School of Human Sciences Sleep, Health and Gender Inequalities - A New Perspective 4 th October 2005, Cambridge Sara Arber and Jenny Hislop Centre for.

School of Human Sciences

Sleep, Health and

Gender Inequalities

- A New Perspective

4th October 2005, Cambridge

Sara Arber and Jenny HislopCentre for Research on Ageing & Gender (CRAG)

Department of SociologyUniversity of Surrey, Guildford, UK

Email: [email protected]

UniS

Acknowledgements

This research was supported by:

the European Union ‘Sleep in Ageing Women’ project, grant QLK6-CT-2000-00499 (2001-04)

and the Economic and Social Research Council (ESRC) ‘Negotiating Sleep: Gender, Age and Social Relationships among Couples’, grant RES-000-23-0268 (2003-06).

Assisted by Jenny Hislop, Rob Meadows and Sue Venn

Sleep – under researched by sociologists …...

• Surprising – because spend a third of our lives asleep

• Sleep is fundamental to well-being and health - a major cause of accidents, important for cognitive functioning, increases risk of heart disease, diabetes, etc.

• Sleep is part of everyday life – therefore may provide a ‘window’ on everyday roles and relationships

• The sleeping context may be contested, and the site where power is played out

Sleep – under researched by sociologists …...

Sociologists have extensively studied other areas of everyday life, e.g.

- food and diet in families - leisure activities - household work- caring for children/ older people

Sociologists study the body - but links to sleep are only beginning to be made - e.g. Simon Williams’ work

Sleep can be studied as a -

TOPIC

and/or as a

RESOURCE

Sociologists studying sleep - as a TOPIC

Identify the sociological/social factors influencing the quality of sleep, e.g.

- social context of everyday life (partners, other family members, social roles and responsibilities)

- roles in the public sphere (e.g. work/education) - constraints of expectations, worries about, etc.

Identify how to improve quality of sleep through awareness of social factors, strategies used

Assess impact of poor sleep on aspects of everyday life of self and others (family members, etc)

Sociologists studying sleep - as a RESOURCE (I)

Studying sleep provides sociological insights/ understandings about other aspects of society, social inequalities, social relationships, which were hitherto hidden

e.g. 1) Understanding more about intimate relationships between partners, within families

- reflects power relationships, patterns of control, inequality, emotional labour - much of which may be unspoken, unrecognised and implicit. These only become revealed through a close analysis of discourses and practices surrounding sleep

Sociologists studying sleep - as a RESOURCE (2) - Further examples

2) Sleeping arrangements reflect broader societal/cultural norms and values - Married partners ‘ought to’ sleep in the same bed/room - if they do not, this signifies a poor marital relationship/ stigmatised; Children ‘should’ have their own room. Differences between cultures/historically?

3) Discourses about sleep provide insights about the meaning of masculinity and femininity- ‘sleep is for wimps’; it’s macho to ‘need’ (or be able to cope with) little sleep; vs ‘getting your beauty sleep’ - these also have health (promotion) implications…

Our research addresses Sleep as both a TOPIC and a RESOURCE:

Takes place in the ‘real’ world (eg. people’s homes) rather than in sleep clinics or laboratories – sleep in labs is ‘abnormal’

Acknowledges the social context of sleep

Examines interrelationship between social roles, relationships, life events and transitions and sleep – gender is fundamental to all of these

Focuses on ‘normal’ sleep disruption rather than specific sleep disorders

Sleep in Ageing Women Project

• Funded by the European Union for 3 years 2001-2004

• Cross-national: team members from Finland, Belgium, Switzerland, Germany, and the UK

• Cross-disciplinary: integration of sociology with biological sciences

• A study of the sleep experiences of women aged 40 & over

• Multiple methods:

– Qualitative: 15 focus groups, 35 in-depth interviews, and 35 audio sleep diaries

– Quantitative: postal questionnaire 1445 women age 40+

Negotiating Sleep among Couples Project

• Funded by the Economic and Social Research Council (ESRC), 2003-06

• Intensive study of 40 couples aged 20s to 50s• 10 couples in 20s/ 30s without children• 10 couples in 20s/ 30s with children (usually young)• 10 couples in 40s/ 50s with children (usually teenage)• 10 couples in 40s/ 50s without children at home

