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Volume 11 No. 06
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Review Articles

Lessons Learned from Sleep Education in Schools: A Review of Dos and Don'ts

Sarah Blunden, PhD1; Gabrielle Rigney, BA (Hons)2
1Central Queensland University, Appleton Institute, Adelaide, Australia; 2University of South Australia, Health and Use of Time (HUT) Group, Sansom Institute for Health Research, Adelaide, Australia

ABSTRACT

Study Objectives:

Sleep duration and quality are associated with negative neuropsychological and psychosocial outcomes in children and adolescents. However, community awareness of this is low and sleep education programs in schools are attempting to address this issue. Several studies now exist assessing the efficacy of these sleep education programs for improving sleep knowledge, sleep hygiene and sleep patterns. This paper presents these sleep education programs, most particularly, it presents the strengths and weaknesses of the current available studies in the hope that this can identify areas where future sleep education programs can improve.

Methods:

A systematic search of all school-based sleep education studies in adolescents was undertaken. Studies were scrutinized for author, teacher and participant comment regarding strengths and limitations of each study, which were then extracted and summarized.

Results:

Two specific types of sleep education programs emerged from the review, those that sought to change sleep behavior and those that sought simply to disseminate information. Issues that dictated the strength or weakness of a particular study including who delivers the program, the theoretical basis, the tools utilized to measure sleep patterns, the content, and their capacity to engage students were assessed. Sleep education was considered important by teachers, students and parents alike.

Conclusions:

Future sleep education programs need to take into account lessons learned from previous sleep education efforts in order to maximize the potential for sleep education programs to improve the sleep health of our young people.

Commentary:

A commentary on this article appears in this issue on page 595.

Citation:

Blunden S, Rigney G. Lessons learned from sleep education in schools: a review of dos and don'ts. J Clin Sleep Med 2015;11(6):671–680.


The critical role of sleep and sleep problems in daytime functioning is increasingly apparent. Epidemiological estimates of sleep problems in children and young people, as classified by the International Classification of Sleep Disorders,1 are largely based on cross sectional data. Sleep disorders, whether physiologically based (such as restless legs syndrome)2 or behaviorally based (such as sleep hygiene disorder)2 are estimated to be prevalent in between 11–45% of young people3,4 with many more adolescents in non-clinical populations reporting high levels of sleepiness5 suggesting insufficient sleep. Indeed, recent literature shows some evidence that the sleep duration of children and adolescents has been declining in recent decades6 promoting the comment that one of the greatest contributors to sleep problems in the 21st century is this increasing sleep loss.5 Although guidelines for what is ‘sufficient’ sleep duration appear based on scant evidence,7 there nonetheless appears a general consensus that adolescents may be displacing sleep for other activities and may be sleep deprived.5,8,9

This is of significance because the subsequent negative daytime sequelae are consequential. Inattention, poorer memory capacity, behavioral problems and poorer academic performance are reported.10,11 Sleep loss more generally has been associated with stress, depression and increased anxiety,12 with compromised immune system function13 and an increased likelihood of overweight or obesity.14

Because adequate sleep is a core foundation of good health and is reportedly decreasing in our young people, sleep education should be an important consideration for school-aged children, not only on an intention to treat basis but also in a preventative capacity. This is particularly the case as several authors have reported that sleep problems appear to be under-reported by parents,15 and under-recognized by individuals, and by primary health professionals.15 Sleep researchers have therefore undertaken the task of increasing awareness and education regarding the importance of sleep health through school based sleep education programs. Although some sleep education studies have specifically targeted problematic sleepers,1619 most have delivered broad based general sleep education programs using a preventative model.2028 School based health education programs such as those targeting physical activity and/or diet are common and efficacious.29 However, sleep education is in its infancy.

There are currently only 121728 worldwide published studies of sleep education programs focussed on adolescents (with one in press30) that describe their education programs in sufficient detail for scrutiny. Many factors may contribute to a successful sleep education program, so it is important to understand what these may be in order to optimize efficacy in future sleep education programs. Two recent reviews31,32 have reported some of these components. Both have identified that effectively translating knowledge into behavior change is more complex than simple knowledge dissemination and is grounded in theoretical debate around health education in general. Behavior change theories such as the Social Cognitive Theory,33 the Stages of Change Theory, and the Theory of Planned Behaviour,34 have been used to assist our understanding of how best to maximize health education messages.35 Together these theories suggest that aspects other than a preoccupation with health have a strong influence upon an individual's decision whether or not to engage in positive health behaviors such as good sleep hygiene. Expectations of improvement, self-efficacy, attitudes towards sleep (the affective dimension), perceived barriers to improving sleep, peer and family attitudes, and sleep behavior have all been known to influence behavior.36 Other theorists have suggested that health education also needs to be pertinent; flexible, evidence based, engaging, and well resourced and should promote motivation and self-regulatory skills.37 It is likely that these factors are also important components of sleep education.

