Physical and social sleep environment of a women’s prison: A qualitative exploration

Abstract

Background:

The physical and social environments of correctional facilities impact the health of incarcerated women. Research indicates that sleep hygiene, which is critical to physical and mental health, deteriorates when people are incarcerated. However, this research is primarily quantitative and drawn from men’s experiences.

Objectives:

The objective of this analysis is to use qualitative data to build knowledge about the physical and social sleep environment of a women’s prison.

Design and Methods:

Nine individual interviews and one focus group, with four participants, were conducted with formerly incarcerated women. All the women had been incarcerated in the same state carceral institution for women located in the southeast region of the United States. These semi-structured interviews asked women to describe their daily habits, behaviors, and practices while incarcerated. Their responses included detail about the sleep environment. All interviews were audio-recorded, transcribed, and coded in Dedoose. Topical and thematic analysis of the women’s narratives was conducted.

Results:

Findings describe the prison’s physical and social sleep environment. These narratives explore the role of peer and staff interactions, lighting, schedules, and norms on women’s sleep behaviors.

Conclusion:

Findings build knowledge about prison’s physical and social environments that can inform carceral policy and health interventions with incarcerated and formerly incarcerated women. The narratives invite dialogue about how changes in carceral practices and facilities could improve women’s sleep habits and behaviors. Findings encourage more education about sleep hygiene for incarcerated women and correctional staff. Further research is needed to better understand the impact of prison on women’s sleep behaviors and health outcomes.

Introduction

Approximately 190,000 women are incarcerated in the United States. ¹ Research has explored the myriad ways in which the experience of incarceration can impact women’s health. The conditions in carceral facilities, including overcrowding, limited access to healthcare, substandard food, lack of opportunity for exercise and fresh air, interpersonal violence, and psychosocial stressors can aggravate existing health problems for women and produce new complications.^2–6 Incarcerated women report high rates of arthritis, asthma, cardiovascular problems, diabetes, HIV risk, dental problems, substance use, pregnancy complications, and mental health issues.^7–13 These associations align with theory that suggests social institutions, including correctional facilities, are structural determinants of health: “Imprisonment can cause health problems or exacerbate pre-existing ones.” ¹⁴

While much is known about the impact of carceral systems on the health of women who are incarcerated, one aspect of women’s health and incarceration that has been underexamined is the impact of this experience on sleep. Sleep, or lack thereof, is a key determinant of physical and mental health. Adults are recommended to get between 7 and 9 hours of sleep per day, and both insufficient sleep and oversleeping can contribute to poor health outcomes. ¹⁵ People who get insufficient sleep on a regular basis are at increased risk for obesity, hypertension, diabetes, cardiovascular disease, and cancer.^16–19 In addition to the physical implications of poor sleep, it is also a contributor to cognitive impairment and poor mental health outcomes. Conditions like depression, anxiety, suicidality, substance use, and aggression can all be influenced by poor sleep health.^20–22 Poor sleep health can also complicate preexisting physical and mental health conditions.^23,24

Sleep hygiene among incarcerated people

Research on sleep among incarcerated people has mainly been conducted outside of the United States and has primarily focused on quantitative analyses of men’s sleep outcomes. Using validated standardized questionnaires, multiple studies have documented rates of insomnia, poor sleep quality, and short sleep duration in carceral facilities that are two to four times higher than rates in the general community. ²⁵ Qualitative studies of prison sleep are sparse but compelling. For example, Elumn et al. analyzed data from semi-structured interviews with 20 formerly incarcerated men conducted as part of a study about trauma and healthcare during and after incarceration. ²⁶ While specific questions about sleep were not part of the interview instrument, discussion about the topic was frequently raised by participants. Participants attributed their sleep problems during incarceration to their concerns about healthcare, lack of access to sleep disorder treatments, and anxiety about personal safety. ²⁶ They described experiencing nightmares, fearing they would be assaulted while they were asleep, and being kept awake with concerns about their untreated chronic health conditions. In another qualitative inquiry, O’Mara and Bonser conducted an ethnography, followed by semi-structured interviews with staff and incarcerated men, at an English prison to learn about sleep hygiene in institutional settings. ²⁷ Participants described how the cold temperature of the prison, inadequate bedding, loss of privacy and control, and institutional schedules inhibited their sleep. ²⁷ By offering specific details about carceral circumstances that made it difficult for incarcerated men to sleep, these qualitative studies offer valuable insight into prison life that can inform the development of interventions to improve the sleep conditions of incarcerated people.

