“A STUDY TO ASSESS THE EFFECTIVENESS OFAROMATHERAPY ON REDUCING SLEEP DISTURBANCESAMONG GERIATRICS BETWEEN 65-80 YEARS IN OLD AGE HOME AND DISTRICT HOSPITAL AT TUMKUR.”
PERFORMA FOR REGISTRATION OF SUBJECT FOR
DESERTATION
MR.PRAVIN RAMESH GHOLAP.
PSYCHIARIC NURSING
ARUNA COLLEGE OF NURSING
RING ROAD, TUMKUR
2009-2010
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. NAME OF THE CANDIDATE:MR. PRAVIN RAMESH GHOLAP.
AND ADDRESS ARUNA COLLEGE OF NURSING
RING ROAD, MARALUR
TUMKUR-572105
2.NAME OF THE INSTITUTION: ARUNA COLLEGE OF NURSING
RING ROAD, MARALUR
TUMKUR-572105
KARNATAKA
3. COURSE OF STUDY : 1 YEAR M.Sc. NURSING
AND SUBJECT PSYCHIATRIC NURSING
4. DATE OF ADMISSION : 01.06.2009.
TO COURSE
5.TITLE OF THE TOPIC :“A STUDY TO ASSESS THE EFFECTIVENESS
OF AROMATHERAPY ON REDUCING SLEEP
DISTURBANCES AMONG GERIATRICS
BETWEEN 65-80 YEARS IN OLD AGE HOME
AND DISTRICT HOSPITAL AT TUMKUR.”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“JOURNEY OF A THOUSAND MILES STARTS WITH A SINGLE STEP”
A good night sleep is essential to us all and without it we cannot perform to our full potential.Once thought of as a “passive, dormant” part of daily life,sleep is now understood to include vital physiologic processes:it helps to “maintain mood, memory, and cognitive performance which play a vital role in the normal function of the endocrine and immune systems”. Lack of sleep can make us grumpy, lose concentration and in severe cases can make us feel ill. Sleep is very important to us all and it is recommended that we get between 7 to 8 hours of sleep per day1.
Sleep proceeds in cycles of REM (Rapid Eye Movement)and NREM(Non Rapid Eye Movement), the order normally being N1 → N2 → N3 → N2 → REM. REM is quiet different from NREM sleep. Whereas NREM Sleep is a peaceful state compared to wakefulness,REM sleep is characterized by high level of brain activity levels that are similar to those of the waking state.During REM sleep there is a generalized muscle atonia.About 90 minutes after the beginning of sleep, the NREM sleep changes to the first REM cycle of the night.This 90- minute period is referred to as the REM latency period and is a consistent finding in most adults. The REM latency period is frequently shorter in depressed individuals. There is a greater amount of deep sleep (stage N3) early in the night, while the proportion of REM sleep increases later in the night and just before natural awakening1.
Sleep timing is controlled by the circadian clock, sleep-wake homeostasis, and in humans, within certain bounds, willed behavior. The circadian clock — an inner timekeeping, temperature-fluctuating, enzyme-controlling device — works in tandem with adenosine, a neurotransmitter that inhibits many of the bodily processes associated with wakefulness. Adenosine is created over the course of the day; high levels of adenosine lead to sleepiness. The timing is affected by one's chronotype It is the circadian rhythm that determines the ideal timing of a correctly structured and restorative sleep episode.Sleep debt is the effect of not getting enough rest and sleep; a large debt causes mental, emotional, and physical fatigue. It is unclear why a lack of sleep causes irritability2.
Sadock and sadock , portrays that Sleep duration is affected by circadian rhythm which is regulated by a gene named DEC2. Requirements for sleep vary from individual to individual.Some people are considered short sleepers and can function effectively on fewer than 6 hours of sleep per night.Others ,considered long sleepers ,require more than 9 hours of sleep each night.Long sleepers experience more REM periods than do short sleepers.3
Aromatherapy is a form of alternative medicine that uses volatile liquid plant materials, known as essential oils (EOs), and other aromatic compounds from plants for the purpose of affecting a person's mood or health. Scientific evidence is growing and preliminary but encouraging for a number of health issues Aromatherapy is the ability to use essential oils to improve both physical and emotionally well-being. These essential oils can improve many things from alleviating headaches and anxiety to help in relax and sleep. Essential oils are distilled from various plant materials including bark, flowers, berries, leaves or fruit4.
