Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity.

Social media for students’ sleep health promotion – a health intervention report during COVID -19

Sleep Disturbance, Sleep Duration, and Inflammation: A Systematic Review and Meta-Analysis of Cohort Studies and Experimental Sleep Deprivation

Sleep health is an important part of children’s physical- and psychosocial health, and crucial for their cognitive development. Sleeping well also contributes to a healthy weight, learning new things, performing well in different aspects of their lives, and feeling mentally healthy. Alongside the various health-related and social benefits of good sleep health, promoting sleep health among those in a vulnerable position (e.g. living in a deprived neighbourhood or coming from a family with a lower socioeconomic position (SEP)) leads to reducing social disparities and economic costs throughout society. Therefore, the total impact of promoting sleep health reaches far wider than population health. Over the last decades, children’s sleep health has deteriorated. Evidence-based health promotion programmes are urgently needed to reverse this trend. Therefore, the aim of this thesis is to describe the systematic development of a programme to promote sleep health for children aged 4-12 years old. For this, we combined Intervention Mapping (IM) with the Health in All Policies perspective (HiAP) to guide the development of a children’s sleep health promotion programme. This thesis primarily focuses on the context of the City of Amsterdam, the Netherlands, but also sheds light on how the results may be transferred to other contexts. To successfully inform intervention programme development, we first conducted a thorough needs assessment to get a clear overview of the determinants of children’s sleep health. This needs assessment, described in chapters 2 to 5, consisted of several studies, i.e. a systematic literature review, two concept mapping studies, and a cross-sectional study using a questionnaire and a sleep diary. All studies provided information about potential determinants of children’s sleep health. Applying the evidence from the needs assessment, we designed a blueprint for the development of a sleep health promotion programme using IM and HiAP. The studies described in this thesis illustrate that children’s sleep health is a complex phenomenon, since it is influenced by many (potentially interacting) personal, behavioural- and environmental determinants, which exist on several social-ecological levels and are often influenced by multiple different actors and sectors. This complexity further increases when children’s sleep health is seen as part of a wider system in which sleep health is intertwined with other health behaviours such as diet, physical activity, and sedentary behaviour. To effectively impact one or more of these health-related behaviours, this complexity must be considered by all fields. In addressing sleep health inequalities, comprehensive multi-level systems approaches can be a valuable step forward. To promote sleep health equity, long-term collaboration between relevant actors across multiple sectors is needed, which is precisely what the ‘Health in All Policies’ (HiAP) perspective aims to achieve. In addition, strong collaboration is needed between research, policy and practice to establish an integrated approach that includes multiple factors, social-ecological levels, and sectors. Children’s sleep health is a multifaceted phenomenon that includes multiple dimensions. However, there is still no consensus about the definition of all these dimensions. We therefore recommend that future research includes the multidimensionality of sleep health, and creates uniform, clear definitions for all dimensions of children’s sleep health. Furthermore, there is a need for valid and reliable child sleep health assessment instruments incorporating this multidimensionality. To conclude, the studies described in this thesis imply that children’s inadequate sleep health can be viewed as a complex problem, indicating that the promotion of children’s sleep health requires multifactorial, multilevel, and multisectoral action. We recommend the integration of children’s sleep health promotion in a wider municipal HiAP approach, in which all relevant policy, practice and research actors across sectors collaborate to improve the system and underlying mechanisms contributing to children’s sleep health equity.