This paper will review the current evidence base of sleep education and extract comments from authors and participants on the relative strengths, limitations and improvements needed, in order that lessons learned can inform future programs. It will conclude with a discussion of how pedagogical approaches to health education may be generalized to sleep education delivery in order to promote innovative delivery.

METHODOLOGY

Identification of factors contributing to the success of current sleep education programs was achieved via two methods. A systematic search strategy was employed to identify all school-based sleep education programs. Four electronic databases (EbscoHost, Ovid, Scopus, and Web of Science) were searched using the terms “sleep education,” “sleep,” “sleep knowledge,” “sleep hygiene,” “sleep onset latency,” “bedtime,” “wake time,” “school,” “intervention,” “child*,” “adolescent*,” “youth,” “student*.”

Inclusion criteria were:

  • published since 1975 (this date was chosen due to the surge in sleep research from that time)

  • delivered in a school setting to a non-clinical population

  • written in English;

  • delivered to school aged participants (5–18)

  • described the study in detail including:

    • the content of education modules

    • the duration

    • methods of delivery

    • sleep outcome measures (e.g., sleep hygiene, sleep patterns, sleep knowledge)

Previous reviews31,32 were scrutinized to ensure all known sleep education studies had been identified. Papers in press are included.30

The second method was analyses of qualitative evaluations from teachers and/or students from exit surveys data reported in the published and in press studies previously mentioned.

RESULTS

Altogether, 13 studies were identified for inclusion cross checked by both authors which are summarized in Table 1. Factors identified in each study that contributed to the success (or otherwise) of their sleep education program were extracted. Although all studies reported delivering at least basic knowledge about sleep physiology and/or sleep hygiene, the scope and aims of the programs fell into one of two groups; those who sought solely to disseminate information and improve sleep knowledge,21,2325 and those who sought to actively change sleep behavior.1720,22,2628 Seven themes that were identified from the studies are listed below in no particular order:

  1. Theoretical underpinnings

  2. Modes of delivery and quality of the sleep educator

  3. Design of the study

  4. Sample size and demographics

  5. Outcome measures and tools

  6. Community and parental inclusion

  7. Students and teacher evaluations

Summary of published sleep education studies noting author reported strengths, weaknesses and future directions.

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Table 1

Summary of published sleep education studies noting author reported strengths, weaknesses and future directions.

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Theoretical Underpinnings

According to behavior change theories, an individual's decision whether or not to engage in or change to positive health behaviors can be affected by many factors including expectations and perceived barriers to improving health, self-efficacy and ability to change those behaviors, attitudes, motivation and perceived importance towards improving health, and importantly the attitudes of significant others such as peers and family. For sleep education programs, these factors would appear to be equally important but have been an integral part of only four studies. Results were mixed. Three teams from Australia1719 and one from Brazil28 recognized that their sleep education programs would be improved by factoring in theoretical guidelines, even suggesting in one study28 that the lack of change was due to a poor theoretical basis. Social cognitive behavior theory,17 motivational interviewing,18 mindfulness based cognitive therapy,19 and meaningful learning approaches28 were the theories reported. The motivation to change was often related to the degree of dysfunctional sleep patterns at baseline and was less successful in changing behavior when the sleep patterns were better at baseline.18 This would suggest that the salience of sleep education depends on the perceived importance of sleep health, which in itself is the aim of sleep education. How best to integrate motivational theories and/or behavior change theories into sleep education programs and which ones may be most beneficial still remains unclear and needs to be further extrapolated and studied in future. Sleep education should be based on the substantial theoretical, pedagogical and educational evidence in structure and delivery, a process that would need to cross disciplinary lines in development and delivery.

