The prevalence of heart disease in the population over age 65 has contributed to the increasing number of aged patients hospitalized in critical care units (Gsell, 1977). Changes which occur in the process of aging and in cardiac disease should be considered when providing nursing care to these patients. A disturbance in the sleep wakefulness cycle resulting in a decrease of restorative sleep is a major change occurring at age 65 and after (Feinberg, 1967). The cardiac patient finds that it takes longer to go to sleep, and then awakens often during the night (Karacan et al., 1969).

Rome (1969) found that the environmental stimuli of the critical care unit increases the arousal of patients. Kornfield (1969) found that with an increase in arousal in critical care, the patient achieves less rest and sleep. Woods (1972) and Walker (1972) found that the rest of postcardiotomy patients in critical care was interrupted at least once every hour for the first day. Since these studies and others, which demonstrate disturbance in the sleep-wakefulness cycle of the patient in critical care, have dealt with subjects under the age of 65, they may not be applicable to the aged population.

Knowing that sleep is already disturbed in the patient over 65 and in the patient with cardiac disease, would being in a critical coronary care unit be more disturbing or would it be an insignificant factor? Studies investigating the sleep of the aged in any type of critical care unit were not found in the literature. To answer this question, it was hypothesized that 72 consecutive hours in the coronary care unit would have no effect, (p=.05) on the observed behavioral sleep patterns of 10 patients who are 65 years or older.

A non-experimental exploratory evaluation study was designed to test the hypothesis. The study sample consisted of 10 patients age 65 or older who were admitted to a seven bed CCU. Demographic data and information on home sleep was obtained by focused interviews. The performance, self-satisfaction with sleep, and mood of each subject were tested; and their sleep during their first three nights in the CCU was observed.

To test the obtained ordinal data for statistical significance three non-parametric tests were used: 1) Friedman two-way analysis of variance, 2) Spearman rank correlation coefficient and 3) Uilcoxon matched-pairs signed-ranks. Two-tailed tests were used in all instances.

In testing for differences in total sleep times for the 72 hours, the null hypothesis was rejected. On the other hand, in testing the variables: 1) age with sleep, 2) environmental stimuli and 3) nursing interruption times, the null hypothesis was retained. Even though the null hypothesis for no effect from environmental stimuli was retained, the test results were in the direction of the alternate hypothesis.

It was concluded that the sleep disturbances observed in this study were related to the normal adjustment one makes to a new environment regardless of age and/or to the state of illness and the patients concern for his health status.

The scores for performance and self-reported satisfaction with sleep were in the upper ranges and improved during the stay in CCU, demonstrating adjustment to the CCU with little detrimental effect from sleep disturbance. Mood levels, defined as anxiety and hostility, decreased during the stay in CCU with a minimal use of medication for sleep and relaxation, demonstrating a positive adjustment in CCU and little effect from sleep disturbance.

This study of patients with an age-related disturbed sleep pattern indicated that further disturbance was experienced in a new environment. Implications for nursing seem to be that nursing care should include specific efforts in presenting and reinforcing information about the environment, routines and activities of the nursing unit. Attention should also be given toward decreasing the environmental stimuli during normal times of rest and sleep and toward adjusting nursing routines to individual sleep patterns.

LLU Discipline





Graduate School

First Advisor

Evelyn L. Elwell

Second Advisor

L. Frances Pride

Third Advisor

Annette M. Ross

Fourth Advisor

Colleen J. Hewes

Degree Name

Master of Science in Nursing (MSN)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Coronary Care Units; Sleep



Page Count

vii; 88

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives