Effect of a warm footbath before bedtime on body temperature and sleep in older adults with good and poor sleep: An experimental crossover trial

Background

The decrease in core body temperature before sleep onset and during sleep is associated with dilation of peripheral blood vessels, which permits heat dissipation from the body core to the periphery. A lower core temperature coupled with a higher distal (hands and feet) temperature before sleep are associated with shorter sleep latency and better sleep quality. A warm foot bath is thought to facilitate heat dissipation to improve sleep outcomes.

Objectives

This study examined the effect of a warm footbath (40 °C water temperature, 20-min duration) on body temperature and sleep in older adults (≥55 years) with good and poor sleep.

Design

Two groups and an experimental crossover design was used.

Setting and participants

Forty-three adults responded to our flyer and 25 participants aged 59.8 ± 3.7 years (poor sleeper with a Pittsburgh Sleep Quality Index score ≥ 5 = 17; good sleepers with a Pittsburgh Sleep Quality Index score < 5 = 8) completed this study.

Methods

All participants had body temperatures (core, abdomen, and foot) and polysomnography recorded for 3 consecutive nights. The first night was for adaptation and sleep apnea screening. Participants were then randomly assigned to either the structured foot bathing first (second night) and non-bathing second (third night) condition or the non-bathing first (second night) and foot bathing second (third night) condition.

Results

A footbath before sleep significantly increased and retained foot temperatures in both good and poor sleepers. The pattern of core temperatures during foot bathing was gradually elevated (poor sleepers vs. good sleepers = +0.40 ± 0.58 °C vs. +0.66 ± 0.17 °C). There were no significant changes in polysomnographic sleep and perceived sleep quality between non-bathing and bathing nights for both groups.

Conclusion

A footbath of 40 °C water temperature and 20-min duration before sleep onset increases foot temperatures and distal–proximal skin temperature gradients to facilitate vessel dilatation and elevates core temperature to provide heat load to the body. This footbath does not alter sleep in older adults with good and poor sleep.     

Effects of melatonin in elderly patients with sleep disturbance: a pilot study

This open-label, short-term pilot study was designed to assess the efficacy and tolerability of melatonin in the treatment of sleep disturbances in elderly patients. The 41 patients (28 women and 13 men; mean age [±SD], 74 ± 12 years) were separated into three groups: (1) patients with sleep disturbances alone (n = 22); (2) patients with sleep disturbances and signs of depression (n = 9); and (3) patients with sleep disturbances and dementia of the degenerative or vascular type (n = 10). All patients received 3-mg gelatin capsules of melatonin orally 30 minutes before expected sleep time for 21 days. Overall sleep quality and daytime alertness were assessed by means of structured clinical interviews and sleep logs completed by the patients (or their caregivers in the case of dementia patients). Starting from day 2 or 3 of treatment, melatonin significantly improved sleep quality and decreased the number of awakenings in patients with sleep disturbances with or without associated depression. Patients with dementia did not show significant improvement of sleep quality. Estimates of next-day function (ie, alertness in the morning and during the day) improved significantly only in patients exhibiting sleep disturbances alone. Clinical assessment indicated that symptoms improved in 16 (73%) of the patients with sleep disturbances alone and 4 (44%) of those with sleep disturbances associated with depression, and that agitated behavior at night (sundowning) decreased significantly in 7 (70%) of the patients with dementia. This was reflected by the coefficient of variation of bedtime, which averaged 58% in patients with dementia compared with 27% and 33% in nondepressed and depressed patients, respectively, on days 0 to 2 of treatment, and which decreased significantly only in dementia patients when reassessed on days 19 to 21. Four (31%) of the 13 patients with primary insomnia who were receiving benzodiazepines concomitantly reduced their benzodiazepine use (by 50% to 75% of initial doses) and 4 (31%) discontinued use of these agents; of the 7 patients with depression and 7 with dementia who were receiving benzodiazepines concomitantly, 2 (29%) in each group reduced benzodiazepine use by up to 50%. No side effects considered to be attributable to treatment were reported. The results of this trial suggest that melatonin may be useful for the treatment of primary sleep disturbances in elderly patients.     

