Insomnia in places of detention: a review of the most recent research findings

Abstract

Up to 40% of prisoner patients in a general medicine outpatient service seek medical consultation for sleep problems. This paper provides a brief overview of what is known about insomnia and its treatment from studies on non-detained patients and discusses the relevance of the findings from studies in liberty for prison health care. The clinical and ethical issues of insomnia in prison are described, followed by a summary of the existing studies on insomnia in prison. The results of the reported studies show that insomnia in places of detention should not be reduced to a secondary problem related to substance abuse and mental illness, as it appears to be an independent situational problem. Correctional health care physicians' evaluation of insomnia is insufficient. Drug prescription works well in some patients, but has a limited effect on insomnia relief in others. A clear need exists for the education of prison health care professionals on insomnia evaluation and management. Additional non-pharmacological treatment in the prison health care setting should be used more frequently. Prison health care services should develop clear guidelines based on research evidence about insomnia and which contain treatment recommendations based on the principle of equivalence of health care outside and inside places of detention.

Prevalence, associated factors and management of insomnia in prison populations: An integrative review

“…The only previous review in this area looked at the evidence of "secondary insomnia" in a prison setting with particular reference to situational factors and then assessed the impact of insomnia upon professional management and outcomes. However, Elger's publication [33] lacked clear evidence of the search strategy, search outcome and any study quality evaluation required to give the reader confidence that the review findings were reliable. In contrast, our integrative review provides a full breakdown of the search criteria with both inclusion and exclusion criteria, databases used and the processing of publications at all stages of the selection process.…”

“…In contrast, our integrative review provides a full breakdown of the search criteria with both inclusion and exclusion criteria, databases used and the processing of publications at all stages of the selection process. Moreover, whilst Elger [33] made reference to some limitations in the evidence, it was not clear what methodological standards were used to assess quality and whether they were used consistently throughout the paper. The current paper showed transparency in its evaluation of each study reviewed and an appropriate critical appraisal checklist was used to assess quality [36].…”

“…In a scoping review published in 2007, Elger [33] asked three research questions: 1) are sleep complaints in prisoners caused by substance misuse, post traumatic stress disorder and mental disorder including insomnia; 2) is insomnia situational; and; 3) what is the importance of reactive anxiety and depression due to being imprisoned compared to prison environmental factors (e.g., light, noise etc.). The review included nine research studies in its analysis, however inclusion and exclusion criteria were not identified and there was no objective evaluation of study quality.…”

Imprisoned Women's Concepts of Health and Illness: The Implications for Policy on Patient and Public Involvement in Healthcare

“…However, the women also raised the problem of sleeplessness in prison. The published literature on sleep disorders and prisoners is limited, but the existing research indicates that it is an important issue (33)(34)(35)(36). Sleeplessness in prison is common for a variety of reasons.…”

Sleep Quality and Risk for Sleep Apnea in Incarcerated Women

“…Poor sleep quality may also result in reduced cognitive functioning, thus limiting women's ability to effectively participate in educational and other prison-based programming beneficial to successful re-entry post release. While data suggest that sleep may be impaired for incarcerated individuals (Elger 2003, 2004, 2007, 2009; Elger & Sekera, 2009), few studies have focused on women's sleep during imprisonment. The aims of this cross-sectional descriptive exploratory investigation were to (a) describe incarcerated women's sleep quality; (b) document the risk for sleep apnea in incarcerated women; and (c) identify specific factors that contribute to poor sleep quality during incarceration.…”