Professor Robert Meadows

Background: Poor sleep is a common problem in adolescents age 14-18. Difficulties with sleep have been found to have a bidirectional link to mental health problems. Objective: This new research sought to involve young people in the co-creation of a new app, particularly those from under-served communities. The Sleep Solved app uses science-based advice to improve sleep-related behaviours and wellbeing. The app was developed using the Person-Based Approach, underpinned by Bandura’s social cognitive theory [1], and the social-ecological model of sleep health [2]. Methods: Young people (14-18 years) were recruited from across the UK to contribute to PPI activities. In partnership with our Peer Researcher (MJ), we used a multitude of methods to engage with PPI contributors, including online workshops, surveys, think-aloud interviews, focus groups and app beta testing. Results: A total of 85 young people provided PPI feedback; 54 young women, 27 young men, 2 genderfluid people, 1 nonbinary person, 1 ‘prefer not to say’. Levels of deprivation ranged from the 40% most deprived, to the 20% least deprived. The majority had self-identified sleep problems ranging from 2-3 times per week, to more than 4 times per week. Attitudes towards the app were positive, with praise for its usability and use of science-based yet accessible information. Think-aloud interviews and a focus group identified a range of elements that may influence the use of the app, including the need to pay attention to language choices and readability. User experiences in the form of narrated audio clips were used to normalize sleep problems and provide examples of how the app had helped them.Conclusions: Young people were interested to use an app to better support their sleep and mental health. The app was co-created with strong links to theory and evidence-based sleep hygiene behaviours. Future work to establish the effectiveness of the intervention, perhaps in a RCT, would enable support for potential UK-wide rollout.

Background: Artificial intelligence (AI) is said to be “transforming mental health”. AI-based technologies and technique are now considered to have uses in almost every domain of mental health care: including decision-making, assessment and healthcare management. What remains underexplored is whether/how mental health recovery is situated within these discussions and practices. Method: Taking conversational agents as our point of departure, we explore the ways official online materials explain and make sense of chatbots, their imagined functionality and value for (potential) users. We focus on three chatbots for mental health: Woebot, Wysa and Tess. Findings: “Recovery” is largely missing as an overt focus across materials. However, analysis does reveal themes that speak to the struggles over practice, expertise and evidence that the concept of recovery articulates. We discuss these under the headings “troubled clinical responsibility”, “extended virtue of (technological) self-care” and “altered ontologies and psychopathologies of time”. Conclusions: Ultimately, we argue that alongside more traditional forms of recovery, chatbots may be shaped by, and shaping, an increasingly individualised form of a “personal recovery imperative”.

Sleep, which is vital for health and wellbeing, is influenced by a complex array of (neuro)biological and social factors. Previous research has suggested that these factors vary across the life course, as well as being affected by transitions, such as parenthood, care-giving and widowhood. This research has also suggested that many of these transitions have a greater affect on women’s sleep. Yet much of this research has focused on women and one-sided reports of partner behaviours. This paper draws on data from Wave 1 of the Understanding Society Survey to examine gender differences in sleep maintenance within younger and older heterosexual couples. Data were collected in 2009 from a representative sample of households in Britain with a response rate of 59%. Sleep maintenance, namely waking on 3 or more nights per week, was included in a self-completion module. A series of logistic regression models are run using sleep maintenance as a dependent variable; i) a two level model for couples where the male is aged 50 or less (n=2452 couples); ii) a two level model for older couples where the male is aged above 50 (n=1972 couples); iii) bivariate models which allow for odds to be calculated separately for male and female partners. Results from the couple level models illustrate how both younger and older women have increased odds of difficulties with sleep maintenance (as compared to their male partners). Poor sleep maintenance is also associated with poor health, own unemployment, dissatisfaction with income, having had a previous cohabiting relationship and having younger children for both men and women. Reports by the husband of frequency of coughing/snoring at night is significantly associated with their wives’ sleep maintenance among younger couples and vice versa; but among older couples there is only a significant association of husband’s snoring on wife’s sleep. Whilst the current analysis is cross-sectional, further understanding of the dynamic relationships of sleep will be revealed through longitudinal analysis as Understanding Society moves through future waves.

