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Table of Contents
Year : 2016  |  Volume : 17  |  Issue : 2  |  Page : 62-64

Effectiveness of acupressure on improvement of sleep quality among elderly

1 Associate Professor, Cheran’s College of Nursing, Coimbatore, India
2 , India

Date of Web Publication9-Jun-2020

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Source of Support: None, Conflict of Interest: None

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Sleep quality is altered with the advance of age. Acupressure is a non-pharmacological therapy, which involves the stimulation of certain acupoints by pressing with the fingers. A study was conducted in two old age homes in Madurai to assess the effectiveness of acupressure on improvement of sleep quality among the elderly. Quantitative approach with one group pre-test post-test design was used. Pittsburg Sleep Quality Index (PSQI) was used to measure the sleep quality. All the subjects reported poor quality of sleep. Majority had moderate level of poor quality of sleep in pre-test (61.7%). Following acupressure 43.3% of subjects reported good quality of sleep. Acupressure was found to be significantly effective in improving sleep quality. As acupressure has no significant adverse effects or side effects, nurses can empower themselves with acupressure skills and intervene when elderly clients have poor sleep quality.

Keywords: acupressure, sleep quality, elderly patient, Pittsburg Sleep Quality Index

How to cite this article:
Rajkumar D R, Savarimuthu RJ. Effectiveness of acupressure on improvement of sleep quality among elderly. Indian J Cont Nsg Edn 2016;17:62-4

How to cite this URL:
Rajkumar D R, Savarimuthu RJ. Effectiveness of acupressure on improvement of sleep quality among elderly. Indian J Cont Nsg Edn [serial online] 2016 [cited 2021 May 8];17:62-4. Available from: https://www.ijcne.org/text.asp?2016/17/2/62/286301

  Introduction Top

Sleep quality is altered with the advance of age. Ancoli-Israel (2000) estimated that upto 40% to 50% of adults over the age of 60 years report disturbed sleep. Alzheimer’s disease, alcohol, circadian rhythm disturbances, sleep-disordered breathing, periodic limb movements in sleep, restless leg syndrome, rapid eyemovement, sleep behavior disorder, insomnia, environmental and life changes, presence of medical and mental disorders, and increased use of medication contribute to sleep problems among the elderly (Roepke & Ancoli-Israel, 2010).

Acupressure is a traditional Chinese treatment which is noninvasive and safe. Acupressure involves the stimulation of certain acupoints by pressing with the fingers or moving limbs or joints slowly to promote health or offer comfort. Acupressure is an effective non pharmacological therapy for improving sleep (Carotenuto, Gallai, Parisi, Rocella, & Eposito, 2013; Yang & Lin, 2007).

  Objectives Top

  • To assess the level of sleep quality among elderly residing in old age homes
  • To assess the effectiveness of acupressure on sleep quality among elderly
  • To find association between pre-test and post-test level of sleep quality among elderly with their selected demographic variables

  Methods Top

A quantitative approach was used to conduct the study. One group pre-test post-test quasi experimental design was used to examine the effect of acupressure on sleep quality in the elderly patients residing in two old age homes. There are 50 residents both men and women in each old age home. Medical care, recreational facilities, food, and accommodation are provided free for all the residents. Good physical and environmental conditions such as spacious rooms, natural ventilation, adequate lighting, calm, and quiet environment and rest room facilities are available. Structured activities according to their health status and interest are provided for all inmates. Visitors are allowed with permission from the management.

Purposive sampling technique was used to select 60 subjects. Elderly residents willing to participate in the study, who could read and understand Tamil, who complained ofsleep disturbances were included in the study. Elderly who were suffering from psychosis, organic brain disorder, and with physical ailments were excluded from the study.

The data collection instruments consisted of demographic data and the PSQI. Demographic data consisted of age, sex, religion, education, marital status, previous occupation, source of income, family support, duration of stay in old age home, mode of admission and number of children. The PSQI is an effective instrument used to measure the quality and patterns of sleep in the older adults. It is a standard tool with four point Likert scale to assess the night time sleep quality over the past one month. The total score is 21. The quality of sleep is classified according to the range of scores as good [0],[1],[2],[3],[4] and poor [5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21]. The poor quality of sleep was further classified as mild [5],[6],[7],[8],[9], moderate [10],[11],[12],[13],[14], and severe sleep disturbances [15],[16],[17],[18],[19],[20],[21] (Buysse, Reynolds, Monk, Berman, & Kupfer, 1989; Smyth, 2007). The PSQI has internal consistency and a reliability coefficient (Cronbach’s alpha) of 0.83 (Smyth, 2007).

