occupational specialization: General Purpose Forces infantrymen (n = 5,361), Ranger Qualified infantrymen (n = 308), and Special Forces personnel (n = 593). Multivariable regression models estimated the association of combat severity, type of combat event (fighting, killing, threat to oneself, death/injury of others), and type of killing with mental health disorders, trouble sleeping, and problem drinking. Combat severity, each type of combat event, and killing noncombatants were associated with adverse health outcomes after adjusting for covariates and other combat exposures. Except for trouble sleeping, these associations did not differ by occupational specialization, though the prevalence and odds of outcomes were generally lower for Special Forces personnel.

The Development, Implementation, and Feasibility of a Circadian, Light, and Sleep Skills Program for Shipboard Military Personnel (CLASS-SM)

Service members face unique barriers to sufficient and high quality sleep. In the present study, a circadian, light, and sleep skills program for shipboard military personnel (CLASS-SM) was designed to encourage and inform strategies that support optimal sleep and circadian health in the context of those barriers. Phase 1 included program development and refinement via an iterative formative evaluation, including structured interviews with service members and feedback from veterans and experts, resulting in further tailoring to the population. In Phase 2, the highly tailored program was administered to shipboard personnel (n = 55), and acceptability indicators were measured. Sleep- and circadian-related knowledge (pre- and post-program) and the perceived relevance of, and satisfaction with, program content (post-program) were assessed. Before the intervention, most individuals were unaware that 7−9 h of sleep is recommended (72%) and had little understanding of the physiological effects of light; however, knowledge scores increased significantly post-program, from 51% to 88% correct (p < 0.0001). Reception was positive, with high reported satisfaction and relevance. Most individuals reported that they learned something new (89%), planned to use one or more learned strategies (100%), and intended to share learned information with others (85%); the physiological effects of light and circadian rhythms were the content areas most frequently reported as new and useful. The results demonstrate the need for, and feasibility of, the delivery of this program in operational environments.

Prevalence and predictors of insomnia and sleep medication use in a large tri-service US military sample

OBJECTIVE

The presence of insomnia in the general military population is not well known. This study aimed to determine the prevalence of probable clinical insomnia and identify factors leading to new-onset insomnia and/or sleep medication use in a large military population.

DESIGN

Cross-sectional and longitudinal analyses of a prospective cohort study.

PARTICIPANTS

A tri-service US military and veteran cohort (sample range 99,383-137,114).

MEASUREMENTS

Participants were surveyed in 2013 (Time 1 [T1]) and 2016 (Time 2 [T2]) using the clinically validated Insomnia Severity Index. The prevalence of insomnia and sleep medication use was quantified at both times. Multivariable models identified military factors associated with new-onset insomnia and/or sleep medication use while adjusting for covariates.

RESULTS

The prevalence of insomnia at T1 and T2 was 16.3% and 11.2%, respectively. New-onset insomnia at T2 was reported by 6.0% of participants screening negative at T1; risk factors included Army service, combat deployment experience, and separation from military service. The prevalence of sleep medication use at T1 and T2 was 23.1% and 25.1%, respectively. Sleep medication use at T2 was newly-reported by 17.1% of participants not reporting sleep medication use at T1; risk factors included number of deployments and having a healthcare occupation.

CONCLUSIONS

The prevalence of probable clinical insomnia in this large general military population is within the range of previous reports in military and civilian populations. Certain military factors that predict new-onset insomnia and/or sleep medication use should be considered when designing and implementing sleep interventions in military populations.

Sleep and PTSD in the Military Forces: A Reciprocal Relationship and a Psychiatric Approach

Sleep disturbances are well-recognised symptoms of Post-Traumatic Stress Disorder (PTSD). This review updates knowledge regarding the relationship between sleep during deployment, combat-related trauma, and PTSD in military personnel, from which the importance of restorative sleep results. The description of the characteristics of sleep in military forces with the considerable roles of the operational and training contexts highlights the important consequences of degraded sleep. Indeed, a lot of data suggest a dynamic link between sleep and the onset and chronicity of PTSD. We propose a reciprocal relationship model with strategies strongly recommended or already adopted by the military to promote restorative sleep before and after combat exposure. Among the alterations in a variety of sleep architecture and sleep patterns described in PTSD, the physiological hypothesis of REM sleep fragmentation in the development of PTSD symptoms may be important because REM sleep is generally associated with emotional memory. Finally, we address clinical and research perspectives that could be used to detect or restore sleep continuity before and during military deployment to possibly alleviate nightmares and insomnia related to combat exposure and PTSD occurrence and improve our understanding of sleep in PTSD.

