Research Article| Volume 7, ISSUE 1, P105-112, February 2021

Sleep health is associated with next-day mindful attention in healthcare workers

Published:October 01, 2020DOI:



      Previous studies have focused on the role of mindfulness in improving sleep health. Sleep health may also increase daily mindfulness; however, this potential directionality is understudied, with a lack of research on healthcare workers who need high-quality sleep and mindful attention for patient care. This study examined whether sleep health predicts next-day mindful attention, and vice versa, in nurses.


      Smartphone-based ecological momentary assessment.


      U.S. hospitals.


      Sixty-one full-time nurses.


      For 2 consecutive weeks, participants provided actigraphy-measured and self-reported daily sleep characteristics. We examined 8 sleep variables across 5 key dimensions: satisfaction (self-report of sleep sufficiency, quality, and insomnia symptoms), alertness (self-report of daytime sleepiness), timing (actigraphy bed- and wake- times), efficiency (actigraphy percentage of time spent asleep during time in bed), and duration (actigraphy sleep duration). Participants reported state mindfulness specific to attention and awareness. Covariates included previous night's sleep, sociodemographics, work shift, workday (vs. nonworkday), and weekend (vs. weekday).


      Multilevel modeling revealed that, at the within-person level, after nights with greater sleep sufficiency, better sleep quality, lower efficiency, and longer sleep duration, daily mindful attention was greater than usual. Daily mindful attention was inversely associated with sleepiness, but not predictive of other sleep characteristics. At the between-person level, participants with greater sleep sufficiency, higher sleep quality, and fewer insomnia symptoms reported greater mindful attention overall.


