Sleep problems, characterized by short sleep duration or poor sleep quality (termed inadequate sleep), are highly prevalent in minority and low-socioeconomic (SES) populations and contribute to significant physical and mental health disorders, and thus are likely mediators of health disparities. Inadequate sleep is often attributable to and perpetuated by poor sleep hygiene (nighttime behaviors and environments that impair sleep) and/or to hyper-arousal (inappropriate central nervous system activation secondary to stress). As such, a primary strategy for improving sleep is recommending the practice of core elements of sleep hygiene coupled with use of behavioral strategies that reduce arousal. Extensive research has established the efficacy of mind- body interventions, including yoga, for reducing stress and hyper-arousal. Research from our team and others also indicates mind-body interventions improve sleep. These therapies, however, are underutilized by low SES populations and little work has been done to optimize these practices for use in these populations. We propose to conduct qualitative formative evaluation research in a low income community to adapt sleep hygiene and a standardized yoga intervention that target(s) sleep outcomes, by ensuring our interventions for behavior change and techniques are practical and useful within the social context in which urban, low SES populations live and work. Following principles of community participatory research, we will conduct focus groups and small pilot studies in a community setting to address beliefs and attitudes towards sleep; identify challenges and strengthen approaches for adhering to behavioral recommendations; and address issues related to the content (particular, home-based practices), intensity and duration of our sleep and yoga interventions, aiming to optimize uptake and effectiveness. After we refine these interventions, we will conduct a 12 week randomized controlled feasibility trial, randomizing 40 adults with short sleep duration (< 6 hours per week) to either a sleep hygiene intervention alone or to a combined yoga and sleep hygiene intervention. These pilot studies will: a) provide estimates of recruitment and retention rates, adherence, and intervention fidelity and b) determine the feasibility of collecting a range of behavioral, social, and physiological measures, including perceived stress, resilience, affect, and self-efficacy, and explore their relevance as potential mediators linking the intervention to the sleep outcomes. This information will allow us to design a Phase 3 randomized controlled trial (RCT) that is based on realistic recruitment/retention rates; identify the key features of an intervention likely to work in real wold settings; identify adherence patterns to inform future dosing protocols; and identify the mediating factors most valuable to study in future research. Thus, this R34 grant will provide critical data to inform the design of a definitive RCT to test the effectiveness of a yoga and slee hygiene intervention to extend sleep duration and improve sleep quality, with attendant improvements in mental and physical health and well-being.
The root causes of inadequate sleep are often related to behavioral practices and stress, both of which may be favorably impacted through use of sleep hygiene recommendations and mind-body practices such as yoga, which reduce stress reactivity and enhance resiliency to multiple environmental stressors. This project will evaluate and attempt to overcome the barriers for their use by individuals in low income communities with sleep problems by adapting standard sleep and yoga interventions specifically for this population, accounting for relevant social and environmental conditions. The proposed studies will inform the design of a future definitive clinical trial aimed to have wide uptake, fidelity, ad adherence.