Sleep hygiene efficacy on quality of sleep and mental ability among insomniac patients

ABSTRACT

Background:

Insomnia affects both quality of life and productivity at work, and it raises the risk of other diseases, such as depression, that coexist with insomnia. Nowadays, it is highly advised to treat insomnia with behavioral and psychological therapeutic methods to ensure the quality of your sleep.

Aim:

This study aimed to find the efficacy of sleep hygiene techniques in improving sleep quality and mental ability among insomnia clients.

Methods:

Self-structured questionnaires used to evaluate sleep quality and the McQuaig Mental Ability Test to test mental ability were used to collect data during the study’s six-week duration, which involved the recruitment of 50 participants using a purposive sample technique. A paired sample t-test and Pearson correlation were used for the statistical analysis.

Results:

Data analysis shows that sleep quality (t = 33.35) (P = 0.0000) and mental ability (t = 35.33) (P = 0.0001) are both highly significant at P =0.0001. Correlation regression data of sleep hygiene elements such as schedule, avoiding caffeine and beverages, relaxation routine, and sleep-stimulating environment shows that there is a positive correlation with the quality of sleep at r = 0.9, 0.89, 0.75, and 0.68, whereas P = 0.000, 0.01, and 0.023, respectively. Similar to this, there is a positive association between mental ability and good sleep habits such as a relaxing routine, a sleep-promoting environment, and a schedule with r = 0.91, 0.88, and 0.92, respectively, with P values of 0.0001, 0.001, and 0.001.

Conclusion:

The results of the study provide compelling evidence that good sleep hygiene can help enhance insomniacs’ mental ability and sleep quality. Furthermore, those with moderate levels of sleep quality, those between the ages of 18 and 38, and those with higher education benefited more than others.

Introduction

Sleep problems are more common in the general population nowadays because of lifestyle changes, work pressure, schedules, and other personal problems. It might have disturbed the normal function of the individual as well as the family by causing a lack of interest in family activities, a lack of family members’ interaction, an increase economic burden because of frequent fallings of illness and rising work absenteeism, and a lack of quality time with family because of feeling improperly rested and always trying.

A systematic review conducted by Chattu et al. (2018)[1] explored that public and healthcare professionals should have knowledge of the side effects of poor sleep, which cause problems in the physical and psychological health of the general population. Because sleep and mental health have a related connection to each other, which directly impacts the individual and society. Public health is a highly concerned area globally. Sleep health promotion is an underrecognized public health opportunity with implications for a wide range of critical health outcomes, including cardiovascular disease, obesity, mental health, and neurodegenerative disease.[2]

Kerkhof GA conducted an epidemiological overview of sleep disorders in the general population in 2017 and concluded that 1/3 of the general population has insomnia, between 4% and 26% experience excessive sleepiness, and between 2% and 4% experience obstructive sleep apnea, 32.1% for a general sleep disturbance, 43.2% for insufficient sleep, 5.3% for circadian rhythm sleep disorder, 6.1% for parasomnia, 5.9% for hypersomnolence, 12.5% for restless legs disorder and limb movements during sleep, 7.1% for sleep-related breathing disorder, and 12.2% for the presence of comorbidity.[3]

Krause AJ et al. (2017)[4] provided more information on the effects of sleep deprivation on the human brain, demonstrating how sleep issues impact hippocampal learning, happy and negative emotions, attention, and working memory. Overuse of them alters cognition and can result in serious neurological and behavioral brain diseases. Insomnia produces clinically significant impairments in social and occupational areas of functioning, as evidenced by a reduction in work productivity, frequent absenteeism, decreased cognition and mood, and increased morbidity of psychological and physical illness, accompanied by a greater healthcare burden due to the chronicity of illness and direct and indirect costs to society.[5]

Pre-existing chronic insomnia is an independent risk factor for the development of depression, as many studies have shown, in addition to the high rates of co-morbidity between mental and physical health.[6] Finally, Insufficient sleep can have many effects on kids and their families. They may make the child less successful academically, more irritable, less social-emotionally stable, less adept at paying attention, and less able to regulate their conduct in the classroom.[7]

To prevent serious harm and the development of both physical and psychological diseases, it is imperative that we treat sleep disturbances, particularly insomnia, as soon as possible using the appropriate sleep hygiene practice measures.

