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Sleep problems tend to increase with age, so much so that insomnia can become entwined with other health issues among older people. This article looks at causes of sleep problems and explains how nurses can help assess their severity.
BACKGROUND: As musculoskeletal disorders are common in general populations and they therefore constitute a heavy burden to society, the identification of their determinants is important. The aim of this study was to identify dose-response associations for location-specific prevalences of musculoskeletal disorders with various physical exposures and psychosocial factors in a large group of workers. METHODS: The study was based on cross-sectional data from self-administered questionnaires filled out by 85 191 male employees in the Swedish construction industry. In addition to symptoms from nine musculoskeletal locations, the questionnaire addresses physical exposures and psychosocial factors. Logistic regression methods were used to study disorder prevalence in relation to scales of these exposures and factors. RESULTS: Compared with working rarely in a stooping or twisted posture, the odds ratio (OR) for lower back disorder with respect to often working in this posture was 3.05 [95% confidence interval (95% CI) 2.73-3.42]. The OR values for work with hands above the shoulders and for neck and shoulder disorders were 2.93 (95% CI 2.65-3.24) and 3.66 (95% CI 3.32-4.04), respectively. Among the psychosocial factors, sleeping problems and hurrying without reason were associated with symptoms in all of the body locations, the highest OR being found for neck symptoms and sleeping problems, 2.44 (95% CI 2.15-2.78). CONCLUSIONS: Work in awkward postures has strong location-specific dose-response associations. In contrast, some psychosocial factors, primarily those reflecting characteristics of individual persons, are strongly associated with symptoms in all body locations. Symptoms seem not to be associated with factors like support from workmates or supervisors or control of the work situation. All location-specific prevalence rates seem to increase strongly with age.
BACKGROUND: To describe falls in urban community elderly people and to identify factors associated with their occurrence. MATERIAL AND METHODS: Data from an age and sex stratified sample of the elderly people living in Leganes (n = 1183). Potentially associated factors are explored in bivariate analyses and a multivariate logistic regression analysis. The variables are entered into the equations in the causal order hypothesized. RESULTS: 14% of the elderly persons in Leganes reported at least a fall in the previous twelve months, 41% of them had consequences, 19% ended in hospitalization. In the bivariate analyses significant positive associations were found with being older than 65, female, widowhood, having more than six chronic conditions, functional limitations in lower extremities, disability, urinary incontinence and sleep problems. In the multivariate model independent associations were observed for females, functional limitations of the lower extremities, cognitive deficit, visual impairment, urinary incontinence and sleep problems. CONCLUSION: The frequency of falls in the elderly population in Leganes, Madrid, is approximately half of that reported in international studies using similar methodology. However, associations with known risk factors are confirmed in our population. The association between falls and difficulties in falling asleep found in this study should be confirmed by others.
One of the most popular herbal remedies for the alleviation of sleep problems is valerian. However, research into valerian is sparse, and studies differ greatly with respect to design, measures, and preparations used. This clinical study used standardized sleep EEG and psychometric tests to evaluate the clinical efficacy of a valerian preparation (Li 156). A placebo-controlled three way crossover clinical trial was completed using 16 (5 male and 11 female) sleep-disturbed participants (aged 50 to 64 years, mean age 55.9, SD 4.68). Participants slept overnight in a sleep laboratory, following a 21:00 hours dose of valerian 300 mg, valerian 600 mg, or placebo (double-blind). EEG sleep was recorded for each participant at 23:00 hours until 07:00 hours, when a psychometric evaluation was performed the morning after dose. Test periods were separated by six days washout period. Results showed no significant effect between valerian 300 mg, valerian 600 mg or placebo on any EEG parameter or psychometric measure. This suggests valerian at these doses is ineffective as an acute dose for sleep problems. However, valerian is widely used, and is traditionally sedative. Therefore, more research is required into therapeutic dose, types of valerian preparation, and the optimum period of use for therapeutic effect.
By means of standardized interviews and a self-rating scale, information was obtained from 51 dialysis patients concerning their duration of sleep, fitness, working capacity, interests, quality of life, etc. 34 of the subjects reported sleep disorders: 2 had difficulties falling asleep, 21 in sleeping through, and 11 experienced both. Severity of the sleeping problems increases with prolonged hemodialysis therapy; the same seems to apply to lack of an active lifestyle. 9 patients, apart from repeated nocturnal urination, no longer complained about sleeping problems following kidney transplantation.
