Abstract
Adequate sleep is essential to support daily functioning, health, and well-being. A 2019 Australian Parliamentary Inquiry made 11 key recommendations, setting a national agenda to grow sleep research and clinical sleep medicine to improve the sleep health of Australians. In 2023, the Australian Federal Government endorsed many of these recommendations. The Network of Early Career Sleep Researchers in Training (NEST), a council of the Australasian Sleep Association, represents students and early-career researchers and clinicians in sleep research and medicine. In this consensus statement, we respond to the Parliamentary Inquiry’s recommendations and call for timely and adequate investments to address the key priorities in the proposed national sleep health agenda. Pivotal towards raising sleep health awareness and improving sleep disorder services nationally, we propose actions including (1) the recognition of sleep as a national health priority and the development of a national 10-year sleep health and well-being strategy, (2) a nationwide sleep health awareness campaign,(3) education for healthcare practitioners in sleep health and sleep medicine, and (4) funding for sleep research into critical areas needed to support the sleep health of all Australians. This consensus statement presents practical considerations for advancing Australia’s national sleep health agenda, drawing on input from emerging leaders in sleep research and medicine. We urge policymakers, healthcare providers, and industry leaders to prioritize these initiatives, which hold the potential to reduce the impact of sleep disorders on our healthcare system and improve the well-being of all Australians.
Keywords: sleep health, sleep medicine, sleep disorder, health advocacy
Statement of Significance.
This position statement endorsed by the Australasian Sleep Association responds to the Australian Parliamentary Inquiry into Sleep Health, urging timely investments in the national sleep health agenda. Key actions include: (1) recognizing sleep as a national health priority, (2) launching a nationwide sleep health awareness campaign, (3) educating healthcare practitioners in sleep health and medicine, and (4) funding critical sleep research. As emerging sleep researchers and clinicians, we call on policymakers, healthcare providers, and industry leaders to prioritize these initiatives to reduce the impact of sleep disorders and improve Australians’ well-being.
We spend up to a third of our lives sleeping. The importance of sleep for health is irrefutable, yet sleep has received much less attention as a national health issue than other pillars of health (e.g. nutrition and physical activity). The economic cost of inadequate sleep in Australia is substantial and increasing. In 2016–2017, the cost of inadequate sleep was $66.3 billion [1], and rose to $75.5 billion in 2019–2020 [2]. Inadequate sleep is a significant risk factor for accidents and injury [3], and a modifiable risk factor for multiple chronic health conditions and all-cause mortality [2]. Hence, establishing sleep as a national health priority is crucial for Australia’s health system.
As a critical step towards recognizing sleep as a national health issue, and in response to enquiries from key stakeholders (e.g. Sleep Health Foundation [SHF], Australasian Sleep Association [ASA]), a Parliamentary Inquiry into Sleep Health Awareness was established by the Federal Government. The Inquiry Committee’s Bedtime Reading report was tabled by the Australian Parliament in April 2019, with 11 recommendations based on 138 submissions representing the SHF, ASA, patients, workplace safety bodies, and community stakeholders. The Government response, supporting 10 of the 11 recommendations, was released in August 2023 (Table 1).
Table 1.
Summary of the Parliamentary Inquiry Recommendations and Australian Government Response.