• Cross-disciplinary: mainly Sociology but includes some techniques used by biological scientists

• Male and Female interviewers - for couple interviews • Multiple methods

Negotiating Sleep among Couples Project - Methods used

• Couple interview (indepth) – initial one-to-one interviews with men were less successful. Couple interview like a ‘mini’ focus group – reveals ‘sensitive’ data

• Audio-sleep diaries for one week – both partners

• Actigraphic recordings for one week – both partners

• Standard ‘scientific’ sleep tests/diaries • Individual interviews with each partner after 4 weeks

• New EU funding will extend the research to include couples in their 60s and 70s – will start in 2006

Qualitative research – (1) Audio sleep diaries

• Soon after waking in the morning• Record using a mini taperecorder –

everything about their nights sleep • E.g. when went to bed, did

they go straight to sleep, Did they wake during the night, If so, what did they do? Overall feelings about the night, etc.

• Compare responses of partners

Audio sleep diaries – produced very rich data

Eileen – 46, married, 3 children (10-13), part-time wkThursday • I actually slept pretty well last night. Went to bed at

11.30 again, slept very deeply and very well til about 5. Didn’t actually sleep in my own bed because my husband had gone to bed at 9 and was in full snore by the time I got there. ..… Oh, I’ve just remembered my daughter woke me up at about 2 in the morning because she’d had an accident in her bed and wet herself so I was awake for a few minutes trying to deal with that but went straight back to sleep.”

Audio sleep diaries – produced very rich data

Gwen – 59, divorced, 2 children (left home), lives alone but has a partner, works full-time

• Each night she wakes during the night, and in order to get back to sleep she turns on the World Service on the radio.

• On Saturday night, her partner stays over. But when she wakes during the night, she can’t adopt her usual strategy for getting back to sleep.

• So, she leaves the partner in her bed, and goes to sleep in the spare room.

Qualitative research – (2) Focus Groups

• 5 age groups of women (3 F.Gs per age grp)

• 40-47; 48-52, 53-59; 60-69; 70+• Reveal ‘socially unacceptable’

behaviours – via support of others• Snoring• Temporary and permanent relocation• When use sleeping pills and ‘over the

counter’ remedies

Qualitative research – (3) Indepth Interviews

• With women across age range – 40 up • Indepth narratives about everyday sleep • How their sleep has changed across the

life course, e.g. effects of adolescent children, serious illhealth of partner, divorce, widowhood, etc.

• Narratives about sleep difficulties and how they dealt with them

•

Qualitative research – Insights, but how representative

• How ‘normal’ is sleep disruption? What causes sleep disruption? How do gender and age impact on quality of sleep?

• To what extent do partners disturb women’s sleep – and for which women?

• How does care for young children, teenage children, partners, elderly parents impact on women’s and men’s sleep?

• BUT lack of existing large datasets which collect data on sleep – so current potential for secondary analysis is very limited

About the Women’s Sleep in the UK Survey, 2003

• Nationally representative sample of 5000 women aged 35 and over from across the UK (England, Wales, Scotland, N. Ireland)

• Drawn from electoral register and census data all of which is in public domain

• Postal questionnaire: 48 items over 12 pages• N=1445, women aged 40+

Survey content

1. About your sleep: quality, satisfaction, duration, problems, changes, impact of poor sleep

2. Influences on sleep: environmental, physical, psychological, children, partner

3. Managing sleep: strategies women use to cope with sleep loss, eg. self-directed activities, OTC medications, alternative therapies, sleeping pills

4. Health and well-being: health status, life events, menopausal status, HRT use, GP consultation, sleep disorders, lifestyle factors

5. Socio-demographics: age, marital status, education, occupation, income

Sleep problems• Sleep problems are a normal feature of

women’s sleep

• Only 4% of respondents say they ‘never’ experience sleep problems

• 75% of respondents say they experience sleep problems at least ‘sometimes’

• 33% of respondents say they experience sleep problems ‘often’ or ‘always’

