Scotland Speaks: A National Mixed-Methods Study and Public Mandate for Sleep Health Policy Reform
1
School of Medicine, University of St Andrews, St Andrews, United Kingdom
2
NHS Fife, Fife, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Sleep is fundamental to physical, mental, and social wellbeing, yet remains marginalised within public health policy and healthcare systems. In Scotland, the absence of a national sleep strategy has positioned sleep as an individual rather than a population health issue. Scotland Speaks was designed to examine public experiences and perceptions of sleep, barriers to evidence-based care, and support for national action across public health, healthcare, and policy systems.
METHODS:
A co-produced mixed-methods national study was conducted using a large cross-sectional online survey and qualitative analysis of open-text responses. Adults aged 16+ across Scotland described barriers to healthy sleep, views on societal and healthcare support, and recommendations for national action. Open-text responses were examined using reflexive thematic analysis (Braun and Clarke).
RESULTS:
Among 5039 adults (53% male), 47% reported moderate-to-severe insomnia symptoms (Figure 1). Short sleep was common, particularly on weekdays (77.4%), and one third reported sleep aid use, including alcohol (41%) and prescribed medication (28.6%) weekly. Participants reported managing sleep problems independently due to unclear referral pathways, limited access to behavioural interventions, and inconsistent primary care responses. Seven thematic domains emerged: (1) Education and Curriculum Inclusion; (2) Mental Health Support; (3) Access to Clinical Services; (4) Sleep Needs Across the Life Course; (5) Environments and Infrastructure; (6) Sleep Normalisation; and (7) Work, Employment and Sleep Equity. Support for embedding sleep as a public health issue across policy, healthcare, and community settings exceeded 90%.
CONCLUSIONS:
Scotland Speaks reveals a disconnect between the population burden of sleep problems and public health system responses. Framing sleep as an individual issue has contributed to independent coping and inequitable access to care. Public perceptions strongly support repositioning sleep as a core pillar of public health, with clear implications for national policy, health system reform, and the development of accessible, evidence-based referral pathways.
Sleep is fundamental to physical, mental, and social wellbeing, yet remains marginalised within public health policy and healthcare systems. In Scotland, the absence of a national sleep strategy has positioned sleep as an individual rather than a population health issue. Scotland Speaks was designed to examine public experiences and perceptions of sleep, barriers to evidence-based care, and support for national action across public health, healthcare, and policy systems.
METHODS:
A co-produced mixed-methods national study was conducted using a large cross-sectional online survey and qualitative analysis of open-text responses. Adults aged 16+ across Scotland described barriers to healthy sleep, views on societal and healthcare support, and recommendations for national action. Open-text responses were examined using reflexive thematic analysis (Braun and Clarke).
RESULTS:
Among 5039 adults (53% male), 47% reported moderate-to-severe insomnia symptoms (Figure 1). Short sleep was common, particularly on weekdays (77.4%), and one third reported sleep aid use, including alcohol (41%) and prescribed medication (28.6%) weekly. Participants reported managing sleep problems independently due to unclear referral pathways, limited access to behavioural interventions, and inconsistent primary care responses. Seven thematic domains emerged: (1) Education and Curriculum Inclusion; (2) Mental Health Support; (3) Access to Clinical Services; (4) Sleep Needs Across the Life Course; (5) Environments and Infrastructure; (6) Sleep Normalisation; and (7) Work, Employment and Sleep Equity. Support for embedding sleep as a public health issue across policy, healthcare, and community settings exceeded 90%.
CONCLUSIONS:
Scotland Speaks reveals a disconnect between the population burden of sleep problems and public health system responses. Framing sleep as an individual issue has contributed to independent coping and inequitable access to care. Public perceptions strongly support repositioning sleep as a core pillar of public health, with clear implications for national policy, health system reform, and the development of accessible, evidence-based referral pathways.
| eISSN: | 2654-1459 |
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