Sleepless individuals with poor sleep hygiene habits, such as smoking, consuming alcohol or coffee, watching television, and other activities, typically engage in these behaviors before bed, which negatively impacts their sleep quality and impairs their mental capacity. Establishing a regular practice of adhering to certain crucial sleep hygiene measures will enhance sleep and mitigate the intensity of insomnia.[8,9] and Mostafa Alikhani et al. (2020)[10] came to the conclusion in their research that sleep hygiene training, either administered alone or in conjunction with trazodone, can be beneficial for HIV male patients experiencing disruptions in their sleep.

In 2021, Scott AJ et al.[11] did a meta-analysis of randomized controlled trials to determine the impact of sleep-improving interventions on seven distinct mental health issues and composite mental health. 65 trials comprising 72 interventions and N = 8608 participants were included. Improving sleep led to a significant medium-sized effect on composite mental health (g+ = −0.53), depression (g+ = −0.63), anxiety (g+ = −0.51), and rumination (g+ = −0.49), as well as significant small-to-medium-sized effects on stress (g+ = −0.42), and finally small significant effects on positive psychosis symptoms (g+ = −0.26). In addition, we discovered a dose-response connection, meaning that higher gains in mental health were correlated with higher gains in sleep quality.

Education about excellent sleep hygiene is usually beneficial and effective; it is frequently given in groups, and planned activities and behavioral changes have been performed with success. Using precision medicine is essential to successful sleep hygiene practices because there are numerous individual characteristics that predispose persons to sleeping issues.[12] Therefore practicing sleep hygiene practices under the supervision of a qualified professional practitioner is an essential basis for applying sleep hygiene, which is crucial.

Although there is much-existing research focused on finding relationships between different aspects of the impact of sleep quality on mental ability among insomnia patients, there are still unexplained or unexplored areas that cannot be ignored. This current study was conducted to assess the efficacy of sleep hygiene on improving quality of sleep and mental ability among clients with insomnia in a strict therapeutic environment.

Material and Methods

In this study, a quantitative, pre-experimental, one-group pre-test-post-test design was adopted. 50 insomnia patients with physical as well as psychological conditions were recruited as participants who satisfied the study’s inclusion criteria by purposive sampling methods from the Fraternal Life Service Home and SMVM Hospital, Pondicherry. Both health service institutions provided sufficient care for patients who have suffered from insomnia. The institutional ethical committee approved this study. Participants were assured of their voluntary written informed consent after a proper explanation of the study intervention and its benefits. Participants aged between 18 and 70 years old who were cooperative and understood the researcher’s instructions, which included the ability to practice sleep hygiene after the demonstration session, were included. Participants who had no interest in participating were poor and uncooperative, and those who were receiving alternative psychotherapy training programs such as cognitive behavior therapy, yoga, meditation, conduct therapy, mindfulness, or their own family remedies were excluded from this study.

The quality of sleep was assessed using a self-structured questionnaire. It consists of 45 items, and the scores between 1 and 15 show no quality of sleep, scores between 16 and 30 indicate moderate quality of sleep, and scores between 31 and 45 resemble quality of sleep. Mental ability was assessed using the McQuaig Mental Ability Test, which consists of 50 items. Items below 25 indicate below-average ability, 25–37 indicate average ability, 38–45 indicate high ability, and 45–50 indicate exceptional high ability.

Study intervention

A strategy for raising sleep quality is called sleep hygiene. The following various techniques were used in this study:

1. Regularize your time schedule; falling asleep and waking up each day at the same time will help reinforce excellent sleeping habits and promote quality sleep.

