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How to work for a good night's sleep
Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).ORCID iD: 0000-0002-2276-8147
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Stress and sleep problems are common in the working population and cause considerable costs for society. Sleep is the most important part of recovery, and poor sleep has a negative impact on overall functioning, which might have important consequences for both the employee, the employer and society. In order to find strategies to alleviate this contemporary public health concern of stress and poor sleep in the working population, this thesis evaluated interventions performed at the workplace to target these issues.

The first intervention is a randomized controlled trial of a 25% work time reduction for full-time workers within the public sector in Sweden. Study I evaluated the impact of work time reduction on subjective sleep quality, sleep duration, sleepiness, perceived stress, and bedtime worries. Assessments included diary data from one week at three occasions over 18 months. Study II investigated time-use patterns through activity reporting sheets used during the work time reduction by evaluating the amount of total workload, paid work, non-paid work and recovery activities. Both studies investigated workdays and days off separately as well as the importance of gender, family status and work situation (only Study II). The second randomized controlled intervention of the thesis is a group cognitive behavioral therapy (CBT) intervention at the workplace targeting sleep disturbances among employees within the retail sector in Sweden (Study III). Data were collected through questionnaires, diaries and objective sleep measurement (actigraphy) over a period of ten days before and after the intervention, as well as at a three-month follow up. The study evaluated the effects of the intervention on sleep and explored the moderating effect of burnout-levels at baseline.

In our studies, an economically fully compensated reduction of work hours for full-time workers lead to long-term positive effects on sleep duration and sleep quality, sleepiness and levels of perceived stress. During this work time reduction, the total workload of both paid and non-paid work was reduced and time spent in recovery activities increased. The results indicate that a more balanced relation between effort and recovery was established. The second intervention, which targets the individual through a group CBT-intervention for insomnia at the workplace, was shown to improve insomnia symptoms in daytime workers who did not suffer from concurrent burnout. Such an intervention could support the individual in handling sleep problems and preventing the development of more severe and chronic sleep disorders, as opposed to interventions aimed at making environmental changes at the workplace. However, the CBT-intervention evaluated within this thesis will need to be further developed in order to be beneficial for more groups of employees. The positive effects of these interventions might be beneficial for public health and help improve employee’s life satisfaction, daily functioning and health development.​

Place, publisher, year, edition, pages
Stockholm: Centre for Health Equity Studies (CHESS), Stockholm University , 2017.
Keyword [en]
Intervention studies, Sleep, Insomnia, CBT, Work time reduction
Keyword [sv]
Interventionsstudier, Sömn, Insomni, KBT, Arbetstidsreduktion
National Category
Work Sciences
Research subject
Public Health Sciences
Identifiers
URN: urn:nbn:se:su:diva-148576ISBN: 978-91-7797-059-0 (print)ISBN: 978-91-7797-060-6 (electronic)OAI: oai:DiVA.org:su-148576DiVA, id: diva2:1153732
Public defence
2017-12-15, rum 207, Stressforskningsinstitutet, Frescati Hagväg 16 A, Stockholm, 10:00 (English)
Opponent
Supervisors
Note

At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Manuscript. Paper 3: Manuscript.

Available from: 2017-11-22 Created: 2017-10-31 Last updated: 2017-11-22Bibliographically approved
List of papers
1. The impact of reduced worktime on sleep and perceived stress – a group randomized intervention study using diary data
Open this publication in new window or tab >>The impact of reduced worktime on sleep and perceived stress – a group randomized intervention study using diary data
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2017 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 43, no 2, p. 109-116Article in journal (Refereed) Published
Abstract [en]

Objective Insufficient time for recovery between workdays may cause fatigue and disturbed sleep. This study evaluated the impact of an intervention that reduced weekly working hours by 25% on sleep, sleepiness and perceived stress for employees within the public sector.

Method Participating workplaces (N=33) were randomized into intervention and control groups. Participants (N=580, 76% women) worked full-time at baseline. The intervention group (N=354) reduced worktime to 75% with preserved salary during 18 months. Data were collected at baseline and after 9 and 18 months follow-up. Sleep quality, sleep duration, sleepiness, perceived stress,and worries and stress at bedtime were measured with diary during one week per data collection.