Recent literature has highlighted the sociological significance of sleep and has suggested that sleep offers a ‘window’ onto the gendered nature of our lives. Yet within this body of work men's sleep has been largely ignored. This paper seeks to rectify this omission and situates itself at the intersection between literature on the sociological aspects of sleep and social-constructionist-orientated writings on men's health. It draws upon qualitative data from 40 men to investigate male understandings of, and attitudes towards, sleep. At first glance, it could be suggested that men have little regard for sleep, and are prone to taking risks with their dormancy. Viewed in this way sleep becomes an instrument used in the negotiation of status and power and intrinsically bound up with the demonstration of masculinities. Yet, men's relationship with sleep is more complex than this. Amongst other things, the men within the present study were embroiled in a function/non-function dichotomy. Sleep was seen as needed for the praxis of ‘father’, ‘worker’, ‘husband’ and ‘mate’ but was also considered as something which should not get in the way of performing these roles.

This article illustrates the ways that sociological research can inform an understanding of sleep. We emphasise the value of qualitative studies of sleep, by reviewing recent research on the ways that gender and co-sleeping influence sleep, and the influence of caregiving at night on sleep. We then consider large-scale quantitative studies of sleep, drawing on data from the UK Understanding Society 2009 survey (n=14,746). We show how providing care to an elderly or disabled relative in the home is linked to reported sleep problems which is only marginally attenuated following adjustment for disadvantaged socio-economic characteristics and poor health.

Within western societies it is commonplace for couples to share a bed. Yet there has been remarkably little research carried out on couples’ sleep. This paper draws upon actigraphy, audio diary and questionnaire data from both partners in 36 heterosexual couples (age 20-59) and aims to quantify the extent to which it is important to take the dyadic nature of sleep-wake cycles into account. It achieves this through two interrelated aims: (i) to use Hierarchical Linear Models to measure dyadic interdependence in actigraphically recorded variables; and (ii) to investigate how much of this dyadic interdependence truly results from couple dynamics. The variables with the most significant couple interdependency were ‘Actual bed time’, ‘Sleep latency’, ‘Light/Dark ratio’ and ‘Wake bouts’. The paper concludes by suggesting that interdependence may be the defining feature of couples’ sleep and that we need to employ analytic approaches which both acknowledge this and which are sensitive to the possibilities that not all aspects of sleep will behave in the same way.

This paper takes a critical look at the role of chronobiology in society today, with particular reference to its entanglements with health and medicine and whether or not this amounts to the (bio)medicalisation of our bodily rhythms. What we have here, we show, is a complex unfolding storyline, within and beyond medicine. On the one hand, the promises and problems of these circadian, infradian and ultradian rhythms for our health and well-being are now increasingly emphasised. On the other hand, a variety of new rhythmic interventions and forms of governance are now emerging within and beyond medicine, from chronotherapies and chronopharmacology to biocompatible school and work schedules, and from chronodiets to the optimisation of all we do according to our ‘chronotypes’. Conceptualising these developments, we suggest challenges us to think within and beyond medicalisation to wider processes of biomedicalisation and the biopolitics of our body clocks: a vital new strand of chronopolitics today indeed which implicates us all in sickness and in health as the very embodiment of these rhythms of life itself. The paper concludes with a call for further research on these complex unfolding relations between chronobiology, health and society in these desynchronised times of ours.

