E-ISSN: 2458-9101
Sociocultural Variations of Coping Strategies for Sleep Difficulties in Couple Relationships in Canada and Brazil
Taís Araújo, Alexandre Lemyre, Annie Vallières, Yvan Leanza
Sleep and Hypnosis: A Journal of Clinical Neuroscience and Psychopathology 2019;21(2):158-169
The couple relationship (marriage/cohabitation) is, for most adults, the primary social context of sleep. Although there is a growing literature on couples’ sleep, no qualitative cross-cultural study on this topic has yet been published. The aim of the present study was to explore the strategies used by adult couples with sleep difficulties from two different cultures, as well as the potential sociocultural variations related to these strategies. Six couples in Quebec City (Canada) and five couples in Fortaleza (Brazil), of which one or both partners experienced sleep difficulties, were recruited. Participants completed the Pittsburgh Sleep Quality Index, the Dyadic Adjustment Scale, and gave open-ended reports regarding their sleep every morning for a week. They also took part in an in-depth semistructured interview for couples. The interviews were transcribed verbatim and analyzed using the Critical Phenomenological Method. The participants’ strategies in the face of sleep difficulties fell into three modalities: individual, common and shared, and common and independent. Within these modalities, seven strategies were identified in both research sites: body and mind relaxation before sleep, stress reduction in daily life, reduction of sleep performance anxiety, respect of the partner’s sleep, intervention or drug use to induce sleep or to reduce diurnal sleepiness, diet monitoring, and naps. The present study reveals that the coping strategies used by partners are related not only to the individual, but can be shared, and are closely related to the sociocultural, economic and environmental contexts of their respective countries.
Keywords: Couples, cross-cultural, phenomenology, content analysis
Antoine, P., Christophe, V., & Nandrino, J. (2008). Échelle d’ajustement dyadique: intérêts cliniques d’une révision et validation d’une version abrégée [Dyadic Adjustment Scale: Clinical interest of a revision and validation of an abbreviated form]. L’Encéphale, 34(1), 38-46.

Araújo, T., Jarrin, D. C., Leanza, Y., Vallières, A., & Morin, C. M. (2017). Qualitative studies of insomnia: Current state of knowledge in the field. Sleep Medicine Reviews, 31, 58-69. doi:10.1016/j.smrv.2016.01.003

Arber, S., Meadows, R., & Venn, S. (2012). Sleep and society. In C. M. Morin & C. A. Espie (Eds.), The Oxford handbook of sleep disorders (pp. 223-247). New York, NY: Oxford University Press.

Bertolazi, A. N., Fagondes, S. C., Hoff, L. S., Dartora, E. G., da Silva Miozzo, I. C., de Barba, M. E. F., & Barreto, S. S. M. (2011). Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Medicine, 12(1), 70-75. doi:10.1016/j.sleep.2010.04.020

Blais, F., Gendron, L., Mimeault, V., & Morin, C. M. (1997). Évaluation de l’insomnie: validation de trois questionnaire [Assessment of insomnia: Validation of three questionnaires]. L’Encéphale, 23(6), 447-453.

Blow, A. J., Curtis, A. F., Wittenborn, A. K., & Gorman, L. (2015). Relationship problems and military related PTSD: The case for using emotionally focused therapy for couples. Contemporary Family Therapy, 37(3), 261-270. doi:10.1007/s10591-015-9345-7

Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213. doi:10.1016/0165-1781(89)90047-4

Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage Publications.

Elfström, M., Karlsson, S., Nilsen, P., Fridlund, B., Svanborg, E., & Broström, A. (2012). Decisive situations affecting partners’ support to continuous positive airway pressure–treated patients with obstructive sleep apnea syndrome: A critical incident technique analysis of the initial treatment phase. Journal of Cardiovascular Nursing, 27(3), 228-239. doi:10.1097/JCN.0b013e3182189c34

Ellis, J. G., Deary, V., & Troxel, W. M. (2015). The role of perceived partner alliance on the efficacy of CBT-I: Preliminary findings from the Partner Alliance in Insomnia Research Study (PAIRS). Behavioral Sleep Medicine, 13(1), 64-72. doi:10.1080/15402002.2013.838768

Giorgi, A. (1985). Sketch of a psychological phenomenological method. In A. Giorgi (Ed.), Phenomenology and psychology research (pp. 8-22). Pittsburg, KS: Duquesne University Press.

