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forensic nursing, prisons, sleep, women's health



  1. Harner, Holly M.
  2. Budescu, Mia


Background: Little is known about characteristics of women's sleep during incarceration.


Objectives: The study objectives were to describe incarcerated women's sleep quality, document incarcerated women's risk for sleep apnea, and identify other factors that contribute to poor sleep quality during incarceration.


Methods: This cross-sectional descriptive exploratory investigation was conducted in a maximum security women's prison in the United States. Incarcerated women's sleep quality and their risk for sleep apnea was assessed by using the Pittsburgh Sleep Quality Index and the Multivariable Apnea Prediction Score, respectively.


Results: Four hundred thirty-eight incarcerated women participated in this investigation. Results indicate that 72% of the sample met the Pittsburgh Sleep Quality Index criteria for "poor sleepers." Poor sleepers were significantly more likely to report sleep disturbances and scored significantly higher on the risk for sleep apnea scale compared to women who did not meet the poor sleep threshold. Approximately 10% of the sample had a probability for sleep apnea higher than .50. Factors that contributed to poor sleep included (a) "racing thoughts/worry/thinking about things," (b) environmental noise and other factors, (c) physical health conditions/pain, (d) nightmares and flashbacks, and (e) not taking sleep medication.


Discussion: Most participants reported poor sleep quality during incarceration. Poor sleep might exacerbate existing health conditions and contribute to the development of new health problems for incarcerated women. Furthermore, poor sleep quality may reduce a woman's ability to fully participate in beneficial prison programming. This investigation provides a first look at how women sleep in prison and offers recommendations for future research.