Everyday social order is said to be based on appropriate bodily conduct. The emphasis on day raises at least two questions for the sociological study of sleep: the first concerns the existence of a ‘sleep habitus’ and whether sleeping bodies can ever be ‘unruly’. The second involves the possibilities for breaching or mediating any such ‘sleep habitus’. What we suggest here is that any ‘sleep habitus’ does appear to be limited. If a sleeper is considered to be ‘unconscious’, in a private space, and in an intimate relationship with his or her audience, bodies appear free to do anything without invoking the need for embarrassment. However, at the same time, couples do suggest that sleeping bodies can feel embarrassed, and thus can experience failed ‘impression management’. Gender and length of relationship appear important factors here. For example, as a relationship becomes ‘routinized’ couples learn to ‘fit together’, and to ‘mutually adapt’. Although, this fitting together negates the requirement for ‘private’ embarrassment, it may actually increase the likelihood that the private is ‘leaked’ into the public domain and thus, augment the possibilities for ‘reputational’ embarrassment.

This book draws on a variety of substantive examples from science, technology, medicine, literature, and popular culture to highlight how a new technoscientifically mediated and modified phase and form of technosleep is now in the making – in the global north at least; and to discuss the consequences for our relationships to sleep, the values we accord sleep and the very nature and normativities of sleep itself.The authors discuss how technosleep, at its simplest denotes the ‘coming together’ or ‘entanglements’ of sleep and technology and sensitizes us to various shifts in sleep–technology relations through culture, time and place. In doing so, it pays close attention to the salience and significance of these trends and transformations to date in everyday/night light, their implications for sleep inequalities and the related issues of sleep and social justice they suggest. 

A wide array of consumer devices that purport to measure sleep are now available, with sleep measurement often an additional feature alongside the measurement of daily activity through steps and monitoring of heart rate. These devices offer their users insight into the duration of sleep and different sleep phases and the ability to share the outcomes in the form of numbers, charts, and graphs. This paper explores the ways in which these technologies are deployed within everyday online interactions. We explore depictions of sleep self-tracking that are commonly available online and analyse how the sleep data collected are interpreted by users and deployed in differing social interactions through a comparison of traces of the Fitbit sleep self-tracker across Twitter, Instagram, and the parenting discussion forum Mumsnet. We find that sleep self-tracking is, across platforms, occasioning new practices of evidencing sleep that acquire particular meaning within existing relationships. There is also however a strong mood of rejection, mistrust, and doubt around self-tracked sleep. The new ways of evidencing sleep sit alongside and in dialogue with previous ways of knowing sleep and of deploying it within social interactions, rather than displacing them.

Introduction: Proton Beam Therapy (PBT) is often described as an advanced mode of radiotherapy. Whilst PBT offers an equivalent chance of cure to conventional radiotherapy, it is said to offer a theoretical reduction in long term side effects. NHS patients have had access to PBT since 2008 and approximately 65% of the 1144 approved referrals have been for paediatric cases. Yet, there is little research on how parents in these paediatric cases perceive their child’s PBT and the information sources they encounter. Methods: This is a qualitative inquiry informed by in-depth interviews carried out with 27 parents of children treated with PBT. Results: Parents primarily frame PBT as a form of radiation but one which is better than alternatives. Whilst medical professionals do play a role, wider sources of information – such as other families and the internet – are important to both initial decision-making and treatment/recovery experiences. Conclusion: Parents are faced with the challenge of a ‘fragmented expertise’ which comes with the ‘novelty’ of the radiation therapy, the ‘rare’ nature of the tumours and the remote location of clinical specialists. Implications for Practice: This article will prove useful for practitioners dealing with parents and care givers of children undergoing proton therapy, and is especially valuable and timely for practitioners based in the newly installed proton centres in the UK. Two high energy proton centres are expected to become fully operational in the UK by the end of 2020. Understanding parents’ experiences and perspectives can help avoid undue anxiety and lead to service improvements and overall satisfaction.

