Sleep security: A rights-based approach

Sleep is a fundamental biological process, yet environmental and social factors can influence sleep health. This study aimed to advance a human rights perspective on sleep by developing the emerging concept of sleep security.

An in-person workshop and online modified Delphi study were conducted (2024-2025) to refine/revise the definition and primary domains of sleep security. Participants were primarily Australian experts with clinical or academic experience in sleep, social determinants of health, health equity, and/or environmental health. Participants rated level of agreement with proposed definitions and domains of sleep security and provided qualitative feedback to justify their choices. Iterative rounds evaluated refined definitions if (a) <75% of participants indicated they "agree" or "strongly agree" and/or (b) content analysis of qualitative data indicated conceptual ambiguity or inconsistent interpretation.

Thirty-one experts participated in Round 1, and 19 in Round 2. Although the overarching definition of sleep security and 4 of its proposed 5 domains reached the a priori agreement threshold in the first round, content analysis of qualitative feedback led to an alternative definition of sleep security and revised descriptions for 2 domains in Round 2. An overall definition of sleep security and its 5 primary domains (Safety and security, conducive environment, policy and practice, opportunities and demands, and autonomy) was agreed upon.

A preliminary conceptualization of sleep security provides a framework for guiding research and advocacy efforts to improve social, environmental, and structural conditions that support sleep health. Further work is needed to test and refine this framework globally.