A warm footbath before bedtime and sleep in older Taiwanese with sleep disturbance

Abstract

A single-group crossover design was used to examine the effects of a warm footbath on body temperatures, distal-proximal skin temperature gradient (DPG), and sleep outcomes in 15 Taiwanese elders with self-reported sleep disturbance. Body temperatures and polysomnography were recorded for 3 consecutive nights. Participants were assigned randomly to receive a 41°C footbath for 40 minutes before sleep onset on night 2 or night 3. Mean DPG before lights off was significantly elevated on the bathing night. There were no significant differences in sleep outcomes between the two nights. However, when the first two non-rapid eye movement (NREM) sleep periods were examined, the amount of wakefulness was decreased in the second NREM period on the bathing night. Keywords sleep/rest; agingInsomnia is a common complaint in older adults. They have trouble falling asleep, as well as frequent or prolonged nocturnal or early morning awakenings with an inability to return to sleep (Ancoli-Israel, 1997;Ancoli-Israel & Roth, 1999;Floyd, Medler, Ager, & Janisse, 2000). The overall prevalence of insomnia in the elderly ranges from 14.0% -42.2% based on epidemiological surveys (Chiu et al., 1999;Kim, Uchiyama, Okawa, Liu, & Ogihara, 2000;Ohayon, 1996). As many as 25% of healthy elderly men and women may have chronic insomnia (Ohayon & Smirne, 2002). Global sleep dissatisfaction, defined as overall dissatisfaction with sleep, ranges from 7.7 -20.8% in the elderly, which is higher than in the general population (7.0-10.1%; Pallesen et al., 2001).Sleep is periodic resting behavior characterized by "few body movements, a recumbent posture, and complex brain electroencephalographic activity" (Carskadon & Dement, 2000, p.15). Human sleep architecture is defined by polysomnography (PSG) and divided into stages: four of non-rapid eye movement (NREM) sleep (stage 1 to 4), and one stage of rapid-eye movement (REM) sleep (Rechtschaffen & Kales 1968 Age has large effects on sleep architecture. Compared to young adults, PSG-derived sleep architecture in older adults shows increased amounts of nocturnal wakefulness, increased NREM stage 1 sleep with reduced amounts or complete absence of NREM stages 3 and 4 sleep (Floyd et al., 2000;Van Someren, 2000a). In some studies, the percentage of REM sleep was reduced slightly in older adults (Van Cauter, Leproult, & Plat, 2000), whereas findings from other studies showed that older adults experienced typical amounts of REM sleep (Campbell & Murphy, 1998). Long sleep latencies (e.g. > 30 minutes), reduced sleep efficiency (e.g. < 85%), and a sleep duration of ≤ 6 hours were common in older adults. These characteristics are consistent with the criteria of insomnia, although not all older adults complained of poor sleep (Vitiello, Larsen, & Moe, 2004).In addition to changes in sleep architecture, there are changes in the circadian rhythm of body temperature in older adults compared to young adults. A circadian rhythm is the variation in body functions and behaviors that occur in a regular pattern ar...

Acute effects of warm footbath on arterial stiffness in healthy young and older women

“…We observed elevation of tympanic temperature coincident with the reduction in CAVI immediately after footbath in both young and older healthy women. The significant elevation in core temperature by local warming contrasts with other studies (Liao et al 2008;Sung and Tochihara 2000). Less tissue volume (up to 20 cm above the ankles) and relatively low temperature (constant 41°C) of water may account for this (Liao et al 2008), in the present study, the lowest temperature used is 41°C, which may constitute a greater temperature gradient, and the body part immersed in water involved the whole lower leg and feet, which indicated more heat absorption area.…”

“…Although warm footbath, just like systemic thermal therapy, might be expected to benefit cardiovascular health, there is little supportive evidence for this assertion. Because heat in warm water can be transferred to the core via the circulatory system (Liao et al 2008), we hypothesized that localized thermal therapy in the form of footbath, would result in systemic improvement of arterial stiffness in humans.…”

Effect of Foot Reflexology Massage and Foot Bath on the Sleep Quality of Patients with Acute Coronary Syndrome: A Comparative Study

“…Mechanism of foot bath is not clear yet, but soaking foot in warm water stimulates sense of touch and reduces sympathetic activity; the cause of this reduction is not clear yet, but reduced sympathetic nerve activity is the main mechanism of increased comfort and reduced pain in patients (17). Foot warm bath may increase peripheral blood flow and also peripheral temperature due to heat loss without increasing core body temperature, and improves falling asleep and sleep quality (24). It seems that soaking feet in warm water is more effective than taking a bath in terms of facilitating falling asleep and increasing sleep quality; it is recommended to people with disabilities, elderly, and also patients with cardiovascular disease (25).…”

Sleep in Patients with ESRD Undergoing Hemodialysis

“…Other potential correlates of RLS include lower socio-economic status, worse somatic and mental health and diabetes (Berger et al, 2004;Siddiqui et al,2005). A high correlation between RLS and PLMS has also been noted (Allen et al 2003, Liao et al,2008. The pathophysiology of RLS in uremia remains unknown however, several theories have been proposed.…”