Sleep, until recently, has been a neglected topic or issue within sociology and the social sciences and humanities in general. At first glance this may seem unsurprising given the predominant waking assumptions, concerns or preoccupations of these disciplines. Further reflection, however, reveals the shortcomings of any such neglect or dismissal of sleep as a topic worthy of sociological attention. Sleep is a socially, culturally and historically variable phenomenon. How we sleep, when we sleep, where we sleep, what meaning and value we accord sleep, let alone with whom we sleep, are all important topics of sociological investigation which do not simply vary around the world, both past and present, but within different segments of society and within and between cultures. The nature, quantity and quality of sleep, moreover, is clearly important both for the individual and society in terms of health and safety, productivity and performance, quality of life and well-being. In part a response to this past neglect, and in part a response to broader social trends and transformations regarding sleep, sociologists and others in the social sciences and humanities are now turning their attention to what might broadly be termed the ‘sleep and society’ agenda (Williams 2005; Williams 2008). Sleep, in this respect, is not simply a rich and fascinating sociological topic in its own right, but a valuable new window or way of approaching a range of existing sociological research agendas on issues as diverse as work, health, gender, ageing and family life. This work in turn opens up significant new opportunities to explore the dynamic interrelations between social and biological factors regarding sleep and sleep disruption across the life course. In these and many other ways then, a sociological approach to sleep is not simply long overdue, but a timely and valuable complement to work in related fields of inquiry such as sleep epidemiology and public health which, in similar fashion, take us far beyond the sleep laboratory or sleep clinic to broader issues concerning sleep, health and society. It is therefore to a further consideration and elaboration of this newly emerging sleep and society agenda within sociology that we now turn in this chapter. We outline several strands of recent sociological work - starting with some preliminary points regarding the very conceptualisation and measurement of ‘sleep’ as a methodological backdrop to the sociological themes and issues that follow.

In this paper we seek to understand the influence of gender on the different approaches to managing poor sleep by older men and women through the conceptual framework of existing theoretical debates on medicalization, healthicization and 'personalization'. In-depth interviews undertaken between January and July 2008 with 62 people aged 65-95 who were experiencing poor sleep, revealed that the majority of older men and women resisted the medicalization of poor sleep, as they perceived sleep problems in later life were an inevitable consequence of ageing. However, older men and women engaged differently with the healthicization of poor sleep, with women far more likely than men to explore a range of alternative sleep remedies, such as herbal supplements, and were also much more likely than men to engage in behavioural practices to promote good sleep, and to avoid practices which prevented sleep. Women situated 'sleep' alongside more abstract discussions of 'diet' and health behaviours and drew on the discourses of the media, friends, family and their own experiences to create 'personalized' strategies, drawn from a paradigm of healthicization. Men, however, solely relied on the 'body' to indicate when sleep was needed and gauged their sleep needs largely by how they felt, and were able to function the following day. © 2012 Elsevier Ltd.

There is evidence that poor sleep mitigates recovery from substance dependence and increases risk of relapse. However, to date research literature is located within biomedical, clinical and psychological paradigms. To complement the extant work, this article offers a sociological exploration of sleep in the context of recovery from dependence on alcohol and/or other drugs. Drawing on qualitative data generated through interviews with 28 men and women living in residential rehabilitation settings in England, we provide a detailed exploration of sleep practices focussing on how these are enacted throughout the night. We offer the concept of sleepfulness to suggest that sleep should not be understood simply as being other than awake; rather it involves a myriad of associations between diverse actants - human and non human – that come to ‘fill up’, enable and assemble sleep. Together these empirical insights and conceptualisations disturb the ontology of sleep and point to the fulsome dimensions of the category.

In this chapter we explore the multiple entanglements between sleep, health and medicine in contemporary society, with particular reference to sociological engagements with these relations so far and the future sociological research agendas this suggests. Five key intersecting strands of existing research are identified here concerning: (i) the social patterning of sleep; (ii) the medicalization of sleep; (iii) living with sleep problems; (iv) sleep, health and the body; (v) customizing sleep. Five key future research agendas are also suggested here regarding: (i) what is ‘good’ and ‘bad’ sleep for whom, when and where; (ii) sleep, mental health and illness; (iii) the intersectionalities of sleep; (iv) sleep and public health; (v) AI and the future of sleep. Sleep we conclude is a vital matter for the sociology of health and illness with much work still to do and exciting research agendas ahead.