Hernandez, J. A. E. (2008). Avaliação estrutural da escala de ajustamento diádico [Structural assessment of the dyadic adjustment scale]. Psicologia em Estudo, 13(3), 593-601.

Hislop, J. (2007). A bed of roses or a bed of thorns? Negotiating the couple relationship through sleep. Sociological Research Online, 12(5). doi:10.5153/sro.1621

Hislop, J., & Arber, S. (2003). Understanding women’s sleep management: Beyond medicalization-healthicization? Sociology of Health & Illness, 25(7), 815-837. doi:10.1046/j.1467-9566.2003.00371.x

Ho, F. Y.-Y., Chung, K.-F., Yeung, W.-F., Ng, T. H., Kwan, K.-S., Yung, K.-P., & Cheng, S. K. (2015). Self-help cognitive-behavioral therapy for insomnia: A meta-analysis of randomized controlled trials. Sleep Medicine Reviews, 19, 17-28. doi:10.1016/j.smrv.2014.06.010

Holliday, S. B., & Troxel, W. (2017). Relationship quality: Implications for sleep quality and sleep disorders. In S. M. McHale, V. King, & O. M. Buxton (Eds.), Family contexts of sleep and health across the life course (pp. 53-84). Switzerland: Springer.

Institut de la Statistique du Québec. (2012). Le bilan démographique du Québec [The demographic profile of Quebec]. Retrieved from http://www.stat.gouv.qc.ca/statistiques/population-demographie/bilan2012.pdf

Koffel, E. A., Koffel, J. B., & Gehrman, P. R. (2015). A meta-analysis of group cognitive behavioral therapy for insomnia. Sleep Medicine Reviews, 19, 6-16. doi:10.1016/j.smrv.2014.05.001

Lalley-Chareczko, L., Segal, A., Perlis, M. L., Nowakowski, S., Tal, J. Z., & Grandner, M. A. (2015). Sleep disturbance partially mediates the relationship between intimate partner violence and physical/mental health in women and men. Journal of Interpersonal Violence, 32(16), 2471-2495. doi:10.1177/0886260515592651

Laplante, B., & Flick, C. (2010). Le mariage, l’union de fait et la santé des conjoints au Québec et en Ontario [Marriage, common law union and partners’ health in Quebec and Ontario]. Cahiers québécois de démographie, 39(1), 1-26.

Le Bourdais, C., & Lapierre-Adamcyk, É. (2004). Changes in conjugal life in Canada: Is cohabitation progressively replacing marriage? Journal of Marriage and Family, 66(4), 929-942. doi:10.1111/j.0022-2445.2004.00063.x

Luyster, F. S., Strollo Jr, P. J., Zee, P. C., & Walsh, J. K. (2012). Sleep: A health imperative. Sleep, 35(6), 727-734. doi:10.5665/sleep.1846

Marshall, C., & Rossman, G. B. (2016). Designing qualitative research, 6th edition. Los Angeles, CA: SAGE Publications.

Martin, P. (2005). Counting sheep: The science and pleasures of sleep and dreams. London: HarperCollins.

