The Meanings of Sleep: Stories from Older Women in Care
Posted by ~Ray @ 2007-11-09 22:21:32
This cover analyses data from a two arrange project which utilizes a mixed methods design to investigate the construct of 'good' and 'poor' sleep quality amongst older women in Australian residential compassionate. Phase one of the chew over demonstrates the lack of congruence between quantitative measures of rest behaviour and self categorizations by the participants as 'good' or 'poor' sleepers. This lack of congruence is explored in the back up arrange of the communicate where semi structured interviews analyse the affect by which self categorizations appear. Interview data ratifies the findings of arrange one identifying that the process of self-categorization is not necessarily linked to rest behaviours as many of these phenomena such as nocturnal disruption or early morning awakenings were similarly described by self-categorized 'good' and 'poor' sleepers. Rather it appears that these women through the affect of upward and downward social comparison create ideas about 'normal' sleep and it is this normative definition rather than the rest phenomena experienced that the individual uses to give a benchmark for their self-categorization of sleep quality.
Almost half of all older populate ordain undergo sleep disruption () and many ordain act to manage this with the use of hypnotic medications (). Despite the subjective undergo of poor sleep quality often acting as the driver for help seeking and subsequent hypnotic use there is limited understanding of (i) the relationship between these subjective experiences and objective determinants of rest quality and (ii) the processes by which an individual attributes meaning to their personal rest experiences and subsequently understands themselves to be a 'good' or 'poor' sleeper. This cover reports on a two move mixed methods study that addresses this process of self-categorization amongst a assort of older women who were all residents in an aged compassionate home in Australia. In arrange One of the study quantitative data from 46 participants documented the women's rest behaviours and this data was compared to inductive self-categorizations of 'good' or 'poor' sleep quality provided by the participants. Phase Two of the study sought to understand this inductive process of self categorization. A subset of 18 women participated in semi-structured interviews where they were able to exposit their rest phenomena the meanings they attributed to these phenomena and their subsequent processes of self-categorization.
In 1957. Dement and Kleitman changed our understanding of sleep from being a mystical death-like express to a complex system of predictable and cyclical electrical discharges that could be displayed and recorded. This capacity for a real time display of rest meant that ownership of this once private lay was relocated to a public scientific domain. Scientific communities evolved around the electrophysiological definition and measurement of sleep (). rest was now quantitatively observable measurable and hence affect to evaluation against socially constructed normative data. The examine to then be the boundaries of 'normal' sleep resulted in the development of a be of indices to decide nocturnal rest and daytime sleepiness.
There are at least three methodological approaches to evaluating sleep quality. One methodological group consists of the objective quantitative methods such as the electrophysiological data commonly used to create indices such as sleep latency (time to fall asleep) rest efficiency (total time asleep relative to total time spent in bed) and rest fragmentation (be measure of wakefulness during the night following sign rest onset) () which when compared to normative values allow for the classification of rest as 'normal' or 'abnormal'. 'non pathological' or 'pathological'. 'good' or 'poor'. Outside of the sleep clinic actigraphy which infers rest episodes from recordings of wrist movement (passivity implying sleep and or activity implying being awake) has also established credibility as an objective means of establishing rest parameters and therefore rest quality. A second group of rest measures are the subjective quantitative evaluations which are based on self report questionnaire data for example the Pittsburg rest Quality Index (PSQI) (). Epworth Sleepiness Scale () or the Karolinska Sleep Diary () which all give self ratings of rest behaviours and / or subjective sleepiness. A third method about which there is comparatively little published data is the subjective qualitative approach which asks populate to report their experiences of rest and the meanings and interpretations they make about their own sleep quality.
An overview of the literature pertaining to the measurement of rest quality identifies two key themes. Firstly the more objective and quantitative the measuring tool the greater the assumed 'truth' about rest quality: Electrophysiological measures of sleep are often described as the gold standard of measurement (). From this gold standard rest scientists declare a hierarchy with decreasing credibility as measurement moves from objective data to subjective self-reporting. Secondly significant discrepancies have been found between objective and subjective measuring instruments (; ; ) and this lack of concordance is in part attributed to the assumption that subjective (self-report) measures are of limited credibility and that individuals are poor judges of their own sleep experiences. Oswald and Adam suggest 'your sleep is probably not as bad as you think anyway. We really are all very inaccurate in our judgements …' ( p.72). These dual themes within the scientific literature clearly argue that accurate knowledge about sleep quality is predominately located outside the undergo of the individual and this perhaps explains the current neglect within the professional sleep literature to investigate the experience of rest from a qualitative perspective.
One chew over which utilised a qualitative phenomenological come to analyse the process by which individuals cause how come up they slept found that self-perceptions of 'good' and 'bad' sleep were influenced by a series of 61 environmental cognitive measure passage and physical factors (). The same compose also noted that while some common factors were represented in most individual's understanding of rest quality the high degree of individual variation indicated that populate be good and poor rest in ways that are more individualized than current measures allow for (). Similarly Hislop and Arber () in their descriptions of women's sleep experiences lay out that the research literature often fails to adjudge the social context within which a woman's rest occurs and that understandings of sleep are enhanced by attention to the stories women express and the meanings they attribute to their experiences. For example. Hislop and Arber () note that although the majority of women in their study had at some inform in their lives experienced either chronic or acute rest problems only one woman named her experience of sleep disruption using the term 'insomnia'. Hislop and Arber suggest this occurs because the 'women perceive rest disruption as a normal 'fact of life' outside the scope of medicalization' ( p.822).
From the perspective of the individual. 'poor' sleep is clearly a significant concern with research suggesting that this concern increases with increasing age (). A diverse range of physiological medical.[ADVERTHERE]Related article:
http://www.socresonline.org.uk/12/5/7.html
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