A trait of mind: stability and robustness of sleep across sleep opportunity manipulations during simulated military operational stress

STUDY OBJECTIVES

Within-subject stability of certain sleep features across multiple nights is thought to reflect the trait-like behavior of sleep. However, to be considered a trait, a parameter must be both stable and robust. Here, we examined the stability (i.e., across the same sleep opportunity periods) and robustness (i.e., across sleep opportunity periods that varied in duration and timing) of different sleep parameters.

METHODS

Sixty-eight military personnel (14 W) spent 5 nights in the sleep laboratory during a simulated military operational stress protocol. After an adaptation night, participants had an 8-hour sleep opportunity (23:00-07:00) followed by 2 consecutive nights of sleep restriction and disruption which included two 2-hour sleep opportunities (01:00-03:00; 05:00-07:00) and, lastly, another 8-hour sleep opportunity (23:00-07:00). Intra-class correlation coefficients were calculated to examine differences in stability and robustness across different sleep parameters.

RESULTS

Sleep architecture parameters were less stable and robust than absolute and relative spectral activity parameters. Further, relative spectral activity parameters were less robust than absolute spectral activity. Absolute alpha and sigma activity demonstrated the highest levels of stability that were also robust across sleep opportunities of varying duration and timing.

CONCLUSIONS

Stability and robustness varied across different sleep parameters, but absolute NREM alpha and sigma activity demonstrated robust trait-like behavior across variable sleep opportunities. Reduced stability of other sleep architecture and spectral parameters during shorter sleep episodes as well as across different sleep opportunities has important implications for study design and interpretation.

Sleep and high-risk behavior in military service members: a mega-analysis of four diverse U.S. Army units

Experimental sleep restriction and deprivation lead to risky decision-making. Further, in naturalistic settings, short sleep duration and poor sleep quality have been linked to real-world high-risk behaviors (HRB), such as reckless driving or substance use. Military populations, in general, tend to sleep less and have poorer sleep quality than nonmilitary populations due to a number of occupational, cultural, and psychosocial factors (e.g. continuous operations, stress, and trauma). Consequently, it is possible that insufficient sleep in this population is linked to HRB. To investigate this question, we combined data from four diverse United States Army samples and conducted a mega-analysis by aggregating raw, individual-level data (n = 2,296, age 24.7 ± 5.3). A negative binomial regression and a logistic regression were used to determine whether subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], and duration [h]) predicted instances of military-specific HRB and the commission of any HRB (yes/no), respectively. Poor sleep quality slightly elevated the risk for committing HRBs (PSQI Exp(B): 1.12 and ISI Exp(B): 1.07), and longer duration reduced the risk for HRBs to a greater extent (Exp(B): 0.78), even when controlling for a number of relevant demographic factors. Longer sleep duration also predicted a decreased risk for commission of any HRB behaviors (Exp(B): 0.71). These findings demonstrate that sleep quality and duration (the latter factor, in particular) could be targets for reducing excessive HRB in military populations. These findings could therefore lead to unit-wide or military-wide policy changes regarding sleep and HRB.

Sleep and occupational well-being in active duty special operations soldiers: A replication and expansion

OBJECTIVE

To assess the relationship between sleep quality and occupational well-being in active duty military Service Members.

DESIGN

Longitudinal prospective analysis.

SETTING

An annual military training event.

PARTICIPANTS

US Army special operations Soldiers (n = 60; 100% male; age 25.41 ± 3.74).

INTERVENTION

None.

MEASUREMENTS

The Pittsburgh Sleep Quality Index (PSQI) was administered prior to the training event, and the Emotional Exhaustion Scale, the Role Overload Scale, the Walter Reed Army Institute of Research Soldier-Specific Functional Impairment Scale, and the Perceived Stress Scale were administered after the event. Linear regression models were used to assess the relationship between sleep and occupational wellness measures, and the outcome measures of "good" and "poor" sleepers (per the PSQI scoring criteria) were compared with Student's t tests.