Two basic mechanisms are offered to explain the purported effects. One is the influence of aroma on the brain, especially the limbic system through the olfactory system. The other is the direct pharmacological effects of the essential oils. While precise knowledge of the synergy between the body and aromatic oils is often claimed by aroma therapists, the efficacy of aromatherapy remains to be proven.
Studies have shown that the top five are lavender, chamomile, bergamot, sandalwood and mandarin.
The mode of application of aromatherapy includes;
Aerial diffusion; for environmental fragrancing or aerial disinfection
Direct inhalation; for respiratory disinfection,decongestion,expectoration
as well as psychological effects.
Topical application; for general massage,baths,compresses,therapeutic skin care.
6.1. NEED FOR THE STUDY
Sleep is a basic human need, and unless we experience difficulty in sleeping, we tend to take all sleep for granted. Sleep is receiving increasing attention in the media and medical research.
In 2003,National Sleep Foundation polled 1,506 older adults ages 55 to 85 and found that about two thirds had one or more symptoms of a sleep problem” at least a few nights a week”.The prevalence of insomnia rises with age, affecting 23% to 41% of adults ages 70 and older,With women ages 80 to 89 having the highest prevalence rate ,and a large epidemiological study of more than 9000 adults ages 65 and older found that more than half reported at least one chronic sleep problem” occurring most of the time.One option, of course, is taking sleeping medications, but why not do something better for our body? Don’t use chemicals. Use a natural approach to help in relax and sleep and what could be better than using aromatherapy5.
The studyestimated that 47 million American suffer from sleep deprivation, which means that a person is not getting an optimal amount of sleep every night. Sleep deprivation leads to chronic fatigue, memory problems, energy deficit, mood difficulties, and a feeling of just generally being out of sorts. We live in fast-paced, high tech world that operates 24 hours a day. Many are willing to trade hours of sleep to “catch up” on work or home projects. Estimates are that over the last century the average nightly sleeping time has been reduced by 2 hours from 9 hours a night in 1910 to 6.9 hours at night in 2002. As adults enter middle age and old age, sleep often becomes more shallow, fragmented, and variable in duration. Studies shows that in old age, stages one and two and the amount of time spent awake during the night tend to increase; REM latency and sleep wakefulness decline6.
Professor Francesco Cappuccio said, "Short sleep has been shown to be a risk factor for weight gain, hypertension, and Type 2 diabetes, sometimes leading to mortality; but in contrast to the short sleep-mortality association, it appears that no potential mechanisms by which long sleep could be associated with increased mortality have yet been investigated. Some candidate causes for this include depression, low socioeconomic status, and cancer-related fatigue. …In terms of prevention, our findings indicate that consistently sleeping around seven hours per night is optimal for health, and a sustained reduction may predispose to ill health."Furthermore, sleep difficulties are closely associated with psychiatric disorders such as depression, alcoholism, and bipolar disorder. Up to 90% of adults with depression are found to have sleep difficulties. Dysregulation found on EEG includes disturbances in sleep continuity, decreased delta sleep and altered REM patterns with regard to latency, distribution across the night and density of eye movements7.
The study shows that sleep problems are also associated with serious medical conditions.for instance sleep apnea is closely related to hypertension,heart failure,and diabetes.sleep deprivation leads to the production of fewer infection –fighting antibodies and thereby increases vulnerability to infection.chronic sleep loss might lead to an earlier onset and an increase in severity of diabetes and obesity.Requirements for sleep vary from individual to individual. Some people are considered short sleepers and can function effectively on fewer than 6 hours of sleep per night. Others, considered long sleepers, require more than 9 hours of sleep each night. Long sleepers experience more REM periods than do short sleepers.8
6.2. REVIEW OF LITERATURE:
The review of literature is an extensive systematic selection of potential sources of previous work, acquaints, facts and findings after scrutinization of location of references of the problem under study.
An extensive review of literature was done by the investigator to gain insight into the selected problem and is depicted under the following headings.
SECTION – A
Review related to Aromatherapy.
SECTION – B
Review related to Insomnia in elderly.