| Bedtime reading: inquiry into sleep health awareness in Australia recommendations |
Australian government responsE | |
|---|---|---|
| 1 | The Committee recommends that the Australian Government prioritize sleep health as a national priority and recognize its importance to health and well-being alongside fitness and nutrition. | Supports |
| 2 | The Committee recommends Safe Work Australia and the Alertness CRC provide updated guidelines (based on current research and science) for industries using shift work, regarding optimal shift structures and other workplace practices that promote alertness, productivity and ensure worker safety. | Supports in-principle |
| 3 |
|
Supports in-principle |
| 4 |
|
Supports in-principle |
| 5 |
|
Supports in-principle |
| 6 |
|
Notes |
| 7 | The Committee recommends that if no distributor is willing to put forward a submission, the Australian Government work with patient advocacy groups such as Narcolepsy Australia or the Sleep Health Foundation to make a submission for the listing or registration of Sodium Oxybate under the Orphan Drug Program. | Supports in-principle |
| 8 |
|
Supports in-principle |
| 9 |
|
Supports in-principle |
| 10 | The Committee recommends that the Australian Government investigate options to separate the existing “Respiratory and Sleep Medicine” specialty into independent “Respiratory” and “Sleep Medicine” specialties under the Australian Health Practitioners Regulation Agency framework. | Supports in-principle |
| 11 |
|
Supports in-principle |
Since the Government response, the SHF and ASA have raised awareness and advocated for sleep as a core pillar of health (e.g. recommending a 10-year National Sleep Health Strategy for Australia, and developing and promoting evidence-based sleep health resources for primary care providers). Such advocacy work is necessary to ensure that original recommendations from the Bedtime Reading Report are achieved. Essential to progress in sleep research and sleep health awareness is the involvement of emerging sleep researchers and clinicians, who will implement these recommendations and grow the field of sleep science and medicine.
The Network of Early Career Sleep Researchers in Training (NEST) is an ASA Council that represents students and early career researchers (ECRs) in the sleep field. This position statement is the NEST Committee’s response to the Parliamentary Inquiry’s recommendations and Government Response, outlining key priorities and actions to support a National Sleep Health Strategy.
Methods
The NEST council
Approximately 30% of ASA members are students and ECR (0–5 years post-PhD), a demographic that spurred the establishment of the NEST Council in 2021. The leadership committee of the NEST Council comprises 12 members including two Co-Chairs, and members across three teams: communications, presentations, and advocacy and networking. NEST’s mission is to promote, connect, and advocate for students and ECRs in the field of sleep research and medicine and provide a platform for their unique perspectives and positions.
The consensus statement process
The NEST committee reviewed the 2019 Bedtime Reading report, the Australian Government’s 2023 response, and other relevant literature before a workshop discussion on May 3, 2024. In this 3-hour workshop, members shared their expertise, knowledge, and personal experience to reach a consensus viewpoint on each recommendation made in the Bedtime Reading report. HS and CG facilitated this discussion. Any disagreements were discussed and resolved in this meeting. The meeting recording and minutes were shared after the meeting to enable clarification of major points.
From workshop discussions, eight of the recommendations made in the Bedtime Reading report were considered key priorities for the NEST Committee that are relevant in the short to medium term. Three recommendations were considered more relevant in the longer term rather than the immediate priorities of the NEST Committee. These recommendations were monitoring the continuous positive airway pressure (CPAP) industry (Recommendation #6), approval for sodium oxybate for narcolepsy treatment (Recommendation #7), and separating respiratory and sleep medicine specialties (Recommendation #10). Accordingly, this consensus statement does not provide viewpoints on these recommendations, however, the NEST Committee supports these recommendations in the long term.
All NEST Committee members contributed to manuscript drafting. Literature reviews to inform each recommendation were conducted from June 4, 2024, until July 16, 2024. HS collated and synthesized each member’s writing contributions into the first manuscript draft. Each member reviewed and edited the manuscript drafts iteratively until a final consensus was reached. The final version was approved by all NEST Committee members.
External consultation process
NEST consulted with our External Advisory Group (comprised of seven mid-career and senior-career researchers and clinicians in sleep medicine) on the editing and final version of this consensus statement. The ASA Research Committee and Board of Directors have endorsed this consensus statement as an official position of the ASA.
Recommendations
Raise sleep health awareness: Response to Recommendations #1 and #8
NEST supports Recommendations 1 and 8 and is pleased that the Australian Government also supports Recommendation 1, with in-principle support for Recommendation 8. Given the importance of sleep for optimal health and daily functioning and the growing costs of inadequate sleep in Australia, sleep health should be recognized as a national priority. The Australian Government have cited that a policy achievement of the 2021–2030 National Preventive Health Strategy will be to have sleep and screen time recommendations for all age groups incorporated into relevant national guidelines and policy by 2030 [4], in recognition of sleep as a public health priority. Public health messaging will be key for educating Australians about the importance of sleep for their health and encouraging proactive engagement with healthcare providers to assess and treat sleep disorders. This public health messaging should incorporate sleep needs across the lifespan, including children and older adults, and promote sleep health to these populations in different ways (e.g. sleep health education campaigns at school).