Purpose The purpose of this study is to deepen our understanding of the well-being of transient organizations/groups and to use this to develop a novel conceptual framework of gig worker well-being during times of crisis. Design/methodology/approach A qualitative approach was adopted combining in-depth semi-structured interviews and daily diaries. Twenty-two workers working in the sharing economy were recruited. Thematic analysis was conducted for the diary and interview data. Findings The findings illustrate a complex picture of sharing economy workers’ four dimensions of well-being, including physical, subjective, psychological and social well-being. A number of the COVID-19 pandemic contexts, such as more time, restriction, economic recession and uncertainty, were seen to influence these workers’ well-being in different ways including both positive and negative impacts. The precarious nature of gig work within the sharing economy was also found influential, which includes flexibility, uncertainty, temporality and diversity. Furthermore, the specific contexts of the hospitality, tourism and event industry (such as labor-intensive, low esteem, self-value and purpose in life) had also impacted gig workers physical and psychological well-being in various ways. Research limitations/implications This study complements the gig workers’ view of the sharing economy by investigating their well-being during the COVID-19 pandemic. In addition, this study reveals the complex and various influences hospitality, tourism and events industry contexts made, amplified by the pandemic. Methodologically, the daily diary approach applied in this research has captured gig workers’ instant feelings and thoughts, which enriches the current understanding of gig workers’ well-being. Practical implications From the findings and the newly developed conceptual framework, practical implications are proposed focusing on how the tourism, hospitality and event industries should look after their gig workers’ well-being in the COVID-ized environment. From the physical well-being perspective, businesses should consider partnering with gym operators to provide corporate packages or discounted membership to their gig workers. From psychological well-being perspective, a recognition system integrating gig workers would be useful to strengthen gig workers’ perception of value in their jobs. In addition, technology can be used to introduce more resources to their gig workers, particularly when distancing. Originality/value A conceptual framework is developed, which captures the influence of both “internal” and “external” determinants of gig worker well-being during times of crisis. This research contributes to theory by developing a framework of well-being in the context of the sharing economy, as well as explicitly addressing how the uncertainty and precariousness of sharing economy work and the hospitality, tourism and event industry contexts relate to well-being. This model is likely to have applicability beyond COVID-19 as the pandemic made clear many existing challenges – rather than just simply creating new ones.

The United Kingdom Government are planning to issue guidance on sleep duration. Whilst sleep is clearly important for health, offering such guidance is not the answer. Within this commentary we put forward three arguments to support this claim: (i) sleep is liminal and beyond the limits of voluntary agency; (ii) sleep is linked to structural inequality; and (iii) sleep is multiple. The first two points are now well established. However, the third encourages a considerable break from established thinking. Recent research has highlighted that we need to move away from viewing sleep as a singular, objectively defined phenomenon, and instead position it as many different practices woven together. Sleep is situated, contingent and is enacted in multiple ways. Public health would be better served by a ground-up approach which explores good and poor sleep across these three axes: liminality, social position and ontology.

Whilst chatbots for mental health are becoming increasingly prevalent, research on user experiences and expectations is relatively scarce and also equivocal on their acceptability and utility. This paper asks how people formulate their understandings of what might be appropriate in this space. We draw on data from a group of non-users who have experienced a need for support, and so can imagine self as therapeutic target – enabling us to tap into their imaginative speculations of the self in relation to the chatbot other and the forms of agency they see as being at play; unconstrained by a specific actual chatbot.   Analysis points towards ambiguity over some key issues: whether the apps were seen as having a role in specific episodes of mental health or in relation to an ongoing project of supporting wellbeing; whether the chatbot could be viewed as having a therapeutic agency or was a mere tool; and how far these issues related to matters of the user’s personal qualities or the specific nature of the mental health condition. Chatbots were situated as both a specific and generic technology; leading to a range of  traditions, norms and practices being used to construct expectations and understandings.

