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Sleep Health as a Public Health Concern and its effects on the Community
Valentine Ndukwe
Mount Saint Mary College

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Abstract
This paper explores the role of a public health nurse (PHN) and health issues as it affects west
point community as a whole. An assessment of the community was initially performed to
determine a prevalent health issue that required intervention to objectively meet the overall goal
of promoting overall health and prevention of disease in the community in line with Healthy
People 2020 mission. In West Point, NY, a highly competitive academic and stressful
environment it was identified that sleeplessness was a major concern that required all levels of
prevention (primary, secondary and tertiary) in order to promote awareness and understanding of
the disorder so as to encourage health maintenance in the area.

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Sleeplessness as a Public Health Concern and its effects on the Community
Community Needs or issues:
Assessment is a primary function a public health nurse (PHN) performs to determine the
health status and health needs of a community (Stanhope & Lancaster, 2009). Numerous healths
related issues have been identified in West Point, but the most common issues encountered were
nutrition, physical stress and sleeplessness. Sleeplessness was giving priority to discuss on
because it affects physiological, psychological and mental ability of the cadet populations at west
point. According to data from the National Health Interview Survey, nearly 30% of adults
reported an average of ≤6 hours of sleep per day in 2005-2007. In 2009, only 31% of high school
students reported getting at least 8 hours of sleep on an average school night.
Sleep health is a topic that Healthy People 2020 determined to be a health priority topic
for Americans. Sleep health is a multidimensional pattern of sleep-wakefulness, adapted to
individual, social, and environmental demands, that promotes physical and mental well-being.
Good sleep health is characterized by subjective satisfaction, appropriate timing, adequate
duration, high efficiency, and sustained alertness during waking hours (journalsleep.org).
Sleep is increasingly recognized as important to public health, with sleep insufficiency
linked to motor vehicle crashes, industrial disasters, and medical and other occupational
errors. Unintentionally falling asleep, nodding off while driving, and having difficulty
performing daily tasks because of sleepiness all may contribute to these hazardous outcomes.
Persons experiencing sleep insufficiency are also more likely to suffer from chronic diseases
such as hypertension, diabetes, depression, and obesity, as well as from cancer, increased
mortality, and reduced quality of life and productivity. Sleep insufficiency may be caused by

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broad scale societal factors such as round-the-clock access to technology and work schedules,
but sleep disorders such as insomnia or obstructive sleep apnea also play an important role. An
estimated 50-70 million US adults have sleep or wakefulness disorder. Notably, snoring is a
major indicator of obstructive sleep apnea.
In recognition of the importance of sleep to the nation's health, CDC surveillance of
sleep-related behaviors has increased in recent years. Additionally, the Institute of Medicine
encouraged collaboration between CDC and the National Center on Sleep Disorders Research to
support development and expansion of adequate surveillance of the U.S. population's sleep
patterns and associated outcomes. Two new reports on the prevalence of unhealthy sleep
behaviors and self-reported sleep-related difficulties among U.S. adults provide further evidence
that insufficient sleep is an important public health concern.
(http://www.cdc.gov/Features/dsSleep/)
A survey was carried out by the Behavioral Risk Factor Surveillance System (BRFSS) in
2009 and it was determined that, among 74,571 adult respondents in 12 states, 35.3% reported
<7 hours of sleep during a typical 24-hour period, 48.0% reported snoring, 37.9% reported
unintentionally falling asleep during the day at least once in the preceding month, and 4.7%
reported nodding off or falling asleep while driving at least once in the preceding month. This is
the first CDC surveillance report to include estimates of drowsy driving and unintentionally
falling asleep during the day. The National Department of Transportation estimates drowsy
driving to be responsible for 1,550 fatalities and 40,000 nonfatal injuries annually in the United
States. “More than one-quarter of the U.S. population report occasionally not getting enough
sleep, while nearly 10% experience chronic insomnia. However, new methods for assessing and
treating sleep disorders bring hope to the millions suffering from insufficient sleep. Fundamental

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to the success of all of these efforts is the recognition that sufficient sleep is not a luxury—it is a
necessity—and should be thought of as a “vital sign” of good health”. (Centers for Disease
Control and Prevention). (Insufficient sleep is a public health epidemic, 2014)
Given the fact that sleeplessness doesn’t discriminate against people of any age, race, or
gender the actual number of people who is at risk for insufficient sleep increases which only
heightens the need for community awareness and intervention. The health status of the
community is directly affected not only physically but emotionally and economically. Data from
the National Health and Nutrition Examination Survey (NHANES) 2005-2008, showed that from
10,896 respondents aged ≥20 years, a short sleep duration was found to be more common among
adults ages 20–39 years (37.0%) or 40–59 years (40.3%) than among adults aged ≥60 years
(32.0%), and among non-Hispanic blacks (53.0%) compared to non-Hispanic whites (34.5%),
Mexican-Americans (35.2%), or those of other race/ethnicity (41.7%). Adults who reported
sleeping less than the recommended 7–9 hours per night were more likely to have difficulty
performing many daily tasks.
Project Planning
To meet the needs of the West Point, NY community a lesson plan (Appendix A)
was developed to educate individuals on what insufficient sleep is and its effects on the body. A
pre test (Appendix B) was developed to gauge the basic knowledge of insufficient sleep prior to
teaching to be performed. Two handout outs (Appendix C, and D) were produced for the purpose
of providing information to review and take home regarding sleep and health on the types of
goals levels, modifiable risk factors, and signs and symptom of insufficient sleep. A post test
(Appendix E) was given to assess if any new knowledge was retained.