We call for a new, evidence-based National Sleep Health Strategy, supported by the Federal Government, to improve sleep health in Australia. This is also a key recommendation of the Australian Health Policy Collaboration’s recent report Sleep: A Core Pillar of Health and Well-being, Improving Population Sleep Health to Reduce Preventable Illness and Injury—A Policy Evidence Brief [5]. To support a Strategy, funding must be allocated for a national sleep health campaign developed with an advisory committee of sleep researchers and experts. This campaign could draw upon successful global sleep health campaigns (e.g. “Count on Sleep” [6]) and successful health campaigns (e.g. “10 000 step program” [7]). Clear, specific sleep health targets should be set for Australians, going beyond sleep duration recommendations to include sleep quality, timing, and regularity that are interconnected but independently known to influence health and functioning. Of critical importance is the need to reduce the stigma associated with sleep disorders. Specific sleep health campaigns need to be developed for underserved, high-priority populations such as Aboriginal and Torres Strait Islander people, shift workers, and people living with chronic health conditions. Indeed, a National Sleep Health Strategy would need to consider the needs of high-priority populations in its approach and strategy outcomes.
The Government’s response highlights the benefits of combining sleep messaging with diet and physical activity to provide a holistic view of health. We emphasize the opportunity to include the interplay between sleep, nutrition, and physical activity within current health-based messaging, such as discussing relationships between sleep and diet [8] and sleep and sedentary behavior [9, 10].
Fund sleep research: response to recommendation #11
NEST fundamentally supports Recommendation 11 to fund sleep research. We recognize the Government has invested in sleep research in the past 5–10 years via National Health and Medical Research Council and Medical Research Future Fund grant schemes, including research to identify prevalence, causes, mechanisms, and treatments for multiple forms of inadequate sleep in Australia. Nonetheless, significant gaps in knowledge remain, which require further Federal Government investment. We therefore call for increased research funding to address key knowledge gaps to improve sleep health in Australia. These efforts will ultimately provide the knowledge needed to action the National Sleep Health Strategy (see an overview in Figure 1).
Figure 1.
A sleep research agenda to inform and support a National Sleep Health Strategy.
Future research should address multiple knowledge gaps. The Parliamentary Inquiry called for further research to identify the prevalence of sleep disorders, especially within under-researched population groups. Focusing on such groups in high-quality longitudinal studies is key to understanding the extent of inadequate sleep and sleep disorders in communities across Australia, as well as identifying and addressing barriers to better sleep health services in these communities. In addition to supporting the Inquiry’s call for research focusing on women and Aboriginal and Torres Strait Islander peoples, we likewise call for more sleep research with young adults and children. Research is critically needed to understand the causes of inadequate sleep in young adults, which is prevalent and costly to our community largely due to lost workplace productivity [11]. Further work is also needed to facilitate effective and practical sleep disorder diagnosis and optimized tailored treatment approaches to prevent a lifetime of poor health. Rigorous clinical trials will be critical here to test new treatment approaches. Research into rare sleep disorders is needed, as is the provision of resources to implement sleep disorder treatments to support these patient groups (including working towards registering sodium oxybate and other medications for narcolepsy). Lastly, longitudinal population-level sleep health data is critical to inform and determine the effectiveness of, sleep health awareness programs. The Australian Bureau of Statistics’ National Nutrition and Physical Activity Survey could serve as an exemplar here.
A critical feature of this sleep research agenda will be recognizing the importance of lived experiences and representation in research. Co-design is a key element of any successful research program; therefore, the conduct of the research outlined above must be informed and driven by the priorities of people with lived experience of poor sleep health. Frameworks such as the Medical Research Future Fund Principles for consumer involvement should be adopted.