The relationship between health and income is well established, but the link between subjective financial wellbeing and self-assessed health has been relatively ignored. This study investigates the relationship between health, subjective financial wellbeing and income in mid-life and later life in Britain. Analysis of the General Household Survey for 2006 examined these relationships at ages 45-64 (n=4639) and 65 and over (n=3104). Logistic regression analysis was used to adjust for income and other socioeconomic factors linked to self-assessed health. Both income and subjective financial wellbeing are independently associated with health in mid-life; those with lower incomes and greater subjective financial difficulties had higher risk of reporting ‘less than good’ health. In contrast in later life, subjective financial wellbeing was associated with health, but the effect of income on health was mediated entirely through subjective financial wellbeing. The poorer health of the divorced/separated was also mediated entirely by differences in subjective financial wellbeing. Research on health inequalities should pay greater attention to the link between subjective financial hardship and ill-health, especially during periods of greater economic difficulties and financial austerity.

Background: Alcohol and other drug use is associated with poor sleep quality and quantity, but there is limited qualitative research exploring substance users’ experiences of sleep and few psychosocial sleep interventions for them. Aim: To inform the development of psychosocial interventions to improve sleep amongst people reporting drug/alcohol problems. Method: Qualitative data were collected during a sleep survey. Of the 549 drug/alcohol users completing the survey, 188 (34%) provided additional information about their sleep using a free text box. Responses were analysed via Iterative Categorization. Findings were reviewed with reference to the Behaviour Change Wheel (BCW). Results: All data were categorized inductively under five headings: i. sleep quality; ii. nature of sleep problems; iii. sleep and substances; iv. factors improving sleep quality; v. factors undermining sleep quality. Substance use undermined sleep, but poor sleep often persisted after substance use had ceased. Sleep problems were diverse; as were the causes of, and strategies for dealing with, those problems. Causes and strategies had biological, psychological, social, and environmental roots. Conclusions: The BCW facilitated the identification of intervention components that might improve the sleep of people who use substances. These components relate to education, training, enablement, modelling, service provision, guidelines and environment.

Study Objectives: To develop a patient reported outcome measure to assess sleep amongst people experiencing problems with alcohol or other drugs. Methods: Item development included secondary analyses of qualitative interviews with drug/alcohol users in residential treatment, a review of validated sleep measures, focus groups with drug/alcohol users in residential treatment, and feedback from drug/alcohol users recruited from community and residential settings. An initial version of the measure was completed by 549 current and former drug/alcohol users (442 in person [IP] and 107 online [OL]). Analyses comprised classical test theory methods, exploratory and confirmatory factor analysis, measurement invariance assessment, and item response theory (IRT). Results: The initial measure (30 items) had good content and face validity, and was named the Substance Use Sleep Scale (SUSS) by addiction service users. After 7 items were removed due to low item-factor loadings, 2 factors were retained and labelled: ‘Mind and Body Sleep Problems’ (14 items) and ‘Substance Related Sleep Problems’ (9 items). Measurement invariance was confirmed with respect to gender, age, and administration format. IRT (information) and classical test theory (internal consistency, stability) indicated measure reliability. Standard parametric and non-parametric techniques supported convergent and discriminant validity. Conclusions: SUSS is an easy-to-complete patient reported outcome measure of sleep for people with drug/alcohol problems. It can be used by those concerned about their own sleep, and by treatment providers and researchers seeking to better understand, assess, and potentially treat sleep difficulties amongst this population. Further validity testing with larger and more diverse samples is now required.

