Sleep as a Vital Sign: Results of a Mixed-Method Study on Insomnia Patients’ Attitudes toward Sleep Care

Theoretical Background and research questions/hypothesis:

More than 50 million Americans suffer from sleep disorders[1], with the majority of these disorders going undiagnosed.[2] Research shows that many physicians do not prioritize asking patients about their sleep health, despite routine collection of other vital signs like weight and blood pressure.[3] How individuals sleep is strongly associated with overall health, and thus, sleep disturbance can exacerbate a variety of medical conditions.[4] However, little is known about patients’ perspectives on sleep care in primary care settings. The current study sought to shed light on insomnia patients’ experiences and needs related to sleep care. The research questions were: (a) Who in the primary care setting is communicating with patients about sleep? (b) What pain points do patients experience when seeking sleep care? And (c) How can sleep care be improved for both patients and providers?

Methods: We employed a mixed-method approach to answer these research questions. We conducted a telephone focus group with 12 participants suffering from insomnia and an online survey of 200 insomnia patient respondents.

Results: Results from the focus group indicated that patients tend to discuss sleep with their primary care providers (PCPs; including physicians, nurse practitioners and physician assistants), with a few patients discussing sleep with nurses. These findings were supported by the survey results, which showed that sleep is discussed 84% of the time with PCPs but only 3% of the time with nurses. The biggest pain point reported by insomnia patients during the focus group was that PCPs do not spend enough time with them. In fact, given some patients expressed concerns regarding PCP education in sleep, 85% of survey respondents reported they would be interested in discussing sleep with a nurse specifically trained in sleep care.

Conclusions: The current study found that, although insomnia patients express the importance of good sleep care, little time is spent discussing it in the primary care setting. Findings show great potential for nurses trained in sleep to take ownership of incorporating sleep into routine primary care visits, despite PCPs being the primary sleep care providers and educators at this time.

Implications for research and/or practice: The findings of this study elucidate a potential need for sleep care training and preparedness among nurses. Further research and evaluation will reveal whether nurses could be considered an ideal provider for sleep care in treating insomnia patients.

[1] Colten HR, Altevogt BM, Institute of Medicine Committee on Sleep Medicine and Research . Sleep disorders and sleep deprivation: an unmet public health problem. Washington, DC: Institute of Medicine: National Academies Press; 2006.

[2] Baran AS, Chervin RD. Approach to the patient with sleep complaints. Semin Neurol. 2009;29(4):297–304. [PubMed]

[3] Papp KK, Penrod CE, Strohl KP. Knowledge and attitudes of primary care physicians toward sleep and sleep disorders. Sleep Breath. 2002;6(3):103–109. [PubMed]

[4] Knutson, K. L., Phelan, J., Paskow, M. J., Roach, A., Whiton, K., Langer, G., . . . Hirshkowitz, M. (2017). The National Sleep Foundations Sleep Health Index. Sleep Health, 3(4), 234-240. doi:10.1016/j.sleh.2017.05.011