Abstract Sleep regularity is important for health and wellbeing. Food intake close to bedtime negatively impacts sleep regularity by lengthening sleep onset and reducing sleep duration. Extending the time between the last meal of the day and bedtime could improve sleep regularity. This pilot study investigated whether extending the time between last meal and sleep onset through time-restricting eating (TRE) impacts sleep regularity. Adults (n=6, 18-38 y, 5 female) completed 2-weeks baseline with usual eating timing followed by 6-weeks of TRE (10-hours between first and last meal, with last meal by 8pm), and a daily sleep diary. The standard deviations of sleep onset and sleep duration were calculated to indicate sleep regularity. Interviews were conducted to understand lived experience of TRE and sleep regularity. A one-way ANOVA revealed differences in time between last meal of the day (p=0.04), with 2.04hours between last meal and sleep onset during baseline and 4.00hours during TRE. There were no significant differences in sleep variables between baseline, 3-weeks TRE, and 6-weeks TRE (onset p=0.54; duration p=0.85). Participants reported positive experiences of TRE on sleep, commenting that TRE is “more consistent…because if I finish eating at a certain time, then I tend to go to bed at a set time.” While there were no significant improvements to sleep regularity after TRE, participants found it easier to have a consistent sleep routine when there was a longer time between eating and sleep. The next step is to build on these findings with objective sleep measures.

Adequate sleep is essential to support daily functioning, health, and well-being. A 2019 Australian Parliamentary Inquiry made 11 key recommendations, setting a national agenda to grow sleep research and clinical sleep medicine to improve the sleep health of Australians. In 2023, the Australian Federal Government endorsed many of these recommendations. The Network of Early Career Sleep Researchers in Training (NEST), a council of the Australasian Sleep Association, represents students and early-career researchers and clinicians in sleep research and medicine. In this consensus statement, we respond to the Parliamentary Inquiry's recommendations and call for timely and adequate investments to address the key priorities in the proposed national sleep health agenda. Pivotal towards raising sleep health awareness and improving sleep disorder services nationally, we propose actions including (1) the recognition of sleep as a national health priority and the development of a national 10-year sleep health and well-being strategy, (2) a nationwide sleep health awareness campaign,(3) education for healthcare practitioners in sleep health and sleep medicine, and (4) funding for sleep research into critical areas needed to support the sleep health of all Australians. This consensus statement presents practical considerations for advancing Australia's national sleep health agenda, drawing on input from emerging leaders in sleep research and medicine. We urge policymakers, healthcare providers, and industry leaders to prioritize these initiatives, which hold the potential to reduce the impact of sleep disorders on our healthcare system and improve the well-being of all Australians.

Bedtime procrastination is associated with inadequate sleep and is a novel intervention target to improve sleep health. Formative work indicates that pre-sleep electronic device use, a ubiquitous bedtime procrastination behaviour, may be targeted using a behaviour change approach. This pilot study aimed to examine (1) the acceptability and feasibility of the Reducing Evening Screen Time online program (REST-O) in new career starters, and (2) the preliminary effect of the program on daily pre-sleep electronic device use and sleep duration, as well as weekly measures of bedtime procrastination, excessive device use, and sleep quality and duration. Participants (N = 55) were randomised into three arms; an active Control (n = 19), Prevent (n = 18) and Substitute (n = 18), who used behavioural substitution at different times of day. Daily assessments were conducted for two weeks, and weekly measures at baseline, pre-intervention, post-intervention, and follow-up (end of Week Three). All groups experienced a reduction in daily pre-sleep device use (M = 23.4 min per day) and an increase in daily sleep duration (M = 12.7 min per day) post-intervention. Continued reductions in bedtime procrastination, excessive device use, and improvements in sleep quality and duration were observed at follow-up. The program appears feasible and acceptable to participants with a high daily completion rate (M = 84.7 %). Reductions in habit strength and hedonic motivation suggest potential mechanisms of change. Findings provide preliminary evidence for behaviour change interventions in targeting pre-sleep electronic device use and bedtime procrastination, with broader implications for sleep health.