The efficacy of massage as a nightly bedtime routine on infant sleep condition and mother sleep quality: A randomized controlled trial

Backgroundand Purpose: Infants' sleep disorders and parents' insufficient sleep are common problems in the infant care. The current study was conducted to assess the effectiveness of infant massage on infants' night-time sleep condition and mothers’ sleep quality.Methods140 number of 15–20 days old infants were randomly put into two different groups, one with bedtime messages and the other with normal infant routine care. For the intervention group, in addition to usual bedtime procedures such as changing diapers and breastfeeding, a 15-min massage was done before sleep for a period of two weeks. For the control group, only the usual above-mentioned bedtime procedures were followed. One week before the intervention, at the end of the first week, and two weeks after the intervention, the information was recorded for both groups. The Brief Infant Sleep Questionnaire, a personal information submission form, and Pittsburgh Sleep Quality Index for the mothers were the tools used to gather data in this study.ResultsInfants in two control and experimental groups showed meaningful differences in variables such as, sleep latency (P = 000, eta = 0.099), number of night waking (P = 0.03, eta = 0.027), and longest continuous sleep period (P = 0.03, eta = 0.026). As for other variables related to the infants' sleep, no meaningful differences were observed. In this study, there was no indication of a meaningful difference in the mother's overall night-time sleep quality between the two groups (P = 0.184, eta = 0.012) except for the duration of the mother's night-time sleep (P = 0.028, eta = 0.026) and the reduction of maternal sleep disorder (P = 0.020 eta = 0.029). As for other sub-factors of maternal sleep quality, no meaningful differences were seen.ConclusionThe findings of this study indicated that infants’ bedtime massages would improve some of the sleep markers of mothers and infants, and therefore, can be suggested as a practical, harmless, and cost-free method to improve sleep.     

Self-care management of sleep disturbances and risk factors for poor sleep among older residents of Taiwanese nursing homes

Aims. To explore self-care management strategies for sleep disturbances and risk factors for poor sleep among older residents of nursing homes in Taiwan. Background. With the deterioration of health that accompanies ageing, sleep quality becomes poorer, making it a significant issue in geriatric care. However, little is known about self-care strategies for management of sleep disturbances among elders worldwide. Design. A cross-sectional design was used. Methods. Residents (n = 196) were recruited from nine nursing homes chosen by stratified sampling across Taiwan. The Pittsburgh Sleep Quality Index, a self-care management of sleep disturbance questionnaire and a demographic form were used to collect data. Results. The prevalence of poor sleep in these older nursing home residents was 46·4%. Only 48·5% of participants used self-care strategies to manage sleep disturbances. The most frequently used strategy was ‘take prescribed medicines’. Self-learning was the main information source for self-care strategies. Logistic regression analysis indicated that having no spouse and a low educational level significantly predicted poor sleep. Conclusions. This study revealed a high prevalence of poor sleep quality among older residents of nursing homes in Taiwan. Older residents’ inability to get relief from sleep disturbances may have been because of their limited use of strategies to manage sleep disturbances. Relevance to clinical practice. As health care providers play an important role in helping older people to manage sleep disturbances in nursing homes, it is crucial to train nursing home staff to perform sleep assessments and provide current knowledge about sleep disturbance management. It is also necessary to pay more attention to the sleep problems of elders without spouses and with little education.     

Predicting post-surgical cognitive disturbance in older Taiwanese patients

The purpose of this study was to test a theoretical model to understand the influences of six predicting variables in post-surgical cognitive disturbance in older Taiwanese patients after elective surgery. The data were collected in a medical center in Taipei, Taiwan. Ninety-three patients were included in the final analysis. The findings showed that cognitive function at admission (beta=0.50, p<0.001), physical function at admission (beta=-0.34, p<0.001), and physiological stability (beta=-0.21, p<0.01) had direct effects on post-surgical cognitive disturbance. Physical function and cognitive function at admission also affected post-surgical cognitive disturbance indirectly through physiological stability. These variables accounted for 67% of the total variance of post-surgical cognitive disturbance. The findings from this study suggest that a careful and systematic assessment of the patient's condition at the time of admission is important. It is necessary to monitor and correct these variables at admission or before surgery to prevent or reduce the impact of post-operative delirium. It is also necessary to monitor these variables during the hospital stay to help nurses to distinguish the etiology of delirium. In each case, knowing when confusion is more likely to occur can assist in focusing more appropriate and effective efforts at detection, thereby reducing the consequences associated with confusion.     