Finally, adequate funding for sleep research is crucial to attract and retain top talent and contribute to global advancements in sleep health. Without funding, there is a risk of losing skilled professionals to better-supported disciplines or countries, which could hinder progress in understanding and addressing Australian sleep health issues. Therefore, sustained investment in sleep research is essential for fostering a robust scientific community and ensuring ongoing contributions to Australia’s public health and innovation.
Educate healthcare practitioners: Response to Recommendations #4 and #9
NEST unequivocally supports Recommendation 9, to increase awareness of sleep health and sleep disorders among healthcare professionals. Sleep is a modifiable lifestyle factor for the prevention and management of cardiometabolic [12, 13] and psychiatric [14, 15] conditions commonly encountered in primary care settings. Yet, sleep health screening and management are often overlooked as a patient care priority [16]. Previous studies have highlighted the lack of formal sleep education for healthcare professionals as a significant perceived barrier to implementing sleep health management within healthcare practice [17]. On average, medical and dental schools in Australia provide 6.2 hours and 4.5 hours of training on sleep disorders, respectively. Similar educational gaps have also been identified among students and current practitioners in nursing/midwifery, pharmacy, occupational therapy, and clinical psychology [18–20]. Ultimately, unmet sleep education needs of Australian healthcare professionals may be contributing to the underdiagnosis and under-management of sleep disorders in the community.
As such, NEST strongly supports Recommendation 4 to develop tailored and structured sleep health education programs for healthcare professionals and note the work that the ASA is doing in this space. Such programs should emphasize the delivery of sleep health training (1) tailored to the relevant scopes of practice for each healthcare professional, (2) led and supervised by sleep health experts, (3) appropriately incentivized, and (4) Continuing Professional Development-accredited [21]. Pilot education programs for trainee psychologists [22] and pharmacy students [23] in Australia have been successfully trialed with promising early evidence.
Shift workers: a critical target for industry change: Response to Recommendations #2 and #3
NEST supports Recommendations 2 and 3 focusing on the development of guidance and regulations for shift work industries. Shift work is considered to be any nonstandard working arrangement that requires a worker to be awake when they may normally be asleep (e.g. at night) [24]. Shift work is associated with inadequate sleep, circadian disruption, fatigue, poor health, and adverse safety outcomes [24, 25]. In our view, more comprehensive and nuanced guidance/regulations would be useful to help workers and managers better approach and navigate the sleep/fatigue-related difficulties of shift work, particularly for those who may not have the resources to develop tailored systems of work. However, we urge caution in offering generic approaches as they are unlikely to be appropriate across the differing operational requirements, flexibility needs, and risk profiles of various sectors. It is, therefore, our view that any fatigue management approach guidance should be established in collaboration with industries and regulatory bodies to provide the opportunity for flexibility across industries and organizations, provided they can demonstrate they are effectively managing fatigue-related risk and are operating within a safe system of work [26].
Importantly, while many existing guidelines have shown efficacy in reducing fatigue and sleep disruption (e.g. shift length, break duration [27, 28]), there is limited evidence supporting others (e.g. restrictions on on-call or advance notice periods [29]). Additionally, for some organizations and industries, there is a lack of available data regarding the effectiveness of certain fatigue risk management strategies [30]. Thus, we believe there is a strong imperative for the development of industry-specific evidence on the effectiveness of both working hour guidelines and other fatigue risk management strategies. Moreover, it is our view data from specific organizations and industries would ideally be shared more broadly to further facilitate evidence-based approaches that support shift workers nationally.
The Inquiry recommendations also suggest a need for additional sleep health support and education for shift workers. Early identification, intervention, and support of those with sleep problems are critical to workers’ health. The onus for sleep and fatigue management should not lay entirely on the worker. Rather, sleep health support and education should be complementary to a systems approach to managing work-related fatigue.
Sleep health equity for all Australians: Response to Recommendation #5
NEST supports Recommendation 5 and has multiple suggestions to build on the Government response. One in two Australians experience deficiencies in duration, efficiency, timing, regularity, or quality of sleep [31, 32]. First Nations people in Australia and New Zealand have almost twice the rates of OSA and are more likely to report all types of sleep deficiencies compared to non-Indigenous populations [33]. Sleep deficiencies disproportionally affect disadvantaged and underserved populations, including racial and cultural minorities, sexual, and gender-diverse communities [34, 35]. Sleep health inequities are a pressing but under-researched issue for Australia, given these inequities in sleep are linked to lower socioeconomic levels, perpetuate poor mental and physical health, and quadruple the risk of early mortality [36, 37]. Investment to address disparities in sleep is critically needed to improve the health of millions of Australians.
