Conclusion
This is the first integrative review to examine insomnia in a prison population. In conclusion, despite the publication of a number of scientific papers, rigorous research surrounding the prevalence, aetiology and management in a prison population is rare. Treatment decisions are frequently made more difficult in prison due to the prison environment and because prisoners with insomnia are more likely to have comorbid disorders which impact upon treatment options and likely efficacy. Furthermore, whilst a range of non-drug interventions have been found to be effective in treating insomnia in the community, there seems to be an emphasis instead towards prescribing medication as first line treatment in prison. However, the higher rates of prescribing may simply reflect higher rates of clinical need and may be entirely appropriate.
Notwithstanding methodological limitations, the literature to date indicates that sleep disturbance in prison populations is common, impairing, linked to greater levels of comorbidity, and treated using a limited range of interventions. While this is comparable in part to insomnia in the general/non-incarcerated population, data indicate that the burden of insomnia is considerably greater in prison, yet the management strategies employed are more limited. A series of studies is required to further characterise the nature, prevalence and aetiology of poor sleep in prison populations.
Future studies should aim to:
•
Assess sleep with validated measures and prospective sleep diaries;
•
Consider the use of objective measures (e.g., actigraphy and polysomography);
•
Conduct longitudinal studies to determine sleep quality/disturbance pre, during and post-prison stay;
•
Assess qualitative reflections from prisoners about the nature of poor sleep;
•
Establish what types of symptoms are most common (initiating, maintaining sleep, early morning awakenings) and how they impact on functioning/wellbeing and interactions with other prisoners/staff;
•
How the prison environment impacts sleep and whether this differentially affects those of a particular age, gender, or chronotype (i.e., morning/evening);
•
Inter-relations between substance misuse, comorbidity and poor sleep;
•
Determine best practice around prison-based prescription of hypnotics and assess the application and delivery of non-pharmacological options;
•
Establish environmental/operational factors that may facilitate/hinder sleep; and,
•
Conduct randomised, controlled evaluations of insomnia treatment options.
It is important to further study insomnia within a prison population in order to identify an accurate rate of prison insomnia; improve staff–prisoner relationships with regards to treatment consultation and satisfaction; to provide effective insomnia management in a prison environment; and to reduce the negative effects of insomnia and their impact upon an individual prisoner's ability to engage with restorative, reparative and rehabilitative activities in prison to increase their life chances upon release.
ConclusionThis is the first integrative review to examine insomnia in a prison population. In conclusion, despite the publication of a number of scientific papers, rigorous research surrounding the prevalence, aetiology and management in a prison population is rare. Treatment decisions are frequently made more difficult in prison due to the prison environment and because prisoners with insomnia are more likely to have comorbid disorders which impact upon treatment options and likely efficacy. Furthermore, whilst a range of non-drug interventions have been found to be effective in treating insomnia in the community, there seems to be an emphasis instead towards prescribing medication as first line treatment in prison. However, the higher rates of prescribing may simply reflect higher rates of clinical need and may be entirely appropriate.Notwithstanding methodological limitations, the literature to date indicates that sleep disturbance in prison populations is common, impairing, linked to greater levels of comorbidity, and treated using a limited range of interventions. While this is comparable in part to insomnia in the general/non-incarcerated population, data indicate that the burden of insomnia is considerably greater in prison, yet the management strategies employed are more limited. A series of studies is required to further characterise the nature, prevalence and aetiology of poor sleep in prison populations.Future studies should aim to:•Assess sleep with validated measures and prospective sleep diaries;•Consider the use of objective measures (e.g., actigraphy and polysomography);•Conduct longitudinal studies to determine sleep quality/disturbance pre, during and post-prison stay;•Assess qualitative reflections from prisoners about the nature of poor sleep;•Establish what types of symptoms are most common (initiating, maintaining sleep, early morning awakenings) and how they impact on functioning/wellbeing and interactions with other prisoners/staff;•How the prison environment impacts sleep and whether this differentially affects those of a particular age, gender, or chronotype (i.e., morning/evening);•Inter-relations between substance misuse, comorbidity and poor sleep;•Determine best practice around prison-based prescription of hypnotics and assess the application and delivery of non-pharmacological options;•Establish environmental/operational factors that may facilitate/hinder sleep; and,•Conduct randomised, controlled evaluations of insomnia treatment options.It is important to further study insomnia within a prison population in order to identify an accurate rate of prison insomnia; improve staff–prisoner relationships with regards to treatment consultation and satisfaction; to provide effective insomnia management in a prison environment; and to reduce the negative effects of insomnia and their impact upon an individual prisoner's ability to engage with restorative, reparative and rehabilitative activities in prison to increase their life chances upon release.
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