Few articles about sleep hygiene in prison have focused specifically on incarcerated women. The topic of sleep among incarcerated women has been raised in research about other subjects. For example, an article about the challenges of menopause in prison mentions that women may have trouble sleeping during this hormonal transition. ²⁸ Sleep also appears in the literature as a dependent variable in program evaluation. For example, Ferszt et al. measured the impact of a mindfulness program with incarcerated women on several health outcomes, including the sleep quality scores. ²⁹ Quantitative research that includes both men and women suggests that incarcerated women may have higher rates of insomnia and poorer sleep quality than men.^25,30

Two articles that explicitly study women’s sleep experiences in prison include Tussey et al. and Harner and Budescu.^31,32 Tussy et al. administered a quantitative sleep survey to a random sample of 176 women incarcerated in two Idaho jails. ³¹ Most of the participants had poor sleep quality (76%) and insomnia (70%); 40.2% reported sleeping less than 6 hours a night. Depression and post-traumatic stress disorder (PTSD) symptoms were both significantly related to these sleep problems. In response to an open-ended survey question about factors that inhibited their sleep, “participants indicated that they had trouble sleeping in jail due to excessive noise, inadequate or uncomfortable bedding, lights, mental health symptoms, or withdrawal from substances.” ³¹ Similarly, a survey of 438 women in a maximum-security prison found high levels of poor sleep quality (72%) that was associated with PTSD, depression, and anxiety. ³² Participants attributed their sleep problems to “racing thoughts/worry/thinking about things, environmental noise and other factors, physical health conditions/pain, nightmares and flashbacks, and not taking sleep medication.” ³² In their responses, women described ruminating about experiences of interpersonal violence (e.g., their child’s murder), being woken by staff flashlights, keys, and radios, and managing chronic pain, hunger, and night sweats, while laying on thin dirty plastic mats and pillows. ³²

Existing research suggests that incarcerated women’s sleep health is a significant problem. Most women in these studies report poor sleep quality and insomnia, conditions which can have serious short- and long-term health consequences. To improve the health of incarcerated women, more information is needed about this phenomenon. Specifically, greater detail about the physical and social sleep environment in women’s prisons can inform institutional operations, prison research, and health interventions.

Methods

To build on the existing literature about sleep in carceral facilities and expand understanding about the physical and social sleep environment in women’s prisons, this article presents findings from a qualitative study conducted in the Southeast region of the United States about life in a women’s state prison. This inquiry was undertaken by two social work researchers who work as faculty members at universities in the United States. Each researcher has over 20 years of social work practice and research experience with justice-involved people. The project was a collaboration with a local community-based organization that provides programming for incarcerated women and re-entry support and housing for women after incarceration.

In March 2022, semi-structured individual interviews were conducted by the first author with nine formerly incarcerated women. To be eligible for the study, women had to be formerly incarcerated women who were current or previous clients of the collaborating community-based partner organization. Interviews, which were conducted in a private office at the agency or at a private room in the local public library, were audio-recorded, transcribed, and uploaded to a cloud-based qualitative data management program (Dedoose; SocioCultural Research Consultants, Redondo Beach, USA) for analysis. ³³ The interviews lasted 60–90 min, and participants were compensated $40 for their time. Written informed consent was administered to all participants prior to beginning the interview. During the transcription process, all identifying information (e.g., names, locations, dates) were removed from the data. Names were replaced with pseudonyms that had been chosen by the participants. The protocol was reviewed and approved by the Institutional Review Board at the first author’s university (Protocol #610). We did not follow EQUATOR or any other prescriptive research guidelines or statement.

