a national survey in 1997 showed that the prevalence of insomnia , including difficulty initiating sleep , difficultly of maintaining sleep and early morning awakening , was 21.4% in the general population . it has been also reported that short sleep duration is associated with mortality , cardiovascular disease and diabetes . being able to inform people of the features of sleep and to provide methods that could improve their sleep , might be a way to contribute to preventing health problems related to poor sleep . a study in an occupational setting in japan reported that a 1-hour sleep hygiene program reduced afternoon sleepiness at work , but did not improve sleep at night . the aim of this pilot study was therefore to evaluate whether sleep was improved by a 1-day sleep education program in an occupational setting , including stopping habitual alcohol intake at bedtime , which may contribute to poor sleep conditions . subjects were participants attending a 1-day sleep education program in december 2010 . the program was arranged by school boards in shiga prefecture , japan , to improve the mental health of employees in public high schools . participants attending the program were principals , vice - principals , teachers , school nurses , and office workers in public high schools . one withdrew by the end of december 2010 , and 40 completed and returned the second questionnaire and were included in the analysis ( 24 males and 16 females , mean age  sd : 49.1  8.9 years ) . the program was created by three professors from sleep medicine disciplines of physiology and sleep - disordered breathing , and environmental physiology . speakers explained using slides and a video presentation to explain basic sleep science information , including the role of sleep in people s health and the sleep mechanisms involved , features of sleep in adolescence for high school students , sleep hygiene education including the risks of low arterial oxygen saturation during sleep resulting from alcohol intake ( see appendix 1 ) , and methods to evaluate sleep . a slide used in the sleep education program : low arterial oxygen saturation during sleep caused by alcohol intake in an obstructive sleep apnea patient . educational materials , consisting of two pamphlets and a paperback pocket edition written by the speakers , were distributed to the participants . these included information on obstructive sleep apnea , basic sleep science and specific methods for improving sleep . the questionnaire comprised the japanese version of the pittsburgh sleep quality index ( psqi ) , the japanese version of the epworth sleepiness scale ( ess ) , the japanese version of the insomnia severity index ( isi ) , and a question on alcohol intake at bedtime ( times per week ) . continuous variables at baseline and 1 month later were compared using the paired t - test . interaction between groups (  continued no alcohol intake ,  stopped intake and  continued intake ) and time ( at baseline vs. 1 month later ) was tested by mixed model analysis of variance ( anova ) . subjects were participants attending a 1-day sleep education program in december 2010 . the program was arranged by school boards in shiga prefecture , japan , to improve the mental health of employees in public high schools . participants attending the program were principals , vice - principals , teachers , school nurses , and office workers in public high schools . one withdrew by the end of december 2010 , and 40 completed and returned the second questionnaire and were included in the analysis ( 24 males and 16 females , mean age  sd : 49.1  8.9 years ) . the program was created by three professors from sleep medicine disciplines of physiology and sleep - disordered breathing , and environmental physiology . speakers explained using slides and a video presentation to explain basic sleep science information , including the role of sleep in people s health and the sleep mechanisms involved , features of sleep in adolescence for high school students , sleep hygiene education including the risks of low arterial oxygen saturation during sleep resulting from alcohol intake ( see appendix 1 ) , and methods to evaluate sleep . a slide used in the sleep education program : low arterial oxygen saturation during sleep caused by alcohol intake in an obstructive sleep apnea patient . educational materials , consisting of two pamphlets and a paperback pocket edition written by the speakers , were distributed to the participants . these included information on obstructive sleep apnea , basic sleep science and specific methods for improving sleep . the questionnaire comprised the japanese version of the pittsburgh sleep quality index ( psqi ) , the japanese version of the epworth sleepiness scale ( ess ) , the japanese version of the insomnia severity index ( isi ) , and a question on alcohol intake at bedtime ( times per week ) . continuous variables at baseline and 1 month later were compared using the paired t - test . interaction between groups (  continued no alcohol intake ,  stopped intake and  continued intake ) and time ( at baseline vs. 1 month later ) was tested by mixed model analysis of variance ( anova ) . the percentage of habitual alcohol intake at bedtime at baseline and approximately 1 month after the program is presented in table 1 . the percentage of subjects with habitual alcohol intake at bedtime was significantly decreased ( 38.5% ( 15 of 39 ) to 20.5% ( 8 of 39 ) , p=0.04 ) . among the 15 subjects who habitually consumed alcohol at bedtime at baseline ( 12 of 23 men ( 52.2% ) , three of 16 women ( 18.8% ) ) , eight ( 53.3% ) stopped alcohol intake at bedtime after the sleep education program . however , one subject started to intake alcohol at bedtime after the program . the self - rated sleep conditions from the first questionnaire and the one approximately a month later are shown in table 1 . the mean ess score was significantly decreased by 1.2 points ( p=0.04 ) , while the mean sleep duration was significantly decreased by 10 minutes ( p=0.02 ) . the mean isi score was decreased , but not significantly . proportion with habitual alcohol intake at bedtime and sleep conditions at baseline and 1 month after the program a : mcnemar test , b : paired student t - test psqi : pittsburgh sleep quality index ; ess : epworth sleepiness scale ; isi : insomnia severity index ; sd : standard deviation . the characteristics of the participants and sleep conditions at baseline by alcohol intake at bedtime are presented in table 2 . mean age was not significantly different between the group which stopped alcohol intake and the