Result A multilevel mixed model showed that compared with the control group, at the 18-month follow-up, the intervention group had improved sleep quality and sleep duration (+23 minutes) and displayed reduced levels of sleepiness, perceived stress, and worries and stress at bedtime on workdays (P<0.002). The same effects were shown for days off (P<0.006), except for sleep length. Effect sizes were small (Cohen’s f2<0.08). Adding gender, age, having children living at home, and baseline values of sleep quality and worries and stress at bedtime as additional between-group factors did not influence the results.

Conclusion A 25% reduction of weekly work hours with retained salary resulted in beneficial effects on sleep, sleepiness and perceived stress both on workdays and days off. These effects were maintained over an 18-month period. This randomized intervention thus indicates that reduced worktime may improve recovery and perceived stress.

Keyword
diary data, gender, perceived stress, public sector, randomized intervention, reduced worktime, sleep, sleep duration, sleep quality, sleepiness, stress, worktime
National Category
Work Sciences Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:su:diva-148218 (URN)10.5271/sjweh.3610 (DOI)000395849200003 ()
Available from: 2017-10-18 Created: 2017-10-18 Last updated: 2018-01-10Bibliographically approved
2. Total workload and recovery in relation to worktime reduction – a randomized controlled intervention study with time-use data
Open this publication in new window or tab >>Total workload and recovery in relation to worktime reduction – a randomized controlled intervention study with time-use data
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: A 25% reduction of weekly work hours for full-time employees has been shown to improve sleep and alertness and reduce stress during both workdays and days off. The aim of the present study was to investigate how employees use their time during such an intervention: does total workload (paid and non-paid work) decrease, and recovery time increase, when work hours are reduced?

Methods: Full-time employees within the public sector (N=636; 75% women) were randomized into intervention group and control group. The intervention group (N=370) reduced worktime to 75% with preserved salary during 18 months. Data were collected at baseline, after 9 months and 18 months. Time-use was reported every half hour daily between 06 and 01 a.m. during one week at each data collection. Data were analyzed with multilevel mixed modeling.

Results: Compared to the control group, the intervention group increased the time spent on domestic work and relaxing hobby activities during workdays when worktime was reduced (p≤0.001). On days off, more time was spent in free-time activities (p=0.003). Total workload decreased (-65 minutes) and time spent in recovery activities increased on workdays (+53 minutes). The pattern of findings was similar in subgroups defined by gender, family status and job situation.

Conclusions: A worktime reduction of 25% for full-time workers resulted in decreased total workload and an increase of time spent in recovery activities, which is in line with the suggestion that worktime reduction may be beneficial for long-term health and stress.

Keyword
total workload, recovery, worktime reduction, gender
National Category
Work Sciences Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:su:diva-148571 (URN)
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2017-11-22Bibliographically approved
3. A randomized controlled intervention of workplace-based group cognitive behavioral therapy for insomnia
Open this publication in new window or tab >>A randomized controlled intervention of workplace-based group cognitive behavioral therapy for insomnia
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose: Sleep disturbance is common in the working population, often associated with work stress, health complaints and impaired work performance. This study evaluated a group intervention at work, based on Cognitive Behavioral Therapy (CBT) for insomnia, and the moderating effects of burnout scores at baseline.

Methods: This is a randomized controlled intervention with a waiting-list control group. Participants were employees working at least 75% of full time, reporting self-perceived regular sleep problems. Data were collected at baseline, post-intervention and at a three-month follow-up through diaries, wrist-actigraphy and questionnaires including the Insomnia Severity Index (ISI) and the Shirom-Melamed Burnout Questionnaire (SMBQ). Fifty-one participants (63% women) completed data collections.

Results: A multilevel mixed model showed no significant differences between groups for sleep over time, while there was a significant effect on insomnia symptoms when excluding participants working shifts (N=11) from the analysis (p=0.044). Moreover, a moderating effect of baseline-levels of burnout scores was observed on insomnia symptoms (p=0.009). A post-hoc analysis showed that individuals in the intervention group with low burnout scores at baseline (SMBQ<3.75) displayed significantly reduced ISI scores at follow-up, compared to individuals with high burnout scores at baseline (p=0.005).

Conclusions: Group CBT for insomnia given at the workplace did not reduce sleep problems looking at the group as a whole, while it was indicated that the intervention reduced insomnia in employees with regular daytime work. The results also suggest that workplace-based group CBT may improve sleep in employees with primary insomnia if not concomitant with high burnout scores. 

Keyword
Group CBT, Insomnia, Sleep problem, Organizational intervention, Burnout, Chronic stress
National Category
Work Sciences Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:su:diva-148575 (URN)
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2017-11-01Bibliographically approved

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