The complex relationship between sleep, cognitive functioning, and emotional well-being has garnered increasing attention, particularly within high-stress occupational environments characterized by elevated psychological demands (1). In high-pressure occupational settings, job demands often exceeded individuals’ coping resources, creating a persistent imbalance (2). These environments were characterized by high workloads, critical decision-making responsibilities, emotional exhaustion, and unpredictability. High-pressure professionals referred to those who worked long-term in such environments and typically needed exceptional emotional resilience and cognitive sharpness to handle these challenges (3). Professions such as those in healthcare, law enforcement, aviation, and emergency response require exceptional emotional resilience and cognitive acuity to navigate high-stakes scenarios high-stakes environments (4). An essential element supporting these attributes is emotional intelligence (EI), which encompasses the capacity to recognize, understand, and manage not only one’s emotions but also the emotions of others (5). This construct is critical for maintaining interpersonal interactions and decision-making processes under stress (6).

EI was a core resource for effective stress management. Individuals with high EI could more accurately assess stressors and use emotion regulation strategies to alleviate anxiety and frustration, thereby maintaining the availability of cognitive resources (7). This was particularly important for making clear decisions in critical situations. In professions that heavily relied on teamwork, such as medical teams and rescue groups, accurately interpreting nonverbal emotional cues from colleagues and service recipients, such as patients or the public, formed the foundation for building trust, effective communication, and collaborative problem-solving (8). Additionally, self-emotion management helped prevent impulsive behavior and emotional exhaustion under stress, which was crucial for maintaining professional integrity and personal mental health (9). Therefore, this construct played a vital role in sustaining effective interpersonal interactions and decision-making processes under pressure.

Ironically, individuals in such professions often predispose individuals to poor sleep patterns due to irregular shifts, prolonged working hours, and chronic exposure to occupational stressors (10). The concept of “poor sleep patterns” was complex and primarily caused by occupational characteristics, manifesting as disruptions in the sleep-wake cycle (11). Specifically, this included irregular sleep timing, such as daytime sleep due to shift work, insufficient sleep duration due to long working hours or being on call, and low sleep efficiency, which refers to difficulty falling or staying asleep because of psychophysiological arousal or external disturbances. For example, a firefighter returning from a late-night emergency call might find it difficult to fall asleep quickly afterward, despite physical exhaustion, because of heightened alertness following the incident. Sleep deprivation and poor sleep quality are well-documented to impair cognitive functions and emotional regulation, thereby undermining the EI essential to optimal job performance (12). Research data further highlighted the prevalence and severity of this issue. International studies showed that the prevalence of insomnia symptoms among healthcare professionals ranged from 30% to 70%, significantly higher than in the general population (13). Domestic regional studies also pointed to similar findings. For example, a survey of police officers in a certain province found that over 50% of respondents experienced sleep quality issues as assessed by the Pittsburgh Sleep Quality Index (PSQI) (14). The main contributing factors included workload, shift work, and psychological stress. Despite the prevalence of sleep-related disturbances in high-stress professions, therapeutic interventions targeting sleep quality, specifically their impact on EI, are not extensively studied (15). Addressing this gap, sleep therapy (ST) emerges as a promising intervention due to its focus on optimizing sleep duration and efficiency through the regulation of sleep-wake cycles and the consolidation of restful periods.

ST was a behavioral intervention based on sleep timing and limitation principles. Its core involved systematically adjusting time in bed to better match an individual’s actual sleep needs, thereby consolidating sleep and improving sleep efficiency (16). Participants recorded sleep diaries to calculate the average weekly sleep efficiency (sleep time divided by time in bed multiplied by 100%). Based on preset efficiency thresholds, bedtime was dynamically adjusted: if the efficiency met the standard, bedtime was slightly advanced; if it was too high, it remained unchanged; if it was too low, bedtime was delayed. This method aimed to rebuild a stable and efficient sleep-wake cycle through behavioral shaping. ST’s potential benefits stem from its ability to instigate a more structured sleep pattern, thereby alleviating the cognitive and emotional deficits associated with sleep deprivation (17). The restoration of sleep has been linked to enhance the prefrontal cortex’s functioning, a brain region integral to emotional regulation and decision-making (18). Furthermore, improved sleep quality has been linked to better mood regulation, reduced anxiety and depression symptoms, and more adaptive social functioning, all of which are components closely tied to EI.