SECTION – C
Review related to Aromatherapy and sleep.
SECTION – D
Review related to Aromatherapy in nursing.
Aromatherapy
Lis-Balchin M. Conducted the study on Essential oils and ‘aromatherapy’: their modern role in healing. ‘Aromatherapy’ is one of the most actively growing forms of alternative medicine combining massage together with counseling and a nice odors. Study revealed out of 250 samples selected randomly, 180 samples revealed relief of stress by using aromatherapy.Most clients suffer from some kind of stress-related disorder and aromatherapy encourages the healing process largely through relaxation and the relief of stress9.
Aromatherapy with massage for geriatric and hospice care—a call for an holistic approach. The medical profession in America would benefit form including aromatherapy with massage in this care of elderly and hospice patients. The appropriate use of these modalities will enhance the quality of patient care and will compliment conventional treatment regimens10.
Aromatherapy facts and fictions: a scientific analysis of olfactory effects on mood, physiology and behavior.A systematic review of scientific experimentation addressing olfactory effects on mood, physiology and behavior was undertaken. From this review, 18 studies meeting stringent empirical criteria were then analyzed in detail and it was found that credible evidence that odors can affect mood, physiology and behavior exists. To explain these effects, pharmacological and psychological mechanisms were explored and a psychological interpretation of the data was found to be more comprehensive. Methodological problems regarding dependent measures and stimuli, which led to inconsistencies in the data were discussed, as were the mediating variables of culture, experience, sex differences, and personality11.
Study was conducted on Therapeutic applications of plant essential oils, the use of essential oils or aromatherapy has increased in recent years. There is a growing body of evidence in the scientific literature suggesting that plant essential oils, alone or in combination with other therapies, may be beneficial in treating a number of health conditions12.
Aromatherapy and Sleep
Cannard G.,conducted the study on the effect of aromatherapy in promoting relaxation and stress reduction in a general hospital. The Tullamore Nursing Development Unit (NDU), since its inception in 1993, has been engaged in improving the quality of nursing practice offered to the patients in the NDU and in the hospital as a whole. One such problem is sleep disturbance, especially in the older patient. In order to try to improve the care available, the staff of the NDU has had to adopt some alternatives to the traditional way of thinking. The use of aromatherapy has significantly improved the sleep patterns of the patients and at the same time, reduced the amount of night sedation required. Following a study of the effectiveness of aromatherapy, it is now being successfully used in the Coronary Care Unit for patients with problems of stress, with encouraging results13.
The study examined the Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an increased sense of well-being. This study measured the responses of 17 cancer hospice patients to humidified essential lavender oil aromatherapy. Vital signs as well as levels of pain, anxiety, depression and sense of well-being were measured (using 11-point verbal analogs). Each subject was measured on three different days before and after a 60 minute session consisting of (1) no treatment (control); (2) water humidification (control); or (3) 3-percent lavender aromatherapy. Results reflected a positive, yet small, change in blood pressure and pulse, pain, anxiety, depression, and sense of well-being after both the humidified water treatment and the lavender treatment. Following the control session (no treatment), there was also slight improvement in vital signs, depression, and sense of well-being, but not in pain or anxiety levels14.
A study on use of complementary and alternative therapies to promote sleep in critically ill patients is largely unexamined. Researchers says that we do not currently recommend aromatherapy and alternative sedatives, for sleep promotion in critically ill patients because the safety of these substances is unclear15.
The study was conducted randomized in evaluating the aroma of Lavandula august folia as a treatment for mild insomnia. Results reported as Ten volunteers (5 male and 5 female) were entered and completed the 4 week study. Women and younger volunteers with a mild insomnia improved more than others16.
The study was conducted on modifies nighttime sleep in young men and women. Aromatherapy is an anecdotal method for modifying sleep and mood. This study investigated the effects of an olfactory stimulus on subsequent sleep and assessed gender differences in such affects. Thirty one young healthy sleepers (16 men and 15 women) completed 3 consecutive overnight sessions in a sleep laboratory. One adaptation, one stimulus and one control night. Subjects received an intermittent presentation (first 2 min of each 10 min interval) of an olfactory (lavender oil) or a control (distilled water) stimulus between 23:10 and 23:40h. Standard poly sommnographic sleep and self-rated sleepiness and mood data were collected. Lavender increased the percentage of deep or slow – wave sleep in men and women. Thus lavender selves as a mild sedative and has practical applications as a novel, non photic method for promoting sleep in young men and women and for producing gender dependent sleep effects17.