This paper reports on a study of sleep amongst men and women who are living in residential rehabilitation centres in the UK and who are receiving support for their recovery from addiction to alcohol and other forms of substance use. Conceptually and methodologically, the paper draws on the work of the French sociologist Lefebvre and, in particular, his rhythmanalysis. We argue that this approach offers a useful way of exploring sleep in terms of biological, experiential, temporal, spatial and social rhythms. It also has the potential to facilitate interdisciplinary dialogue. Empirical data comprising qualitative interviews with 28 individuals, sleep diaries, and actigraphy reports (which measure movement as a proxy for sleep) are examined in combination to generate insights into the challenges associated with sleep in recovery from substance misuse. We examine how sleep in recovery involves an alignment of the spatiotemporal rhythms of rehabilitation and the multiple embodied rhythms of individuals. Institutionalised routines reproduce and impose ideas of day/night sleep cycles which are presumed to accord with ‘natural’ circadian rhythms. Although study participants very much want to achieve these ‘natural hegemonies’ of sleep, alignment of individual and institutional rhythms is difficult to achieve. We develop the notion of ‘sleep waves’ as an analytic to capture the multifaceted elements of sleep and to argue that sleep waves recur but are also shaped by complex networks of rhythms, rituals and routines. Sleep waves can become relatively stabilised in rehabilitation settings, but the anticipation of moving on disturbs rhythms and generates anxieties which can affect recovery.

This paper analyzes data from a nationally representative survey of adults in the United Kingdom (Understanding Society, N = 37,253) to explore the marital status/health nexus (using categories that include a measure of relationship distress) and to assess the role that sleep problems play as a potential mediator. Findings indicate how it is not just the "form" marital status takes but also the absence or presence of relationship distress that is essential to self-rated health. We demonstrate two further findings that: (1) sleep problems act as a mediator of the link between marital status/relationship distress and self-rated health, most notably for those in cohabiting relationships with medium/high distress or who have a history of relationship loss, and (2) the mediating role of sleep problems differs for divorced men and women.

Objectives: Significant research has shown that health is a heterogeneous concept, and one person’s poor health may not be comparable with another’s. Yet, little consideration has been given to whether sleep quality judgements are also heterogenous or whether they cohere between individuals. Another possibility is that there are group differences in the ways in which sleep quality is perceived. If this is the case, it is possible known inequalities in sleep are – in part – an artefact of social position influencing how we conceive of sleep problems. The current study explores this possibility. Design: Cross-sectional, using World Health Organisation data from 207,608 individuals; aged between 15 to 101 years of age from 68 countries. Alongside a battery of sleep and demographic variables, data contained sleep and energy vignettes. Random effect anchoring vignette models were applied to investigate interpersonal incompatibility and whether sleep quality perceptions operate differently depending on social location, context and function. Results: Whilst sleep quality judgements are largely comparable across individuals, findings also highlight how the relationship between education and self-reported sleep changes following adjustment for reporting heterogeneity. Estimates of threshold parameters suggest that those with more years of education have a slightly increased threshold for reporting mild sleep problems (B 0.005; s.e. 0.001) but a lower threshold for reporting sleep problems as extreme (B -0.007; s.e. 0.001). Conclusions: Sleep quality judgements occupy a complex position between heterogeneity and coherence. This has implications for both epidemiological methodologies and contemporary debates about social justice, public health and sleep.

Considerable attention has been paid to inequalities in health. More recently, focus has also turned to inequalities in ‘recovery’; with research, for example, suggesting that lower grade of employment is strongly associated with slower recovery from both poor physical and poor mental health. However, this research has tended to operationalise recovery as ‘return to baseline’, and we know less about patterns and predictors when recovery is situated as a ‘process’. This paper seeks to address this gap. Drawing on data from the UK Household Survey panel, we operationalise recovery as both an ‘outcome’ and as a ‘process’ and compare patterns and predictors across the two models. Our analysis demonstrates that the determinants of recovery from poor health, measured by the SF-12, are robust, regardless of whether recovery is operationalised as an outcome or as a process. For example, being employed and having a higher degree were found to increase the odds of recovery both from poor physical and mental health functioning, when recovery was operationalised as an outcome. These variables were also important in distinguishing health functioning trajectories following a poor health episode. At one and the same time, our analysis does suggest that understandings of inequalities in recovery will depend in part on how we define it. When recovery is operationalised as a simple transition from poor health state to good, it loses sight of the fact that there may be inequalities (i) within a ‘poor health’ state, (ii) in how individuals are able to step into the path of recovery, and (iii) in whether health states are maintained over time. We therefore need to remain alert to the additional nuance in understanding which comes from situating recovery as a process; as well as possible methodological artefacts in population research which come from how recovery is operationalised. •There is no consensus on what recovery is and how it should be operationalised.•Understanding of inequalities in recovery across health conditions remains scarce.•We operationalised recovery both as an outcome and as a process.•We found robust inequalities in recovery across the two approaches.•Considering recovery as a process revealed more nuanced patterns in inequalities.

