Apr 28, 2020 in Health

Sleep Behavior


At present, many Americans live with chronic sleep disorders that reduce their activeness and have adverse effects on their health. According to the recent estimations, there exist at east eighty different types of sleep disorders at least one of which is present in 50-70 million of American adults. Sleep medicine is considered interdisciplinary, since it is connected with almost all branches of medicine in a direct or indirect way. The comprehensive control of sleep disorders incorporates the methods used in psychology, pediatrics, psychiatry, pulmonary medicine, neurology, dentistry, and otolaryngology. Moreover, sleep disturbances have proven to be interrelated with a wide range of diseases including diabetes mellitus, hypertension, depression, cardiovascular disease, obesity, and cancer. As a result, this health behavior issue gain special prominence and demand in further investigations for the sake of social health and welfare. However, while millions of adults and children face certain sleep problems, a high percentage of them do not become subject to clinical attention. As a result, the sleep disorders left without treatment may not only aggravate the chronic health conditions present in patients but also provoke the development of other health-related issues.

The purpose of this paper is to provide the outline of the sleep behavior disorders, analyze their impacts on the individual welfare and health of elderly people, discuss and compare different health behavior models and apply them to the solutions of the chosen problem.


Characteristics of the Sleep Behavior Disorders

Sleep behavior is mostly associated with a variety of sleep disorders that can develop because of the particular illnesses or as a chronic condition resulting in serious health-related outcomes. The majority of sleep disturbances can occur in every person regardless of age and socioeconomic status and are increasingly widespread among the elderly residents of the United States. As a rule, most of the widespread sleep disorders such as insomnia and obstructive sleep apnea lead to the impairment in quality of life and affect memory, learning abilities, and energy exchange. Similar to sleep disturbances, sleep deprivation as well as violation of recommended sleep regime may lead to either minor or irreversible damage to physical and mental health depending on the duration of period without sleep. This problem becomes especially urgent in case with the elderly people, since the disorders of sleep patterns may amplify the chronic diseases and increase the adverse effects of other health-related problems and medication. The variety of factors influencing sleep behavior of the elderly requires the utilization of health behavior theories to address these issues.

A number of studies have been conducted to determine the relationship between sleep disturbances and chronic diseases, especially in the late life. According to the results of meta-analysis based on five studies, there is an association between insomnia symptoms such as difficulty initiating and difficulty maintaining sleep and the development of diabetes mellitus. St-Onge also indicate that on the basis of subjective symptoms, the scientists revealed a moderate connection between combined insomnia symptoms and the development of hypertension. In addition, the results of meta-analysis based on thirteen studies confirmed the relationship between insomnia symptoms and developing or dying of cardiovascular disease. Therefore, both short- and long-term sleep disorders as well as sleep deprivation are associated with adverse cardiometabolic conditions and corresponding outcomes.

Several studies have been conducted to examine the impact of sleep restriction on energy intake and expenditure. The research assessing energy intake after periods of sleep restriction that was equal to four hours in bed instead of the needed eight hours reported an increase in 24-hour energy intake. As stated by St-Onge, the higher energy intake observed after periods of sleep restriction can be explained by alterations in appetite-regulating hormones, particularly leptin, ghrelin, and glucagon-like peptide 1 in women. On the other hand, the researcher have measured 24-hour energy expenditure in a metabolic chamber to provide a more restricted environment. From this perspective, the participants undergoing sleep restriction demonstrated an increase in energy expenditure in relation to habitual sleep. These results can be partly explained by the need to expend additional energy to maintain wakefulness after an insufficient period of sleep. Therefore, a person who controls the duration of sleep periods and their proper timing is likely to consume less energy than those who have restricted sleep hours as well as expend less energy during the day.

For adults, the maintenance of healthy lifestyle and well-being presupposes the development of sleep regime to follow on a regular basis. According to Liu, a healthy adult aged 18-60 years should sleep at least seven hours per day. Sleeping less than seven hours per night can lead to an increased risk of obesity, high blood pressure, diabetes, stroke, coronary heart disease, frequent anxiety, and all-cause mortality. In addition, the lack of sleep deteriorates cognitive performance increasing the likelihood of transportation and industrial accidents, loss of work productivity, medical errors and other factors affecting the community.

