Robert Meadows

Gender and socio-economic patterning of self-reported sleep problems in Britain.

Sleep is fundamental to health and well-being, yet relatively little research attention has been paid to sleep quality. This paper addresses how socio-economic circumstances and gender are associated with sleep problems. We examine (i) socio-economic status (SES) patterning of reported sleep problems, (ii) whether SES differences in sleep problems can be explained by socio-demographic characteristics, smoking, worries, health and depression, and (iii) gender differences in sleep problems, addressing the relative contribution of SES, smoking, worries, health and depression in explaining these differences. Logistic regression is used to analyse the British Psychiatric Morbidity Survey 2000, which interviewed 8578 men and women aged 16-74. Strong independent associations are found between sleep problems and four measures of SES: household income, educational qualifications, living in rented housing and not being in paid employment. Income differences in sleep problems were no longer significant when health and other characteristics were adjusted. The higher odds of sleep problems among the unemployed and adults with low education remained significant following adjustment. Women reported significantly more sleep problems than men, as did the divorced and widowed compared with married respondents. Gender differences in sleep problems were halved following adjustment for socio-economic characteristics, suggesting that SES inequalities play a major part in accounting for gender differences in sleep problems. Our study casts doubt on the primacy of physiological explanations underlying these gender differences. Since disadvantaged socio-economic characteristics are strongly associated with sleep problems, we conclude that disrupted sleep may be a mechanism through which low SES is linked to poor health.

The Acute and Sub-chronic Effects of Levocetirizine, Cetirizine, Loratadine, Promethazine and Placebo on Cognitive Function, Psychomotor Performance, and Weal and Flare

Summary Aim: To compare the central and peripheral H1 inhibitory effects of acute and sub-chronic doses of levocetirizine (l-CTZ), cetirizine (CTZ), loratadine (LOR) and promethazine (PRM) versus placebo, using a battery of psychomotor and cognitive tests together with measures of the weal and flare reaction. PRM was included in the study as a positive internal control to validate the sensitivity of the psychometric test battery to the CNS effects of the various treatments. Methods: Twenty healthy volunteers (18–50 years) received l-CTZ 5 mg, CTZ 10 mg, LOR 10 mg, PRM 30 mg and placebo once daily for four days in a five-way, double-blind, crossover study. For each treatment condition, subjects were assessed using a psychometric test system and a pinprick weal and flare response to 100mg/ml histamine solution at baseline and at 1, 2, 3,4, 6,8,10 and 12 hours post-dose on days 1 and 4. The psychometrics comprised critical flicker fusion (CFF), choice reaction time (CRT), a continuous tracking task (CTT) and subjective rating scales for sedation (LARS). On days 2 and 3, subjects took their medication at pre-designated times while out of the unit. Results: The verum (PRM) established the sensitivity of the test battery: a significant overall reduction in CFF thresholds on both days 1 and 4 (p < 0.05); an overall significant increase (impairment) in recognition, motor and total reaction times on day 1 (p < 0.05); a significant impairment of both the tracking accuracy and reaction time aspects of the CTT task on day 1 (p < 0.005) and significantly higher ratings of subjective sedation on day 1 (p < 0.05). l-CTZ, CTZ and LOR were not distinguishable from placebo in any of the objective and subjective tests at any time point on either day 1 or day 4. With regards to the peripheral inhibitory effects, l-CTZ inhibited both the weal and flare reaction, with maximum inhibition (almost 100%) occurring within two hours of drug ingestion. CTZ also showed evidence of potent peripheral inhibition of histamine, whereas PRM, and especially LOR, showed only a weak weal and flare reaction which had completely attenuated at day 4. Conclusions: In a study where the psychometric assessments were shown to be sensitive to impairment, l-CTZ 5 mg was found not only to be a potent inhibitor of the histamine-induced weal and flare reaction,

The ‘negotiated night’: an embodied conceptual framework for the sociological study of sleep

Sleep is essential for our health and wellbeing but it has, historically, been the subject of little sociological study. Yet sleep is not, as common sense would have us believe, ‘asocial inaction’. Like our waking lives, it is a time of interaction. The sociology of sleep presently exists in a state similar to the early stages of development of the sociology of the body, waiting for something like Franks (1991) typology of body action, which served as a heuristic guide through which action and its multifaceted components could be understood. This paper argues that one productive analytical framework is to adapt Watsons (2000) ‘male body schema’ for the sociological investigation of sleep. This revolves around four interrelated forms of embodiment: normative (opinions and perceptions about healthy sleep behaviour); pragmatic (‘normal’ as related to social role); experiential (feelings related to sleep); and visceral (the biological body and sleep). The possibilities this model provides for the sociology of sleep is illustrated in the paper through the analysis of a case study of sleep negotiation between a couple.