2. Relaxing routine: following a pattern that includes taking a warm bath, drinking warm milk before bed, performing simple muscle relaxation exercises such as stretches, listening to calming music, walking, and dancing, this strategy will assure restful sleep due to high-quality sleep as a result of reducing stress and tension.

3. Sleep Stimulating Environment: This involves creating an environment that is suited for sleeping, such as turning off the lights or utilizing dim lighting, a quiet setting, and a soothing aroma.

4. Avoid using electronic devices and drinking brain stimulants such as alcohol and caffeine within two hours of going to bed.

Results

Table 1 results show in-depth information about the frequency and percentage distribution of the chosen participant’s baseline data through various perspectives: 15 (30%) of the subjects were aged 18–30 years; 26 (52% of subjects) were aged 31–50 years; and 9 (18%) were aged 51–70 years. In relation to gender, 27 (54%) of the subjects belonged to females, and 23 (46%) of them belonged to males. The subject family income per month data shows that 5 (10%) were from 5001–10000, 26 (52%) were from 10001–15000, 14 (28%) were from 15001–20000, and 05 (10%) belonged to Above 20001. With regard to residence, 28 (56%) of them resided in urban areas, and 22 (44% of the subjects) were from rural areas. In relation to religion, 34 (68%) of the subjects belonged to the Hindu religion, 15 (30%) belonged to the Muslim religion, 1 (2%) belonged to the Christian religion, and 0 (0%) of them belonged to others.

Table 1.

Demonstrate that Frequency and percentage distribution of insomniac patients according to pre and post-test level of mental ability

Mental ability	Pre test		Post-test
	f	%	f	%
Low average ability	28	56	06	12
Average ability	19	38	15	30
High ability	03	06	21	42
Exceptional high ability	00	00	08	16
Total	50		50

Table 2 shows that the test had a mean value of 16.49 and a standard deviation of 3.37. The post-test mean was 12.1, with a 3.08 standard deviation. The mean difference is 15%, t = 33.61, P = 0.000, which is statistically significant at P < 0.001.

Table 2.

Illustrate that paired t-test value for effectiveness of sleep hygiene on level of quality sleep among insomniac patients

Area	Pre test		Post-test		Mean difference	t	P
	Mean	SD	Mean	SD
Overall	16.49	3.37	12.11	3.08	15%	33.35	0.0000

It is evidenced that sleep hygiene plays a pivotal role in enhancing the quality of sleep.

Table 3 shows the efficacy of sleep hygiene on mental abilities at a t value of 35.33 and P = 0.00001. It is statistically highly significant at P < 0.000.1. These findings support the idea that sleep hygiene plays a vital role in promoting the quality of sleep and improved mental abilities among study participants.

Table 3.

That paired t-test value for effectiveness of sleep hygiene on enhancing level of mental ability among insomniac patients

Area	Pre test		Post-test		Mean difference	t	P
	Mean	SD	Mean	SD
Overall	21	5.13	28.2	6.01	7.2	35.33	0.00001

In addition, regression analysis results show that schedule regulation has a stronger positive correlation with sleep hygiene and quality of sleep than other factors, with a correlation coefficient of 0.9 and a P-value of 0.0001, respectively. This is because it encourages the patient’s physiological sleep processes, such as arousal of sleep, drive, circadian rhythms, and sleep system, in an appropriate manner and helps the patient set their mind to take proper rest.

Discussion

A primary care physician may fail to notice insomnia, a common sleep issue unless they are specifically requested to. The primary care physician should test patients for insomnia using a self-assessed questionnaire and provide counselling if they are middle-aged or older, as the incidence increases with age and co-morbidities such as diabetes.[13]

Stress, anxiety, and bad sleeping habits are all risk factors for insomnia, which has a significant impact on scholastic achievement. There exists a correlation between mental health, academic achievement, and symptoms of sleeplessness and health behaviors. Promoting sleep and mental well-being may be a useful strategy for raising their academic achievement.[14] Decreased sleep issues and improved sleep quality can be achieved by maintaining a regular bedtime and abstaining from stimulants that stimulate brain cells, such as alcohol, caffeine, and other substances.[8,15]

This study shows interest in testing the efficacy of sleep hygiene such as regularizing time schedules, relaxing routines, sleep-stimulating environments, and avoiding beverages to promote sleep quality, as well as the relationship with mental abilities such as thinking, decision-making, verbal or nonverbal skills, reasoning, and mathematical ability of insomniac patients, which is a co-morbid condition of many psychological and physical disorders.