In addition, the sleep behavior disorders frequently result in the insomnia, which is a common sleep disorder that affects different groups of patients and depends on the character of its symptoms. According to the definition given by Walia and Mehra, insomnia difficulties in falling sleep, maintenance of sleep, or poor sleep quality regardless of the favorable circumstances and opportunities. The analysis of 50 studies addressing this issue demonstrates the incidence of insomnia in women and patients with family history of this disorder. Insomnia is frequently associated with psychiatric disorders due to its incidence in approximately 40-50 percent of patients with anxiety and mood disorders. The health determinants of insomnia are linked to the physical environment, working settings and physical load, undertaken by the patients. In case with the elderly, the insomnia may lead to impairments in quality of life in the form of depression, anxiety, and sleepiness.

Another problem of the sleep behavior disorders is the circadian sleep disorders, which frequently affect the elderly population, presuppose the inability of individuals to fall asleep during the desired period. As a result, a person often fails to wake up at the desired time and experiences sleep episodes when it is least appropriate. The most common type of circadian sleep disorders involve delayed sleep wake phase disorder, advanced sleep phase disorder, time zone change (jet lag) syndrome, and shift work sleep disorder. All of them negatively affect the individual welfare and may provoke the occurrence of the related diseases on both physiological and psychological levels. 

Obstructive sleep apnea represents another major type of sleep disturbances that influence physical condition and psychological state of individuals. This disorder manifests itself in periodic episodes of partial or total collapse of the upper airway within the sleep period. As a result, a person may suffer from fatigue, daytime sleepiness, snoring, witnessed apneas and difficulty maintaining sleep. In the United States, obstructive sleep apnea is prevalent in 24%–26% of males and 17%–28% of females aged from 30 to 70. As stated by Walia and Mehra, the amount of affected individuals increases is associated with advancing age and an increase in body mass of while nearly 80% of cases remain unidentified. Therefore, the management of this disorder requires more precise diagnostics to avoid severe complications caused by it.

The findings of the research conducted by Van Rijn, Lucignoli, Izura, and Blagrove proved that recently acquired memories are not equally consolidated during sleep. However, sleep plays an active role in the consolidation of memories perceived as valuable and relevant. The scientists have revealed the involvement of sleep in consolidating memory after the increase in memory for Welsh and Breton words demonstrated by the participants after sleep. The processing of memory during sleep has a sophisticated and selective character that is valuable for the acquisition of learned material.

The Importance of Sleep Behavior for the Elderly People

It is commonly known that spending a couple of days without sleep may lead to irreversible negative outcomes. After a single night without sleep, a person may feel slight discomfort and tiredness. A two-night sleep deprivation usually results in an extreme feeling of fatigue. After the third sleepless night an individual cannot concentrate and perform calculations and becomes irritated and impolite. As stated by Orzeł-Gryglewska, four night without sleep lead to the impairment in attention and experiencing hallucinations, illusions, and perception disorders. After the five-night sleep deprivation, the elderly people may encounter disturbances in orientation, intellectual and problem-solving abilities, and visual and tactile hallucinations. Finally, after six nights without sleep, a person displays symptoms of depersonalization and is no longer able to interpret reality. These research findings demonstrate that any healthy individual may experience physical and mental disabilities in case of being deprived of sleep.

The Utilization of Health Behavior Theories

The multifunctional approach to sleep behavior issues requires the application of specific health behavior theories. Among them, the most suitable ones are The Transtheoretical Model (TTM) and The Health Belief Model (HBM). The Transtheoretical Model (TTM) comprises six stages of change and concentrates on the readiness of an individual to change the existing health behavior. In case of addressing the sleep behavior issues, this model can be utilized as a basis for the development of intervention plans for those individuals who deliberately deprive themselves of sleep or are exposed to the conditions where sleep deprivation is unavoidable. Therefore, this model emphasizes the role of the relevant interventions and influences of the external factors on the promotion of healthy patterns and models of behavior among the individuals. 