OBJECTIVE:Establishing to what extent everyday behaviors are habitual will help intervention developers understand whether and which specific behaviors can become habitual or may require habit disruption to enable adoption of desired behaviors. Previous estimates of the prevalence of habit in everyday life have not distinguished between habitual instigation, whereby habit triggers action selection of a target action, and habitual execution, whereby habit facilitates smooth performance of action. METHODS AND MEASURES:Participants (N = 105) from the UK and Australia completed an ecological momentary assessment study, in which they self-reported their current behavior, and to what extent that behavior was habitually instigated, habitually executed and intentional, 6 times daily over 7 days. RESULTS:Most observed behaviors were habitually instigated (65%), habitually executed (88%), and aligned with intention (76%). Whether a person's behavior was generally habitual or aligned with intention did not vary as a function of demographics. Exercise behaviors were more commonly habitually instigated, and less habitually executed, than other action types. CONCLUSION:Our findings illustrate the pervasive influence of habit on everyday life. We recommend that techniques conducive to forming new habits and disrupting old habits be built into behavior change interventions to maximize effectiveness.

OBJECTIVES:This study assessed the feasibility of Sleepfit, an app-based sleep intervention for shiftworkers, to evaluate participant reach, engagement, and interaction. METHODS:The RE-AIM framework guided the feasibility assessment. Participants from various shiftwork industries (e.g. healthcare, mining) completed a 14-day trial of the Sleepfit app, alongside baseline and post-intervention surveys. Descriptive statistics were used to evaluate participant enjoyment and engagement, including daily app usage and the number of activities completed. RESULTS:Among the 110 enrolled shiftworkers, 53 (48%) completed post-intervention assessments, and 34 (30.9%) adhered to the full study protocol. Of those who completed baseline surveys, 85.4% downloaded and used Sleepfit, engaging with an average of 17.3% of available activities, with shiftwork-specific modules like "Coping with Shiftwork" showing the highest engagement. Participants cited lack of time, inconvenience, and losing interest as reasons for discontinuing app use. CONCLUSIONS:This study indicates the potential feasibility of app-based interventions like Sleepfit to improve shiftworkers' sleep health through tailored, relevant content. Future studies should consider longer durations and larger samples, incorporating wearable technology to enhance data accuracy and assess sustained effects across varied shift schedules.

We compared domain-specific cognitive function between adults with chronic low back pain (CLBP) and pain-free controls. PubMed, CINAHL, PsycINFO, EMBASE, and CENTRAL were searched from inception to 21 February 2025. Pairwise random-effects meta-analysis estimated standardised mean difference (Hedges' g). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach assessed certainty of evidence. JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies assessed risk of bias. Twenty-six studies (participants: 5572) were included. Compared to pain-free controls, adults with CLBP performed worse on tests of executive function (g [95%CI]: 0.50 [0.27, 0.74], P<0.001, GRADE: very low), global cognition (-0.23 [-0.43, -0.04], P=0.018, GRADE: low), memory (-0.65 [-0.90, -0.41], P<0.001, GRADE: very low), motor skills (0.44 [0.25, 0.64], P<0.001, GRADE: very low), and processing speed (0.27 [0.03, 0.51], P=0.027, GRADE: very low), yet not attention (-0.32 [-1.29, 1.68], P=0.363, GRADE: very low), language (-0.57 [-4.27, 3.13], P=0.302, GRADE: very low), and perception (-0.19 [-1.43, 1.05], P=0.584, GRADE: very low). CLBP may be associated with slightly worse global cognition. CLBP may also be associated with worse executive function, memory, motor skills, and processing speed, but the evidence is very uncertain. While there is a lack of evidence regarding causal mechanisms, assessing cognitive function among adults with CLBP appears warranted. Registration: PROSPERO (CRD42022356396). PERSPECTIVE: This systematic review and meta-analysis compared domain-specific cognitive function between adults with chronic low back pain and pain-free controls. While there is a lack of evidence regarding causal mechanisms, assessing cognitive function among adults with chronic low back pain appears warranted.

