A Comparative Study of the Bedtime Routines and Sleep of Older Adults

Abstract

Sleep is a basic physiological need that all human beings experience. It is such an important and overwhelming need that we spend about one third of our lives asleep. Unsatisfactory sleep results in irritability, increased pain sensitivity, decreased daytime alertness, and apathy (Webb, 1975). Satisfactory sleep enhances our sense of well-being (Shirmer, 1983). The adverse effects that result from sleep loss are of particular concern to the aged, who may already be experiencing decreased cognitive or physical functioning from other causes (Johnson, 1988). When these factors are combined, the aged are particularly vulnerable to environmental hazards leading to falls, burns, and automobile accidents. Institutionalization could result (Burnside, 1988). To ensure a good night's sleep, many people follow a bedtime routine before going to bed. Mangusson (1953) suggested that the ritual of performing certain activities for an hour every night before retiring is of great significance to some people. Sleep is disturbed when these activities are neglected. For others, the awareness of these routines is not particularly important. These individuals may be unaware that they have a bedtime routine because it may be as inconspicuous as the way they arrange their bodies and covers for sleep. Even without this awareness, these acts provide comfort and encourage sleep onset (Luce & Segal, 1969). Hauri (1968) investigated the influence on each of the 15 subjects for these three pre-sleep activities: 6 hr of relaxation, 6 hr of concentrated study, and 6 hr of strenuous physical activity. None of these activities influenced sleep stability. In contrast, Baekeland (1968, 1969) found that watching stressful films and listening to tape recordings before bedtime influenced subjects' sleep patterns and dream content. Johnson (1986, 1988) found that institutionalized and noninstitutionalized older women reported sleep disturbances regardless of the use of bedtime routines. However, those disturbances were more pronounced in subjects who did not follow a certain routine each night. Several researchers (Goldson, 1981; Johnson, 1985; Regestein, 1980; Webb, 1975) have found that sleep patterns change with age. By the age of 60, the number of nocturnal awakenings increases from about one to four to six per night (Hayter,