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The presentation details were reviewed by Joy LaRiviere, MSMC clinical instructor, and
discussed with Major Johnston and LTC McKinney, Community Health nurse. It was determined
and greed upon to have the presentation at the prep school for cadets, west point on the same day
and window time that Major Johnston will be delivering a lecture. The goal behind having the
presentation run concurrently was to share part of time allotted to him for his presentation at prep
school for the cadets.
Implementation
Participants
The participants were male and female cadet students well over two hundred in the hall
Materials
A pre and post test (Appendix A and B) included the same five questions. Each question
was chosen in order to assess learning needs in order to help the client meet the objective by the
end of the learning session.
Procedure
The presentation was a power point presentation held at prep school for cadets in West
point, NY on Friday, July 25, 2014. The students were asked to take a 2 minute pre-test to assess
their knowledge on the subject matter. Following the brief pre-test the power point presentation
was carried out. Teaching time varied from 2.5- 3.0 hour. During the teaching, sleep health
pamphlets were dispensed to reinforce the information being provided for the participants to
keep. Following the teaching the participants were asked to participate in taking a post test,
provided they did not initially answer all the questions correctly, to evaluate if the information
provided was retained.

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Evaluation
Because of the high number of participants (about 200 participants), It was observed that
about 20 percent of the participants answered it incorrectly. However, all the participants later
answered all of the questions correctly following the teaching provided. The goal of the
presentation was to provide teaching and awareness as a means of primary prevention for the
community.
The presentation was successful in the sense that all who volunteered to participate stated
that they now know the importance of having 7-9 hours of sleep at night. The presentation had
limitations that were unexpected because it was difficult to put together those cadets for
presentations as a result of their various academic and military schedules.

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Works Cited
Insufficient sleep is a public health epidemic. (2014, january 13). Retrieved from CDC web site:
http://www.cdc.gov/Features/dsSleep/
sleep and sleep disorder. (2013, july 1). Retrieved from cdc web site: http://www.cdc.gov/sleep/
Stannhope M, L. (2010). Foundation of Nursing in the commuinty, Community oriented
practice. In M. Stannhope, & J. Lancaaster, Foundation of Nursing in the commuinty,
Community oriented practice (pp. 3-5). Missouri: Mosby.

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Appendix A
Valentine Ndukwe
Mount Saint Mary College
COMMUNITY HEALTH NURSING
Sleep Health education to West Point United State Military Community Members
Objective: Increase the proportion of persons with symptoms of obstructive sleep apnea who seek medical
evaluation; Reduce the rate of vehicular crashes per 100 million miles traveled that are due to drowsy
driving; Increase the proportion of students in grades 9 through 12 who get sufficient sleep; Increase the proportion
of adults who get sufficient sleep
Goal: Per healthy people 2020 the goal is to increase public knowledge of how adequate sleep and treatment of sleep
disorders improve health, productivity, wellness, quality of life, and safety on roads and in the workplace.
OBJECTIVES CONTENT (Topics) TIME FRAME PRESENTER
Learner-oriented with one,
measurable behavioral verb
per objective.
Outline of the content to be covered that will
enable the learners to meet their objectives.
State the time
frame for each
objective.
List the faculty or content expert
for each objective.
At the completion of this
session,the learners will:
Pretest: Test knowledge to assess awareness of
risk factors related to inadequate sleep or
chronic short sleep
2) Test knowledge to assess understanding of
benefits associated with good sleep health
2 minute Valentine Ndukwe
1. The learner will identify 3
importance of a good sleep
health
Discuss common factors that contribute to a
good sleep health
- Sleep 7-8 hours every 24 hour
-No caffeine within 6 hours of light out
- Sleep in a safe quiet environment
- empty bladder just before light out
3 minutes
Valentine Ndukwe
Post test: 1 minute
(n.d.). Retrieved from
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=21

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True/False
1.The older you get, the fewer hours of sleep you need .
 True
 False
2.If you’re sleepy, raising the volume of your radio is a great way to stay awake while driving .
 True
 False
3.If you wake up in the middle of the night, it is best to lie in bed, count sheep, or toss and turn until you eventually
fall back asleep. .
 True
 False
4.During sleep, your brain rests.
 True
 False
5.Snoring is not harmful as long as it doesn’t disturb others.
 True
 False
Appendix B and Appendix E
Appendix’s C and D are as attached