STUDY DESIGN: Epidemiological review. OBJECTIVE: To evaluate sleep disturbances in the spinal cord injured. SETTING: The Clinic for Para- and Tetraplegia, Hornbaek/Copenhagen, Copenhagen University hospital, Denmark. METHODS: All patients admitted with traumatic SCI during the 20-year period 1968-1987 were reviewed. The normal population consisted of 339, 222 men and 117 women. These groups were asked to fill in the self-administered Nordic Sleep Questionnaire (NSQ) containing 21 questions. Questions were added regarding employment, smoking, alcohol, coffee or tea consumption, height and weight. The questionnaire for SCI individuals included questions about bladder emptying method, mobility, and spasms. For the SCI population age at injury, cause of injury, neurological level, and functional class were retrieved. RESULTS: Four hundred and eight SCI individuals, 331 men and 77 women, answered the NSQ corresponding to a response rate of 83.8%. Forty-seven per cent had a cervical cord lesion and about half of the population had a complete motor lesion. In comparison with the normal population the SCI individuals had greater difficulty in falling asleep, described more frequent awakenings, slept subjectively less well, were more often prescribed sleeping pills, slept more hours, took more and longer naps, and snored more and for more years. In particular, spasms, pain, paraesthesia, and troubles with voiding were claimed to be part of the sleep problems. CONCLUSION: In spite of the same average age and a higher body mass index in the normal than the SCI population, the SCI individuals showed significantly more sleep problems than the normal population.
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Sleep problems are very prevalent during childhood and may have adverse developmental impact. The efficacy of a number of cognitive-behavioral interventions for the most prevalent problems such as difficulty falling asleep and night-wakings has been repeatedly demonstrated with relatively rapid outcomes and high success rates. Preventive interventions in infancy have shown some promise in lowering the rates of sleep problems in infants of trained parents. Cognitive-behavioral interventions have also been proposed for childhood parasomnias (sleepwalking, night terrors, nightmares, and rhythmic behaviors), however, very limited research has been conducted to assess the efficacy of these interventions. Specific methodological issues, limitations and needs have been identified in the clinical literatures. These issues include: (a) integrating objective sleep assessment methods in clinical research; (b) identifying the specific curative factors of various effective interventions; (c) the absence of long-term follow-up studies for assessing relapse problems; (d) assessing the role of mode of delivery (i.e., professional consultation versus written information) in treatment efficacy; and (e) the need to expand the research on clinical interventions for the parasomnias.
Shift work has potentially adverse effects on health, particularly on sleep. The purpose of the present study was to assess sleep parameters among personnel working in oil and gas offshore installations in the Campos Basin, Rio de Janeiro, Brazil. One hundred and seventy-nine subjects were asked to complete a sleep questionnaire with multiple-choice answers. Offshore workers were divided into two groups according to their work schedule: (1) fixed daytime workers (n = 86; age: 35.8+/-9.6 yrs) and (2) shift (n = 87) or night (n = 6) workers (total n = 93; age: 37.7+/-9.7 yrs). Shift/night workers reported poor sleep more frequently than the daytime workers (20.4% vs. 1.2%, p < 0.01), as well as habitual difficulty in falling asleep (15.1% vs. 4.7%, p<0.01), long latency of sleep onset (28% vs. 7%, p<0.01), fragmented sleep (45.2% vs. 16.3%, p<0.01), short sleep episodes (44.1% vs. 16.3%, p < 0.01), irregular bedtimes (29.0% vs. 12.8%, p < 0.01), and feeling tired upon awakening (15.1% vs. 3.5%, p < 0.01). Habitual napping and loud snoring were reported twice as often in shift/night than in day workers (p < 0.01). Nightmares, somnambulism, and unpleasant feeling in the legs were equality reported by both groups (p > 0.05). Few offshore workers had sought medical help for their sleep problems. A higher number of shift/night workers reported feelings of sadness compared with day workers (26.9% vs. 9.3%, p < 0.01). The findings of this study show that subjective reports of sleep-related problems are quite common among Brazilian offshore shift workers. Reliance on self-reported sleep problems and a cross-sectional design are the main limitations of our study.
Sleep problems (i.e., insomnia) affect midlife women as they approach and pass through menopause at rates higher than at most other stages of life. The purpose of this article is to critically review what is known about insomnia (perceived poor sleep) and physiologically assessed sleep, as well as sleep-related disordered breathing (SDB), in women according to menopausal status and the role of hypothalamic-pituitary-ovarian (HPO) hormones. Self-report evidence that sleep difficulties are related to the hormonal changes of menopause is mixed. Data from studies in which sleep was physiologically measured reveal that sleep problems appear corequisite with hot flashes and sweats. Results are difficult to compare across studies because of varying methodologies in how sleep quality and patterns were assessed and how age cohorts and menopausal status were defined. The risk of SDB increases with age, although women are less susceptible at any age than men. As with men, snoring, obesity, and high blood pressure are clear risk factors. Some women may be underdiagnosed for SDB, as they have somewhat different symptom manifestations than men. Usually, frank apnea is not as evident. Primary care clinicians should be mindful of the potential for SDB in women who are obese, have high blood pressure, are cognizant of snoring, and report morning headaches and excessive daytime sleepiness. Improved care will result from consistently incorporating sleep insomnia assessments into practice as a basis for referring to sleep centers as necessary or prescribing sleep-enhancing behavioral and pharmacological treatments.