INTRODUCTION:Shiftwork contributes to poor sleep and circadian disruption, leading to adverse health outcomes. With a high number of young adults (18-25 years) engaging in shiftwork, exposure to these health challenges can occur from early adulthood. Therefore, there is an urgent need for age- and career-stage-appropriate resources focused on sleep health to mitigate poor health outcomes as early as possible. Given the absence of such resources, this study aimed to develop tailored, evidence-based sleep health materials for young shiftworkers. METHODS:A participatory approach was employed, with co-designers (n = 48) attending 1-2 online workshops to develop sleep health resources for young shiftworkers. Co-designers included young, experienced, and previous shiftworkers, workplace health and safety experts, and science communications specialists, who worked alongside academic experts. Workshops explored which sleep health topics co-designers believe are important for young shiftworkers. Reflexive thematic analysis of workshop transcripts identified key themes, which were aligned with current scientific evidence, forming both the structure and content of the resulting sleep health resources for young shiftworkers. RESULTS:Analysis of workshop transcripts identified five themes: sleep science, impacts of poor sleep, habits impacting sleep, strategies to improve sleep, and recommendations for workplaces. Themes were populated with evidence-based information to develop a website, a pictorial infographic, an animated video, and a social media presence. DISCUSSION:Tailored, evidence-based sleep health resources for young shiftworkers were co-designed, with qualitative data elucidating individual and work-related sleep health themes. Future studies should evaluate the resources to determine their impact on knowledge and behaviour.

Nightshift is associated with impaired cognitive performance on many tasks, yet performance is also moderated by individual differences. We investigated the effect of circadian type (two factors: flexible-rigid, and languid-vigour), and the efficacy of a novel countermeasure, breaking up sitting with light-intensity physical activity, in the context of nightshift performance. Thirty-three healthy adults (age M ± SD: 24.3 ± 4.6 y; 19 females) participated in a sleep laboratory study over five consecutive simulated nightshifts (2200-0600 h). Sleep opportunities occurred at 0800-1700 h. Participants were randomised to a sedentary (SIT; n = 14), or "breaking-up" sitting (BREAK; n = 19) condition. BREAK participants completed 3 min of light-intensity walking every 30 min at 3.2 km/h, while SIT participants remained seated. Every 2 h during nightshift, participants completed the Psychomotor Vigilance Task (mean RRT), Stroop Task, and Digit Symbol Substitution Task. Participants completed the revised Circadian Type Inventory which categorises individuals on a rigid-flexible scale and a languid-vigorous scale (rigid; n = 12, flexible; n = 11; languid; n = 11, vigorous n = 13). Linear mixed models showed a significant 3-way interaction between Nightshifts (1-5), Condition (SIT, BREAK), and flexibility-rigidity for mean RRT (p = 0.03) only. Flexible types in the BREAK condition had better performance than rigid BREAK, rigid SIT, and flexible SIT over five nights, with performance marginally worse on the first night for all participants apart from rigid SIT. Linear mixed models showed a significant 2-way interaction between Nightshifts (1-5), and flexibility-rigidity for percentage accuracy on the Stroop task, and a significant 2-way interaction between Nightshifts (1-5), and languid-vigour for response time on the Stroop task. Accuracy worsened for rigid types, while response time on the Stroop task improved for languid types over five nights. No other significant differences were found. Breaking up sitting with light-intensity physical activity maintained sustained attention for flexible circadian types across all five experimental nightshifts. Both rigidity and languidity moderated trends in performance, though whether these differences have meaningful real-world implications must be explored further. Our results indicate that circadian type classifications should be accounted for in breaking up sitting interventions overnight.