体感振动音乐疗法改善睡眠障碍的研究

目的：探讨体感振动音乐疗法改善睡眠障碍的疗效。方法：164例经匹兹堡睡眠质量指数量表（PSOI）评定存在睡眠障碍者．同时使用症状自评量表（SCL-90）对身心状况进行评估．随机分为治疗组与对照组．治疗组除进行睡眠健康宣教外再给予音乐体感振动治疗．对照组则按照睡眠健康宣教．进行自我调节。治疗结束后进行睡眠质量及身心症状测评。结果：①治疗后治疗组PSOI总分、睡眠障碍因子、睡眠质量因子和日间功能障碍因子分低于对照组，差异有显著性意义（P〈0．05）；两组在入睡时间、睡眠时间、睡眠效率及安眠药物服用因子上差异无显著性意义。②治疗前两组在SCL-90各因子分上与国内常模比较，除人际关系障碍因子外其他因子均高于国内常模。治疗后治疗组在躯体化、强迫症状、抑郁、焦虑、敌对、偏执因子分低于对照组，差异有显著性意义（P〈0．05）；在人际关系、恐怖和精神病性这三个因子与对照组相比无明显的变化。结论：体感振动音乐疗法可以在一定程度上改善睡眠状况及身心症状。     

Prehospital correlates of sleep in patients hospitalized with cardiac disease

The purpose of this study was to examine relationships among selected endogenous factors and sleep patterns during hospitalization in patients with cardiac disease. Participants included 33 male and female patients with myocardial infarction and unstable angina. Wrist actigraph recordings and a computerized sleep algorithm demonstrated that the participants slept for a mean of 424.55 min (SD = 114.52), had a mean sleep efficiency of 77.30% (SD = 15.80), and experienced from 5 to 32 awakenings each night (M = 13.94, SD = 6.29). The mean duration of nighttime awakenings was 9.24 min (SD = 5.60). Self-reports of sleep efficiency, sleep supplementation, and sleep disturbance, using the Verran and Snyder-Halpern (1990) sleep scale, were better than normative data reported for hospitalized patients. The combination of age, gender, New York Heart Association Functional Classification scores (NYHA Criteria Committee, 1964), and prehospitalization sleep loss explained 29% of the variance in objectively measured sleep efficiency and 46% of the variance in duration of nighttime awakenings. These findings suggest the importance of prehospitalization variables as predictors of sleep patterns in hospitalized cardiac patients and provide baseline data for future study. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 27–37, 1998     

Self-reported napping and nocturnal sleep in Taiwanese elderly insomniacs

Abstract The aim of this study was to investigate the relationships between self-reported nocturnal sleep quality and napping patterns in elderly persons with insomnia and to compare the nocturnal sleep quality between napping and non-napping groups. Convenience sampling was used to recruit 60 community-dwelling elderly residents of Taichung City, Taiwan (age range 60-83 years, mean 67.1 years) who reported insomnia. All participants scored greater than 5 on the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Napping prevalence, frequency, and duration were assessed by participant interview. Self-reported sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction were measured with the PSQI. Sixty-four percentage of participants (n = 38) reported napping. There were no age, gender, and ethnicity differences on napping patterns. Global sleep quality, sleep efficiency, and sleep disturbance were significantly associated with prevalence of napping (r = 0.24-0.26, p < 0.05). A significant correlation was also found between global sleep quality and nap duration (r = 0.31, p < 0.05). Elders in the napping group reported better global sleep quality (t = 2.2, p < 0.05) and sleep efficiency (t = 2.1, p < 0.05) than those in the non-napping group. The findings suggest that there is no need for health care providers to restrict elderly insomniacs' daytime napping.     