The interview instrument used in this study included 10 questions about food and eating in prison and 8 questions about toileting practices (Instrument provided as Supplemental Material). To begin the interview, participants were asked “Tell me about a typical day in the prison.” This line of questioning was designed to invite conversation about women’s quotidian lives inside the prison. The interview encouraged women to reflect upon the micro-activities of their daily routines and habits, including the many sights, sounds, tastes, smells, and feelings of incarceration. This discussion about prison life generated information about sleeping patterns and experiences, even though there were no questions in the interview instrument on this specific topic. For example, in response to the first question about a “typical day,” participants described when they woke up, what time they went to sleep, and what it was like to sleep in the prison. Sleep was also raised in response to question about food and bathroom practices: Women reported that hunger or the need to urinate at night could make it difficult to sleep.

In November 2022, after the nine interviews were transcribed and preliminary analysis of the data had been conducted, the first and second authors facilitated a Member Reflection focus group at the community-based organization.^34,35 Group participants included four formerly incarcerated women who were current clients with the organization, including one woman who had participated in an individual interview in March, and the executive director of the organization. The purpose of this group was to share the preliminary findings and gather feedback from this expert community about the analysis. During this discussion, clients shared their own personal experiences which served to confirm, interrogate, or expand upon the preliminary analysis. Prior to beginning the group, written informed consent was administered. The group discussion was recorded, transcribed (including de-identification), and uploaded to Dedoose. Participants chose their own pseudonyms and were compensated $40 for their time.

For this analysis, the interview and focus group data was reviewed in Dedoose by the first author and all discussion related to sleep or sleeplessness was coded as “sleep.” The result was 46 excerpts, including responses from all individual interview and Member Reflection group participants. Next, the data were exported to Excel for further analysis by the first and second authors.

Topical and thematic analysis of these excerpts was conducted by the authors to assign meaning to the participants’ narratives about their sleep experiences.^36–38 Following the steps set forth by Braun and Clark, ³⁶ the first author read through the data that had been coded “sleep” to re-familiarize herself with the data and notice her reaction to the data and the ideas that the data generated in her mind. She took note of her initial coding ideas and how these codes might fit together into coherent themes. Next, she used these topics and themes to code the data, noticing the extent to which participants’ narratives aligned with, endorsed, or disrupted these categories. This analysis was presented to the second author who reviewed the data and discussed the themes and topics with the first author. Topics and themes related to the physical and social sleep environment, including meals and showers, work and school, and virtue signaling, are presented here.

Results

Demographics

Nine cisgender women participated in the individual interviews (see Table 1). The sample included participants who identified as White (n = 4), African American (n = 4), Native American (n = 1), lesbian/gay (n = 4), and straight/heterosexual (n = 4). None of the women identified as Hispanic or Latina. One participant declined to describe her sexual orientation. Participants ranged in age from 34 to 48 years old, with average age of 40 years old. All the women had been incarcerated one time, except for one participant who was incarcerated two times. Their sentences ranged from to 1 to 20 years (mean = 7 years). Four cisgender women participated in the focus group, including one person who had also completed an individual interview. Demographic information was not collected from focus group participants, but data about identity that they shared during the group conversation has been included in Table 1.

Table 1.

Description of sample.

Pseudonym	Age	Race	Gender	Sexual orientation	Total years incarcerated	Participation
Ramona	41	White	Cis female	Heterosexual	1.5	Interview
Leah	41	Native American	Cis female	Lesbian	11	Interview
Jules	48	African American	Cis female	Lesbian	20	Interview
Imani	a	African American	Cis female	a	14	Interview
Anne	34	White	Cis female	Lesbian	2	Interview
Sonja	41	African American	Cis female	Gay	2	Interview
Kelly	34	White	Cis female	Heterosexual	1	Interview, Focus Group
Eboni	42	African American	Cis female	Heterosexual	2	Interview
Beth	42	White	Cis female	Heterosexual	12	Interview
Tami	a	a	Cis female	a	a	Focus group
Kathy	a	a	Cis female	a	20	Focus group
Crystal	a	a	Cis female	a	13	Focus group

a

Information not collected.