It is important to acknowledge that sleep disparities are not “inherent” to underserved communities, but a product of structural, systemic inequities. Social determinants of health, or the social conditions in which people are born, grow, work, live, and age also play a critical role in sleep health disparities and are driven by factors outside traditional health domains, including colonization, racism, social, and environmental factors [38–40]. For instance, higher rates of OSA are observed in rural men compared to those in metropolitan regions [41] and general treatment accessibility is poorer in regional areas. Despite our strong history of multiculturalism and immigration, research on sleep health inequities within Australia continues to be limited. NEST advises the use of an intersectionality framework to document and address these inequities [42].
NEST recommends “switching the narrative” to advance sleep health equity. This requires moving the focus from change at the level of the individual to investigating macro-level changes, supported by government policy to reduce barriers to appropriate care. We advocate for expanding access to specialized sleep health services, particularly in regional, rural, and remote areas, including: subsidizing CPAP therapies for OSA, listing or registering Sodium Oxybate (and other novel therapies for hypersomnolence) for Narcolepsy treatment, active programs to increase community awareness, developing culturally and inclusively responsive services, and increasing the number of First Nations sleep researchers and clinicians is critical to improving the health of all populations. Culturally sensitive sleep interventions are being successfully trialed in young First Nations Australians and provide a blueprint for co-producing evidence-based interventions with communities, addressing their specific concerns [43].
Final comments
Sleep health is a national health issue and priority for the Australian Government. In this consensus statement, NEST have provided their perspective and suggestions to help address a national sleep health agenda to improve sleep health and sleep equity for all Australians. The work of students, ECRs, and clinicians within the sleep field in Australia will be critical to addressing these key priorities, now and in the future. With further research investment and support, we can reduce inadequate sleep and promote a healthier future for all Australians.
Acknowledgments
All authors contributed equally to this consensus statement. The NEST Committee would like to acknowledge the contributions of the NEST Advisory Committee in reviewing this work (Dr. Alex Wolkow, Dr. Rosemary Gibson, A/Prof Andrew Vakulin, A/Prof Amy Reynolds, Dr. Camilla Hoyos, Professor Leigh Signal), alongside the ASA Research Committee, Executive Council, and ASA personnel. We thank the ASA for endorsing this consensus statement as an official position of the ASA. The NEST Committee would also like to acknowledge the advocacy work done by the Australasian Sleep Association and the Sleep Health Foundation to promote sleep health in Australia, and to promote the development of students and early career researchers in sleep.
Contributor Information
Meagan E Crowther, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.
Charlotte Gupta, Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, QLD, Australia.
Aislinn Lalor, Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia.
Samantha K M Lee, Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
Cele Richardson, Centre for Sleep Science, School of Psychological Science, University of Western Australia, Perth, WA, Australia.
Hannah Scott, Flinders Health and Medical Research Institute: Sleep Health, Flinders University, Adelaide, SA, Australia.
Tim D Smithies, Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, QLD, Australia; Melius Consulting, Mount Hawthorn, Perth, WA, Australia.
Natasha Sneddon, Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia; Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
Madeline Sprajcer, Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, QLD, Australia.
Prerna Varma, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.
Grace E Vincent, Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, QLD, Australia.
Zoe Walsh, Sleep/Wake Research Centre, Massey University, Wellington, New Zealand.
Sian Wanstall, Flinders Health and Medical Research Institute: Sleep Health, Flinders University, Adelaide, SA, Australia.
Disclosure Statement
Financial disclosure: This is an investigator-initiated project. Nonfinancial disclosure: All authors are members of the NEST Council of the ASA. HS is a Director on the Board of the ASA and abstained from voting for the endorsement of this position statement.
Data Availability
Not applicable.
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Data Availability Statement
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