The aim of this study was to follow health-related quality of life (HRQOL) in diabetic subjects over a three-year period in relation to their medical situation. Forty-eight subjects 42-81 years of age in 1992 were identified as those responding to the HRQOL questionnaire on both occasions from a larger study of 341 diabetic patients in 1992 and 413 in 1995 in Stockholm County. Age- and sex-matched controls were taken from randomly collected samples of the general Swedish population. HRQOL was assessed by the SWED-QUAL (the Swedish Health-Related Quality of Life Survey). Medical data were extracted from medical records at community health centres. Pearson's correlation coefficient for SWED-QUAL results over time exceeded 0.60 for seven of the ten scales (p < 0.001). A significant difference between 1992 and 1995 was found only for "Physical functioning" (p < 0.01). The general deterioration in health seen in medical records was accompanied by a decrease in the "Sleep problems" scale. In conclusion, worse outcome was noted only for "Physical functioning", while deterioration in health according to medical records was related to a worse outcome with respect to "Sleep problems". However, as the sample was small and not randomly selected, the results should be interpreted with caution and need confirmation in further studies.
BACKGROUND AND PURPOSES: Sleep and nighttime behavioral disturbances are widespread in community-dwelling dementia patients, but little is known about the usefulness of behavioral interventions for treating them. This article presents data from three cases enrolled in an ongoing study of sleep problems in community-dwelling Alzheimer's disease (AD) patients: nighttime insomnia treatment and education for Alzheimer's disease. PATIENTS AND METHODS: All subjects received written materials describing age- and dementia-related changes in sleep, and standard principles of good sleep hygiene. Caregivers also received education about dementia, listings of relevant community resources, and general support. Subjects' sleep-wake activity was measured at baseline, post-test (2 months), and 6-month follow-up using an Actillume wrist-movement recorder, which was worn continuously for 1 week. RESULTS: Post-test actigraphic improvements in sleep quantity and sleep efficiency, number of nighttime awakenings, and amount of daytime sleep, as well as subjective sleep ratings were observed. One subject maintained improvements at 6-month follow-up. Subjects varied widely in the type of sleep problems reported and behavioral strategies implemented by family caregivers, illustrating the complexity that characterizes nighttime behavioral disturbances in AD. CONCLUSIONS: This paper provides clinical and empirical evidences that behavioral strategies including standard sleep hygiene recommendations can be helpful in treating sleep and nighttime behavioral disturbances in dementia patients.
STUDY OBJECTIVES: To investigate the prevalence of self-reported insomnia symptoms among Mâori (indigenous people) and non-Mâori adults in the general population of New Zealand. To explore the possible links between insomnia symptoms and ethnicity, gender, age, employment status and socio-economic deprivation. DESIGN: Mail-out survey to a stratified random sample of 4,000 people aged 20 to 59 years, selected from the electoral roll. SETTING: Nationwide survey of New Zealand adults (72.5% response rate). PARTICIPANTS: The sample design aimed for equal numbers of Mâori and non-Mâori participants, men and women, and participants in each decade of age. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Population prevalence estimates indicated that self-reported insomnia symptoms and sleeping problems were higher among Mâori than non-Mâori. Multiple logistic regression analyses identified unemployment and socioeconomic deprivation as being strongly associated to all insomnia symptoms and to reporting a sleeping problem lasting more than 6 months. CONCLUSIONS: Socioeconomic factors and ethnicity are significant independent predictors of reported insomnia symptoms. This finding has important implications for the provision of treatment services to those most in need.
Young children with sleep problems received either "standard" or graduated ignoring treatment. Both brief treatments were superior to a wait-list control condition and resulted in comparable improvements in bedtime and nighttime sleep problems. At bedtime, the treatments did not differ with respect to maternal compliance and stress. For nighttime wakings, mothers in the graduated ignoring group reported higher rates of compliance and less treatment-related stress. Maternal characteristics predicted treatment outcome in the standard ignoring condition. Following treatment, only positive side effects were observed. When compared to the wait-list group, mothers in the standard ignoring group reported less verbose discipline and decreased stress in parenting, while mothers in the graduated ignoring group reported improved parent-child relationships. Treatment gains were maintained over a 2-month follow-up period.
