Social-ecological considerations informing a universal screening strategy for sleep health in the community

Abstract

“Poor sleep health” (PSH), defined as reduced amount of sleep and non-restorative sleep, affects cognitive, social and emotional development. Evidence suggests an association of sleep deprivation and mental health problems; however, there are no universal concepts allowing a first-tier screening of PSH at a community level. The focus of this narrative review is to highlight the cultural context of the current medicalized approach to PSH and to suggest social ecological strategies informing new and holistic community-based screening concepts. We present two conceptual screening frameworks; a “medical” and a merged “social emotional wellbeing framework” and combine them utilizing the concept of “ecologies.” The first framework proposes the incorporation of “sleep” in the interpretation of “vigilance” and “inappropriate” labeled behaviors. In the first framework, we provide a logic model for screening the myriad of presentations and possible root causes of sleep disturbances as a tool to assess daytime behaviors in context with PSH. In the second framework, we provide evidence that informs screening for “social emotional wellbeing” in the context of predictive factors, perpetuating factors and predispositions through different cultural perspectives. The distinct goals of both frameworks are to overcome training-biased unidirectional thinking and a priori medicalization of challenging, disruptive and/or disobedient behaviors. The latter has been explicitly informed by the critical discourse on colonization and its consequences, spearheaded by First Nations. Our “transcultural, transdisciplinary and transdiagnostic screening framework” may serve as a starting point from which adaptations of medical models could be developed to suit the purposes of holistic screening, diagnosis, and treatment of complex childhood presentations in different cultural contexts.

Staying vigilant about the sleep–wake states—is one question the whole story?

“…For example, the local and asynchronous distribution of slow waves across the cortical surface, which reflects the flexibility of our physiological sleep needs [ 5 ], is not taken into account by conventional sleep classification techniques [ 6 ]. Phenomena like first night effect [ 7 ] or sociocultural norms may interfere or undermine the objectiveness of lab-based sleep studies [ 8 ], and the mismatch between objective and subjective sleep perceptions [ 9 , 10 ] inform the current norms.…”

“…On the contrary, science-oriented thinking and changes in cultural norms have coined the focus on quantitative measures of sleep. It is a fact that social, psychological, and biological factors influence physiological measures, but from the individual’s perspective, all is seen and perceived within their cultural framework [ 9 ]. The controversial discussion on co-sleeping practices with children reflects this paradigm change [ 14 ].…”

“…Namely, we often seek to correct such malfunctioning or affected vigilance promptly and effectively through compensatory coping, such as the excessive use of caffeine and/or other stimulants. While questions related to daytime well-being or quality of life are unspecific and may not necessarily reflect insufficient sleep [ 29 ] and while functionality can vary based on developmental state, intellectual abilities, and cultural norms, the concept of vigilance serves as a neutral descriptor for the ability to “survive the day.” Obviously, poor vigilance can be caused by multiple factors, but a majority of them are associated with underlying and/or overlooked poor sleep [ 9 , 29 ]. Therefore, we hypothesize the concept of vigilance to be more specific for exploring and capturing affected sleep health, whether caused by sleep disturbances and/or disorders [ 28 ].…”

“…Dickens” conceptual understanding is rooted in empathy, enabling his exploratory observations of Joe’s vigilance, including affected daytime-functioning, quality-of-life, and well-being in context with his sleep health. In the professional setting, the concept of vigilance promotes empathy and encourages transdisciplinary thinking, ensuring that the fundamental public health principles are followed and that basic factors, such as sleep health measures associated with lifestyle, are not overlooked [ 9 ]. Furthermore, vigilance will encourage a step-by-step approach, as promoted by public health experts who aim to establish prevention concepts.…”