On the contrary, the Health Belief Model (HBM) points to the prominence of individual beliefs in addressing of a particular health behavior issue. These beliefs comprise perceived susceptibility, severity, benefits, and barriers. According to this model, it is possible to explain the health risks and negative outcome associated with sleep disorders and compare them with benefits resulting from their elimination. The HBM also supposes that the health promotion and elimination of symptoms of different disorders highly depends on the individual beliefs, opinions and attitudes to the personal welfare and stability. In this case, this theory suggests the alternative to the TTM, as it emphasizes the individual efforts and attempts in the eradication of the health disorder or behavior patterns. Nevertheless, it is possible to state that both theories admit about the importance of the opportune and appropriate interventions and conscious attitudes to the health issues as the basis of improvement and elimination of negative symptoms. 

Application of Health Theory Models to the Solution of Sleep Disorders

The study, conducted by Jones, Smith, & Llewellyn aimed at utilizing the Health Belief Model in order to show its influence on the elimination of health disorders and promotion of healthy lifestyle and habits among the participants. The researchers state that lack of information and coherence of the personal opinions and attitudes to health provoke the behavior disorders, connected with the sleep patterns, as well. The authors suggest that the implementation of HBM interventions significantly increases the personal awareness of health and ways of recovering from the existed health-related problems, such as diabetes, bacterial vaginosis, insomnia and obstructive sleep apnea. It is also estimated that the HBM interventions help to reduce the level of behavior disorders due to the prevalence of the positive and adequate opinions on individual care and well-being. The suggested solutions include the adherence-enhancing interventions, replication practices and health-protecting patterns of behavior. 

Overall, the study admits about the probability of application of HBM to the treatment of sleep behavior disorders. It states that individual imaginations and opinions on heath strongly influence the risks of incidence with the sleep disorders as well as the ways of their treatment and rehabilitation. The HBM helps to establish the appropriate approach to the treatment of sleep behavior disorders due to their universal character and affordable techniques. In this light, the efficiency of HBM in curing of sleep disorders causes no doubts and requires further investigations, concerned with the improvement of the quality of results. 

Another study, conducted by Prochaska, applies the Transtheoretical Model (TTM) to the treatment of sleep behavior disorders. This model includes several stages, which are pre-contemplation, contemplation, preparation, action and maintenance. The first two stages happen unconsciously, when individuals are not yet aware of the importance of the suggested interventions and health-promoting practices. However, they help to set the background for the further changes and modifications in the health-related behaviors. The following three stages involve the individual efforts and knowledge, channeled to overcome the existed health problems in accordance with the suggested technique and tools.  The author suggests that this model helps to prepare individuals to changes and set the clear instructions, regarding the shifts in health behaviors. 

Prochaska states that the TTM can highly promote the change of the healthy habits and increase of health awareness through the gradual preparation and adjustment to them. The author supposes that seep behavior disorders arise, because of the lack of conscious attitude to the problem and awareness of the potential solutions. The gradual adoption of the new rules helps to rethink the sleep behavior disorders and react to them adequately and promptly.  


In general, sleep behavior incorporates a variety of sleep disorders, sleep deprivation, and planning of sleep periods according to the professional recommendations. Sleep disorder may occur in children, teenagers, and adults regardless of gender as a response to particular environmental factors; however, this problem highly affects the elderly people, in the first turn. The affected individuals experience the overall impairment in quality of life that manifests itself in the development of diseases and psychological problems. The determinants associated with sleep disorders comprise individual, societal, and environmental impacts. The high prevalence of sleep disturbances stresses the necessity of addressing this issue and the development of plans based on particular health behavior theories. There are many health theory models, which can be successfully implemented in the treatment of sleep behavior disorders. Among them, the roles of Transtheoretical Model (TTM) and The Health Belief Model (HBM) should be considered. The scientific studies and researches prove the efficiency of implication of those theories in curing the sleep behavior disorders.


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