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La plataforma permanente Atomium Culture reúne a las universidades, periódicos y empresas más prestigiosos de Europa para promover el flujo del conocimiento más allá de fronteras, entre sectores y hacia el público en general.

Restful Mind, Restful Sleep: The Key to Insomnia in Nursing Homes

Por: | 17 de mayo de 2013

12 oh 5 after midnight

By Wolfram Herrmann of Humboldt-Universität zu Berlin

In our aging population, the probability of anyone of us needing to live in a nursing home at some point is growing. Many of us already have relatives living in nursing homes. Thus, the quality of life and living conditions of nursing home residents is a topic that affects us all.

In old age, and especially in the nursing home, sleeping problems are a big issue. Several studies have been conducted on the sleeping behaviour of nursing home residents, and several different treatments have been tested, such as physical activity and bright light during daytime. But the effects of these treatments have been only small.

However, no one has asked the residents for their perspective regarding sleep and sleep disorders yet. Thus, many questions are still unanswered: do nursing home residents suffer as a result of their sleep disturbances or do they accept their sleep fragmentation as natural? What does good sleep mean to nursing home residents? How do residents deal with sleeping problems? And what do they need in order to sleep well? I want to answer these questions with my PhD project at the PhD program “Multimorbidity in Old Age” at Charité – Universitätsmedizin Berlin. As a member of the research project INSOMNIA, I am studying nursing home residents’ subjective concepts about sleep and sleep disorders.

From my point of view, it is important to research the residents’ perspective about their sleeping problems. Often researchers do not talk to nursing home residents themselves because we expect them not to be cognitively able to have a sensible conversation, and often we expect that we ourselves know better what is good for them. Together with my advisor Prof. Dr. Uwe Flick, I decided to use qualitative methods—that is, talking with the residents directly—to explore residents’ opinions and experiences.

I conducted interviews having the topics I want to cover during the interview in mind, but they did not direct the interview. Therefore, every interview was different. I recorded the interviews and transcribed them afterwards so I could interpret them in depth.

There are several difficulties with conducting an interview study with nursing home residents though. A large proportion of residents are just too cognitively impaired to be interviewed. Also, for the mentally healthier ones, I had to adjust my interview style, talking more slowly and clearly. Several of my 30 interviewees had slight cognitive or language impairments, and an interview could become a unique challenge. In return, however, I got fascinating interviews and could listen to fantastic life stories, such us the old man who told that he was a fisherman but at the end of his 20s decided to go into the arts, and did so successfully.

There are many possibilities when it comes to interpreting such interviews. My method of interpretation was based on so-called “coding.” I broke down each interview into small segments, and every segment got a title, a “code.” These codes could be classed into different categories. Thus, in a second step I could have a closer look at the text segments belonging to the codes and categories I was interested in. Such interpretation is quite time consuming compared with analysing questionnaires, but in return one is able to discover new important topics. That is the main strength of qualitative methods: one can really explore new things.

At the beginning of my study I expected the diseases and illnesses of the residents to have the greatest impact on their sleep. Surprisingly, for nursing home residents their diseases and illnesses were not the most important causes of sleep disturbances. Something else was much more important: peace of mind. For the residents I interviewed, peace of mind and calmness were the most important preconditions to sleeping well. Exciting situations, conversations, and appointments could cause sleep disturbances. Many nursing home residents complained about how ruminating on their life stories, fate, and illnesses could stop them sleeping well. Not least, memories from war times played an important role in keeping residents awake.

What shall we conclude? Life does not end when one moves into a nursing home. We often forget that nursing home residents have psychological needs. They experience many stresses, such as an appointment with a physician the next day. Often nursing home residents feel lonely and miss having someone to talk to about their problems. Their life stories and fate weigh on their minds and are an important source of thought. This means that we—as professionals, relatives, and members of the public—should take the psychological needs of nursing home residents seriously. Physicians should take psychological barriers to sleeping well into account, and nurses should offer residents the opportunity to talk about their problems. Volunteers from the community might also offer possibilities for residents to talk and to deal with being lonely. And it is important for research to give nursing home residents a voice, to empower them to work together with us on making life in a nursing home a better place.

Wolfram Herrmann
Humboldt-Universität zu Berlin


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