Over the past decade, sociological studies have convincingly demonstrated that sleep is a socially, culturally and historically variable phenomenon. How we sleep, when we sleep, where we sleep, what meaning and value we accord sleep, let alone with whom we sleep, vary around the world, both past and present, within and between cultures and within different segments of society. This chapter outlines two interrelated strands of recent sociological work; how (i) sleep is a ‘practice’, which is ‘done’ and ‘negotiated’ with others; and (ii) the problems and prospects surrounding the medicalisation of sleep. The concluding section summarises the importance of sociological studies of sleep for public health.

Background: Sleep problems are common amongst people who use alcohol and other drugs, but treatment options are limited. This paper explores how people in residential treatment for alcohol and other drug problems perceived and described ‘non-problematic’ sleep to provide insights that might inform sleep interventions for this population. Methods: Qualitative interviews were conducted with 28 residents (19 women, 9 men; ages 24-83 years) in two residential drug and alcohol treatment centres in England during 2014/15. Interviews were audio-recorded, transcribed, and coded. Accounts of non-problematic sleep were then analysed inductively. Results: Non-problematic sleep comprised three linked components: i. personal sleep patterns and routines; ii. sleep perceptions; and iii. sleep metacognitions. Some participants reported they slept well; others described their sleep as problematic but improving. Participants believed that sleep improved naturally with residential treatment and abstinence, but perceptions of ‘good’ sleep varied greatly. Participants used a range of metacognitive strategies (e.g. downgrading the importance of sleep; adapting their sleeping patterns; and focusing on sleep quality alongside sleep quantity) to manage sleep problems and render them non-problematic. Conclusions: Metacognitive strategies that focus on changing perceptions of sleep can potentially inform sleep interventions for people with a history of alcohol and other drug use.

Traditionally, sleep science is grounded in biology, physiology, and medicine.But socio-cultural considerations provide a crucial lens into sleep health.Exploring the sociology of sleep in Aotearoa New Zealand (AoNZ) couldbroaden our understandings and better represent sleep-related practices amongour diverse communities. This scoping review represents the pre-existingliterature concerning sleep as a social or cultural practice in AoNZ. The initialsearch (via Discover and Scopus) search yielded 2,442 results. Of these results,113 manuscripts were characterised of interest, but only 20 were directly relatedand included in the review. This literature was presented in relation to Meadows’(2005) modes of ‘sleep embodiment’ including sleep practice norms, thepragmatics of sleep and social roles, individual experiences and feelings relatedto sleep, and the visceral need for sleep. The findings highlight the progress ofsleep literature in AoNZ. This covers diverse sleep practices, perspectives andexperiences of sleep and sleeping, as well as the broader socio-cultural factorsand unique AoNZ context that influence sleep. However, gaps in the field oflocal sleep research are also identified. Findings lay the foundation for furtherresearch in AoNZ to explore sleep-related discourses and practices that willultimately broaden existing perspectives.

Cognitive behavioral therapy for insomnia (CBT-I) is now widely recognized as the first-line management strategy for insomnia, both for insomnia in its "pure" form, and when comorbid with a physical or psychological illness. However, there is a definite need to develop and test both alternative and adjunct interventions to CBT-I, before implementing them into routine practice. The aim of this article is to provide a narrative review of the literature with regard to what is known about the influence of partners on sleep, insomnia, and its management.