Type of problem % respondents overall*

Waking several times during the night 50

Feel sleepy during the day 37

Wake up tired and unrefreshed 35

Disturbed, restless sleep 34

Wake up too early 25

Difficulty falling asleep 22

Difficulty waking up 4

* Experiencing problem 3 or more nights a week

Figure 1: Types of sleep problems, women 40+

© EU 2003 Women’s Sleep in the UK Survey

Figure 3: Sleep disturbance* from worries about the family, work, loneliness, and money by age

* at least 3 times a week

AGE

70 & over60-6950-5940-49

% c

on

cern

ed

at

lea

st 3

nig

hts

a w

ee

k

20

15

10

5

0

CONCERNS

FAMILY

WORK STRESS

MONEY

LONELINESS

Women aged 40 and over

Source: Women’s Sleep in the UK Survey 2003

AGE

70 & over60-6950-5940-49

% a

ffe

cte

d 3

or

mo

re n

igh

ts a

we

ek

70

60

50

40

30

20

10

0

TOILET

HOT

PAIN

Figure 4: Sleep disturbance* from going to the toilet, feeling hot, and pain by age

* at least 3 times a week

Women aged 40 and over

Source: Women’s Sleep in the UK Survey 2003

eg. Children:

- young children: coming into parent’s bedroom or calling out during the night

- teenagers: coming home late, listening to loud music

-partners: snoring; going to the toilet; disturbed by partner’s illhealth

- caring for an older frail, disabled or cognitively impaired spouse, parent or other relative

For most women, sleeping is a shared experience. Women’s sleep quality is influenced by their relationships with children and partners.

• partner snoring (23%)

• partner getting up early (13%)

• partner going to the toilet (13%)

The three main partner behaviours reported by women as affecting their sleep 3 or more nights a week are:

Source: 2003 Women’s Sleep in the UK Survey

Figure 5: Sleep disturbance* from partners snoring and going to the toilet by woman’s age

* at least 3 times a week

p<.001

AGE

70 & over60-6950-5940-49

% a

ffe

cte

d a

t le

ast

3 n

igh

ts a

we

ek

40

30

20

10

0

PARTNER BEHAVIOUR

SNORING

TOILET

Women aged 40 and over

• 88% of couples share a double bed

• 12% sleep apart

- 2% in twin beds in same room

- 10% in separate rooms

• Sleeping arrangements are age-related

“The only way to ensure quality of sleep is to be in my own bed and room. The onset of menopause gave me an excuse to do this. Hot flushes at night make sleep impossible if you share a bed!” (Age: 66)

Source: 2003 Women’s Sleep in the UK Survey

The double bed is not the only option available for partnered women in our study:

Figure 3: Sleeping arrangements by age*

Major increase in incidence of couples sleeping apart from the age of 60.

28% of couples no longer sleep in same bed after the age of 60

Almost twice as many couples aged 70 and over are sleeping apart cf. those in their 60s.

* Women aged 40 and over

N=1054

p<.001

AGE

70 & over60-6950-5940-49

% s

lee

pin

g a

pa

rt

50

40

30

20

10

0

© EU 2003 Women’s Sleep in the UK Survey

Conclusions• Women’s and men’s sleep patterns are embedded in the gender roles and

relationships which characterise their lives

• As sleep is located in the private sphere, for many women, their husband/partner is a key factor in structuring women’s sleep

• Teenage/adult children (as well as young children) have an impact on parent’s sleep, especially women’s sleep

• Midlife women (in their 50s) have the most disrupted sleep, because of:- - stresses associated with full-time work, - continuing caring responsibilities for children and ageing parents- Partner’s snoring, getting up during the night, partner’s health, etc- Menopause and women’s own health

• Women are more conscious than men of the ‘need’ to have a ‘good night’s sleep’, and develop more personal strategies to try to attain this (often unattainable) goal.

• Jenny Hislop and Sara Arber (2003) ‘Sleepers wake! The gendered nature of sleep disruption among mid-life women’, Sociology, 37(4): 695-711.

• Jenny Hislop and Sara Arber (2003) ‘Understanding women’s sleep management: Beyond medicalisations-healthisation?’ Sociology of Health and Illness, 25 (7): 815-837

• Jenny Hislop and Sara Arber (2003) ‘Sleep as a social act: A window on gender roles and relationships’ in S. Arber et al. (eds) Gender and Ageing: Changing Roles and Relationships, Maidenhead: Open University Press.

Thank you for your attention