Clinical Implications of Community Attitudes and Beliefs about Sleep: An Examination of Excessive Daytime Sleepiness and Fatigue

Abstract

Background: Excessive daytime sleepiness (EDS) and severe fatigue are two widely prevalent, yet undervalued and undertreated clinical conditions. The disparity in their treatment is surprising given their respective multidimensional physiological effects. This may be explained due to the known effects that public attitudes and beliefs can have on utilizing healthcare. Therefore, this study aims to analyze if one’s beliefs and attitudes about sleep and sleep treatment impact one’s own sleep health, or vice versa.Methods: N = 28 participants presenting with excessive daytime sleepiness (ESS ≥ 10) were recruited from the community. Participants were administered an Epworth Sleepiness Scale and Fatigue Severity Scale at baseline, as well as a survey about a wide range of beliefs and attitudes about both common strategies to ameliorate daytime sleepiness, as well as seeking medical care about sleepiness. Participants reported whether they Strongly Agree (SA), Agree (A), Disagree (D), or Strongly Disagree (SD) with each respective statement. Ordinal logistic regressions examined agreement associated with baseline sleepiness and fatigue, adjusted for age, sex, and race/ethnicity. Nominal significance was determined as p<0.05. Results: Individuals with higher levels of baseline daytime sleepiness were more likely to agree that taking medication (both prescription and/or over-the-counter), napping, and “power[ing] through” are good strategies to alleviate sleepiness symptoms during the day. However, only higher fatigue severity was associated with the endorsement of statements relating to seeking treatment, particularly that they already have spoken with a clinician about their symptoms. Conclusions: Some beliefs and attitudes about sleep were correlated with higher levels of daytime sleepiness and fatigue, especially those related to “powering through” daytime sleepiness and advocacy for medication. Similarly, there is a discrepancy in seeking treatment for sleep problems between those with high EDS levels versus those with high fatigue levels. Therefore, attitudes and beliefs, and possibly presence of respective conditions/symptoms, can potentially affect treatment utilization and/or efficacy. This fact confirms the importance for clinicians and researchers to pay attention to their own patient’s attitudes and beliefs about health. This also emphasizes the need for an increase in public health education about sleep and sleep health.