<p indent=0mm>As an instinctive part of human life, sleep not only is of great significance to the individual’s physical and mental health, but also could be a natural means of regulating, restoring and enhancing body functions. Accordingly, sleep quality not only affects people’s quality of life, but also is closely related to the occurrence and development of many physiological and psychological diseases. Statistics show that about one-third of the population in China has sleep disorders, and a growing number of people have sleep health requirements. There is a prominent contradiction between this demand and the backward daily sleep health management. Therefore, it is urgent to set up theories and methods ranging from sleep structure conversion mechanism to sleep quality monitoring and intervention. For this reason and based on the discussion of the Y5th Xiangshan Scientific Conference (Smart Sensing and Computing for Sleep Health), this paper provides an in-depth analysis of sleep perception, intelligent sleep computing and sleep intervention methods in recent years. It foresees the key scientific and technical issues in the three stages of this closed-loop system. Combining wearable sensing and medical artificial intelligence technology, we should form a platform and develop algorithms from sleep quality monitoring to objective diagnosis of sleep disorders. Principles and methods of physical and behavioral interventions should be also explored to improve the physical and mental state of sleep regulation, so as to establish a new paradigm of “active sleep health” comprehensively. Considering the feasibility of the next few years from the perspective of principle, mechanisms, methods and measures, we propose the following recommendations: (1) Sleep-wake transformation mechanism. The study of sleep-related electrophysiology biomarkers could reveal the sleep-wake transformation and regulatory mechanisms to guide the development of sleep health standards for the Chinese population. Based on such a mechanism, an objective assessment of people’s overall health status could be achieved. It will be used for national sleep health screening and prevention of sleep disorders, and provide a theoretical basis for active sleep health promotion. (2) Sleep health promotion for specific populations. In order to adapt to the sleep health of children, youth, elderly and special types of personnel, research on the brain neural mechanism of biological rhythm should be carried out for different groups in order to build personalized multi-physiological parameter monitoring devices, intelligent analysis algorithms and active intervention paradigms. (3) Sleep health promotes physical and mental health. Sleep is closely related to the development of many physiological diseases. To reduce the incidence of chronic diseases, we should explore the mechanism of its association with the cardiovascular system, respiratory system, nervous system and endocrine system. A multimodality data analysis system could be developed with independent intellectual property rights. This will promote the advancement of sleep-related industries in China and propose relevant technical standards and guidelines to achieve active health management.

Increasing resilience through promotion of healthy sleep among service members.

Position statement: Reducing fatigue associated with sleep deficiency and work hours in nurses

The concept of sleep health provides a positive holistic framing of multiple sleep characteristics, including sleep duration, continuity, timing, alertness, and satisfaction. Sleep health promotion is an underrecognized public health opportunity with implications for a wide range of critical health outcomes, including cardiovascular disease, obesity, mental health, and neurodegenerative disease. Using a socioecological framework, we describe interacting domains of individual, social, and contextual influences on sleep health. To the extent that these determinants of sleep health are modifiable, sleep and public health researchers may benefit from taking a multilevel approach for addressing disparities in sleep health. For example, in addition to providing individual-level sleep behavioral recommendations, health promotion interventions need to occur at multiple contextual levels (e.g., family, schools, workplaces, media, and policy). Because sleep health, a key indicator of overall health, is unevenly distributed across the population, we consider improving sleep health a necessary step toward achieving health equity.

Targeting Innate Immunity: A New Step in the Development of Combination Therapy for Chronic Hepatitis B

Introduction Social workers are frontline behavioral health clinicians and comprise the majority of the mental health workforce. As poor mental health often co-occurs with inadequate sleep and sleep disorders, social workers can play a pivotal role in promoting sleep health among their patients as well as provide referral and treatment options if a sleep disorder is suspected. However, the Council on Social Work Education (CSWE) does not mandate sleep education in the social work curricula. There is little knowledge about how much training social workers have received about sleep. This study aims to investigate the state of sleep health education and sleep health awareness among social workers. Methods Recruitment emails were sent to licensed social workers across the US, through national social work organizations and faculty listservs. Eligibility criteria included being a licensed social worker in the US and ability to read and write in English. Respondents were queried about the extent of their sleep health training and clinical practice in this domain using QuestionPro software. Results A total of 363 social workers, predominantly female (72.4%) and non-Hispanic white (76.2%) participated. Most (62.0%) reported not receiving any sleep education during their formal social work training. Among those reporting sleep education during their graduate studies, the average duration was 3.3 hours (SD=2.8). Many social workers (67.9%) reported receiving formal sleep education post-licensure (mean=7.0 hours; SD=6.5). Few participants (2.8%) reported confidence in recognizing insomnia disorder, and only half (50.2%) were aware that CBT-I is an evidence-based treatment for insomnia. Despite this, a majority (80.0%) reported discussing sleep with their patients during treatment. Most social workers (84.0%) reported interest in learning more about sleep health. Conclusion The majority of social workers did not receive sleep education during their formal graduate studies, with many seeking to address this deficit following professional licensure. Only a small fraction of social workers report confidence in recognizing sleep disorders, which can impact proper referral and treatment of sleep disorders. Considering the relationship between sleep and mental health, promoting sleep health education and awareness in educational programs for behavioral health clinicians can have important implications for overall health promotion. Support (if any)

