Sleep Attitudes Influence Sleep More than Knowledge

How can knowledge—and positive attitudes—about sleep improve quality of life for patients?

Research shows that a combination of sleep knowledge and education about sleep can have a substantial impact on a person’s sleep habits. An often underrecognized fact is that healthy sleep habits are not intuitive, and attitudes about sleep vary widely. Inconsistent sleep schedules, sacrificing sleep, poorly timed naps, and use of electronics before sleep are all common habits among individuals of all ages, including those with and without sleep disorders. These habits can lead to consequences like behavioral and emotional issues, even among individuals who do not fit the criteria for a psychiatric diagnosis.1

For example, a study assessing parental practices among parents whose children were enrolled in an early child education program showed that 81% of the parents surveyed believed that their children had healthy sleep habits, yet 50% and 33% of the children had unhealthy bedtime practices and insufficient sleep that were not recognized as such by their parents.1 These habits may lead to lifelong sleep problems if parents and children are not provided with the correct information about the importance of sleep and instructed about safe and effective ways to improve sleep quality and quantity.

Older adults often have sleep practices that can be detrimental to emotional and health as well. A large study that included 2312 participants aged 65 and older showed a high prevalence of insufficient sleep that was found to be associated with a sedentary lifestyle and an overall lack of physical activity.2

Sleep knowledge and attitudes include several different components. One study conducted at the Department of Psychological Science at the University of North Carolina at Charlotte defined 3 separate components of sleep attitudes:

1) A cognitive component includes a person’s beliefs about the importance and necessity of adequate sleep.

2) An emotional component involves having a positive evaluation of the necessity of sleep.

3) A behavioral component involves taking action to make time for sleep in a person’s schedule.

The study found that participants who reported positive attitudes about sleep also experienced longer sleep duration, better sleep quality, and better sleep hygiene.3 Of these 3 interrelated components, it is the behavioral that has the most definitive impact, as it is a necessary factor in actually achieving adequate sleep. However, most individuals would not take the steps to incorporate the behavioral component in the absence of the cognitive and emotional components, so they are all key factors.

Another study used objective measures tracked by a Fitbit Flex accelerometer for 7 days to assess sleep among a group of 218 college students. Interestingly, while the study also showed that sleep attitudes were directly associated with longer sleep duration and better sleep quality, the researchers found that greater sleep knowledge did not correlate with these outcomes.4 These results suggest that a fundamental comprehension about the benefits of sleep and a baseline knowledge of the effective ways to attain good sleep are not enough to impact a person’s daily sleep habits and sleep outcomes. It appears that the attitudes a person has about sleep play a far greater role than pure knowledge when it comes to influencing behavior.

Of course, a positive attitude about sleep must be paired with accurate knowledge, as even the most well-intentioned patient can potentially attempt to use methods for sleep that are not beneficial. These can include drinking alcohol before bed, which many believe promotes healthy sleep, but can reduce the quality of a person’s sleep. For individuals who do not have sleep problems, interventions to improve sleep can include a variety of strategies, including stress management, relaxation, stimulus control, sleep hygiene, and exercise.5

It is not uncommon for people to underestimate the importance of sleep and its impact on health. For instance, workaholism and competitive sleep deprivation are common among highly productive individuals—even health professionals. The outcomes can lead to interpersonal relationship difficulties, and in some instances, may lead to a referral for a psychiatric or psychological evaluation.

Physicians can help promote accurate sleep knowledge and healthy sleep attitudes for patients. Cognitive and behavioral interventions have been shown to have a positive impact on sleep,5 and these interventions can have lasting effects once patients experience an improved quality of life with less daytime fatigue, improved mood, and better productivity after adopting them.

Dr Moawad is associate editor, Humanities in Neurology; clinical assistant professor, Case Western Reserve University School of Medicine, Division of Medical Education; and editor in chief emeritus of Neurology Times (2017-2019).

References

1. Bonuck KA, Schwartz B, Schechter C. Sleep health literacy in head start families and staff: exploratory study of knowledge, motivation, and competencies to promote healthy sleepSleep Health. 2016;2(1):19-24.

2. Ortolá R, García-Esquinas E, Cabanas-Sánchez V, et al. Association of physical activity, sedentary behavior, and sleep with unhealthy aging: consistent results for device-measured and self-reported behaviors using isotemporal substitution modelsJ Gerontol A Biol Sci Med Sci. 2021;76(1):85-94.

3. Ruggiero AR, Peach HD, Gaultney JF. Association of sleep attitudes with sleep hygiene, duration, and quality: a survey exploration of the moderating effect of age, gender, race, and perceived socioeconomic statusHealth Psychol Behav Med. 2019;7(1):19-44.

4. Peach HD, Gaultney JF, Ruggiero AR. Direct and indirect associations of sleep knowledge and attitudes with objective and subjective sleep duration and quality via sleep hygieneJ Prim Prev. 2018;39(6):555-570.

5. Murawski B, Wade L, Plotnikoff RC, et al. A systematic review and meta-analysis of cognitive and behavioral interventions to improve sleep health in adults without sleep disordersSleep Med Rev. 2018;40:160-169.