Narratives of the night: The use of audio diaries in researching sleep

This article draws on data from two major empirical studies of sleep to examine the use of audio diaries as an approach to researching sleep. Sleep has only recently emerged as a topic of interest to the sociologist, providing a valuable resource through which to examine the roles and relationships and gender inequalities which underpin everyday life. Yet accessing individual experiences of sleep is problematic. Considered a non-conscious activity, sleep takes place in most cases at night within the private domain of the home and is thus generally inaccessible to the social researcher and outside the conscious reality of the sleeper. In exploring the social aspects of sleep, we rely primarily on respondents’ interpretations of the sleep period given retrospectively in focus groups and in-depth interviews, distanced from the temporal, spatial and relational dimensions of the sleep event. This article also focuses on the use of audio diaries as a method designed to help bridge the gap between events in real time and retrospective accounts. We examine the narrative structure of audio diaries, discuss the principles and practice of using audio diaries in sleep research, illustrate the contribution of audio diary narratives to an understanding of the social context of sleep, and assess the use of audio diaries in social research. We conclude that, used in conjunction with other methods, audio diaries are an effective method of data collection, particularly for understanding experiences of intimate aspects of everyday life.

Gender roles and women's sleep in mid and later life: A quantitative approach

Women in mid and later life report particularly poor quality sleep. This article suggests a sociologically-informed quantitative approach to teasing out the impact of womens roles and relationships on their sleep, while also taking into account womens socio-economic characteristics and health status. This was accomplished through analysis of the UK Womens Sleep Survey 2003, based on self-completion questionnaires from a national sample of 1445 women aged over 40. The article assesses the ways in which three central aspects of womens gender roles: the night-time behaviours of their partners, night-time behaviours of their children, and night-time worries – impact on womens sleep, while also considering how disadvantaged socio-economic circumstances and poor health may compromise womens sleep. Using bivariate analysis followed by hierarchical multiple regression models, we examine the relative importance of different aspects of womens gender roles. The key factors implicated in the poor sleep quality of midlife and older women are their partners snoring, night-time worries and concerns, poor health status (especially experiencing pain at night), disadvantaged socio-economic status (especially having lower educational qualifications) and for women with children, their children coming home late at night.

AN ACTIGRAPHIC STUDY COMPARING COMMUNITY DWELLING POOR SLEEPERS WITH NON-DEMENTED CARE HOME RESIDENTS

Sleep disturbances are a common problem among institutionalized older people. Studies have shown that this population experiences prolonged sleep latency, increased fragmentation and wake after sleep onset, more disturbed circadian rhythms, and night-day reversal. However, studies have not examined the extent to which this is because of individual factors known to influence sleep (such as age) or because of the institutional environment. This article compares actigraphic data collected for 14 days from 122 non-demented institutional care residents (across ten care facilities) with 52 community dwelling poor sleepers >65 yrs of age. Four dependent variables were analyzed: (i) “interdaily stability” (IS); (ii) “intradaily variability” (IV); (iii) relative amplitude (RA) of the activity rhythm; and (iv) mean 24 h activity level. Data were analyzed using a fixed-effect, single-level model (using MLwiN). This model enables comparisons between community and institutional care groups to be made while conditioning out possible “individual” effects of “age,” “sex,” “level of dependency,” “level of incontinence care,” and “number of regular daily/prescribed medications.” After controlling for the effects of a range of individual level factors, and after controlling for unequal variance across groups (heteroscedascity), there was little difference between community dwelling older adults and institutional care residents in IS score, suggesting that the stability of day-to-day patterns (such as bed get-up, lunch times, etc.) is similar within these two resident groups. However, institutional care residents experienced more fragmented rest/wake patterns (having significantly higher IV scores and significantly lower mean activity values). Our findings strongly suggest that the institutional care environment itself has a negative association with older peoples rest/wake patterns; although, longitudinal studies are required to fully understand any causal relationships. (Author correspondence: r.meadows@surrey.ac.uk)

Suppression of the histamine-induced wheal and flare response by fexofenadine HCl 60 mg twice daily, loratadine 10 mg once daily and placebo in healthy Japanese volunteers

