The effect of acupressure on quality of sleep in Iranian elderly nursing home residents
Introduction
Sleep, as a vital component of human life, is a dynamic and a complex rhythmic state that may be affected by the normal aging process. Many studies have reported that more than 50% of community-dwelling people aged 65 or older experience sleep disturbances.1 This problem is magnified (more common) among elders living in long-term care institutions, with the prevalence rising to approximately 70%.2 Typical complaints of sleep impairment in the elderly include difficulty falling asleep and maintaining sleep, early morning awakening, and excessive daytime sleepiness.3 Sleep problems may have a negative impact on health related quality of life by increasing the risk of accidents, malaise, and chronic fatigue. Sleep disturbance also is associated with an increased risk of falls,4 cognitive decline,5 and higher rate of mortality.6 One method to improve sleep quality is to take medications. Sedative-hypnotic medications appear to have little effect on sleep symptoms in nursing home residents.7 In addition, long-term usage of sleeping pills is associated with increased risk of falls in the community and nursing home settings,8 increased mortality in community-dwelling older people.9 Therefore, non-pharmacological methods with presumably few or no side-effects should be considered as an alternative safe approach in the treatment of sleep problems in elderly people.
Acupressure is a massage technique using fingers and palms with a certain amount of force to stimulate acupoints and meridian lines on the surface of the skin.10According to Traditional Chinese Medicine, the body has a network of energy channels or meridians tissue, similar to the vascular system for the circulation of blood. Twelve (12) main pathways called meridians, 2 unpaired channels, several other connecting or conjoint meridians, and 361 acupuncture points along the meridians constitute this network.11 The meridian tissue is highly conductive and preferentially directed compared to adjacent nonmeridian tissue.12 When the network is disrupted, health affects; therefore, acupuncture and acupressure were developed to stimulate these clogged meridians.13
Previous studies demonstrated that Acupressure or acupuncture may alleviate lower back pain, headaches, osteoarthritis pain, neck pain, musculoskeletal pain, perioperative pain, postoperative and chemotherapy related nausea, and managing sleep disturbance in chronic illness patients.14, 15 Several studies have showed that acupressure may be helpful in treating sleep problems. Tsay and Chen (2003) studied the effectiveness of acupressure on sleep quality of 98 patients with end stage renal disease in three groups, and reported significant differences between acupressure group and control group in subjective sleep quality, sleep duration, sleep efficiency and sleep sufficiency.16 Guerrero da silva et al. (2005), studied the effects of acupuncture on 30 pregnant women with insomnia, and reported a significant improvement on insomnia in experimental group compared to the control group.17 Auricular Acupuncture Therapy is one form of acupuncture of the ear that has been showed to improve sleep latency in older adults.18 Acupressure may regulate the production of melatonin, a neurohormone that affects chronobiological activity and has been theorized to restore melatonin levels to normal sleep cycles.19 In addition, acuppressure has been showed to reduce pain by activating the endogenous opioid system, and thus reducing or eliminating sleep disruption due to pain.20
Early identification of sleep problems and interventions to improve sleep quality are crucial, because sleep disturbances that persists for a long period of time could decrease general health and functional status thus affecting quality of life21 Although there are adequate research on sleep, few studies have focused on the effects of acupressure on improving sleep quality in Iran, and particularly on older adults.