Previous studies have largely concentrated on the physiological consequences of inadequate sleep, while relatively few studies have addressed its psychological and emotional impacts within occupational contexts (19). This knowledge gap calls for the need for targeted investigations into the efficacy of sleep interventions like ST within these fields, alongside an exploration of factors influencing their efficacy.

This study aims to investigate the impact of ST on EI among individuals engaged in high-stress occupations. It evaluates the therapy’s effectiveness and the various factors that may affect outcomes. Furthermore, we aim to identify baseline characteristics and behavioral factors, such as adherence to the therapy and initial psychological well-being, that might modulate the therapeutic benefits of ST.

In the emerging field of occupational health, particularly within high-stress professions, the intersection of sleep quality and EI presents a fascinating and critical area of study for investigation. Our study, which explored the impact of ST on EI among individuals in such high-pressure roles, revealed significant post-intervention improvements in emotional intelligence. Furthermore, it identified a range of interrelated factors contributing to the therapy’s overall effectiveness.

The observed benefits of ST are consistent with a study during the chronic stress of the COVID-19 pandemic, which showed that high-quality sleep provides a foundation for adaptive cognitive-emotional regulation strategies by maintaining good executive function, helping individuals resist depression and anxiety, thus directly supporting the notion that improved sleep facilitates emotional regulation (30). The mechanism behind this relationship is likely related to the restorative functions of sleep, which play a critical role in modulating brain regions involved in emotional processing such as the prefrontal cortex and the amygdala (31). By promoting better quality sleep, ST may help optimize the functioning of these neural substrates, thereby enhancing core dimensions of EI, including self-awareness, emotional control, and interpersonal empathy (32).

A particularly notable outcome of our findings was the significant enhancement in self-emotion assessment, regulation, and utilization, highlighting the critical role of sleep in nurturing intrapersonal emotional competencies. This improvement was comparable to that achieved through mindfulness interventions in teacher populations, although our intervention period was shorter (33). Sleep insufficiency is known to impair emotional regulation and increase emotional reactivity, primarily due to altered activity in neuroregulatory circuits. ST, by alleviating these sleep-related disruptions, seems to facilitate an increased ability to understand and modulate one’s emotions (34). This improvement could be essential for individuals in high-stress occupations where emotional resilience is of primary relevance for sustaining professional performance and psychological stability.

Moreover, the specific increase in ‘evaluation of others’ emotions’ following ST may reflect enhanced interpersonal EI. Sleep impacted social interactions, previous studies demonstrated that sleep deprivation not only heightened perceptions of social threats but also directly impaired various aspects of empathy, such as empathic concern, perspective-taking ability, and empathic sensitivity (35). The self-regulatory benefits of ST might reduce such biases, thereby improving the ability to accurately perceive and interpret the emotional states of others. This finding complemented the results of studies using the “mind-reading” task, which demonstrated that sleep deprivation impaired individuals’ ability to recognize others’ emotional states (36). Our intervention, on the other hand, provided evidence from a positive perspective, showing that sleep restoration enhanced this ability. This capacity is particularly essential in professions such as healthcare and law enforcement, where human interactions are frequent and intense (37).

Our study further highlights adherence as a major factor influencing the success of ST. This finding aligns with established behavioral intervention literature, where consistent engagement with prescribed strategies often dictates therapeutic success. We observed that approximately one-third of the participants did not fully adhere to the intervention, a phenomenon worthy of further exploration. The relatively low rate of full adherence in the study could be attributed to multiple factors. First, the inherent characteristics of the participants’ professions, such as unpredictable work schedules, frequent night shifts, and emergency tasks, conflicted with the structured and regular sleep-wake routines required by ST (38). Second, sleep restriction, a core component of ST, often led to increased subjective sleepiness and fatigue during the initial stages, which might reduce participants’ motivation and perceived efficacy, thereby hindering their continued adherence (39). Additionally, individual factors such as lower baseline self-esteem and higher anxiety levels, known predictors of poorer outcomes, likely contributed to reduced self-efficacy and persistence in adhering to the behavioral protocol (40). It highlights the necessity for supporting strategies to enhance adherence among participants, such as behavioral coaching or the incorporation of feedback mechanisms in therapy design. Importantly, adherence as a predictor of therapeutic success is consistent with broader behavioral intervention frameworks, where fidelity to regimen is often a determinant of efficacy.

