A Quality Improvement (QI) study on detecting bedtime procrastination in the United States Military.

In US Military Service Members (SMs) across all branches there is a prevalence of insomnia, which leads to cognitive and psychological impairments. Bedtime Procrastination (BP) contributes to sleep insufficiency leading to worsened health and operational readiness. In our military sleep disorders center, BP was identified as a gap in the initial intake assessment of patients for which targeted interventions could be made.

A QI study was developed utilizing a Plan-Do-Study-Act (PDSA) cycle using clinically validated questionnaires (Bedtime Procrastination Scale (BPS), While-in-Bed Procrastination Scale (WIBPS), and the While-in-Bed-Smartphone-use-Induced Sleep Procrastination Scale (WSPS) with a second cycle educating providers on interpreting scores and incorporating these findings into treatments.

There were 322 validated and complete questionnaires from SMs without significant burden on patients completing intake questionnaires in a timely manner. Demographics included patient ages ranging from 18-62, 23.91% female vs 79.09% male. Smartphone use was reported in 192 (59.6%) of patients with average questionnaire scores of BPS 24.2±6.8, WIBPS 12.9±5.0, WSPS 12.8±4.8. Findings that suggest BP and smartphone use in bed is prevalent among SMs.

With increasing rates of insomnia in SMs, this study showed the significance and feasibility of routinely assessing for BP. With high completion rates and acceptance among SMs and staff this study showed actionable insights to enable providers to identify high-risk patients. These patients can be targeted for individualized interventions to mitigate BP behaviors, improving overall sleep health and operational readiness. Results indicate BP and related smartphone use are common behaviors that contribute to sleep insufficiency in SMs.

Future PDSA cycles will focus on expanding BP knowledge and education, emphasizing behavior modification techniques, and systematically measuring changes in sleep outcomes following interventions allowing healthcare providers to better manage sleep challenges faced by military personnel.