OBJECTIVES:This pre-planned secondary analysis examined the effects of a running intervention on mental health symptoms and pain catastrophising in adults with chronic low back pain. DESIGN:Two-arm parallel individual randomised (1:1) controlled trial. METHODS:This study randomised 40 adults (mean [standard deviation] age: 33 [6] years, female: 50 %) with non-specific chronic low back pain to a 12-week running (progressive run-walk interval exercise training) intervention (n = 20) or waitlist control (n = 20). Outcomes were mental health symptoms (21-item Depression, Anxiety, and Stress Scale) and pain catastrophising (Pain Catastrophising Scale). Data were collected at baseline, six, and 12 weeks post-baseline. Separate linear mixed models with random effects (participants) evaluated within- and between-group changes. RESULTS:At 12 weeks post-baseline, running improved overall mental health symptoms (estimated marginal mean net difference [95 % confidence interval] points: -4.35 [-7.73, -0.97], P = 0.012), depression symptoms (-1.75 [-3.42, -0.08], P = 0.040), stress symptoms (-1.65 [-3.01, -0.29], P = 0.017), and pain catastrophising (-7.85 [-11.98, -3.72], P < 0.001), yet not anxiety symptoms (-0.95 [-2.16, 0.26], P = 0.122), compared with control. CONCLUSIONS:Running improved mental health symptoms and pain catastrophising among adults with non-specific chronic low back pain when compared to waitlist control. Differences in pain catastrophising, yet not mental health symptoms, were clinically meaningful. Running appears to be an efficacious treatment for psychological comorbidities common among adults with non-specific chronic low back pain.

Chronic pain and comorbid sleep difficulties impact many children and adolescents. This study aimed to evaluate the efficacy of psychological interventions on sleep in children and adolescents with chronic pain. Five databases (PubMed, CINAHL, APA PsychInfo, Embase, CENTRAL) were searched from inception to April 17, 2023, for randomized controlled trials examining the effects of psychological interventions on sleep in participants aged ≤ 19 years with pain persisting for ≥ 12 weeks. Six studies (participants, n = 686; 78.43 Systematic Review Registration: Registry: PROSPERO; Name: Efficacy of Psychological Interventions for Sleep in Children and Adolescents with Chronic Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials; URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023454620 ; Identifier: CRD42023454620. Thwaite TL, Craige EA, Mundell N, et al. Efficacy of psychological interventions on sleep in children and adolescents with chronic pain: a systematic review with meta-analysis of randomized controlled trials. J Clin Sleep Med. 2025;21(8):1445–1461.

OBJECTIVE:The main aim of this pilot study was to examine the impact of sexual activity on objective and subjective sleep parameters. METHODS:A repeated-measures counterbalanced, cross-over design with three conditions - no sex, solo masturbation, and partnered sex was employed with cohabiting couples. In this pilot study 14 individuals participated in the study (7 females, 7 males; mean age 29.9 ± 3.4years). Sexual activities and sleep were monitored for 11 consecutive nights using a portable polysomnography system (DREEM3) and daily sex and sleep surveys. STATISTICAL ANALYSES:Linear mixed models were employed to examine differences in sleep, readiness, and motivation following three conditions (i.e., no sex, solo masturbation, and partnered sex). Cohen's d effect sizes with 95% confidence limits were also calculated for pairwise comparisons between conditions with the effect of magnitude interpreted as follows: small= 0.2, medium 0.5, large 0.8, very large 1.0. Wilcoxon Signed-Rank tests were conducted to compare the sleep stage concordance between partners across conditions. RESULTS:Participants attempted sleep considerably later following the solo masturbation and partnered sex conditions compared to the no sex condition (p = .004). Wake after sleep onset and sleep efficiency improved considerably following solo masturbation and partnered sex compared to no sex (p < .05). No differences were observed across conditions for subjective sleep (p > .05). Sleep stage concordance for rapid eye movement sleep was longer when participants slept together regardless of whether they engaged or did not engage in sexual activity (p < .05). CONCLUSIONS:Engaging in sexual activity, whether solo masturbation or partnered, significantly enhanced objective sleep quality by reducing wakefulness after sleep onset and improving sleep efficiency. Objective wake up time, sleep duration, sleep latency and subjective sleep measures showed no differences postsexual activity, potentially attributable to the small sample size and the inclusion of only healthy sleepers. Future research should focus on expanding the sample size and incorporating participants with sleep disorders to thoroughly investigate if sexual activity before bedtime can improve sleep.

