LAUSR

Sleep disturbance is prevalent among service members; however, little is known about factors that impede sleep in unique operational environments, such as aboard naval ships. Given the importance of sleep to health and performance, identifying both causes and potential solutions to sleep disturbance is critical. The objective of this qualitative study was to elucidate barriers to sleep and the strategies U.S. Navy sailors use to improve their sleep and combat fatigue while underway. Interviews were conducted with 22 active duty service members assigned to sea duty. The semi-structured interview guide assessed the experiences of service members sleeping in shipboard environments, including the strategies used to improve sleep and combat fatigue. Interview transcripts were analyzed using applied thematic content analysis by two independent coders. Most participants were male (91.8%) and enlisted (95.5%). The most commonly reported barrier to sleep was stress (e.g., job-related stress), followed by rotating schedules, and environmental factors (e.g., noise, light). Many reported prioritizing other activities over sleep when off duty. Though only a few reported specific strategies to improve sleep while underway, strategies that were described primarily included mitigation of environmental barriers (e.g., noise-canceling headphones or sleep masks). However, some participants acknowledged these strategies are not always feasible (e.g., cost, reduced responsiveness to alarms or commands). Notably, few sailors reported using stress mitigation or relaxation strategies to help sleep. Caffeine intake was the only reported strategy for alerting when fatigued. Sailors reported many barriers to sleep that are unique to the shipboard environment, yet most did not report using any mitigation strategies. Further, few used alerting techniques (other than caffeine) when fatigued. This at-risk population could benefit from targeted educational interventions covering sleep-promoting behaviors, prioritization of sleep, and fatigue mitigation. This work was supported by the Military Operational Medicine Research Program, Early Assessment and Intervention Working Group, under work unit no. N1702.