Objective: Although college students are at heightened risk for sleep disturbances, healthy sleep is associated with positive physical, cognitive, psychological, and academic benefits for this group. The goals of the current study were to (1) describe sleep health in an undergraduate college sample and (2) examine the role of a class activity using self-determination theory to promote better sleep health in this group. Methods: A cohort study was conducted using data drawn from class activities conducted in two undergraduate Introduction to Psychology courses. Students were undergraduates at a mid-Atlantic public university in the United States. Total sample size was N = 224 (intervention class [n = 98], and the control class [n = 127]). Both the intervention and control classes completed the RU SATED sleep health questionnaire at the beginning and the end of the semester. The intervention class also completed a self-determination activity focused on sleep health mid-semester. Both the RU SATED questionnaires and the self-determination activities were completed via in-class responder technology. Data were de-identified and downloaded from the responder technology at the end of the semester. Mixed methods were used for data analysis including quantitative analyses and a qualitative approach using a phenomenological, inductive, and reflexive qualitative method whereby themes were allowed to emerge from the data. Results: Overall, almost 25% of the students reported never or rarely obtaining healthy sleep on average. The majority (76%) said they sometimes have healthy sleep and no students reported usually or always obtaining healthy sleep. The components of sleep health the entire sample scored highest on were timing (sleeping between 2 and 4 AM), sleep duration (between 7 and 9 h), and staying awake during the day. The areas they scored the lowest on were maintaining regular bed and wake times, spending less than 30 min awake at night, and feeling satisfied with their sleep. Qualitatively, the most frequently obtained sleep health behaviors of the intervention class were rhythmicity, prioritizing sleep, timing of sleep, and tech hygiene. The intervention class had significantly better sleep health across the entire semester and significantly better daytime alertness post-intervention. The most commonly chosen sleep health behaviors to change were sleep hygiene, tech hygiene, and stimulus control. Conclusion: We examined the classroom environment as a venue for promoting sleep health among college students. Given the popularity of Introduction to Psychology courses, this class is a promising avenue to deliver sleep health promotions to a large number of students. The implementation of a self-determination framework, as part of sleep health promotion, shows potential for creating a person-centered, strengths-based approach to health behavior change within this population.

Sleep health of children and adolescents in foster and kinship care: A systematic review.

Based on a randomized controlled trial applied to employees of a manufacturing company, this study examines the extent to which a corporate sleep program improves workers' sleep health and productivity. In the three-month sleep improvement program, applicants were randomly divided into a treatment group and a control group, and the treatment group was provided with a noncontact sensing device to visualize their sleep. A smartphone app linked to the device notified them of their sleep data every morning and presented them with advice on behavioral changes to improve their sleep on a weekly basis. The results of the analysis revealed the following. First, even after controlling for factors that may cause sleep disturbances and nocturnal awakenings, such as increased workload and the number of days spent working from home during the measurement period, the treatment group showed improved sleep after the program compared to the control group. Second, the treatment group showed statistically significant improvement in presenteeism (productivity). The effect size on presenteeism through sleep improvement was similar regardless of the estimation method used (i.e., ANCOVA estimator of ATT and two 2SLS methods were performed). In particular, we confirmed that productivity was restored through sleep improvement for the participants who diligently engaged in the program. These results suggest that promoting sleep health using information technology can improve sleep deficiency and restore productivity.