Section snippets
The study
Following ethical approval from USWR and the research and Ethics Committee of kahrizak charity nursing home, a randomized controlled clinical trial was carried out to test the effect of acupressure on quality of sleep of elderly insomniacs. After Convenience sampling by means of balanced randomization method elders who scored 5 points or higher on the Pittsburgh Sleep Quality Index (PSQI) were randomized into an experimental (receiving acupressure plus usual care), a placebo (receiving sham
Sample and setting
This study was conducted in a nursing home (KCF = Kahrizak Charity Foundation) in Tehran- Iran. The required sample size for this study was estimated 26 subjects for each group (with power of 0.80, medium effect size, of 0/5, And at confidence level of 95% and an attrition rate of 10%). 30 subjects per group were chosen to participate in this study amounting a total sample size of 90 elders. Inclusion criteria for participation in the study was set as: (1) aged 60 years or older; (2) scoring 5 or
Procedures
A trained research assistant screened 350 elders using PSQI. All participants interviewed by research assistant because the majority (%64.9) of subjects were illiterate. The questions were read aloud and more explanations were given as needed. Medical records were used to evaluate some of criteria (severe CHF,…) set for the study. Of those 350 original elders, 146 met the inclusion criteria. All of the subjects gave their informed consent prior to randomization, and 116 were identified as
Measures
The PSQI is a questionnaire that measures self-reported sleep habits during the previous 4 week. It is a global measure with seven components: perceived sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, sleep sufficiency and use of sleep medication. The score for each component ranges from 0 to 3, and the sum of the score gave a global score. High scores indicated poorer sleep quality. A score of 5 (indicating poor sleep) yielded a diagnostic sensitivity of
Results
Of the original 77 subjects, 41 were men, and 36 were woman. The mean age of subjects was 75.21 (SD = 8.88) and 64.9% was illiterate. The median of their chronic disease was 2. They stayed in an institution from 6 to 168 months and the mean months was 34.7 (SD = 32.3). There was no significant difference in data pertaining to gender, age, education, (Table 1) sleep style, Exposure to sun light, bed condition, habit of naps, light and voice at night, consumption of tea, coffee or smoking, current
Discussion
The result indicated that there were significant differences in improvements of sleep among three groups after intervention. Post hoc comparison revealed that the improvements in the acupressure group were significantly greater than those in the sham acupressure and control groups. This difference in improvements may be mainly due to the effect of acupressure on various acupoints such as the Yungchuan, Shenmen16 and Anmian points.14 The results also suggest that acupressure might have an
Conclusion
Sleep disturbances are common problem in elderly people. The use of medications is always a concern. Acupressure, as was evidenced in this study, seems to be an efficacious means to improving quality of sleep in elderly nursing home residents. Therefore, it is suggested that nurses, nurses aid and patient or their relatives can use this simple, noninvasive healing method to manage sleep disturbances.
Acknowledgements
The authors wish to thank the University of Social Welfare and Rehabilitation Sciences and the nursing home staff of Kahrizak nursing home in Tehran, Iran for their kind assistance and contributions.
References (30)
- et al.
Pevalence of self-reported poor sleep in a healthy population aged 50–65
Soc Sci Med
(1992) - et al.
Acupressure and quality of sleep in patients with end-stage renal disease—a randomized controlled trial
Intl J Nurs Stud
(2003) Sleep in the elderly. What is normal?
Clin Geriatr Med
(2003)- et al.
The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research
J Psychiatr Res
(1989) - et al.
Sleep disturbances among nursing home residents
Int J Geriatr Psychiatry
(2002) Sleep problems in the elderly
Am Fam Physician
(1999)- et al.
Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64–99 years
J Am Geriatr Soc
(2000) - et al.
The impact of insomnia on cognitive functioning in older adults
J Am Geriatr Soc
(2001) - et al.
Functional outcomes of excessive daytime sleepiness in older adults
J Am Geriatr Soc
(2003) - et al.
Psychotropic medications in incontinent nursing home residents: association with sleep and bed mobility
J Am Geriatr Soc
(1995)
Association between falls in elderly women and chronic diseases and drug use: cross sectional study
BMJ
Acupressure massaging to keep healthy
Complementary therapies: the gentle power of acupressure
RN
Acupuncture: textbook and atlas
The science of acupuncture-theory and practice. II. Electrical properties of meridians
IEEE EngMed Biol
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2019, Complementary Therapies in Clinical PracticeCitation Excerpt :The total score of the PSQI is between 0 and 21. Obtaining a total score of more than 5 from the PSQI indicates a serious sleep problem [26–28]. Before the intervention, the PSQI was completed by the subjects.