      Findings show that optimal sleep health is an antecedent of daily mindful attention in nurses. Improving sleep may provide important benefits to their well-being and to the quality of patient care.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Sleep Health: Journal of the National Sleep Foundation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shallcross A.J.
        • Visvanathan P.D.
        • Sperber S.H.
        • Duberstein Z.T
        Waking up to the problem of sleep: can mindfulness help? A review of theory and evidence for the effects of mindfulness for sleep.
        Curr Opin Psychol. 2019; 28: 37-41
        • Allen T.D.
        • Kiburz K.M
        Trait mindfulness and work-family balance among working parents: The mediating effects of vitality and sleep quality.
        J Vocat Behav. 2012; 80: 372-379
        • Howell A.J.
        • Digdon N.L.
        • Buro K
        Mindfulness predicts sleep-related self-regulation and well-being.
        Pers Individ Dif. 2010; 48: 419-424
        • Hülsheger U.R.
        • Lang J.W.B.
        • Depenbrock F.
        • Fehrmann C.
        • Zijlstra F.R.H.
        • Alberts H.J.E.M
        The power of presence: the role of mindfulness at work for daily levels and change trajectories of psychological detachment and sleep quality.
        J Appl Psychol. 2014; 99: 1113-1128
        • Kanen J.
        • Nazir R.
        • Sedky K.
        • Pradhan B
        The effects of mindfulness-based interventions on sleep disturbance: A meta-analysis.
        Adolesc Psychiatry (Hilversum). 2015; 5: 105-115
        • Ong J.C.
        • Ulmer C.S.
        • Manber R
        Improving sleep with mindfulness and acceptance: A metacognitive model of insomnia.
        Behav Res Ther. 2012; 50: 651-660
        • Garland S.N.
        • Zhou E.S.
        • Gonzalez B.D.
        • Rodriguez N
        The quest for mindful sleep: A critical synthesis of the impact of mindfulness-based interventions for insomnia.
        Curr Sleep Med Reports. 2016; 2: 142-151
        • Campbell R.
        • Soenens B.
        • Weinstein N.
        • Vansteenkiste M
        Impact of partial sleep deprivation on psychological functioning: Effects on mindfulness and basic psychological need satisfaction.
        Mindfulness (N Y). 2018; 9: 1123-1133
        • Hülsheger U.R.
        • Walkowiak A.
        • Thommes M.S
        How can mindfulness be promoted? Workload and recovery experiences as antecedents of daily fluctuations in mindfulness.
        J Occup Organ Psychol. 2018; 91: 261-284
        • Brown K.W.
        • Ryan R.M.
        • Creswell J.D
        Mindfulness: theoretical foundations and evidence for its salutary effects.
        Psychol Inq. 2007; 18: 211-237
        • Shapiro S.L.
        • Carlson L.E.
        • Astin J.A.
        • Freedman B
        Mechanisms of mindfulness.
        J Clin Psychol. 2006; 62: 373-386
        • Brown K.W.
        • Ryan R.M.
        The benefits of being present: mindfulness and its role in psychological well-being.
        J Pers Soc Psychol. 2003; 84: 822-848
        • Lee S.
        • Buxton O.M.
        • Andel R.
        • Almeida D.M
        Bidirectional associations of sleep with cognitive interference in employees’ work days.
        Sleep Heal. 2019; 5: 298-308
        • Yang F.N.
        • Xu S.
        • Chai Y.
        • Basner M.
        • Dinges D.F.
        • Rao H
        Sleep deprivation enhances inter-stimulus interval effect on vigilant attention performance.
        Sleep. 2018; 41: 1-12
        • Buysse D.J
        Sleep health: can we define it? Does it matter?.
        Sleep. 2014; 37: 9-17
        • Lee S.
        • Crain T.L.
        • McHale S.M.
        • Berkman L.
        • Almeida D.M.
        • Buxton O.M
        Daily antecedents and consequences of nightly sleep.
        J Sleep Res. 2016; 26: 498-509
        • Carmody J.
        • Baer R.A.
        • Lykins E.L.B.
        • Olendzki N
        An empirical study of the mechanisms of mindfulness in a mindfulness‐based stress reduction program.
        J Clin Psychol. 2009; 65: 613-626
        • Creswell J.D.
        • Lindsay E.K
        How does mindfulness training affect health? A mindfulness stress buffering account.
        Curr Dir Psychol Sci. 2014; 23: 401-407
        • Sin N.L.
        • Almeida D.M.
        • Crain T.L.
        • Kossek E.E.
        • Berkman L.F.
        • Buxton O.M
        Bidirectional, temporal associations of sleep with positive events, affect, and stressors in daily life across a week.
        Ann Behav Med. 2017; 51: 402-415
        • Crain T.L.
        • Schonert-reichl K.A.
        • Roeser R.W
        Cultivating teacher mindfulness: Effects of a randomized controlled trial on work, home, and sleep outcomes.
        J Occup Health Psychol. 2017; 22: 138-152
        • Jones D.R.
        • Graham-Engeland J.E.
        • Smyth J.M.
        • Lehman B.J
        Clarifying the associations between mindfulness meditation and emotion: Daily high‐and low‐arousal emotions and emotional variability.
        Appl Psychol Heal Well-Being. 2018; 10: 504-523
        • Carter P.A.
        • Dyer K.A.
        • Mikan S.Q
        Sleep disturbance, chronic stress, and depression in hospice nurses: testing the feasibility of an intervention.
        Oncol Nurs Forum. 2013; 40: E368-E373
        • Christian F.
        • Muppavarapu K.
        • Aston C.
        • Bauer C.Y.
        • Doshi V
        Sleep health of nursing staff in an academic medical center: Results of a survey study.
        Sleep. 2019; 42 (A251-A251)
        • Eldevik M.F.
        • Flo E.
        • Moen B.E.
        • Pallesen S.
        • Bjorvatn B
        Insomnia, excessive sleepiness, excessive fatigue, anxiety, depression and shift work disorder in nurses having less than 11 H in-between shifts.
        PLoS ONE. 2013; 8
        • Sun Q.
        • Ji X.
        • Zhou W.
        • Liu J
        Sleep problems in shift nurses: A brief review and recommendations at both individual and institutional levels.
        J Nurs Manag. 2019; 27: 10-18
        • Escuriex B.F.
        • Labbé E.E.
        Health care providers’ mindfulness and treatment outcomes: A critical review of the research literature.
        Mindfulness. 2011; 2: 242-253
        • Scott S.B.
        • Graham-engeland J.E.
        • Engeland C.G.
        • et al.
        The effects of stress on cognitive aging, physiology and emotion (ESCAPE) project.
        BMC Psychiatry. 2015; 15: 1-14
        • Sliwinski M.J.
        • Mogle J.A.
        • Hyun J.
        • Munoz E.
        • Smyth J.M.
        • Lipton R.B
        Reliability and validity of ambulatory cognitive assessments.
        Assessment. 2018; 25: 14-30
        • Shiffman S.
        • Stone A.A.
        • Hufford M.R
        Ecological momentary assessment.
        Annu Rev Clin Psychol. 2008; 4: 1-32
        • Buxton O.M.
        • Lee S.
        • Marino M.
        • C. B.
        • Almeida D.M.
        • Berkman L.
        Sleep health and predicted cardiometabolic risk scores in employed adults from two industries.
        J Clin Sleep Med. 2018; 14: 371-383
        • Marino M.
        • Li Y.
        • Rueschman M.N.
        • et al.
        Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography.
        Sleep. 2013; 36: 1747-1755
        • Geiger-Brown J.
        • Rogers V.E.
        • Trinkoff A.M.
        • Kane R.L.
        • Bausell R.B.
        • Scharf S.M
        Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses.
        Chronobiol Int. 2012; 29: 211-219
        • Buysse D.J.
        • Reynolds C.F.
        • Monk T.H.
        • Berman S.R.
        • Kupfer D.J
        The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research.
        Psychiatry Res. 1989; 28: 193-213
        • Buxton O.M.
        • Lee S.
        • Beverly C.
        • et al.
        Work-family conflict and employee sleep: Evidence from IT workers in the Work, Family and Health Study.
        Sleep. 2016; 39: 1871-1882
        • Marino M.
        • Li Y.
        • Rueschman M.N.
        • et al.
        Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography.
        Sleep. 2013; 36: 1747-1755
        • Raudenbush S.W.
        • Bryk A.S.
        Hierarchical Linear Models: Applications and Data Analysis Methods. 1. Sage, Newbury Park, CA2002
        • Maas C.J.M.
        • Hox J.J.
        Sufficient Sample Sizes for Multilevel Modeling.
        Methodology. 2005; 3: 86-92
        • Schuurman N.K.
        • Ferrer E.
        • Hamaker E.L
        How to compare cross-lagged associations in a multilevel autoregressive model.
        Psychol Methods. 2016; 21: 206-221
        • Astill R.G.
        • Verhoeven D.
        • Vijzelaar R.L.
        • Van Someren E.J.W
        Chronic stress undermines the compensatory sleep efficiency increase in response to sleep restriction in adolescents.
        J Sleep Res. 2013; 22: 373-379
        • Carlson L.E.
        • Brown K.W.
        Validation of the mindful attention awareness scale in a cancer population.
        J Psychosom Res. 2005; 58: 29-33