This qualitative study aimed to describe sleep patterns and sleep quality from the perspectives of Chinese elderly, as well as gain insight into how family situations affect sleep appraisals by Chinese elderly.
Naturalistic Inquiry served as a philosophical framework to guide in-depth interviews of 50 Chinese elderly in Taiwan. Naturalistic inquiry, a special form of inquiry, emphasizes that the phenomenon needs to be studied in its natural ongoing circumstances. The interviews primarily were guided by a script and were initiated with a "grand tour" question. Probing and follow-up questions were asked to expand upon specific topics. Convenient sampling and snowball sampling were used in recruiting the participants. The strategies of content analysis were adopted to sort the interview texts. Four techniques were utilized to assess the trustworthiness of the interview data: peer debriefing, member checking, inter-coder agreement, and audit trail.
Twenty-three Chinese men and 27 Chinese women aged 60 to 104 years were recruited. The mean age was 76.3 ± 11. “Toss and turn,” “difficulty falling asleep,” and “poor sleep quality,” were commonly used by the participants to describe their sleep complaints. The key themes represent family situations that influenced the sleep of Chinese elderly including family household size and configuration, living arrangements, filial piety, family roles and responsibilities, and family relationships. The most common family household in this study (46%) was the extended family, a unit including at least three different generations. From the viewpoints of 23 participants, the extended family household was a function of a traditional cultural norm. Twenty-six percent of the participants who lived with offspring in the same building, but on a different floor reported that such a living arrangement resulted in a less disturbing influence on sleep, compared to those who lived with their descendants on the same floor. They enjoyed living with their family members in such a household. Approximately 1/3 of all participants perceived that filial piety is associated with sleep disturbance because the failure to perform filial behavior causes negative moods, such as worry and unhappiness for the parents, who don’t receive them, but the obligations of filial behavior cause stress for the children, who have to perform them. The participants living alone were more likely to report feelings of loneliness, poor sleep quality, and long sleep duration. The participants involved in a strained or demanding family relationship tended to report poor sleep quality and difficulty falling asleep. Interestingly, the majority of the participants in this study were reluctant to “air their dirty laundry” in public because disclosing negative family information to an “outsider” is thought to be shameful in Chinese society.
Family situations, including family household size and configuration, living arrangements, family roles/responsibilities, filial piety, and family relationships, may play roles in affecting the sleep quality of older adults. The influences of family situations on sleep are complex because family roles along with responsibilities, living arrangements, and family relationships naturally change over time when family events or crises occur. Thus, it is crucial for health care providers to take the multiple aspects of family situations into consideration in evaluating and treating sleep problems. The influences of family situations on sleep need to be studied ethnographically by including participants and family members in the research at different time points.