Moreira, V. (2004). O método fenomenológico de Merleau-Ponty como feramenta crítica na pesquisa em psicopatologia [Merleau-Ponty’s phenomenological method as a critical tool to the research on Psychopathology]. Psicologia: Reflexão e Crítica, 17(3), 447-456. doi:10.1590/S0102-79722004000300016

Morin, C. M., & Jarrin, D. C. (2013). Epidemiology of insomnia: Prevalence, course, risk factors, and public health burden. Sleep Medicine Clinics, 8(3), 281-297. doi:10.1016/j.jsmc.2013.05.002

National Sleep Foundation. (2010). 2010 sleep in America Poll: Summary of findings. Retrieved from https://sleepfoundation.org/

Payne, S., Swami, V., & Stanistreet, D. L. (2008). The social construction of gender and its influence on suicide: A review of the literature. Journal of Men’s Health, 5(1), 23-35. doi:10.1016/j.jomh.2007.11.002

Reishtein, J. L., Pack, A. I., Maislin, G., Dinges, D. F., Bloxham, T. J., George, C. F. P., . . . Weaver, T. E. (2006). Sleepiness and relationships in obstructive sleep apnea. Issues in Mental Health Nursing, 27(3), 319-330. doi:10.1080/01612840500503047

Rogojanski, J., Carney, C. E., & Monson, C. M. (2013). Interpersonal factors in insomnia: A model for integrating bed partners into cognitive behavioral therapy for insomnia. Sleep Medicine Reviews, 17(1), 55-64. doi:10.1016/j.smrv.2012.02.003

Rosekind, M. R., & Gregory, K. B. (2010). Insomnia risks and costs: Health, safety, and quality of life. The American Journal of Managed Care, 16(8), 617-626.

Rosenblatt, P. (2006). Two in a bed: The social system of couples bed sharing. New York, NY: State University of New York Press.

Schwartz, S. H. (2009). Culture matters: National value cultures, sources, and consequences. In R. S. Wyer, C.-y. Chiu, & Y.-y. Hong (Eds.), Understanding culture: Theory, research, and application (pp. 127-150). New York, NY: Psychology Press.

Spanier, G. B. (1976). Measuring adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and Family, 38(1), 15-28. doi:10.2307/350547

Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191-205. doi:10.7326/m14-2841

Troxel, W. M., Braithwaite, S. R., Sandberg, J. G., & Holt-Lunstad, J. (2016). Does improving marital quality improve sleep? Results from a marital therapy trial. Behavioral Sleep Medicine, 15(4), 1-14. doi:10.1080/15402002.2015.1133420

Troxel, W. M., Buysse, D. J., Hall, M., & Matthews, K. A. (2009). Marital happiness and sleep disturbances in a multi-ethnic sample of middle-aged women. Behavioral Sleep Medicine, 7(1), 2-19. doi:10.1080/15402000802577736

Troxel, W. M., Robles, T. F., Hall, M., & Buysse, D. J. (2007). Marital quality and the marital bed: Examining the covariation between relationship quality and sleep. Sleep Medicine Reviews, 11(5), 389-404. doi:10.1016/j.smrv.2007.05.002

Venn, S. (2007). “It’s okay for a man to snore”: The influence of gender on sleep disruption in couples. Sociological Research Online, 12(5). doi:10.5153/sro.1607

Venn, S., Arber, S., Meadows, R., & Hislop, J. (2008). The fourth shift: Exploring the gendered nature of sleep disruption among couples with children. British Journal of Sociology, 59(1), 79-98. doi:10.1111/j.1468-4446.2007.00183.x

Vercelli, L. (2006). Versões de sentido: um instrumento metodológico [Sense’s versions: A methodological tool]. Cadernos de Pós-Graduação, 5(1), 191-196.

Williams, S. J. (2005). Sleep and society: Sociological ventures into the (un)known. London, UK: Routledge.

Williams, S. J., Coveney, C. M., & Gabe, J. (2013). Medicalisation or customization? Sleep, enterprise and enhancement in the 24/7 society. Social Science & Medicine, 79, 40-47.

Williams, S. J., Seale, C., Boden, S., Lowe, P., & Steinberg, D. L. (2008). Medicalization and beyond: The social construction of insomnia and snoring in the news. Health, 12(2), 251-268. doi:10.1177/1363459307086846

Wittenborn, A. K., Culpepper, B., & Liu, T. (2012). Treating depression in men: The role of emotionally focused couple therapy. Contemporary Family Therapy, 34(1), 89-103. doi:10.1007/s10591-012-9176-8