Education about the importance of sleep

sleeping kingWe know sleep helps with education – a well-rested brain can more readily learn – but what about education about sleep.  Does it work?  Does telling people about the importance of sleep, instructions for sleep hygiene, the symptoms of sleep disorders, and the good and bad points of treatments help them understand?  How much is getting through and what can we do better?

This question is of interest to public health officials, parents and teachers of children and teens, and even us at Sleepdex.  (This site exists partly to convey information about sleep to the pubic.)

Harvard Medical School runs an excellent website at http://understandingsleep.org that includes videos.  The site does not dumb down the issues, which we appreciate.  Serious fans of sleep should take a look.

The American Academy of Sleep Medicine runs www.sleepeducation.com.  Note that although it contains information about common sleep disorders it is produced by an organization of health care providers and the site seems eager to get you to go to a sleep clinic.  The same organization produces http://yoursleep.aasmnet.org/

Health Literacy Nerds

Public health people worry a lot about health literacy and are forever generating programs to deal with the fact that – they think – people can’t figure out how to use health and medical information.  A federal government website says “nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely available.”  http://www.health.gov/communication/literacy/

Higher costs and lower quality outcomes are said to be the result.  This sounds like an exaggeration to us.  Compliance with doctors’ orders may not be high and people may not get the right diet and exercise, but that doesn’t mean they are illiterate.

Do people really not know about the importance of sleep?  They probably do, but they choose to forgo sleep because of other interests and commitments.  Many people feel vaguely guilty about not getting enough sleep, but it’s not a situation that they don’t know sleep is good for them.

Learning

CPAP machines require some instruction, and perhaps notoriously, they are underused, although this isn’t because they are difficult to use so much as uncomfortable and inconvenient.  The Sleep Apnea Association takes a stand against CPAP machines being directly shipped to the patient, preferring that it go through health professionals who can offer instruction.

Cognitive behavioral therapy, shown to be the best long-term solution for insomnia, requires a lot of instruction and requires the patient to put in mental effort to learn and adopt new habits and attitudes.   Its effectiveness is estimated at 40% to 50%.  Failure could be ascribed to laziness, conflict with other events in the patients’ lives, the belief that a pharmacological approach is better, or a general downgrading in the perception that troubled sleep is a problem worth addressing.

Improvement in hygiene is always recommended for people with sleep problems. The lackadaisical attitude too many people take to sleep causes too many to ignore this important part of life.

A test in New Zealand found a formal education program aimed at teens appeared to have some efficacy. A Chinese study found similar results in a program aimed at adult women. Researchers at Brigham and Young Hospital found college students responded to an internet-based sleep learning system.

A Japanese study found a sleep hygiene education program at the IT company helped reduce afternoon sleepiness in workers. The workers in the night shift got not observable benefit from the program. A test of sleep hygiene education in a psychiatric facility found something similar.

Educating the health care providers

Sleep medicine is a branch of medicine, but most sleep disorders are handled by doctors and nurses who are not speficially trained in sleep. The NIH State­of­the­Science Conference Statement called for more education and awareness campaigns aimed at both health care providers and the general public. The conferences and overview articles always call for more education. It's an easy thing to call for. But doctors, nurses, and the general public already have enough to cram into their brains.

Public Health Efforts 

The federal government used to operate a program and website called Star Sleeper directed at children to get them to value sleep.  This program ended.  No doubt there is plenty of instruction in schools about sleep today, through different programs.  We don’t know how effective it is. Some Croatian researchers found leaflets have a little efficacy in educating teens, girls more than boys. There is wide agreement that insomnia costs society serious money.

When he was surgeon general in 2004, Richard Carmona said in a speech "sleep disorders probably represent health literacy in our society at its worst," although he said that at a conference of sleep medicine researchers and practitioners. So he may have been playing to the crowd and flattering them to some extent.

Advocates for sleep education campaigns point to other successful efforts like the campaign to raise awareness of hypertension in increasing the percentage of Americans who know high blood pressure can be a problem.  Everyone agrees that doctors and nurses need to be instructed in the importance of sleep to overall health and in common disorders.  Most everyone agrees the general public needs to pay more attention to sleep issues.  Whether anyone is willing to put their money and efforts where their mouths are is another question.

The Smart Sleeper

The Sleepdex book is now available on Amazon.com.

Click here