Perceptions of Insomnia among an Iranian Population: Causes and Responses
AbstractBackground and Objective: People’s perceptions toward insomnia are influenced by the socio-cultural context of their lives. Therefore, the purpose of this study was to investigate beliefs, attitudes, and practices of the participants about causes of insomnia and its management.Materials and Methods: Nineteen participants with a self-reported history of insomnia from the community were recruited in this study. Semi-structured qualitative interviews were conducted. The interviews were recorded and tran-scribed verbatim. The transcriptions were analyzed using thematic analysis.Results: Four themes were identified: underlying causes of insomnia, help-seeking barriers, my coping strategies, and good food - bad drugs. Participant’s reactions to insomnia depended on their broader socio-cultural beliefs.Conclusion: Studying these perceptions and responses in our sample would contribute to better understanding of patients’ therapeutic preferences. It would also help to identify effective socio-cultural beliefs on insomnia self-management methods. Identification of these beliefs and practices also can contribute to adaptation of common insom-nia treatments.
Ohayon MM. Epidemiology of insomnia: What we know and what we still need to learn. Sleep Med Rev 2002; 6: 97-111.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Pub, 2013.
Rosekind MR, Gregory KB. Insomnia risks and costs: Health, safety, and quality of life. Am J Manag Care 2010; 16: 617-26.
Taylor DJ, Lichstein KL, Durrence HH. Insom-nia as a health risk factor. Behav Sleep Med 2003; 1: 227-47.
Morin CM, LeBlanc M, Daley M, et al. Epide-miology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behav-iors. Sleep Med 2006; 7: 123-30.
Aikens JE, Rouse ME. Help-seeking for insom-nia among adult patients in primary care. J Am Board Fam Pract 2005; 18: 257-61.
Angst J, Gamma A, Clarke D, et al. Subjective distress predicts treatment seeking for depression, bipo-lar, anxiety, panic, neurasthenia and insomnia severity spectra. Acta Psychiatr Scand 2010; 122: 488-98.
Cheung JM, Bartlett DJ, Armour CL, et al. In-somnia patients' help-seeking experiences. Behav Sleep Med 2014; 12: 106-22.
Kyle SD, Espie CA, Morgan K. "...Not just a minor thing, it is something major, which stops you from functioning daily": Quality of life and daytime functioning in insomnia. Behav Sleep Med 2010; 8: 123-40.
Carey TJ, Moul DE, Pilkonis P, et al. Focusing on the experience of insomnia. Behav Sleep Med 2005; 3: 73-86.
Redding CA, Rossi JS, Rossi SR, et al. Health behavior models. Int Electron J Health Educ 2000; 3: 180-93.
Henry D, Rosenthal L, Dedrick D, et al. Under-standing patient responses to insomnia. Behav Sleep Med 2013; 11: 40-55.
Brotherton PS, Nguyen VK. Revisiting local bi-ology in the era of global health. Med Anthropol 2013; 32: 287-90.
Williams SJ. The social etiquette of sleep: Some sociological reflections and observations. Sociology 2007; 41: 313-28.
Williams SJ. The sociological significance of sleep: Progress, problems and prospects. Sociol Com-pass 2008; 2: 639-53.
Jansson-Frojmark M, Linton SJ. The role of psychological mechanisms to insomnia in its early phase: a focus on arousal, distress, and sleep-related beliefs. Psychol Health 2008; 23: 691-705.
Morin CM, Blais F, Savard J. Are changes in beliefs and attitudes about sleep related to sleep im-provements in the treatment of insomnia? Behav Res Ther 2002; 40: 741-52.
Sepehrmanesh Z, Ahmadvand A, Ghoreishi F. PW01-111-Prevalence of insomnia in general popula-tion. Eur Psychiatry 2010; 25: 1524.
Eskandarieh S, Hajebi A, Noroozi A, et al. Epi-demiology of Alcohol Abuse in Iran. Asia Pac J Med Toxicol 2014; 40: 22.
Andrews LK, Coviello J, Hurley E, et al. "I'd eat a bucket of nails if you told me it would help me sleep:" Perceptions of insomnia and its treatment in patients with stable heart failure. Heart Lung 2013; 42: 339-45.