Modes of Delivery

Modes of delivery refers to method of delivery (e.g., mass circulation of documentation or delivery of traditional classroom sessions), style of delivery (e.g. didactic teaching methods versus more interactive learning) and status of the educator (sleep expert vs teacher/school staff member). One study disseminated information via pamphlets21 as the primary mode thus allowing quick distribution to a wide audience. The authors recognized that this method has limited effect for behavior change and that the lack of personal interaction accompanying the written material may have reduced its engagement effect. Most studies utilized written documentation in classrooms in combination with didactic teaching modules.1720,2228,30 Although all studies showed improvements in sleep knowledge through these methods, many studies reported that students preferred more interactive activities rather than traditional didactic methods.17,23,26 Indeed, Bakotić et al.21 suggest utilizing graphic designs and interactive sleep activities is more likely to promote interest in the content. It has been suggested that traditional pen and paper delivery methods may no longer be sufficiently stimulating for these young people who spend significant amounts of time online,31,32 which concurs with evidence from the health education literature that online delivery is an effective and cost efficient method.37 Given the absence of online sleep education to date, a future for online interactive programs appears warranted.

Although there is to date still little empirical evidence suggesting one specific mode of delivery is superior to another in changing sleep behavior, studies do report that who delivers the program can be influential. Engagement in content and improvement in outcomes may be dependent on the skill and teaching capacity of the deliverer. In all studies reported here, the deliverer was either the sleep researcher/author, or a trained teacher or school based professional (e.g. school counsellor). Whether successful engagement or retention of information was more apparent when the program was delivered by a researcher or sleep expert has been tested in one study. Blunden et al.23 studied the differences between delivery of the same program by the author compared to a teacher who was trained in the program. Sleep knowledge significantly improved in both cases however, students reported increased engagement with the author. When sleep researcher/author was compared to teacher delivery, 100% of students thought it was helpful and not boring compared to 88% reporting it to be helpful and 15% reporting it to be boring. These differences, albeit minor, may be due to an outside expert engaging and enthusing students more or perhaps that the sleep education module may have been a distraction from a normal curriculum. Alternatively it may have been that the level of expertise and focus from a sleep researcher/author promoted more interest and curiosity compared to a general teacher. However, in terms of a sustainable model for sleep education, it must be considered that sleep researchers/authors may not always be available. Integration of teaching staff trained in sleep, as suggested by some authors,16,20,23 would alleviate this problem but fails to specify how much training is needed and how increased teacher training could be accommodated. Indeed, teacher evaluations from two studies report that the time consuming nature of learning additional curricula material was inhibitive.23,26 Adequate resourcing in terms of time and financial support were also noted. As suggested by some researchers,19,23,26,32 integration and incorporation into existing curricula, such as health modules, science, health, and psychology course material may well be a solution to this.

Design of the Study

Designs of studies to date have depended on the aims of individual studies. If the scope of the sleep education program was primarily to improve sleep knowledge, cross sectional large community based studies were deemed sufficient and are reportedly successful.21,25 For those studies that targeted changes in sleep behavior, several authors undertook pre versus post intra individual designs that identified time effects,19,20,27 and most reiterated the need for a level of controlled evaluation of sleep programs as a minimum. At best, a randomized, controlled design was identified as the gold standard, undertaken by eight research teams.17,18,21,22,24,26,28,30 In addition, multi-site trials of the same program23,26,30 have been undertaken in Australia and New Zealand, which may increase the power of studies to detect change and improve the program, and may well be an additional method of achieving best practice.

Sample Size

Several of the researchers were undertaking pilot or feasibility studies and so sample sizes were small.23,24,26 In addition, all of the published studies were undertaken in adolescents. In general, findings showed that greater differences appeared between pre and post outcome measures when the sample participants were older (14 years of age or older).1721,23,24,2628 This is perhaps due to the increased prevalence of sleep problems in adolescent students,36 compared to younger children. Thus age group comparisons would plausibly be an important consideration in future studies. However, this raises further questions. If the scope of sleep education is to prevent, should they be delivered to participants earlier before the emergence of significant sleep problems?