Sleep disorders in children are very common and their impact on emotional and cognitive functions is considerable. Clinical work necessitates an interdisciplinary access to the subject because the scope of sleep medicine is related to various medical disciplines (e.g. paediatric neurology, pulmology and child psychiatry). Although many sleep problems are seen in both children and adults diagnoses, symptoms and pathogenetic factors are quite different in the two groups. In childhood especially parent-child interactional factors and developmental aspects of the sleep architecture and the sleep-wake cycle have to be taken into account leading to different diagnostic and therapeutic approaches. In this article we focus on important developmental aspects of childrens' sleep problems. Their relationship to neurologic, paediatric and psychiatric diseases is demonstrated and finally clear indications to diagnostic procedures, especially polysomnography, are given.
OBJECTIVES: To assess the effectiveness of a workplace intervention aimed at reducing adverse psychosocial work factors (psychological demands, decision latitude, social support, and effort-reward imbalance) and mental health problems among care providers. METHODS: A quasi-experimental design with a control group was used. Pre-intervention (71% response rate), and one-year post-intervention measures (69% response rate) were collected by telephone interviews. RESULTS: One year after the intervention, there was a reduction of several adverse psychosocial factors in the experimental group, whereas no such reduction was found in the control group. However, there was a significant deterioration of decision latitude and social support from supervisors in both experimental and control groups. There was also a significant reduction in sleeping problems and work related burnout in the experimental hospital, whereas only sleeping problems decreased in the control group while both client related and personal burnout increased in this hospital. The comparison between the experimental and control groups, after adjusting for pre-intervention measures, showed a significant difference in the means of all psychosocial factors except decision latitude. All other factors were better in the experimental group. CONCLUSION: Results suggest positive effects of the intervention, even though only 12 months have passed since the beginning of the intervention. Follow up at 36 months is necessary to evaluate whether observed effects are maintained over time. In light of these results, we believe that continuing the participative process in the experimental hospital will foster the achievement of a more important reduction of adverse psychosocial factors at work. It is expected that the intensity of the intervention will be directly related to its beneficial effects. Long term effects will however depend on the willingness of management and of staff to appropriate the process of identifying what contributes to adverse psychosocial factors at work and to adopt means to reduce them.
The quality of life of people with Parkinson's disease (PD) and their carers is often made worse by impaired sleep. Sleep problems are common in PD and there are several causative factors in their aetiology including the ageing process, anti-Parkinson's disease medication, the disease process itself, and concomitant factors such as nocturia, anxiety and immobility. Non-pharmacological approaches are the most desirable method to treat sleep-related problems. The nurse can have an important role in assessing sleep, providing support, offering practical advice, and making appropriate referrals. This article will discuss the various sleep problems experienced in PD, the underlying aetiology, and the role of the nurse.
OBJECTIVES: To develop and validate a short and user-friendly questionnaire measuring psychological job strain in truck drivers. METHODS: In cooperation with an occupational physician in the Dutch road transport industry we developed items on the basis of face validity and information of existing questionnaires on the subject. These items were pilot-tested, by means of interviews, in 15 truck drivers. Study I examined the factorial structure of the initial 30-item trucker strain monitor (TSM) in a sample of 153 truck drivers. Subsequently, number of items per factor was reduced on the basis of reliability analyses (Cronbach's alpha). Study II examined construct and criterion validity of the TSM in a randomly selected group of 2,000 truck drivers, of whom 1,111 participated (adjusted response = 63%). Additionally, sensitivity and specificity were assessed by examining the ability of the TSM to identify truck drivers with or without self-reported sickness absence in the past 12 months because of psychological complaints. RESULTS: Factor analyses of the initial 30-item TSM revealed a two-factor solution. Item reduction resulted in a six-item work-related fatigue scale and four-item sleeping problems scale with high internal consistency. Results of study II confirmed the internal consistency of the TSM scales and provided support for construct and criterion validity. The composite, work-related fatigue, and sleeping problems scale had a sensitivity of 83%, 80% and 71% respectively, in identifying truck drivers with prior sickness absence because of psychological complaints. Specificity rates were 72%, 73% and 72% respectively. CONCLUSION: Despite methodological limitations, the results suggest that the TSM is a reliable and valid indicator of psychological job strain in truck drivers. In particular, the composite and work-related fatigue scale identified drivers with prior absenteeism because of psychological complaints, quite accurately. Future longitudinal research in specific sub-groups of truck drivers including both self-reported and objective psychological health measures should evidence whether (1) the distinction between two indicators of psychological job strain is useful, and whether (2) the TSM can be used in screening out truck drivers at risk of developing psychological health problems.