Sleep Intervention for NHS Healthcare Shift Workers: A Pilot Study of Noise-Masking Earbuds

Background: Shiftwork disrupts natural sleep-wake cycles, alters light exposure patterns, and contributes to circadian misalignment. Detrimental health consequences associated with shift work include elevated risk for metabolic disorders, cardiovascular disease, cancer and all-cause mortality. Healthcare workers have one of the highest rates of shift work exposure, yet there are relatively few non-pharmacological interventions (with good evidence) developed to improve sleep outcomes in this population. Objective: A pre-post pilot interventional study assessed the acceptability and perceived effectiveness of commercial noise-masking earbuds on improving subjective sleep characteristics among National Health Service (NHS) healthcare staff working fast rotating shifts. Methods: Noise-masking sleep earbuds (Kokoon NightBuds) were worn for a pilot six-week intervention by twenty-seven NHS nurses (aged 26-43 years, 88.9% female) working fast rotating shifts from the EClocker Study. Sensors inside the earbuds were paired with a smartphone app to monitor sleep. An audio library in the smartphone app delivered personalised relaxation exercises and sleep techniques drawn from cognitive behavioural therapy for insomnia (CBT-I). A pre-post two-week monitoring period with daily smartphone-based Experience Sampling Methods (ESM) captured perceived daily sleep patterns. Acceptability and perceived effectiveness of the earbuds in promoting better sleep outcomes was assessed. Results: Use of the noise-masking sleep earbuds over a six-week period was associated with positive sleep improvement trends and elicited promising acceptability. Almost two thirds of NHS fast rotating shift nurses (63%) subjectively reported reductions in general sleep disturbance symptoms (PSQI Global), one in four experienced perceived sleep quality improvements (SQ; 25.9%), one in five reported sleeping longer (TST; 22.2%), and a third perceived falling asleep faster (SOL; 33.3%), had better sleep efficiency (SE; 33.3%) and improved daytime dysfunction (33.3%) (PSQI subcomponent scores). Sleep diaries (CSD) collected daily using smartphone-based ESM also demonstrated small improvements post-sleep earbud use; nurses reported sleeping an average 18 minutes longer (TST) and fell asleep more easily, on average 11 minutes faster (SOL). Sleep earbuds were generally well tolerated; 56% of nurses reported the earbuds as (somewhat to very) helpful, 52% reported (somewhat to strongly) falling asleep more easily (SOL), 44% felt (somewhat to strongly) their sleep quality was improved (SQ) and 30% agreed (somewhat to strongly) they slept longer (TST) and had less disturbed sleep. Conclusions: To our knowledge, this is the first study in Europe to pilot noise-masking earbuds as a potential non-pharmacological aid to improve sleep-wake behaviours or mitigate fatigue for healthcare staff. Preliminary results showed promising acceptability and (small) perceived sleep improvement trends following a targeted six-week earbud intervention in NHS fast rotating shift nurses.