Evidence suggests an association between sleep and chronic low back pain. However, the effects of exercise training (first-line treatment) on sleep in this susceptible population group has received limited attention to date. This two-group parallel (1:1) randomised controlled trial (ACTRN12615001270505) allocated 40 adults with non-specific chronic low back pain to six months of either general strength and conditioning (n = 20) or motor control and manual therapy (n = 20). Sleep quality and sub-components were measured by the Pittsburgh Sleep Quality Index. Both general strength and conditioning (β [95 %CI]: 1.58 [-2.70, -0.46]) and motor control and manual therapy (β [95 %CI]: 1.61 [-2.79, -0.43]) improved sleep quality, but there was no between-group difference (β [95 %CI]: 0.03 [-1.60, 1.65]). For sleep quality sub-components, general strength and conditioning improved daytime dysfunction (β [95 %CI]: 0.33 [-0.65, -.0.01]), but led to a decline in sleep efficiency (β [95 %CI]: 0.06 [0.01, 0.10]). Motor control and manual therapy improved sleep disturbance (β [95 %CI]: 0.31 [-0.55, -0.07]). Both interventions improved sleep quality and some sub-components. Future studies could include a true control, objective sleep measures, and investigation of potential mediators.

This study investigated the relationship between gambling and extended wakefulness using a novel within-subjects design. In a laboratory setting, 19 participants (9 males, 10 females) were subjected to 18.75 h of extended wake to mimic the sleep pressure typically present during late night gambling sessions. Participants completed two test batteries, the first at baseline at 1800 h and the second at 0300 h. Each test battery consisted of four online gambling tasks (electronic gaming machine, roulette, sports betting, and bingo) and a series of subjective and cognitive measures (Karolinska Sleepiness Scale, visual analogue scale of performance, Psychomotor Vigilance Task (PVT) and Profile of Mood States). Compared to at 1800 h, participants at 0300 h showed slower responses and more lapses on the PVT indicated impairment, increased subjective feelings of tiredness, and increased negative affect, but no significant changes in gambling intensity. The current study illustrates that gambling during a period of extended wake may not impact gambling behaviour as hypothesised and as shown in previous studies. While periods of wakefulness mimic alcohol in other cognitive performance domains, the same may not be true of gambling.

Objectives Running is one of the most accessible forms of exercise, yet its suitability for adults with chronic low back pain (LBP) is unknown. This study assessed the efficacy and acceptability of running in adults with chronic LBP.Methods This two-arm parallel (1:1) individually randomised controlled trial allocated 40 participants (mean (SD) age: 33 (6) years, female: 50%) with non-specific chronic LBP to a 12-week intervention or waitlist control. The intervention was a progressive run-walk interval programme comprising three 30-min sessions per week that were digitally delivered and remotely supported by an exercise physiologist. Efficacy outcomes were self-reported pain intensity (100-point visual analogue scale) and disability (Oswestry Disability Index). Acceptability outcomes were attrition, adherence and adverse events.Results At 12-week follow-up, the intervention improved average pain intensity (mean net difference (95% CI): -15.30 (-25.33, -5.27) points, p=0.003), current pain intensity (-19.35 (-32.01, -6.69) points, p=0.003) and disability (-5.20 (-10.12, -0.24) points, P=0.038), compared with control. There was no attrition, and mean (SD) training adherence was 70% (20%; ie, 2.1 of 3 sessions per week). Nine non-serious adverse events deemed likely study-related were reported (lower limb injury/pain: n=7, syncope associated with an underlying condition: n=1, LBP: n=1).Conclusions A run-walk programme was considered an acceptable intervention by the participants to improve the pain intensity and disability in individuals aged 18-45 years with non-specific chronic LBP when compared with the control. An individualised and conservative run-walk programme should be considered a suitable form of physical activity for adults with chronic LBP.Trial registration number Australian New Zealand Clinical Trials Registry: ACTRN12622001276741. Registered on 29 September 2022.