Physical and social sleep environment

Research has described the geographies of carceral space and the ways in which the architecture, noise, and light of correctional institutions shape the lives and sensory experiences of incarcerated people.^39,40 Participants’ narratives about the physical and social sleep environment in the prison’s dorms, large rooms where 100–150 women slept on bunk beds, align with these complex understandings of the myriad factors that construct place. Given the number of people living in each dorm, the room was loud and the site of constant commotion, even during the evening hours. Ramona, who was incarcerated for 18 months, remembered chaotic moments with little staff supervision:

One day I’m asleep and I watch this other girl hit this one girl and, freaking, like, they fell over the bed and rolled off my, my, the bed and under me and, somehow or another ended up back on the other bed, they rolled over like two or three beds fighting. And I was like, oh my gosh. You know, of course the officers, they, they really don’t care and like, they’ll come in, but everybody will be like, oh, it’s okay. It’s okay. And so, they’ll just turn around and walk back out and let whatever’s gonna happen happen, you know?

In addition to these interpersonal dynamics and disputes, women reported that the dorm lighting made sleep difficult. In this facility, half of the ceiling lights were kept on all night long: the side of the room which was lit would alternate each night.

It’s horrible because they leave certain lights on and everybody fights about what side of the lights are supposed to be on for the night because, if you’re on this side, you know, and you’ve got a light over you, well, that light is gonna shine on, on right over top of you, you know? And it’s, it is, it’s really hard to sleep like that. (Ramona)

Women collaborated with each other to come up with solutions to manage the “sensory penalties” of the prison space. ³⁹

We put black garbage bags up over our lights and they never did say anything about it. And what’s really crazy is about two or three days after we put black garbage bags over the lights, the one bulb that stayed in the, the middle blowed [out]. So we had, it was completely dark back there where we was at. It wasn’t for the rest of the dorm, but you know, it was great. (Ramona)

Similarly, Beth, who served 12 years, recalled how she and her friends pushed their beds together to create a pod at the edge of the room that afforded them some privacy and calm. Through these partnerships, friendships were forged:

You always have somebody in your dorm that you’re close to or that you’re friends with. So, y’all go eat together, that was about it. Some of them slept close to you. Some of ‘em went to school with you. Some of them you just related to. Some of ‘em you just hit it off instantly and you knew that was gonna be your buddy. (Leah)

The fact that sleeping “close to you” is included in a list of activities that built relationships, along with eating, going to school, and talking, reflects the social character of sleeping in this environment.

Morning meals and showers

The institution schedule was another dimension of the prison’s social environment that shaped women’s sleeping behaviors. At 10:00 pm, women were required to be on their beds for the night. Six to 7 h later (between 4:30 am and 5:30 am) staff woke the dorm for breakfast.

Five o’clock in the morning. . .. They’d [staff] come over the loudspeaker or they would come by our beds and hit our bed with keys just at different ways. . .just to wake ‘em up, just to start our day. (Kelly)

The decision about whether or not to go to breakfast played a key role in determining women’s sleep schedule. Imani reported that she would make the effort to get up early because she considered breakfast to be the best meal of the day.

I always got up for breakfast. Cause it’s like at breakfast you can least eat one thing on the tray, it might be some eggs, or it might be some grits. I normally didn’t like grits, so I would eat the eggs and maybe a biscuit. And that would hold me over.

Alternatively, Crystal choose to forgo breakfast and sleep until dorm inspection at 8:00 am.

As a rule of thumb every day I didn’t, I didn’t go to breakfast. . .. I didn’t wanna get up. The lights come on at five o’clock so you’re like, you know, okay I got like three hours until dorm inspection or whatever. . .. I can’t speak for anybody else but for me I would wake up for a very short time, when the lights first come on, or whatever. But once they come on, you know, you get adjusted to it. Yeah. [I would go back to] sleep you get used to it. . .

Leah woke up early, but generally chose to skip the cafeteria and use the time when others were at breakfast to shower and get ready for her day:

I never went to breakfast but I would get up at 5, 5:30 every day, get my shower, get ready for school and be out there, lined up to go to school at seven o’clock that morning. . .. You, you just wouldn’t [go to breakfast] ‘cause you wanted to get all the sleep you could get. I mean, we barely got in sleep anyways because you know, the officers, like they would wake us up throughout the night sometimes doing shakedowns and you know, it was very hard to sleep in there.

This narrative, ostensibly about breakfast, reveals her desire to “get all the sleep” she could in the face of the officers’ actions that would “wake us up throughout the night.” As Leah reports, “getting my shower” was an activity that conflicted with sleep in the context of the prison’s morning schedule.