Sleep health is increasingly recognized as a critical determinant of worker productivity, safety, and long-term health outcomes. Occupational environments expose workers to a range of environmental stressors—including noise, chemical agents, shift work schedules, temperature extremes, lighting conditions, and psychosocial stress—that can disrupt sleep patterns and circadian rhythms. Chronic sleep disturbance contributes to increased risks of cardiovascular disease, metabolic disorders, mental health conditions, workplace accidents, and reduced occupational performance. Globally, industrialization, urbanization, and the expansion of 24-hour economies have intensified exposure to sleep-disrupting occupational factors. This review examines occupational environmental exposures affecting sleep health, summarizes global trends in occupational sleep disturbances, discusses health and economic consequences, and outlines preventive and policy strategies aimed at promoting healthier work environments. Integrating occupational health policies with sleep health promotion is essential for sustainable workforce productivity and worker well-being.

Introduction Mobile technologies, including wearable devices and mobile apps, have been widely promoted as potentially effective tools for the assessment and improvement of sleep and circadian health in populations at high risk for circadian disruption, such as military personnel. However, little research has been done to assess the perceived utility of these technologies within this population. The purpose of this study was to qualitatively assess attitudes towards the use of mobile technologies for the promotion of sleep health among active duty service members. Methods Five focus groups were conducted with active duty Marines (N = 30; 90% male, 10% female) as part of a needs assessment designed to identify current sleep-related needs and potential intervention approaches. Focus group transcripts were analyzed by two independent coders using applied thematic analysis to identify and interpret salient themes. Results Many participants reported currently using wearable devices capable of providing data on sleep health, including Apple watches and Fitbits, and some reported using popular sleep-focused apps. Despite the current use of these technologies, participants expressed ambivalence about future interventions that exclusively relied on apps or wearables to promote sleep and circadian health. Instead, participating Marines reported a desire for other approaches for promoting sleep health, with many describing a preference for in-person, small-group education sessions led by civilian facilitators. Participants reported that education sessions may increase motivation among Marines to improve their sleep hygiene behaviors or provide instruction on how to maximize the utility of wearable devices (e.g., “If they already have the smartwatch capability and you say, ‘Hey, this would be an excellent tool.’ I think that gives them some sort of metric to compare themselves to.”) Additionally, participants expressed a desire for organizational efforts to improve sleep health, including leadership training and scheduling interventions. Conclusion Study results indicate that wearables and other technological interventions for sleep may be acceptable among active duty Marines, but that they must be accompanied by other strategies to maximize their effectiveness in this population. Support (if any)

Background: Extreme sleep duration defined as either short (&lt;6 hours) or long (&gt;9 hours) sleep is positively associated with cardiovascular disease (CVD). Because sleep disturbance is prevalent in older women, we evaluated the relationship between extremes of sleep duration and type II diabetes (diabetes) in older women. Methods and Results: In a cross-sectional analysis, we examined the association between self-reported short and long sleep duration and diabetes among 21, 769 older women (mean age = 71. 2 ± 6.0 years old) participating in the ongoing follow-up cohort of the Women’s Health Study. Compared to women with diabetes (N=2539) who slept an average of 6-9 hours, diabetic women who reported short sleep were younger, more likely to be current smokers, less likely to use 1+ drinks/day, were less physically active, had lower annual household income and were less likely to possess a bachelor’s degree. Diabetic women who reported long sleep were older, less likely to be a current smoker, more likely to drink 1+ drinks/day, more likely to have hypertension, depression and anxiety symptoms, were less likely to have a bachelor’s degree, and had a lower annual household income. Logistic regression analyses adjusted for age and race/ethnicity revealed that both short [OR, 95% CI: 1.86 (1.48-2.34)] and long [OR, 95% CI: 1.49 (1.34-1.66)] sleep were significantly associated with a higher odds of diabetes (reference = 6 to 9 hrs sleep). These significant relationships persisted but were somewhat attenuated after control for CVD risk factors and psychological status (i.e., depression and anxiety symptoms) [Short: OR, 95% CI: 1.38 (1.07-1.70); Long: 1.28 (1.14-1.45)]. Conclusion: Extremes of sleep duration were significantly associated with higher odds of diabetes in older women participating in the Women’s Health Study. These hypothesis-generating data suggest that short and long sleep duration might confer key heightened cardiometabolic risk even in older women.