Should this suggest wide and systematic dissemination of information to all students? Or, given the aforementioned resources needed to deliver sleep education, should programs only be delivered and targeted when most pertinent to the student? Perhaps if it were the latter, then screening of sleep problems via school awareness campaigns followed by delivery to those students with sleep difficulties would arguably be the most beneficial.1719

Outcome Measures and Tools

Sleep Knowledge

All studies tested sleep knowledge with most reporting improvements after delivery. No standardized tool exists, therefore authors have developed their own tools including a range of quizzes and sleep questionnaires.20,21,2326,28 The development of one standardized and reliable sleep knowledge tool would be beneficial for multi-site comparisons and should be possible, given that all sleep education programs likely deliver standard and similar evidence based information for at least sleep physiology and sleep hygiene. Without a standardized tool, it is difficult to disentangle why some studies improved sleep knowledge, some found few changes and some no changes at all.21,23 It has been suggested perhaps some tools are too easy, and/or have dichotomous response formats (True/ False formats have a 50/50 chance of correct answers)24,30 resulting in a possible ceiling effect with subsequently low sensitivity to change. Sousa et al.28 suggest that a pedagogical approach to questionnaire development would result in sleep knowledge questionnaires being better targeted, resulting in greater sensitivity and behavior change. The consensus from the perused studies appears to suggest that a standardized sleep knowledge tool that following strict development guidelines (as suggested by Spruyt and Gozal38) would be not only helpful but necessary.

Sleep Patterns

For those studies that measured sleep patterns measurement was undertaken with either sleep logs,22,26 questionnaires,1719,22,27 diaries,20,28 or in rare cases Actiwatches.19,22,30 Most researchers clearly acknowledge that subjective assessments of sleep patterns are subject to considerable reporting bias39 and identify that objective measurement of sleep patterns is preferable but that it is also cost prohibitive in many cases. Standardized questionnaires (e.g Pittsburgh Sleep Quality Index; Morningness/Eveningness questionnaires) were used in only five studies.1719,25,26 The use of standardized tools such as these would enable greater confidence in data collection and increased more comparability between studies.

Community and Parental Inclusion

Several authors17,20,23 have recognized that changing sleep behaviors or sleep knowledge is better achieved if significant others (e.g. parents, peers and the broader school community) are engaged in the process, a notion reflected by teachers (see following discussions). Sleep schedules and patterns are established in the home and are affected by both cultural factors and family environment. While neither may be easily amenable to change, both could potentially affect the willingness to change.34 Inclusion of the family unit (in as much is as possible) has been identified in most studies as being of significant importance given its known affect on motivation to change behavior.17 Two studies have attempted to address these factors with inclusion of parent and whole school communities in the dissemination of information.20,30 Azevedo et al.20 widely disseminated relevant information across multiple channels to most significant others (radio, school, parents, teachers). Rigney et al.30 distributed booklets to parents and invited them to a parent information evening with the broader school community and led by a sleep researcher, where students presented their sleep projects, 10 weeks post intervention. Neither study reported whether parental or broader school inclusion was instrumental in changing sleep, but the behavior change literature and previous studies support parental involvement.40

Student and Teacher Evaluations

Gathering qualitative data about sleep education programs was undertaken by summarizing reports from the published literature. Post program evaluations mainly used in exit surveys with students,1719,23,24,26,28 and authors used these in conjunction with the pre-post quantitative data measurement to assess acceptability and feasibility of their programs.1719,23,26

Student Evaluations

When all qualitative evaluations were examined collectively (see Table 2), similar findings were reported. Most students reported that sleep education was important to them and useful, informative and helpful. Most cited increased sleep knowledge and increased awareness of their own sleep patterns as the most beneficial welcoming behavioral strategies and sleep hygiene tips to change their sleep patterns. Only three studies that formally assessed sleep behavior change also asked participants about behavioral intention, willingness and/or the capacity to change sleep patterns.17,18,28 Theoretical based evaluations of “readiness to change” or “motivation to change” were included in two randomized controlled trials18,30 and may indeed be helpful in evaluating why participants did or did not change sleep behavior. Indeed, responses were evenly divided between those willing to change or not willing to change but overall neither study found a significant difference in measures of motivation or readiness to change. Some reported not feeling the need to change. Although this may reflect a simple lack of motivation it may also reflect a different allocation to the importance of sleep or alternatively an indication of how sleep health is perceived by these adolescents. Indeed why would students want to change their behavior if it is not perceived as a problem, as suggested in one study?22 Sleep educators would do well to further clarify why some participants do not feel the desire or the need to change.

Results of exit surveys and evaluations expressed as a percentage of students who answered “yes.”

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Table 2

Results of exit surveys and evaluations expressed as a percentage of students who answered “yes.”

