Nursing researchers explore sleep interventions created with patient populations they serve

As essential to our daily needs as food and water, sleep is vital to our health and well-being. It affects our mental health, physical health, quality of life and safety. While we all seem to understand the importance of sleep, trying to change our behaviours and attitudes around it is another story.

Two researchers with UCalgary Nursing agree it’s not just about education but implementation of research in a way that’s meaningful to people to adopt good sleep practices in a sustainable way.

UCalgary Nursing’s postdoctoral fellow Amy Beck focuses on adolescent sleep and how wearable technologies can improve sleep hygiene and duration. Adjunct clinical associate Elizabeth Keys  has devoted her research to promoting healthy sleep patterns in families of young children to improve family health and optimize child development.

Research informed by work experiences

Both share previous backgrounds as public health nurses and each pursued sleep research based on what they experienced and observed on the job. Dr. Beck, BN'05, MN '14, PhD'22, says while she worked as a school nurse, nutrition, physical activity and mental health were always key focus areas.

“But sleep is a foundation to make all of these things better,” says Beck. “If you have more sleep, you’re more likely to be physically active; physical activity helps your sleep and both physical activity and sleep have been linked or associated with mental health and people eat better when they're getting more sleep.”

Beck noticed teens would often tune out education-based strategies. “I wanted a way that would resonate with these adolescents. It's not really that accessible to get a new teen to open up to you about their mental health but it's pretty easy to talk to teens about sleep.”

For Dr. Keys, BSc'03, BN'07, PhD'19, her research origins were two-fold. Working as a community health nurse, she saw a gap in resources available to parents with infant sleep issues. And her oldest child, now 11, struggled with sleep as a baby.

That really struck me because as a public health nurse with all these excellent resources and colleagues, I still had a lot of trouble and so I thought, what do people who don't have these resources and these networks do?

Keys is currently an assistant professor in the School of Nursing at UBC Okanagan. For her doctoral research at UCalgary, she evaluated the effect of a parent-child interaction home visiting intervention (Play2Sleep) on infant sleep. Specifically, the work was around helping parents read and respond to their babies’ social and sleep cues.

“Babies will progress in their distress, or they become dysregulated as they get more and more tired. They give us lots of subtle signals and hints before they get to that state,” she explains. “By helping parents learn to watch for those more subtle signals, we can help them learn when their baby needs to be fed versus when does their baby just needs sleep.”

Keys continued her research with a postdoctoral fellowship at Dalhousie University where she developed an app called the ABCs of SLEEPING for Babies for parents to use. At UBC Okanagan, she’s in the process of building her SLUMBER program, co-designed with parents, which will be a hybrid intervention; parents can start off accessing educational information and as they need more intensive support, the online information will be combined with in-person coaching.

Beck is also interested in using participatory design methods to develop mobile and wearable technology to help individuals to monitor and manage their health and wellness.

She approached her doctoral research in two parts. The first was a dyad study where she had adolescents and their parents wear actigraphy watches (research-grade sleep-tracking devices) for 10 days and the other was follow-up focus groups with just adolescents. 

Real-time feedback makes change more likely

“The point of the wearables for me was actually giving adolescents this real-time feedback,” she says. “They're more likely to make changes or we can nudge them towards change when we actually have some data to go on.”

Beck says the teens in the focus groups knew why healthy sleep habits are important. But social connections and having new experiences with friends outweighed taking care of their sleep. And even when parents shared articles or info about good sleep habits with their child — while all valid and full of helpful information — the advice would often be ignored simply because it came from their parents.

Interestingly, she found that when it came to dysfunctional beliefs around sleep (for example, “I had a bad night of sleep, so I should go to bed earlier” or “I’ve had less sleep during the weekdays, I can make up for this by sleeping in on the weekends”), teens didn’t have them but the parents did.

“My main takeaway from this adolescent-parent dyad study was that whatever intervention gets developed, there's a family context component that needs to be addressed as well,” says Beck.

Where I would like to see my research going is using a wearable technology to address sleep issues in an effort to alleviate some of the high levels of anxiety and depression in adolescents.

Both Keys and Beck agree that nurses are a small, unique segment of sleep researchers nationally. But with genuine community and stakeholder engagement, meaningful changes can be made around sleep behaviour, impacting overall health.

“Nurses are always focused on finding an intervention, something to help people,” says Beck. She says with nudging behaviour change in teens and getting them to buy into strategies that work for them, it’s critical those approaches are informed or developed with teens, for teens.

Keys concludes: “Sleep really is so interdisciplinary but I think the thing that nursing can add is the practical implementation piece: How can we actually implement this in people's actual lives and health services? We spend so much time with people and we use a lot of relational communication to help people figure out what they want to do.”