Beth explained how the women “worked together” to maximize sleep time and still get a shower: “We all worked together. And so just say, if I was behind [Sara] for shower, she would send somebody to get me and say, ‘Hey, you need to get up. [Sara]’s supposed to get outta the shower.’” Leah also reported that women who skipped breakfast helped each other by sharing commissary snacks: “A lot of times, if you were really close to somebody, somebody will give you something, they would give you a soup or something out of their box that they had or something like that.”

On the weekends, the institutional meal schedule was slightly different, which allowed women “to enjoy sleeping in.”

Now weekends is different. Cause that’s, that’s our down time. . . they don’t do the lights at five o’clock in the morning on Saturday and Sunday. And a lot of people take that time to enjoy sleeping in. Usually everybody goes to breakfast on Sunday ‘cause you only get fed twice a day. (Tami)

While the weekend brunch time was only an hour later than the weekday breakfast, this later start gave the weekends a more leisurely feel. This shift illustrates the ways in which time is socially constructed: the 60-min delay in wake-up time seemed significantly later by virtue of the fact that it was “different” and people can “enjoy sleeping in” and still have a morning meal.

Work and school

Work and school schedules also impacted when women’s sleep behaviors. Start times for work and school varied. For example, Imani described waking up “real early” to eat breakfast before going to school: “You’d get up real early, get up about four to go to breakfast. And I would get bus to trade school. I would go up the hill to trade school every day. That was my day.” Factory laborers, who had to be on the job by 6:00 am, reported waking up around 5:00 am. Morning meal kitchen workers had an even earlier rise, waking up at 2:00 am to begin their shift at 3:00 am.

Ebony, who did not have these commitments, described how she could have slept through the morning wake-up call, but chose to “get up” in order to follow with the community’s schedule:

You don’t get used to noise and stuff [of others getting up for breakfast and activities], but as time goes, if you’re sitting there, you get used to, you able to sleep through it, but you get up. Cause you got people getting up, getting ready for work and stuff like that. You get up probably about eight o’clock. I’d get up and drink me a cup of coffee and I would try to get me like a state job to keep my day going.

In this narrative, Ebony described a process of fitful waking: hearing noise, waking up, going back to sleep, waking up again, having a coffee, and settling into a day where “there was nothing to do.” While she did not have a work schedule that required waking up, she tended to “get up” with her peers “cause you got people getting up.”

In the early afternoon, around 2:00 pm, participants reported that women would begin to come back to the dorm from work and school. The afternoon hours were unstructured, with some optional classes, and many women “end up going to sleep.”

Most of the time I would finish my school at two o’clock and then I’d be free. So, I’d end up, end up going to sleep. You just have time to yourself. At four, I always shower. And then, after that, it’s either you sit and watch TV or read. (Kelly)

Similarly, Beth shared she would be “too tired” to do much in the afternoon:

Usually if you’re gonna write letters home or whatever, read a book, you can watch TV, play dominoes, talk with a friend, whatever. Just hang out. . .. Honestly, me being on my feet, I would be too tired. I would be too tired.

The institutional schedule, that required them to wake up early in order to eat, shower, and be on time to work and school, combined with the overstimulation of the crowded, loud, and bright dorms, and the stressors of “being on my feet” all day left women feeling “too tired” at the end of the day to do anything. Participants, especially those who got up extra early for work, reported going to sleep before the official “lights out” at 10:00 pm because they were so exhausted.

Virtue signaling

While waking up early left women feeling exhausted by days end, participants’ narratives constructed waking up early as a positive behavior, worthy of admiration and respect. Crystal spoke about “long timers” who kept an early morning routine:

There’s people that get up and go to work, they have a schedule that they adhere to. They’ll get up probably about 2:00 or 2:30 in the morning when they know they have to be at work or school or whatever. That way they can go in there and get their shower and go eat and everything and so forth and so on. You come to have an internal alarm clock where you know when you get up and other people respect that. . .. You can bank on it every day, which people are gonna be in that shower at two o’clock in the morning. It’s the same people every day. And the other inmates give them respect because that’s their thing. That’s their schedule. . .

