Sleep Health Behind Bars: A Global Scoping Review of Sleep in Carceral Settings.

BACKGROUND

Sleep is a fundamental determinant of health, yet little is known about sleep in carceral environments where structural, environmental, and psychosocial factors uniquely disrupt rest. Incarcerated individuals face disproportionately high burdens of illness, with sleep disturbances contributing to these disparities. Understanding the evidence on sleep in incarceration is essential for informing care, policy, and research.

METHODS

We conducted a scoping review of peer-reviewed literature on sleep in incarcerated populations, following the Joanna Briggs Institute Manual and PRISMA-ScR guidelines. Ten databases were searched from inception to March 2025 for studies addressing sleep among currently incarcerated individuals. Two reviewers screened and extracted data, with quality appraisal adapted from Joanna Briggs Institute tools.

RESULTS

Of 5,518 records identified, 63 studies published between 1978 and 2025 met inclusion criteria. Most were observational (75%), cross-sectional (59%), and published after 2014, with studies conducted mostly outside the United States. Research clustered into three domains: (1) descriptions of sleep quality and insomnia; (2) sleep and health outcomes, particularly depression, anxiety, PTSD, aggression, and suicidality, with limited study of cardiometabolic risk; and (3) interventions including cognitive behavioral therapy for insomnia, mindfulness, yoga, and relaxation, which showed feasibility but were limited by small samples, lack of controls, or short follow-up. Objective measures were rarely used.

CONCLUSIONS

Evidence demonstrates compromised sleep health in carceral settings due to psychiatric comorbidity, environmental stressors, and restricted care. Gaps remain in physical health outcomes, women's experiences, and post-release effects. Interventions tailored to carceral realities and adapted evidence-based interventions showed promise.