Fusch PI, Ness LR. Are we there yet? Data satu-ration in qualitative research (Article). Qual Rep 2015; 20: 1408-16.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77-101.
Stinson K, Tang NK, Harvey AG. Barriers to treatment seeking in primary insomnia in the United Kingdom: A cross-sectional perspective. Sleep 2006; 29: 1643-6.
Constantino MJ, Manber R, Ong J, et al. Patient expectations and therapeutic alliance as predictors of outcome in group cognitive-behavioral therapy for in-somnia. Behav Sleep Med 2007; 5: 210-28.
Swift N, Stewart R, Andiappan M, et al. The ef-fectiveness of community day-long CBT-I workshops for participants with insomnia symptoms: A random-ised controlled trial. J Sleep Res 2012; 21: 270-80.
Yamamoto M, Sasaki N, Somemura H, et al. Ef-ficacy of sleep education program based on principles of cognitive behavioral therapy to alleviate workers' distress. Sleep Biol Rhythms 2016; 14: 211-9.
Gerami S. Mullahs, martyrs, and men: Concep-tualizing masculinity in the Islamic Republic of Iran. Men and Masculinities 2003; 5: 257-74.
Meadows R, Arber S, Venn S, et al. Engaging with sleep: Male definitions, understandings and atti-tudes. Sociol Health Illn 2008; 30: 696-710.
Archer M, Brown JS, Idusohan H, et al. The de-velopment and evaluation of a large-scale self-referral CBT-I intervention for men who have insomnia: An exploratory study. Behav Cogn Psychother 2009; 37: 239-48.
Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process 1991; 50: 179-211.
Martin SS. Illness of the mind or illness of the spirit? Mental health-related conceptualization and practices of older Iranian immigrants. Health Soc Work 2009; 34: 117-26.
Bagasra A, Mackinem M. An exploratory study of American Muslim conceptions of mental illness. Muslim Mental Health 2014; 8: 57-76.
Harvey AG, Soehner A, Lombrozo T, et al. 'Folk theories' about the causes of insomnia. Cognit Ther Res 2013; 37.
Lichstein KL, Rosenthal TL. Insomniacs' per-ceptions of cognitive versus somatic determinants of sleep disturbance. J Abnorm Psychol 1980; 89: 105-7.
Fung A, Lai V. Local coping strategies adopted by people with insomnia-a pilot study. Sleep Hypn 2009; 11: 5-8.
Espie CA, Barrie LM, Forgan GS. Comparative investigation of the psychophysiologic and idiopathic insomnia disorder phenotypes: Psychologic character-istics, patients' perspectives, and implications for clini-cal management. Sleep 2012; 35: 385-93.
Boon H, Kachan N, Boecker A. Use of natural health products: How does being "natural" affect choice? Med Decis Making 2013; 33: 282-97.
Fainzang S. Managing medicinal risks in self-medication. Drug Saf 2014; 37: 333-42.
Cheung JM, Bartlett DJ, Armour CL, et al. Peo-ple with insomnia: Experiences with sedative hypnotics and risk perception. Health Expect 2016; 19: 935-47.
Morin CM, Gaulier B, Barry T, Kowatch RA. Patients' acceptance of psychological and pharmaco-logical therapies for insomnia. Sleep 1992; 15: 302-5.
Vincent N, Lionberg C. Treatment preference and patient satisfaction in chronic insomnia. Sleep 2001; 24: 411-7.
Jalal B, Samir SW, Hinton DE. Adaptation of CBT for traumatized Egyptians: Examples from cultur-ally adapted CBT (CA-CBT). Cogn Behav Pract 2017; 24: 58-71.
Hodge DR, Nadir A. Moving toward culturally competent practice with Muslims: Modifying cognitive therapy with Islamic tenets. Soc Work 2008; 53: 31-41.
Lundh LG. The role of acceptance and mindful-ness in the treatment of insomnia. J Cogn Psychother 2005; 19: 29-39.
Honarbin-Holliday M. Becoming visible in Iran: Women in contemporary Iranian society. New York, NY: I.B.Tauris, 2013.