After a daily screen evaluation of participants’ mental and sleep quality, study intervention strategies were given over the course of four weeks. The results of the investigation are presented in Figure 1. Regularly practicing sleep hygiene techniques that ensure punctuality at bedtime, along with other necessary elements to promote sleep, leads to improvements in both the quality of sleep and mental abilities.

Figure 1.

Frequency and percentage distribution of pre test and post-test level quality of sleep among Insomniac patients

Limiting brain cell stimulation promoted a regular sleep cycle and was favorably correlated with sleep quality at r = 0.89 and P = 0.0001, a level of significance that is extremely statistically significant. Avoiding alcohol, caffeine, and other stimulants before bed helps the sleep cycle return to normal functioning. These substances have the potential to impair cell rest. It was largely based on the amount of time and information consumed.

Furthermore, a beneficial correlation has been seen between the quality of sleep and a relaxation regimen, which includes walking, easy muscular stretches, and muscle relaxation (r = 0.75, P = 0.01). These exercises reduced stress by raising circulation and providing distraction, which enhanced the quality of sleep. Numerous articles provided evidence that exercise is a safe, effective treatment for insomniacs that can enhance their sleep quality.[16] Similar to this, the Sleep Stimulating Environment research promotes healthy sleeping practices and raises the quality of sleep by reducing distractions. It does this by considering the environment of the bedroom, which includes nice scents, silence, calming music, and low lighting. Despite their differences, the r = 0.68 and P = 0.023 each have a special impact on raising the quality of sleep. Quality sleep is ensured by the quality of the living environment, and the maintenance of the sleeping environment is necessary to prevent sleep disorders.[17]

Encouraging healthy sleeping practices prioritizing conventional messaging about getting enough sleep might limit the benefits for mental health. Instead, a more comprehensive strategy for public health messaging that raises sleep health literacy may be advantageous for mental health.[18]

Because mental ability has an immediate influence on the quality of sleep, the relationship between mental ability and sleep can be described through quality sleep. Raising the quality of sleep affects mental ability by lowering stress, providing a satisfying sense of rest, and strengthening physiological cell function by regenerating energy for effectively completing everyday tasks. Overall, there was a positive correlation between the mental ability score and sleep quality. The relaxation routine of sleep hygiene practice has more of an impact on improving mental ability than other practices because it will encourage the patient to avoid the primary cause of sleep deprivation, such as insomnia, and it increases attention and concentration directly, which strengthens other mental abilities such as memory, learning, and intellectual function, with a significant correlation of r = 0.91 and a P-value of 0.001. Numerous studies have found that cognitive training and sleep hygiene interventions are effective ways to increase cognitive performance and sleep quality.

Furthermore, a sleep-stimulating environment and mental ability showed a positive correlation with r = 0.88 and P = 0.001, respectively. Understanding the connection between mental ability and sleep quality is a crucial finding. To ensure the quality of sleep, reduce sleep distraction, and increase sleep stimulation, the ideal sleeping environment is necessary. In the end, it contributes to the constancy of the physiological process of sleep, particularly the commencement and continuation of the sleep cycle, which eliminates sleep disorders and makes patients feel emotionally stable and get quality sleep. This has a direct impact on the patients› ability to convey their learning and to use suitable mental abilities such as memory.[19,20] Likewise, the implementation of a time schedule demonstrated a positive correlation with mental ability at the level of r = 0.92, P = 0.001, as it will enhance patients› sleep quality and mental abilities by preventing naps and maintaining regular sleeping hours. A negative correlation of r = 0.4 and P = 0.621 indicates that eliminating coffee and beverages had no significant impact on improving mental performance statistically at P > 0.05., despite having a beneficial impact on improving the quantity and quality of sleep.

