Table 3. Qualitative themes with example quotations.

Theme one: Patient-related factors		Theme 2: Service-related factors	Theme 2: Other environmental factors
Subtheme 1: Lifestyle of patient	Subtheme 2: Illness-related factors
“Lifestyles can also contribute to poor sleep hygiene and patients may have a reluctance to engaging in work to improve daily structure”	“Patient too unwell to follow treatment and advice, too anxious to follow any plan”	“Time pressure”	“Chaotic and noisy wards”
“Sleep problems more likely where there is alcohol or substance misuse or dependence”	“Medication side effects – particularly sedation leading to poor sleep patterns”	“Lack of knowledge in staff”	“Inpatients have trouble sleeping because hospital wards are not conducive to good sleep”
“Motivation and willingness to do the work necessary”	“Patients may be reluctant to engage, suspicious, or fearful of the process”	“Lack of knowledge and resources to treat sleep problems”	“In prisons, there is a reluctance to prescribe sedative medication because of its ‘street value’ amongst prisoners – makes treating sleep problems in the prison (a very big problem) difficult”
	“In an acute state I think you have to take a medication route before even thinking about CBT for insomnia”	“Clinicians may not assess complaints of sleep problems in sufficient detail”	“Lack of therapeutic interventions on ward”
		“It appears to me to be a significant issue that often seems neglected or viewed as a symptom of mental distress”