Insomnia in elderly
The study was conducted onInsomnia, depression and aging. Assessing sleep and mood interactions in older adults. Insomnia and depression are related to each other on the level of epidemiology, clinical presentation, neurobiology, and treatment implications. The changes in sleep seen in older adults make these relationships particularly strong. Epidemiological studies show that depression is one of the strongest risk factors for current insomnia, but recent evidence indicates that this relationship is bi-directional: current insomnia is a risk factor for future depression. Changes in objective measures of sleep in depression mirror the changes seen in the aging process. Treating sleep disturbances may improve outcomes in patients with depression. Physicians should routinely question their older patients about sleep problems and depression18.
The study was conducted on anxiety symptoms and objectively measured sleep quality in older women. Few studies have examined the association between anxiety symptoms and objectively measured sleep quality in older adults. The authors determined this association in a large cohort of very old community-dwelling women. Participants completed the Goldberg Anxiety Scale (ANX), the 15-item Geriatric Depression Scale (GDS), and > or = 3 nights of actigraphy--a method of measuring sleep by recording wrist movement with a device called an actigraph. Elevated anxiety symptoms were defined as ANX > or = 6. Elevated depressive symptoms were defined as GDS > or = 6. RESULTS: Participants' mean ANX score was 1.4 (standard deviation: 2.2); 9.2% (N = 280) had ANX > or = 6. Elevated anxiety symptoms were associated with greater odds of poor sleep efficiency (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.34, 2.23) and time awake after sleep onset (OR: 1.64, 95% CI: 1.27, 2.11). Associations remained after adjustment for GDS > or = 6, antianxiety medications, and other potential confounders (sleep efficiency OR: 1.50, 95% CI: 1.15, 1.97; time awake after sleep onset OR: 1.33, 95% CI: 1.01, 1.75). Anxiety symptoms were not associated with other sleep parameters. Findings suggest that elevated anxiety symptoms are independently associated with poor objectively measured sleep efficiency and elevated sleep fragmentation in very old women, after accounting for significant depressive symptoms, medical co morbidities, and use of antianxiety medications19.
The study was conducted on Treatment of elderly primary insomnia patients with EVT 201 improves sleep initiation, sleep maintenance, and daytime sleepiness.Two doses of EVT 201, a partial positive allosteric modulator of the GABA(A) system, were evaluated in elderly primary insomnia patients with daytime sleepiness. Participants were 149 elderly patients with DSM-IV primary insomnia including evidence of daytime sleepiness (53 males, 96 females; mean age 71.3yrs, range 65-86yrs). A randomized, multicentre, double-blind, placebo-controlled, parallel-group design was used to assess the hypnotic efficacy of EVT 201 1.5 and 2.5mg during seven consecutive nights. Polysomnography (PSG) was performed on nights 1, 6 and 7 of treatment. Daytime assessments on Day 8 included the multiple sleep latency test (MSLT), Rey Auditory Verbal Learning Test (RAVLT), Psychomotor Vigilance Task (PVT) and the Karolinska Sleepiness Scale (KSS). The primary endpoint was total sleep time (TST) and the key secondary endpoint was mean MSLT latency. Compared to placebo, EVT 201 1.5 and 2.5mg increased TST (30.9, 56.4min, )reduced wake after sleep onset (WASO; -15.2, -36.1min, respectively; p=0.014, p<0.0001); reduced latency to persistent sleep (LPS; -15.9, -19.9min, respectively; p=0.009, p=0.001). The 2.5mg dose also reduced WASO in hours 5-8 (-16.3min, p=0.001). Both doses also improved subjective sleep quality and usual subjective efficacy measures. A significantly longer mean MSLT latency was observed on Day 8 with both doses, compared to placebo (2min increase; p=0.03, both doses). The PVT, RAVLT, and POMS did not differ among treatment groups. No serious or unexpected treatment emergent adverse events were noted. These findings suggest that treatment of primary insomnia in older patients has the potential to improve daytime sleepiness as well as sleep20.