In addition, the association Chi-square data finding of quality sleep and mental ability with demographical variables illustrated that there is a valuable association with some of the variables. Quality of sleep was not connected with characteristics such as educational status, residency, or religion at P > 0.05, although it was with the respondent›s age, gender, and family income per month. Age of response is the most important factor to take into account when demonstrating the effectiveness of sleep hygiene practice because age differences show differences in the sleep cycle, and in particular, the age group between 18 and 38 showed more interest in practicing sleep hygiene every day without fail than other groups.

Data show that both genders responded equally, indicating that participants are serious about using this treatment strategy to enhance their sleep by lowering stress and encouraging relaxation. Economic issues play a significant role in increasing the mental stress of hospitalized and inpatient patients, which has an impact on their ability to sleep normally. The patient’s income information reveals that highly paid individuals responded more successfully than other groups.

Although mental ability was related to participant age and educational level at P = 0.001 to 0.0001, respectively, this is because different age groups have different mental abilities to learn and practice sleep hygiene, which directly affects the mental ability of patients. The group between 39 and 59 years old in particular showed more responses than other groups. When participants were the same age, however, there was no correlation between other factors and mental ability. Education makes a distinction in their mental ability based on how well they have learned to practice good sleep hygiene. However, there was no correlation between other factors and mental ability.

Conclusion

The results of the study showed that sleep quality (t = 33.35) (P = 0.0000), which is extremely significant at P > 0.0001, and mental ability (t = 35.33) (P = 0.0001), which is significant at P > 0.001, In the interpretation of correlation regression data, information on sleep hygiene factors such as time schedule, avoiding alcohol, caffeine, and beverages, relaxation routine, and sleep-stimulating environment reveals that there is a positive correlation with the quality of sleep at r = 0.9, 0.89, 0.75, and 0.68, respectively, whereas P = 0.000, 0.01, and 0.023, which is statistically significant at the level of P > 0.0001 and 0.05. There is strong evidence that sleep hygiene is a useful strategy for treating insomnia.

Correlation statistics for mental ability and sleep hygiene demonstrate that participants’ cognitive function significantly improved after implementing the study intervention. The results indicate that there is a considerable efficacy in the association between the relaxation routine and mental ability (r = 0.91, P = 0.0001). The second most significant component-enhancing factor is the sleep-stimulating environment (r = 0.88, P = 0.001), followed by this time schedule (r = 0.92, P = 0.001). These findings illustrate that sleep hygiene indirectly motivates the mental ability of participants by promoting the quality of sleep.

Quality of sleep had an association with age, gender, and income at P < 0.05, 0.001, whereas mental ability had an association with age and educational status at P < 0.05, 0.001. Overall, this study provided convincing evidence that proper sleep hygiene practices can improve insomniac patients› quality of sleep and mental ability.

This research emphasizes the need for specific therapeutic approaches, such as sleep hygiene, to improve sleep quality and preserve mental abilities in patients with insomnia. It also highlights the need for further research on more aspects of sleep quality and mental ability.

Limitation

Sample size, research design, setting, use of sleep hygiene practices, and participant age were among the study’s limitations.

Strengths

This study attempted to elucidate the relationship between the effects of sleep hygiene parameters on quality of sleep and mental abilities that have not been considered in previous studies.

Recommendations

According to the study’s findings, the following suggestions have been made.

1. A high sample size allows for similar studies to be performed across the nation.

2. The same study can be performed in many settings.

3. Other research designs can be used to perform the same investigation.

4. The control group can be used in the same investigation.

5. A comparison of this study’s findings with those of other psychotherapies, such as time out, modeling, shaping, meditation, token economies, and thought stopping, can be made.

Financial support and sponsorship

In order to conduct and publish this research study, the author received no outside funding.

Conflicts of interest

There are no conflicts of interest.