The effect of footbath on the quality of sleep in older adults: A pilot study

This pilot study was a randomized controlled trial that aimed to investigate the effect of the warm footbath on the sleep quality of Iranian older adults. Males and females aged over 60 were randomly divided into three groups (footbath group with water at 40°C, footbath group with water at 37°C, and one control group) using the permutation block method. Repeated measures design was used to compare the groups after week two and week four to study the effects of footbath on sleep quality. Footbath with water at 40°C and 37°C caused significant improvement in the participants' sleep quality. No significant difference was found between the participants' sleep quality treated with water at 40°C and 37°C. Future studies with larger samples are recommended for assessing the effectiveness of warm footbath in enhancing sleep quality in older adults.     

Factors associated with sleep disturbance in women of Mexican descent

heilemann m.v., choudhury s.m., kury f.s. & lee k.a. (2012)?Factors associated with sleep disturbance in women of Mexican descent. Journal of Advanced Nursing68(10), 2256-2266. ABSTRACT: Aims. The aims were to identify the most useful parameters of acculturation in relation to self-reported sleep disturbance and describe risk factors for sleep disturbance in women of Mexican descent. Background. Little is known about acculturation as a factor for poor sleep in the context of other personal factors such as income or sense of resilience or mastery for Latinas in the United States. Design. This study was a secondary analysis of cross sectional survey data. Methods. Personal factors were incorporated into a modification of the Conceptual Framework of Impaired Sleep to guide our secondary analysis of self-reported sleep disturbance. Data were collected from a convenience sample of 312 women of Mexican descent of childbearing age (21-40?years) located in an urban California community were collected and previously analysed in relation to depressive symptoms and post-traumatic stress disorder. The General Sleep Disturbance Scale (in English and Spanish) was used to assess sleep disturbance. Data was collected in 1998 from September through December. Results. Early socialization to the United States during childhood was the most useful acculturation parameter for understanding self-reported sleep disturbance in this sample. In a multivariate regression analysis, three factors (higher acculturation, lower income and higher depressive symptoms) were statistically significant in accounting for 40% of the variance in sleep disturbance. Conclusion. When low income Latinas of Mexican descent report sleep problems, clinicians should probe for environmental sleep factors associated with low income, such as noise, over-crowding and exposure to trauma and violence, and refer the woman to psychotherapy and counselling rather than merely prescribing a sleep medication.     

The effects of footbath on sleep among the older adults in nursing home: A quasi-experimental study

ObjectivesTo examine the long-term effects of foot-bathing therapy, using different water temperatures, on the sleep quality of older adults living in nursing homes.DesignA quasi-experimental study design with non-equivalent control group.SettingsThirty participants were recruited from a nursing home in Gyeong-gi Province, South Korea.InterventionsThe participants were randomly assigned to experimental, placebo, and control groups. The foot-bathing therapy was performed for 30 min daily for four weeks. Water at 40 °C was used for the experimental group, while water at 36.5 °C was used for the placebo group. The control group did not receive any intervention.Main outcome measuresThe participants’ sleep patterns (total sleep amount, sleep efficiency, and sleep latency) and sleep-disturbed behaviors were compared based on group, using actigraphy and a sleep disorder inventory.ResultsThe total amount of sleep and sleep efficiency were significantly different for the experimental group, especially those with poor sleep quality. There were no differences in sleep latency or sleep-disturbed behaviors among the groups. The long-term effect of the therapy decreased in the third week of the therapy.ConclusionsDaily, 30-min foot-bathing therapy sessions with water at 40 °C were effective in improving sleep quality for older adults. The therapy was more effective for participants with poor sleep quality at baseline assessment than those with relatively good sleep quality. The long-term effects of foot-bathing therapy decreased three weeks after initiation; therefore, it might be desirable to deliver the therapy for two weeks, pause it for a week, and then resume it.     