Inadequate sleep is common and contributes to poor health outcomes. Physical activity has a positive impact on sleep outcomes, however the prevalence of physical inactivity is increasing, coupled with the rise of sedentary behaviour at work. Interventions that promote physical activity and reduce sedentary behaviour are essential, as they can improve sleep. The current study investigated the effects of breaking up prolonged sitting with physical activity during the day or night, compared to not breaking up sitting, on sleep architecture during a 9 h or 5 h sleep opportunity. Participants (n = 125, 51% male, 23.4 ± 4.8 years of age) completed an in-laboratory sleep study, with five simulated shifts during the day or night. Sleep opportunities were either 9 h or 5 h following each shift. Participants were allocated to one of six conditions: Sit9D or Break9D (sedentary or breaking up sitting day and 9 h sleep opportunity), Sit5D or Break5D (sedentary or breaking up sitting day and 5 h sleep opportunity), or Sit9N or Break9N (sedentary or breaking up sitting night and 9 h sleep opportunity). Sleep was monitored using polysomnography. In the analysis of day shifts, mixed model ANOVAs demonstrated a significant physical activity *sleep opportunity interaction for total sleep time (p < 0.001), sleep onset latency (p < 0.001), time spent in N2 (p < 0.001) and N3 (p = 0.03). Post-hoc analyses revealed that participants in the 9 h sleep opportunity conditions had longer total sleep time, shorter sleep onset latency, and more slow-wave sleep (N3) during sleep opportunities 1-4 but not sleep opportunity 5. There were no significant differences in sleep architecture between physical activity condition for the nightshift conditions. Better sleep quality was seen in the 9 h condition compared to the 5 h condition, and breaking up sitting did not affect sleep. Given the benefits of breaking up sitting on health, our findings suggest a breaking up sitting intervention can be promoted without detrimental impacts on sleep.

On-call work is known to contribute to disrupted sleep, fatigue, and an increased risk of incidentor injury. This review aimed to a) identify current on-call management strategies that are suggested or required by regulatory bodies, and b) determine if there is empirical evidence to support these strategies in managing the fatigue of on-call workers. A grey literature search produced 65 relevant guidance materials. A systematic inductive thematic process identified consistent strategies included in these materials: 1) regularity/predictability of shifts, 2) fatigue management policy, 3) prescriptive rule sets, 4) fitness for work assessment, 5) on-the-day control measures, 6) risk assessment, 7) training and education, and 8) call management. Subsequently, a systematic review identified 17 original studies on the effectiveness of fatigue management strategies in on-call workers. Very little research has been done on fatigue management strategies for on-call workers outside of some prescriptive hours of work limitations. These limitations generally reduced fatigue, but often had the unintended consequence of increasing workload, which may inadvertently increase overall risk. Training, education, and call management (e.g., protected naps during on-call periods) also had some supporting evidence. The current gap in evidence emphasises the critical need for research on tailored on-call fatigue management strategies.

Shift work, involving night work, leads to impaired sleep, cognition, health and wellbeing, and an increased risk of occupational incidents. Current countermeasures include circadian adaptation to phase shift circadian biomarkers. However, evidence of real-world circadian adaptation is found primarily in occupations where light exposure is readily controlled. Despite this, non-photic adaptation to shift work remains under researched. Other markers of shift work adaptation exist (e.g., improvements in cognition and wellbeing outcomes) but are relatively unexplored. Timeframes for shift work adaptation involve changes which occur over a block of shifts, or over a shift working career. We propose an additional shift work adaptation timeframe exists which encompasses acute within shift changes in markers of adaptation. We also propose that physical activity might be an accessible and cost-effective countermeasure that could influence multiple markers of adaptation across three timeframes (Within Shift, Within Block, Within Work-span). Finally, practical considerations for shift workers, shift work industries and future research are identified.