Abstract

Sleep is necessary for physical and psychological restoration of the body. Studies indicate that tissue repair is augmented during sleep, showing that rates of protein synthesis and of mitotic division are higher at times of rest and sleep. Studies evaluating sleep-deprived subjects reveal that after loss of normal sleep, some types of memory and learning processes are impaired. These subjects generally become anxious and irritable, especially after loss of dreaming sleep.

Sleeping medications have been implicated by observers and researchers to be a cause of altered sleep patterns. These medications not only disrupt normal sleep cycles, but their continued use may lead to a pattern of dependence, tolerance and escalating doses.

Despite the wide acceptance of these facts, nondrug methods as an alternative aid for sleepless patients are rarely investigated or recommended. Sleeping pills are still one of the most frequently used of all medications for the hospitalized patient.

The purpose of this study was to investigate the quality of sleep obtained by 16 male hospitalized patients receiving flurazepam 30 milligrams or natural measures to aid in sleep. The hypothesis tested was that there will be no difference in patient satisfaction as measured by the Stanford Sleepiness Scale, the Sleep Satisfaction Scale, the Profile of Mood States (POMS), and urinary catecholamine excretion levels between those subjects taking flurazepam 30 milligrams and those patients receiving natural measures to aid in sleep.

One independent variable and four dependent variables were measured in this study. The independent variable was natural measures versus flurazepam to aid in sleep. The dependent variables were urinary catecholamine excretion, the Sleep Satisfaction Scale scores, the Stanford Sleepiness Scale score and Profile of Mood State scores consisting of six mood factors as a total mood disturbance score. The sample was a convenience sample. The criteria for the sample selection were designed to eliminate as many of the extraneous variables as possible. Patients who met these criteria, who agreed to participate in the study, and for who a physician's consent had been obtained, were placed alternatingly into the two study groups. Patients in the natural measures group were given a 10- minute back rub, eight ounces of hot chocolate-flavored Ovaltine, and time with the researcher to ask questions and to verbalize possible anxieties and have to prayer if desired. Patients in the flurazepam group received 30 milligrams of flurazepam at bedtime. Twelve-hour urinary catecholamine excretions, AM and PM Profile of Mood State scores, AM and PM Sleep Satisfaction Scale scores, and AM and PM Stanford Sleepiness Scale scores were measured on all patients on the control night for baseline evaluation. The appropriate sleeping aid was administered on study nights 2 and 3, with daily measurements of 12-hour urinary catecholamine excretion, AM and PM Profile of Mood States, AM and PM Stanford Sleepiness Scale, and AM and PM Sleep Satisfaction Scales. The data were compared by using measures of central tendency and the t-test, Mann-Whitney U and Chi square.

At baseline the groups had no significant differences in the dependent variables data and no consistent trends were noted in biographic information from either group. The baseline/control night and study night 2 and 3 urinary catecholamine excretion values were compared. No significant results at alpha = 0.05 were noted.

Comparisons of study nights 2 and 3 AM and PM Profile of Mood State Scores showed no significant difference from the baseline/control night at alpha = 0.05. There was a decrease, however, of the AM tension, depression, and anger factors in the natural measures group, and an increase in these factors in the flurazepam group. There was no significant difference in the PM measurements of any of the six factors measured by the Profile of Mood States between the two groups.

Stanford Sleepiness Scale score comparisons for baseline/control night and study nights 2 and 3 showed no significant differences. The natural measures group, however, had higher overall scores, indicating a greater alertness or a lesser degree of sleepiness when compared to baseline values, but these results were not significant at alpha = 0.05.

In addition to the Sleep Satisfaction Scale, each subject was asked to mark one of seven statements on the Stanford Sleepiness Scale which best described how he was feeling on the morning and evening of each study night. Comparisons of baseline/control data and study night 2 data reveal a significant difference between the groups. FIurazepam patients appeared to awaken less alert than patients receiving natural measures to aid in sleep. This was supported by the Chi square (alpha = 0.05) test for study night 2. No significant difference between groups was found for study night 3.

The null hypothesis was retained. One or more of the following factors may have influenced this conclusion:

  1. Correct collection procedures for the urinary catecholamine excretion values may not have been followed consistently by each patient.

  2. It was impossible to control patient awakenings and other disturbances on the hospital units.

  3. It was not possible to control the amount or kind of diagnostic studies performed on the patients, which may have resulted in high levels of anxiety, and thus decreasing satisfaction with sleep or increasing disturbances in sleep.

  4. Because of nursing care policies, flurazepam patients may have had in addition to the medication, a night time back rub, time with a nurse to verbalize anxieties or to have prayer.

LLU Discipline

Nursing

Department

Nursing

School

Graduate School

First Advisor

Evelyn L. Elwell

Second Advisor

Annette M. Ross

Third Advisor

Grenith J. Zimmerman

Degree Name

Master of Science (MS)

Degree Level

M.S.

Year Degree Awarded

1980

Date (Title Page)

8-1980

Language

English

Library of Congress/MESH Subject Headings

Sleep Disorders; Insomnia

Type

Thesis

Page Count

ix; 134

Digital Format

PDF

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.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

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

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