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Despite positive feedback in general, three studies18,23,26 reported that up to 40% of students deemed programs to be either boring, too difficult or too long. Interactive activities with less didactic lecturing were most highly favoured when students were asked how to improve the programs23,26 suggesting that in those two programs there were sufficient opportunities to interact and engage. Some students liked interactive homework activities such as completing sleep diaries while others did not. Perhaps these differential preferences reflect different learning styles and/or the need for targeted themes for different groups. For example, Rigney et al.30 ensured classroom sleep projects embraced all student learning styles when allocating sleep focussed school projects, while Cortesi et al.24 specifically focussed on sleep hygiene and irregularity of sleep wake patterns in order to specifically target information where the need was greatest (older adolescents). This would suggest that assessing the individual needs of the target group based on our current understanding of developmental sleep patterns may be an important consideration to avoid a “one size fits all” sleep education program.

Teacher Evaluations

Only five studies have interviewed teachers and recorded teacher thoughts and comments.17,18,20,23,26 Findings are remarkably similar. Teachers all agreed that sleep education was important, relevant and necessary. Three studies however reported that teachers found including sleep education into already crowded school curricula was problematic23,26,30 and suggested a need for allocation of time in teachers' workloads to deliver the program. Alternatively, as reported in two studies,17,18 33–50% of teachers (respectively) reported that sleep education delivery would be better delivered by a sleep trained teacher or sleep expert to reduce teacher workload in both learning the information and delivering the content. Apart from the need for more trained deliverers, teachers reported the need for more interactive activities,18,23 and all five studies cited the importance of simultaneous information dissemination to parents and school wide communities.17,18,20,23,26

DISCUSSION

Investment in the sleep health of our young people is at the core of sleep educators' efforts. Sleep education programs are still in their infancy and vary widely in their scope, delivery and outcomes. This paper has attempted to synthesize the information available from current sleep education programs, in order to maximize the potential for improving delivery and subsequent outcomes. Two specific types of sleep education programs have emerged from the review and will inform future trials - those that aim to increase awareness and are delivered to the general student population in a preventative fashion to increase sleep knowledge,21,2325 and those that target sleep behavior and aim to improve not only sleep knowledge but also sleep patterns.1720,22,2628 Each type of program may require a different methodology, a different target group and different dissemination methods.

The provision of high-quality education and training that is responsive, relevant, accessible and evidence based is critical if the vision for quality sleep education programs is to be fulfilled. Sleep education would be well served at learning lessons from the health education literature, which has a considerably longer history in school based education than sleep education. Pedagogical approaches and quality assurance mechanisms would potentially maximize the effectiveness of these educational interventions.

Pedagogical Approaches Applicable to Sleep Education

Pedagogical approaches that may be applicable to sleep education are largely based on three principle components41 which are (1) adapting learning content to each student's learning style or needs thus understanding when instructional methodologies need to vary to accommodate differences in student learning needs or pace (2) ensuring that the content delivered is synthesized into understandable and applicable information that utilizes not only learning skills at a lower cognitive level but also promotes application of information into real understanding and higher order thinking skills as in Bloom's Taxonomy42 and (3) translating health information into behavior change.

Learning Styles

The health education literature has noted that differential learning styles (i.e some children learn better with visual informant whereas others learn better with written information)41 should be integrated to learning modules. Although some sleep education studies above have utilized numerous modes of delivery, there is no evidence given that would suggest a systematic approach. However, inadvertently, both written and visual information are automatically integrated into current classroom activities and learning due to the online technologies utilized in current education.43 Indeed all teacher reports from the aforementioned sleep education studies stated that interactive and engaging should be considered in future programs. Mobile technologies, both interactive and engaging, have revolutionized the application of health care messages to the population, particularly in the age groups that are targeted in these sleep education programs.44 This is evidenced in the plethora of diet and physical activity applications available.44 However, the speed and advance of technologies far outweigh our capacity to critically evaluate their efficacy.

Bloom's Taxonomy

Bloom's taxonomy refers to a classification of the different objectives that educators set for learning objectives and has been considered a foundational and essential element within the education community.42 The potential application of Bloom's taxonomy to sleep education comes from the literature on its efficacy in optimizing learning outcomes in traditional educational curricula45 and complimenting learning styles. Indeed one study has attempted the application of Bloom's taxonomy to a sleep education program.30 The difficulties noted above with changing sleep behaviors through information dissemination may well be assisted by taking into account the principles embedded in Bloom's taxonomy. These methods have been accredited for increasing the learning experience of students45 by utilising a full range of student cognitive capacities, from lower to higher order thinking skills to learn and engage with the information and to maximize its retention.

