Sleep habits and coping methods of
people with schizophrenia living in the community
(1) Chang, Yun-Jou; (1) Lin, Yi-Chu; (2) Chen, Ming-De; (3) Chang, Yen-Ching*
(1) Student, Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan (2) Associate professor, Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung City, Taiwan
(3) Assistant professor, Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan * Corresponding author: Address: 1 University Road, Tainan City 70101, Taiwan. E-mail address: ychang@mail.ncku.edu.tw
Introduction
Sleep plays an important role in health and occupies one-third of one’s lifetime. Without good quality of sleep, it’s very possible to cause other diseases. Many people with schizophrenia have sleep problems that impact their illness management and life
arrangement. Several studies have investigated the effects of sleep interventions on people with schizophrenia living in the hospital. However, when they return to the community, fewer resources and professional assistance are available. More studies are needed to understand the sleep issues of people with schizophrenia living in the community.
Objectives
This study aimed to investigate associated factors of sleep and coping methods of people with schizophrenia living in the community.
Methods
The study used the mixed method. The researchers collected data from three community psychiatric rehabilitation centers in the southern Taiwan. Eighteen people with schizophrenia (9 men) were recruited and completed the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). The full score of the PSQI is 21 and the higher score indicates worse quality of sleep. Moreover, the full score of the ESS is 24 and the higher score means higher extent of sleepiness. After filling out the scales, participants had a one-on-one interview with the researcher. Thematic analysis was used to analyze qualitative data. Descriptive analysis was used to analyze quantitative data to provide auxiliary information.
Results
The average age of 18 participants was 42.2 years (range 28-58). Their average score of the PSQI was 9.56 (range 3-17). Most
participants (83.3%, n=15) had poor sleep quality (PSQI score >5). For the ESS, the average was 7.22 (range 0-16). Most participants
(72.2%, n=13) did not show excessive sleepiness (ESS score <11). Based on the Person-Environment-Occupation Model (PEO Model), sleep performance can be influenced by person,
environment, and occupation (see Table 1). Almost all participants relied on medication to solve their sleep problems. Some could use other methods to help them sleep, like listening to music or
exercising. Moreover, they were not interested in receiving interventions to improve their sleep.
Discussion
The results of sleep scales showed that most participants had poor sleep quality and mild level of sleepiness. The factors influencing sleep varied. Medication was the most common method that participants used to solve sleep problems.
Based on the PEO Model, the factors associated with sleep were categorized into 3 domains. In the Person domain, participants mentioned that they needed medication to control psychiatric symptoms, like hallucination, in order to get sleep, but they disliked the side effects of medication that made them tired and dizzy.
Participants had contradictory attitudes toward taking medication. In the Environment domain, temperature was mentioned most
frequently. Since many participants were in the low social-economic status, they might have limited access to air conditioners. However, they would use some methods to solve the problem, such as taking a shower or changing to another room. In the Occupation domain, many participants suffered from sleep interruption. They could fall asleep quickly with pills, but would wake up because of the urge to urinate. It’s hard for them to fall asleep again, which made them feel
sleepy and perform badly in the next day. The urge to urinate during sleep might be partially due to the side effects of medication.
Most participants declared that they did not have sleep problems, but they did report they had poor sleep quality both from the PSQI score and interview results. Many of them stated that they can have good sleep if they take medication on time. Otherwise, they might have poor sleep quality. In addition, few participants were willing to try interventions to reduce/replace the sleep medication usage. The reason might be that they were afraid of getting worse sleep quality after using a new method. As for participants who wanted to try alternative methods, they stated that the side-effects of medication had big impact on their daily life, especially work performance. We found the study participants relied on medication to solve sleep problems and discussed their sleep problems with mental health professionals in psychiatric rehabilitation centers infrequently. Professionals usually provided advices about general principles on lifestyle changing rather than evidence-based sleep interventions. The sample size was small, so the results of this study may not be generalized to other areas of Taiwan or other countries.
Acknowledgement
The authors gratefully acknowledge the College Student Research Scholarship (no. 106-2813-C-006-125-B) from
Ministry of Science and Technology and the Summer Research Project Grant (no. NCKUMCS2017006) from College of
Medicine at National Cheng Kung University.
Domains Categories Examples of quotations
Person
Drug influence “After taking a pill, I can’t do anything.”—C9
Emotion “I am afraid at night.”—C5
Symptom “Sometimes I have hallucination, and I will take a pill and Chinese medicine (to help me sleep).”— C1
Thought of sleep “Sleep is important to me.”—K14
Environ -ment
Light “I don’t like darkness, so I’ll turn the light on when sleeping.”—K14 Noise “It is hard to get sleep when I
hear something.”—C6 Temperature “Too hot or too cold both
influence my sleep.”—C6 Bed sharers “My mom would snore and I
would be awakened.”—K16 Bed “I can’t sleep well on a too soft
bed.” —C4 Occup- ation
Quality of sleep “I feel sleepy but can’t fall asleep.”—K16
Static activities
before sleep “Chat with family and chat with my friends via social apps.”—C2 Dynamic activities
before sleep “I will go out for a walk if I have time.”—C6 Time of sleep “About 7 hours (of sleep), it’s
enough.”—C7
Dream “Sometimes, I will wake up due to nightmares.”—C7
Sleep interruption “I will wake up because of going to the restroom, and I can’t fall asleep again easily.”—C6