Patterns and predictors of sleep pattern disturbance after cardiac surgery

The purposes of this study were to examine changes in sleep patterns after cardiac surgery and the contributions of preoperative sleep to postoperative sleep. Seventy-two cardiac surgery patients wore wrist actigraphs for 3 days during the preoperative period (T1) and the 1st (T2), 4th (T3), and 8th (T4) postoperative weeks. They completed the Pittsburgh Sleep Quality Index at T1, T3, and T4. Sleep was most disturbed during the 1st postoperative week and improved at T3 and T4. Overall, sleep pattern disturbance was higher at T3 and T4 than at T1. Age, gender, preoperative New York Heart Association Functional Class, and preoperative sleep variables explained 20%-50% of the variance in sleep at T2, T3, and T4. Sleep disturbance is present preoperatively and continues during the postoperative period.     

Music improves sleep quality in older adults

AIM: The aim of this paper is to report an investigation of the effects of soft music on sleep quality in older community-dwelling men and women in Taiwan. BACKGROUND: Sleep is a complex rhythmic state that may be affected by the ageing process. Few studies have focused on the effects of music, a non-pharmacological method of improving the quality of sleep in older adults. METHOD: A randomized controlled trial was used with a two-group repeated measures design. Sixty people aged 60-83 years with difficulty in sleeping were recruited through community leaders and screened using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale. Those reporting depression, cognitive impairment, medical or environmental problems that might interfere with sleep; and those who used sleeping medications, meditation, or caffeine at bedtime were excluded. Participants listened to their choice among six 45-minute sedative music tapes at bedtime for 3 weeks. There were five types of Western and one of Chinese music. Sleep quality was measured with the PSQI before the study and at three weekly post-tests. Groups were comparable on demographic variables, anxiety, depressive symptoms, physical activity, bedtime routine, herbal tea use, napping, pain, and pretest overall sleep quality. RESULTS: Music resulted in significantly better sleep quality in the experimental group, as well as significantly better components of sleep quality: better perceived sleep quality, longer sleep duration, greater sleep efficiency, shorter sleep latency, less sleep disturbance and less daytime dysfunction (P = 0.04-0.001). Sleep improved weekly, indicating a cumulative dose effect. CONCLUSION: The findings provide evidence for the use of soothing music as an empirically-based intervention for sleep in older people.     

Music improves sleep quality in older adults

Aim.  The aim of this paper is to report an investigation of the effects of soft music on sleep quality in older community-dwelling men and women in Taiwan.
Background.  Sleep is a complex rhythmic state that may be affected by the ageing process. Few studies have focused on the effects of music, a non-pharmacological method of improving the quality of sleep in older adults.
Method.  A randomized controlled trial was used with a two-group repeated measures design.
Sixty people aged 60–83 years with difficulty in sleeping were recruited through community leaders and screened using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale. Those reporting depression, cognitive impairment, medical or environmental problems that might interfere with sleep; and those who used sleeping medications, meditation, or caffeine at bedtime were excluded. Participants listened to their choice among six 45-minute sedative music tapes at bedtime for 3 weeks. There were five types of Western and one of Chinese music. Sleep quality was measured with the PSQI before the study and at three weekly post-tests. Groups were comparable on demographic variables, anxiety, depressive symptoms, physical activity, bedtime routine, herbal tea use, napping, pain, and pretest overall sleep quality.
Results.  Music resulted in significantly better sleep quality in the experimental group, as well as significantly better components of sleep quality: better perceived sleep quality, longer sleep duration, greater sleep efficiency, shorter sleep latency, less sleep disturbance and less daytime dysfunction ( P  = 0·04–0·001). Sleep improved weekly, indicating a cumulative dose effect.
Conclusion.  The findings provide evidence for the use of soothing music as an empirically-based intervention for sleep in older people.     

The sleep of older people in hospital and nursing homes

Disturbed sleep can affect personal wellbeing and impede the rehabilitation and recovery of older people from illness. This paper reports the findings of a pilot study which included examination of sleep quality and sleep patterns of older people in community hospital and nursing home settings. A marked proportion of older people reported sleeping well in nursing care settings, and those in nursing homes slept better than those in the community hospital. The main causes of sleep disturbance in both settings were: needing to go to the toilet, noise, pain, and discomfort; a similar pattern was seen across the different settings. No discernible difference was found in quality of sleep and whether patients felt rested or not between those patients on hypnotic medication and those who were not. The implications of the findings for practice and future research are discussed.