Measurable student outcomes, those that require higher levels of expertise, will require more sophisticated classroom delivery and assessment techniques and potentially need more innovation methods. In terms of delivering sleep education, this would suggest that to ensure proper integration of information from all cognitive levels, then effective evaluations and assessments tasks, including real changes to sleep behavior, would need to be included to ensure that students have utilized effective higher order thinking skills to retain the information and adapt it to their own circumstances. This is similar to the competency based training systems utilized in adult education domains.46

For instance, (see Table 3) to test if a student is able to evaluate what has been learned, the teacher/deliverer can assess if the student has applied the information to varying levels of implementation engaging, according to Bloom, different cognitive levels of understanding.

Cognitive levels of information integration according to Bloom applied to sleep education.

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Table 3

Cognitive levels of information integration according to Bloom applied to sleep education.

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Further, Bloom's taxonomy includes three sub taxonomies that require different levels of cognitive appraisal: knowledge-based goals, skills-based goals, and affective goals (affective: values, attitudes, and interests). Which of the three could be used for a given measurable student outcome depends on the original goal to which the measurable student outcome is connected. For example, a knowledge based goal would be “student understands proper sleep hygiene” because it requires that the student learn certain facts and concepts. A skills-based goal might be “student practices effective sleep hygiene” because it requires that the student learns how to do something. Finally, an affective goal might be “student cares about proper sleep hygiene” because it requires that the student's values, attitudes, or interests be affected by the course.47

Some critiques of the taxonomy's cognitive domain whilst admitting the existence of these six categories,45 question the order of the sequences in traditional curricula. However, the domains as they stand in the revised version, do appear to fit sleep education requirements. Indeed as health and sleep education both share the need for translating information into practice, Bloom's three taxonomies could be an important guide for the content and delivery of student learning in these domains.

But, as previously noted, information dissemination alone is not sufficient and this has been widely demonstrated in the health education literature.48 Discussion around translating information into behavior change has not been sufficiently taken into account in sleep education programs to date because what students do about their sleep health is more important than what they know about their sleep health.49 The effectiveness of most health care programs is highly dependent on the recipients' adherence to changing or refraining from specific activities or habits and this is applicable to sleep education. Health researchers48,50 have described the process of health behavior change as entailing the dual tasks of initiating and maintaining change, with distinct and measurable outcomes supported by peers, families and communities in a whole-school approach.34,51

Clearly these components are applicable to sleep education and sleep educators need to embrace the lessons learned not only from each other but from the broader health education, behavior change and curriculum delivery models. Considering novel aspects utilized in other education so such as online and mobile technologies44 and other interactive and innovative presentations of information would no doubt appeal to the media savvy generations at risk of sleep loss. Designing sleep education with the student input, and/or student led teaching which has been used in school health behavior programs such as sexual activity52 and/or weight management/eating disorders, may well be an additional method of maximising engagement. Certainly engaging the expertise of teaching professionals in the development and best practice delivery would be of assistance in future programs.

In summary, high prevalence rates of sleep problems in adolescents which are routinely documented, suggest the need for including at least some sleep education as part of their general health education. Information presented here shows this is unanimously agreed upon by researchers, clinicians, teachers and participants. Sleep education programs can ensure that sleep knowledge and the level of salience allocated to sleep health are increased so that any poor sleep habits may be more of a choice than a lack of awareness.27 Sleep knowledge acquisition therefore represents the major goal of sleep education in the first instance. Although we do not know the longer term impact of sleep education on the sleep health of our young people, lack of sleep education would surely be worse. What we do know is that sleep education programs are generally feasible, acceptable, and successful and so by taking into account factors extracted from current studies and the relevant literature, with ongoing evaluation and quality assurance strategies (see Table 4), we are maximizing our chances of success.

Dos and Don'ts of sleep education extracted from published studies.

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Table 4

Dos and Don'ts of sleep education extracted from published studies.

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DISCLOSURE STATEMENT

This was not an industry supported study. The authors have indicated no financial conflicts of interest.

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