group which continued . the percentage of men in the  continued intake group was higher than in the  stopped intake group , although not significantly . the number of times alcohol was taken at bedtime per week at baseline and the proportion taking alcohol at bedtime 5 times or more per week at baseline in the  continued intake group were significantly higher than in the  stopped intake group . the psqi score at baseline in the  stopped intake group was significantly higher than that in the  continued intake group . although not significant , the ess and the isi scores at baseline in the  stopped intake group were higher than those in the  continued intake group . characteristics of groups according to alcohol intake at bedtime a : student t - test , b : chi - square test , sd : standard deviation . the sleep conditions at baseline and approximately 1 month after the program in the  continued no alcohol intake at bedtime group , in the  stopped intake group and in the  continued alcohol intake group are shown in table 3 . although interactions between time ( at baseline vs. 1 month later ) and alcohol intake at bedtime (  stopped intake ,  continued intake and  continued no alcohol intake ) were not significant on any sleep parameters owing to the relatively small number of subjects , ess scores , isi scores and sleep duration in the  stopped alcohol intake group decreased more than in the  continued group and in the  continued no alcohol intake group . change in sleep conditons by groups according to alcohol intake at bedtime a : student paired t - test ; b : mixed model analysis of variance ; sd : standard deviation . the ess score was significantly decreased after the program , while sleep duration was significantly shortened . shortened sleep duration coincided with a decrease in sleepiness . the most marked effect of the sleep education program was to stop alcohol intake at bedtime . approximately half of the subjects who had habitual alcohol intake at bedtime stopped taking alcohol at bedtime after the program . although a 1-day sleep education program promoted a reduction in sleepiness and symptoms related to sleep problems according to the ess ( 1.2-point average reduction ) and the isi ( 1.1-point average reduction ) in all subjects , subjects who stopped alcohol intake at bedtime received the most benefit , with a greater decrease in sleepiness and symptoms related to sleep problems as evaluated by ess ( 2.6-point average reduction ) and isi ( 2.1-point average reduction ) . the risks of sleep related breathing disorder resulting from alcohol intake at bedtime were explained in the program . in the education program , a slide showing low arterial oxygen saturation during sleep caused by alcohol intake in an obstructive sleep apnea patient was presented ( appendix 1 ) . we believe that this data in a clinical setting may promote stopping alcohol intake , by providing a better understanding of the risk of alcohol intake , although data why the participants stopped alcohol intake at bedtime was not available . alcohol consumption is one of the risk factors for sleep apnea and is associated with difficulty in maintaining sleep and early morning awakening . the proportion of alcohol use as a sleep aid one or more times per week is 48.3% among men and 18.3% among women in the general japanese population , similar to the proportions of alcohol intake at bedtime in the subjects in this study . if a sleep education program similar to that used in this study was to be widely conducted in future , half of those with habitual alcohol intake at bedtime in the general population could conceivably stop alcohol intake at bedtime . thus sleep education might contribute to a reduction in the general population of sleep problems and health problems resulting from alcohol intake at bedtime in future . bedtime alcohol drinkers who continued alcohol intake after the program tended to take alcohol every night , many were men , and they had relative low psqi , ess , and isi scores . they might not want to stop alcohol intake at bedtime because they might consider it unnecessary to improve sleep by self - rated good sleep . in contrast , bedtime alcohol drinkers who stopped alcohol intake after the intervention tended not to take alcohol every night , many were women , and they had relative high psqi , ess , and isi scores . if these populations who are conscious of their poor sleep with alcohol intake at bedtime could be targeted in future programs , there might be easily gained benefits in these populations . the preliminary study did not have a control group and selection bias of subjects might have occurred . second , the number of subjects was small , especially in the sub - analysis by alcohol intake at bedtime . the subjects might have reported more effects , because of using a self - administered questionnaire . the 1-day sleep education program contributed to stopping alcohol intake at bedtime which may lead to improved sleep conditions . therefore , this program offers the possibility of improving sleep conditions among the general population , especially those with habitual alcohol intake at bedtime .
abstractthe aim of this pilot study was to evaluate whether sleep was improved by a 1-day sleep education program in an occupational setting and whether stopping alcohol intake at bedtime might influence sleep . 
 subjects were 40 high school employees . 
 the sleep education program lasted 4.5 hours and consisted of sleep science information , and sleep hygiene education including the risk of sleep related breathing disorder resulting from alcohol intake . 
 sleep conditions were evaluated by self - administered questionnaires at baseline and approximately 1 month later . 
 the mean the epworth sleepiness scale ( ess ) score was significantly decreased by 1.2 points ( p = 0.04 ) , while the mean sleep duration was significantly decreased by 10 minutes ( p = 0.02 ) . 
 shortened sleep duration coincided with a decrease in sleepiness . 
 this may indicate an improvement in sleep quality . 
 the percentage of habitual alcohol intake at bedtime was significantly decreased ( from 38.5% ( 15/39 ) to 20.5% ( 8/39 ) , p = 0.04 ) . 
 subjects who stopped alcohol intake at bedtime ( n = 8) received the most benefit , with decreased scores of ess and insomnia severity index ( isi ) , although the reductions were not significant . 
 this education program offers the possibility of improving sleep conditions among the general population , especially in those who cease habitual alcohol intake at bedtime . 
 further larger , randomized , controlled studies are warranted .