In this narrative, Crystal offers respect to people who have an “internal alarm clock” and “schedule that they adhere to.” This group is reliable; their schedule and performance of work, school, shower, and meals is something “you can bank on.” For some, the prison schedule aligns with their pre-incarceration routines: “I was already accustomed to waking up early, so I was already up, so I just went ahead” (Jules). For others, the early morning routine represents a new meritorious choice: “I did work at the factory. And so I did have to get up early, So I would have to get up at like five o’clock, get showered or, I didn’t have to, but I chose to” (Beth).

When asked about how the prison experience had shaped her life after release, Imani replied:

I get up at 3:00 am. So I kept a lot of the good things I learned in prison and that’s, I don’t understand a lot of people when they get out, they don’t want to do nothing they done in prison. They don’t read ‘cause they reminds them of prison. It is just a, but me, I just kept up with, you know, the good stuff I learned in prison.

Here Imani explicitly stated that getting up at 3:00 am was one of the “good things I learned in prison.” Similarly, Tami boasted that she since her release from prison she has been waking up without an alarm clock at 3:30 am. When asked if this early wake-up reflected her time in prison, she responded: “Yeah. Cause I used to not [wake up so early] . . . [Today] I set an alarm but most times I beat my alarm.” With this language of “beating” the alarm, Tami suggests that she is winning, that the automatic early wake-up is a good thing. In these narratives about waking up early, Crystal, Jules, Beth, Imani, and Tami signal to themselves and others that the “early risers” are reliable, productive, and good people.

Discussion

Knowledge about the social and physical sleep environment in correctional facilities is critical to understanding women’s experience of incarceration and the impact of this experience on their health and psychosocial outcomes. The prison’s strict meal and activity schedules limited women’s sleep, especially in the morning hours. At the same time, lack of nighttime supervision in the dorms produced noise and uncertainty that was a barrier to sleep. In short, participants’ narratives describe a sleep environment that was simultaneously rigid and disorderly, and largely out of their control. Nevertheless, within the narrow range of possibilities that were available, women worked together to claw back some modicum of control over their circumstances.

These narratives describe how women collaborated with each other to create time and space for sleep. Peer support was key to women’s ability to maximize sleep while also accessing showers and food during the morning rush. While Beth’s remarks about the shower suggests that women “all worked together,” Leah’s description of sharing commissary snacks underscores the importance of social relationships. By her telling, food support was reserved for those who were “really close to somebody.” Similarly, when Ramona described how she worked with peers to alter the harsh lights by draping black plastic over the ceiling lights, she admitted that while the strategy helped her group, it was not a benefit “for the rest of the dorm.” Beth described how she and her friends moved their bunks together to create a pod to protect themselves against intrusion from staff and other women. In short, these descriptions of prison life suggest that access to tools that improved and extended sleep opportunities (shower reservations, commissary snacks, dimmed lights, sleep pods) was moderated by the strength and resources of women’s social networks.

The structural violence of everyday prison life is also represented in these narratives. Prison policy, agents, and the physical environment were portrayed as hostile. Staff did little to address the interpersonal conflicts that arose in the dorm’s tight quarters and institutional protocols required staff to leave lights on at night and wake women up for security checks: “They [the officers] really don’t care” (Ramona). The participants’ descriptions of the constant light and noise generated by voices and movement, the loudspeaker, and the staff hitting their keys against the metal beds, suggest a toxic environment of continuous noise and light pollution. Required to wake up early and be on their feet all day, created an exhausting grind. However, there were moments when the regime softened: the weekend brunch schedule that allowed women to sleep an extra hour was greatly appreciated. This brunch policy illustrates how marginal changes can shift the prison sleep environment in positive ways.

Participants’ narratives about the respect that was earned by people who were able to get up early and go to work illustrates the ways in which prison norms shape sleep practices. American author, philosopher, and scientist Benjamin Frankin (1706–1790) is credited with the writing the proverb, “Early to bed, early to rise, makes a man (sic) healthy, wealthy, and wise” in the Poor Richard’s Almanac in 1736. ⁴¹ This phrase represents a glorification of waking up early that persists in contemporary U.S. society. While research has shown no association between health, economic, or intellectual outcomes and the time in which one wakes up, ⁴² getting out of bed early in the morning to go to work still carries positive connotations. Similarly, in these narratives about prison life, early risers were held in high esteem. Women offered examples of their early morning practices as a demonstration of their own virtue. Having an internal alarm clock that woke them up at 3:00 am to report to a job at 5:00 am was considered a “good thing.” While it is possible that these early risers go to sleep at 8:00 pm and get adequate sleep, this is unlikely, especially in this prison setting where the dorm does not transition to nighttime until 10:00 pm. In these ways, institutional practices and norms within the prison create an environment which normalizes, and even encourages, poor sleep hygiene.