Interestingly, baseline sleep quality, as indicated by the PSQI, is a robust predictor of treatment outcomes. Individuals with poorer initial sleep may experience greater barriers to benefiting from ST. This is an important consideration for clinicians, as it emphasizes the need for personalized treatment plans that might involve complementary interventions. Future clinical practice could consider combining ST with other evidence-supported interventions (41). For instance, cognitive behavioral therapy for insomnia helped address persistent sleep-related thoughts and behaviors. Mindfulness-based interventions or acceptance and commitment therapy improved awareness and acceptance of nighttime awakenings and negative emotions (42). Sleep hygiene education laid the groundwork for behavioral changes (43). Additionally, methods such as light therapy for shift workers and music therapy could serve as beneficial supplements, depending on individual needs and the source of their sleep issues.

The moderating role of baseline mental health, particularly anxiety, was another key finding. Elevated anxiety levels were associated with diminished therapeutic gains, echoing existing literature which highlights the bidirectional interplay between psychological distress and sleep dysfunction. Emotional disorders can impair sleep and hinder the benefits of sleep interventions. Thus, embedding comprehensive mental health support within sleep-focused treatments may amplify improvements in EI.

On the other hand, higher self-esteem emerged as a predictor of positive therapeutic outcomes. This relationship underlines the role self-perception plays in health behavior and intervention responsiveness. Individuals with higher self-esteem may present better coping strategies and a positive outlook that enhance their engagement with and responses to therapy (44). This finding aligned with studies in the field of chronic disease management, which consistently reported that high self-esteem was a predictor of better self-management behaviors among patients (45). This suggests that initial assessments of self-esteem may inform the tailoring of interventions, perhaps by incorporating elements that build self-efficacy alongside traditional sleep therapies.

Finally, our study points to the important contributions of physical health and health-related quality of life as factors influencing the efficacy of ST in enhancing EI. This finding may be explained by the bi-directional relationship between physical health and sleep quality, where poor physical health exacerbates sleep problems, potentially blunting the effects of sleep treatments (46). The protective effect of superior physical health on ST outcomes highlights the benefits of adopting a holistic approach that considers physical health maintenance as part of an integrated intervention strategy, promoting overall well-being and maximizing therapeutic outcomes.

Despite these valuable insights, our study has some limitations. First, our study design relied on self-reported data collected through questionnaires, which are inherently subject to various biases, such as recall bias and social desirability bias. In addition, the study was conducted within a specific cohort with certain demographic and occupational characteristics, potentially limiting the generalizability of our findings to other populations or occupational settings. Furthermore, potential confounding factors such as individual resilience traits, lifestyle variables (e.g., diet, exercise), and concurrent stress exposures were not controlled, possibly influencing both sleep quality and EI. Finally, the absence of a randomized control group limits the ability to draw causal inferences from our findings. Future studies should aim to address these limitations by employing prospective, randomized controlled designs and incorporating a broader range of influencing factors.

Future research could explore comprehensive treatment methods that combine sleep optimization strategies with support measures to enhance psychological resilience and physical health. This holistic approach includes personalized sleep optimization plans, such as CBT-I based on individual baseline sleep quality assessments or improvements in sleep hygiene; psychological resilience training, which employs mindfulness training, emotion regulation techniques, and stress management courses to help individuals better cope with stress; healthy lifestyle guidance, offering nutritional counseling, exercise plans, and advice on smoking cessation and alcohol moderation to promote overall well-being; and the development of social support systems, leveraging support from family, friends, and professional counseling to assist individuals in managing various life challenges.

This study found that sleep therapy effectively improved emotional intelligence among high-stress professionals. The effectiveness depended on treatment adherence, baseline sleep quality, and mental health. These findings had clear implications for clinical practice, future interventions should combine sleep optimization with psychological support to better enhance occupational well-being and job performance among professionals.