RESULTS

Higher (poorer) PSQI Global Scores predicted poorer occupational wellness of all measures (emotional exhaustion: B = 1.60, P < .001, R² = 0.25; functional impairment: B = 0.29, P = .03, R² = 0.14; role overload: B = 0.28, P = .008, R² = 0.12; and perceived stress: B = 0.34, P = .004, R² = 0.20). There were additional relationships between specific PSQI component scores and occupational wellness measures, which is a replication of This team's previous work. Furthermore, emotional exhaustion (t(58) = -4.18, P < .001), functional impairment (t(59)= -3.68, P = .001), role overload (t(58) = -3.20, P = .002), and perceived stress (t(58) = -2.43, P = .02) were all higher in poor sleepers.

CONCLUSIONS

The findings of this study suggest that US Army special operations Soldiers who have poorer sleep quality may be at increased risk for having poorer occupational well-being.

A Qualitative Examination of Factors That Influence Sleep Among Shipboard Sailors

INTRODUCTION

Sleep disturbance is prevalent among service members; however, little is known about factors that compromise sleep in unique operational environments, such as naval ships. Given the importance of sleep to health and performance, it is critical to identify both causes and potential solutions to this serious issue. The objective of this qualitative study was to elucidate the barriers to sleep and the strategies service members use to improve their sleep and combat fatigue while living and working aboard ships (i.e., underway).

METHODS AND MATERIALS

Interviews were conducted with 22 active duty service members assigned to sea duty. The semi-structured interview guide assessed the experiences of service members sleeping in shipboard environments. Interview transcripts were analyzed using applied thematic content analysis by two independent coders.

RESULTS

Participants were largely male (77.8%) and enlisted (88.9%). The most common barrier to obtaining sufficient sleep was stress, followed by rotating schedules, and environmental factors (e.g., noise and light). Additionally, many participants reported prioritizing other activities over sleep when off duty. Many participants did not report using any specific strategies to improve their sleep while underway. Among those who did, most described mitigating environmental barriers (e.g., noise-cancelling headphones or sleep masks). However, some participants also acknowledged these strategies are not always feasible, either attributable to cost or because sailors must be able to respond to alarms or commands. Notably, few sailors reported using stress mitigation or relaxation strategies to help sleep. Ingesting caffeine was the only strategy sailors reported using to alert themselves while fatigued.

CONCLUSIONS

Service members reported many unique barriers to sleep in the shipboard environment, yet many did not report the use of strategies to mitigate them. Further, few used alerting techniques when fatigued. This at-risk population could benefit from targeted educational interventions on sleep-promoting behaviors, prioritization of sleep, and fatigue mitigation.

Transitioning from daytime to nighttime operations in military training has a temporary negative impact on dynamic balance and jump performance in U.S. Army Rangers

OBJECTIVES

Explore the impact transitioning from daytime to nighttime operations has on performance in U.S. Army Rangers.

METHODS

Fifty-four male Rangers (age 26.1±4.0 years) completed the Y-Balance Test (YBT), a vertical jump assessment, and a grip strength test at three time points. Baseline testing occurred while the Rangers were on daytime operations; post-test occurred after the first night into the nighttime operation training (after full night of sleep loss), and follow-up testing occurred six days later (end of nighttime training).

RESULTS

On the YBT, performance was significantly worse at post-test compared to baseline during right posteromedial reach (104.1±7.2cm vs 106.5±6.7cm, p=.014), left posteromedial reach (105.4±7.5cm vs 108.5±6.6cm, p=.003), right composite score (274.8±19.3cm vs 279.7±18.1cm, p=.043), left composite score (277.9±18.1cm vs 283.3±16.7cm, p=.016), and leg asymmetry was significantly worse in the posterolateral direction (4.8±4.0cm vs 3.7±3.1cm, p=.030) and the anterior direction (5.0±4.0cm vs 3.6±2.6cm, p=.040). The average vertical jump height was significantly lower at post-test compared to baseline (20.6±3.4 in vs 21.8±3.0 in, p=.004). Baseline performance on YBT and vertical jump did not differ from follow-up.

CONCLUSIONS

Army Rangers experienced an immediate, but temporary, drop in dynamic balance and vertical jump performance when transitioning from daytime to nighttime operations. When feasible, Rangers should consider adjusting their sleep cycles prior to anticipating nighttime operations in order to maintain their performance levels. Investigating strategies that may limit impairments during this transition is warranted.

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.

Sleep health of incoming army trainees and how it changes during basic combat training

OBJECTIVE

To examine the sleep health of incoming Army trainees and how it is impacted during basic combat training (BCT).

DESIGN

Prospective.