Limitations

There are several limitations to this analysis. One, the sample size is quite small. With only 12 participants, all of whom were active participants in a re-entry program, the generalizability of the data is limited. Two, all the participants were incarcerated in the same correctional facility, so the description may not be relevant to other institutions. Three, because the study was not specifically designed to elicit information about sleep, there were no questions about this topic in the instrument. An interview instrument designed to build knowledge about sleep in correctional facilities would have questions about the topic that would gather more detailed information. Four, given the inductive nature of the sleep findings, the size of the sample, and the interview instrument, saturation on the topic of incarcerated women’s experiences with sleep was not considered a goal for this inquiry. For these reasons, the analysis is not comprehensive or exhaustive. However, given the lack of information about incarcerated women’s sleep experiences, the analysis offers an important glimpse of the issue that can inform and inspire future inquiries.

Conclusions

These findings can inform carceral practices and research to improve the health of incarcerated and formerly incarcerated women. One, this explication of the prison’s physical and social sleep environment invites interrogation and modification of the carceral environment. Findings illustrate how even minor changes in lighting, dorm configuration, and facility schedules can improve the prison’s sleep environment. Education about sleep hygiene is a critical part of this conversation as prison administrators, staff, and incarcerated women may be unaware of the impact of poor sleep on individuals’ physical and mental health outcomes. Understanding of the long-term health impacts of bright lights, loud nights, interrupted sleep, and early morning wake-ups may bring a greater urgency and legitimacy to institutional reforms and guide the self-care and peer support strategies employed by incarcerated women.

Two, research about incarcerated women’s sleep habits and behaviors can inform the translation and implementation of individualized sleep hygiene interventions, including cognitive behavioral therapy for insomnia, sleep hygiene education, mindfulness and relaxation techniques, and medications for sleep disorder treatment, during and after incarceration.^29,43,44 Tools that boost sleep hygiene, like sound machines, ergonomic pillows, and adequate window coverings could be provided by halfway houses and other re-entry services providers to help formerly incarcerated women (re)establish healthy sleeping behaviors. ⁴⁵ Research with incarcerated people consistently centers men, and knowledge is needed about the unique physiological and psychosocial factors that impact women’s sleep health.^3,13,46,47

Three, this project encourages qualitative research about women’s lived experiences of incarceration that center their nighttime experiences. Ethnography about prison life has focused on daytime experiences, in part because most outsider visits, including research observations, happen during the day. ⁴⁸ Less is known about what happens during the “third shift.” Nascent research about prison nights sheds light on the vulnerabilities that surface in the quiet and isolation of night, and on overlooked forms of structural violence, including the practice of waking people up on a regular basis for security checks.^48,49 Projects that invite incarcerated women to keep journals about nighttime activity and conduct analysis of nighttime staffing records and medical calls could help to expand knowledge about these evening hours.

This exploratory project raises more questions than answers about the physical and social sleep environment in a women’s prison. What is clear from this work, and prior research on prison sleep and night, is that prisons and jails never sleep. Security checks are conducted, transfers and intakes occur, and incarcerated people are engaging with self and others. The ability of incarcerated people to fall asleep, stay asleep, and wake up rested is shaped by the physical and social environment. Qualitative inquiry about the prison sleep environment of incarcerated women brings attention to an understudied issue and expands knowledge about prison as a structural determinant of women’s health and psychosocial outcomes.

Supplemental Material

sj-pdf-1-whe-10.1177_17455057261425469 – Supplemental material for Physical and social sleep environment of a women’s prison: A qualitative exploration

Supplemental material, sj-pdf-1-whe-10.1177_17455057261425469 for Physical and social sleep environment of a women’s prison: A qualitative exploration by Amy B. Smoyer and Johanna E. Elumn in Women's Health