Summary Background: The effects of the selective H1-receptor antagonist fexofenadine have been widely demonstrated in Western populations; however, to date, limited data comparing the effects of fexofenadine with other antihistamines have been reported in Japanese subjects. Objective: To investigate the effect of fexofenadine and loratadine on the histamine-induced cutaneous wheal and flare response in healthy Japanese volunteers. Methods: Eighteen healthy male and female Japanese volunteers aged 20-53 years were randomized to receive fexofenadine HCl 60 mg twice daily, loratadine 10 mg once daily or placebo in a 1-day, three-period, double-blind, crossover study. For each treatment, the wheal and flare response to 100 mg/mL histamine was assessed at baseline and at 1, 1.5, 2, 2.5, 3, 3.5, 4, 8, 12 and 24 hours post-dose. Blood samples were taken for pharmacokinetic analysis. Results: Fexofenadine produced significantly greater percentage suppression of the overall wheal response compared with placebo and loratadine (43.1% versus 10.0% and 15.2%, respectively; p < 0.001). Similarly, fexofenadine significantly suppressed the overall flare response compared with placebo and loratadine (43.0% versus 3.5% and -8.9%, respectively; p < 0.01). Loratadine was statistically no different from placebo in terms of both overall wheal and flare suppression. Area under the curve analysis for wheal and flare reduction (0-12 hours post-dose) confirmed these findings. For wheal inhibition, fexofenadine had a significantly faster onset of action (defined as time to ≥ 35% inhibition) compared with placebo (p < 0.001) and loratadine (p < 0.01); for flare, fexofenadine had a significantly faster onset of action than loratadine (p < 0.01). Mean maximum inhibition (the mean of the greatest inhibition achieved from baseline for each treatment) for wheal was achieved significantly faster with fexofenadine than loratadine (p < 0.01), and fexofenadine had a significantly longer duration of effect on suppressing wheal and flare compared with placebo and loratadine (p < 0.05 for all). The antihistamine effects of fexofenadine correlated significantly with its Cmax, while loratadine activity did not correlate significantly with its plasma levels. Conclusions: Fexofenadine is a potent suppressor of the histamine-induced wheal and flare response in healthy Japanese volunteers. These results support findings in Caucasian subjects, and confirm that fexofenadine has greater antihistaminergic activity than loratadine in this human model

Development of a Portable Psychometric Testing Device for Use in the Field: An Alcohol Investigation

Cognitive and psychomotor performance have traditionally been assessed in the laboratory. There is a need for an objective portable assessment tool to assess cognitive and psychomotor performance. This study investigated the viability of a portable psychometric test battery, in a controlled laboratory environment, possibly leading to use in the field. A randomised, double-blind placebo controlled, three-way crossover design was employed. 16 subjects received 50 mg/100 ml and 80 mg/100 ml of alcohol and alcohol placebo. Performance was assessed with a tracking task, and an attention task presented on a small ruggedised handheld computer. The attention task showed no significant training effects; however, an element of the tracking task did. Statistical significance, effect size, and test-retest reliability analyses are presented indicating sensitivity of the portable psychometric test battery to the impairing effects of two separate doses of alcohol. Ability to undertake wide-scale impairment testing in the field with meaningful results in the absence of baseline data collection may have wide reaching implications, particularly in relation to the assessment of drivers impaired by drug use.

Sleep waves and recovery from drug and alcohol dependence: Towards a rhythm analysis of sleep in residential treatment

This paper reports on a study of sleep amongst men and women who are living in residential rehabilitation centres in the UK and who are receiving support for their recovery from addiction to alcohol and other forms of substance use. Conceptually and methodologically, the paper draws on the work of the French sociologist Lefebvre and, in particular, his rhythmanalysis. We argue that this approach offers a useful way of exploring sleep in terms of biological, experiential, temporal, spatial and social rhythms. It also has the potential to facilitate interdisciplinary dialogue. Empirical data comprising qualitative interviews with 28 individuals, sleep diaries, and actigraphy reports (which measure movement as a proxy for sleep) are examined in combination to generate insights into the challenges associated with sleep in recovery from substance misuse. We examine how sleep in recovery involves an alignment of the spatiotemporal rhythms of rehabilitation and the multiple embodied rhythms of individuals. Institutionalised routines reproduce and impose ideas of day/night sleep cycles which are presumed to accord with ‘natural’ circadian rhythms. Although study participants very much want to achieve these ‘natural hegemonies’ of sleep, alignment of individual and institutional rhythms is difficult to achieve. We develop the notion of ‘sleep waves’ as an analytic to capture the multifaceted elements of sleep and to argue that sleep waves recur but are also shaped by complex networks of rhythms, rituals and routines. Sleep waves can become relatively stabilised in rehabilitation settings, but the anticipation of moving on disturbs rhythms and generates anxieties which can affect recovery.

Marital Status, Relationship Distress, and Self-rated Health: What Role for "Sleep Problems"?

This paper analyzes data from a nationally representative survey of adults in the United Kingdom (Understanding Society, N = 37,253) to explore the marital status/health nexus (using categories that include a measure of relationship distress) and to assess the role that sleep problems play as a potential mediator. Findings indicate how it is not just the “form” marital status takes but also the absence or presence of relationship distress that is essential to self-rated health. We demonstrate two further findings that: (1) sleep problems act as a mediator of the link between marital status/relationship distress and self-rated health, most notably for those in cohabiting relationships with medium/high distress or who have a history of relationship loss, and (2) the mediating role of sleep problems differs for divorced men and women.