SETTING

BCT site (Fort Jackson, SC).

PARTICIPANTS

A total of 1349 trainees (936 = male, 413 = female, 20.73 ± 3.67 years).

MEASUREMENTS

Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Morningness/Eveningness Questionnaire, and the Epworth Sleepiness Scale at the start of BCT and a modified PSQI at the end of BCT.

RESULTS

At baseline, trainees reported an average sleep duration of 7.65 ± 1.68 hours per night, with 81.8% rating their sleep quality as "Very Good or Fairly Good." The mean reported Morningness/Eveningness Questionnaire score was 50.63 ± 8.11 and the mean Epworth Sleepiness Scale was 8.60 ± 4.02. Reported sleep duration was significantly less during BCT (6.73 ± 0.90 hours) compared to baseline (P< .001). There was no significant difference in the mean PSQI Global score at the end of BCT compared to the start (5.33 ± 3.00 vs. 5.42 ± 2.85, P = .440), however, 6 of the 7 component scores were significantly different (with Sleep Quality, Sleep Duration, and Daytime Dysfunction scores being higher/worse and Sleep Latency, Sleep Efficiency, and Sleep Medication Use scores being lower/improved [all P < .01]).

CONCLUSIONS

Army BCT trainees in this large sample reported good sleep health characteristics at entry to training, including achieving recommended sleep amounts (>7 hours per night) and reporting good sleep quality. During BCT, negative changes were observed in reported sleep duration and quality in trainees. Further investigation into the factors contributing to changes in trainees' sleep health during BCT and the implications on subsequent readiness, injury risk, and performance is warranted.

Sleep leadership in the army: A group randomized trial

OBJECTIVES

Examine impact of training military leaders in sleep health on leaders and unit members.

DESIGN

Following a baseline survey, two-person platoon leadership teams were randomly assigned by company to a training or waitlist control condition. After training, leadership teams completed a post-training survey. Six weeks later, leaders and unit members completed a final survey.

SETTING

Classroom-style areas on a US military base.

PARTICIPANTS

US soldiers (76 leaders and 448 unit members) from 39 platoons across 14 companies in a brigade combat team.

INTERVENTION

One-hour training in sleep leadership.

MEASUREMENTS

Leaders were surveyed about sleep knowledge, sleep attitudes, sleep training, sleep quantity, sleep quality and sleep problems. Unit members were surveyed about sleep leadership behaviors, sleep hours, sleep quality and sleep problems.

RESULTS

Leaders rated the training highly and most knowledge and some attitudes about sleep improved from the baseline to post-training survey. Fewer leaders in the training condition reported sleep problems at follow-up than those in the waitlist control condition; there were no differences in sleep hours or sleep quality. More unit members with leaders in the training condition reported that their leaders engaged in sleep leadership behaviors at least sometimes and reported sleeping at least 7 hours/24 hours period than did unit members in the waitlist control condition; sleep quality and sleep problems did not differ by condition.

CONCLUSIONS

Results suggest a simple training intervention targeting leaders may be able to shift sleep health and the cultural perspective on sleep across an organization.

Poor Subjective Sleep Quality Is Associated with Poor Occupational Outcomes in Elite Soldiers

We aimed to assess the relationship between subjective sleep quality and occupationally-relevant outcomes in military personnel. Participants were from an elite unit of US Army soldiers who worked extended (~30 h) shifts (with minimal recovery time between shifts) during 3-week work sessions. Questionnaires assessing subjective sleep quality during the month prior (Pittsburgh Sleep Quality Index [PSQI]) were administered at the beginning of the session. Occupational outcomes (emotional exhaustion, functional impairment, role overload, daytime sleepiness) were assessed on the final day of the session. Regression analyses were conducted to link sleep quality and occupational outcomes. The study sample participants had relatively poor sleep prior to the exercise (PSQI Global score average = 6.3 ± 3.1). Higher PSQI Global Scores prior to the work session longitudinally predicted daytime sleepiness (f2: 0.56) after the work session. PSQI component 7, which queries daytime dysfunction attributed to poor sleep quality, longitudinally predicted emotional exhaustion, functional impairment, and role overload (f2 range: 0.19-0.70). In conclusion, poor sleep quality-in aggregation with occupationally-mandated sleep loss-is predictive of poorer subsequent occupational outcomes. Future work should aim to increase sleep opportunities prior to occupationally-mandated sleep loss in order to build resilience when sleep loss is unavoidable.