Data Collection Procedure

Formal permission was obtained from the dissertation committee of the respective institution and authorities of the old age home. Verbal consent was obtained from study sample after explaining the purpose of study and assuring the confidentiality of the data. Forty subjects were selected from one home and 20 subjects from another home. Demographic data were collected. Acupressure therapy was explained and pre-test assessment of sleep quality was done. The acupressure therapy was administered in the acupressure points as shown in [Figure 1], for three weeks, twice a day. Post-test assessment was done after three weeks.
Figure 1: Acupressure points

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  Result and Discussion Top

Majority of the subjects were aged between 66 and 70 (43.3%), females (58.3%), married (88.3%), lacking family support (78.3%), and residing in the old age home for 4 to 6 years (46.7%).

Sleep quality assessment revealed that all the subjects had poor quality of sleep prior to acupressure therapy. Among them 17 (28.3%) had mild, 37 (61.7%) had moderate, and 6 (10%) had severe levels of poor quality of sleep. In post-test 26 (43.3%) had good quality of sleep and 34 (56.7%) poor quality of sleep. Among those who had poor quality of sleep all (100%) had only mild levels of poor quality of sleep. Acupressure was found to be significantly effective in improving the quality of sleep (p = .000) (see [Table 1]. The findings are supported by many research studies. (Carotenuto et al., 2013; Chen, Chao, Lu, Shiung, & Chao et al., 2012; Chen, Lin Wu, & Lin, 1999; Lu, Lin, Chen, Tsang, & Su, 2013; Reza et al., 2010; Shariati, Jahani, Hooshmand, & Khalili ,2012; Sun, Sung, Huang, Cheng, & Lin, 2010; Yeung et al., 2012).
Table 1: Pretest and Posttest Sleep Quality

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Among the demographic variables, Occupation was significantly associated with quality of sleep (p = .054).


Small sample size and limited duration of intervention were some of the limitations which curtail the generalizability of the findings.

  Conclusion Top

Acupressure is a non-pharmacological therapy and involves the stimulation of certain acupoints by pressing with the fingers. Acupressure is significantly effective on improvement of quality of sleep and has no significant adverse or side effects. Accupressure can be a simple and effective intervention in improving sleep in older adults. It can be effectively used by nurses trained in the technique.

Conflicts of Interest: Authors have declared no conflicts of interest.

  References Top

Ancoli-Israel, S. (2000). Insomnia in the elderly: A review for the primary care practitioner. Sleep, 23, S23 - S30.  Back to cited text no. 1
Buysse, D. J., Reynolds III, 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. Journal of Psychiatric Research, 28(2), 193 - 213.  Back to cited text no. 2
Carotenuto, M., Gallai, B., Parisi, L., Roccella, M., & Esposito, M. (2013). Acupressure therapy for insomnia in adolescents: A polysomnographic study. Neuropsychiatric Disease and Treatment, 9,157 -162.  Back to cited text no. 3
Chen, J. H., Chao, Y. H., Lu, S. F., Shiung, T. F., & Chao, Y. F. (2012). The effectiveness of Valerian acupressure on the sleep of ICU patients: A randomized clinical trial. International Journal of Nursing Studies, 49 (8), 913 - 920.  Back to cited text no. 4
Chen, M. L„ Lin, L. C., Wu, S. C., & Lin, J. G (1999). The effectiveness of acupressure in improving the quality of sleep of institutionalized residents. The Journals of Gereontology. Series A, Biological Science and Medical Sciences, 54(8), 389 - 394.  Back to cited text no. 5
Lu, M. J., Lin, S. T., Chen, K. M., Tsang, H. Y., & Su, S. F. (2013). Acupressure improves sleep quality of psychogeriatric inpatients. Nursing Research, 62(2), 130 -137.  Back to cited text no. 6
Reza, H., Kian, N., Pouresmail, Z., Masood, K., Sadat Seyed Bagher, M., & Cheraghi, M. A. (2010). The effect of acupressure on quality of sleep in Iranian elderly nursing home residents. Complementary Therapies in Clinical Practice, 16( 2), 81-85.  Back to cited text no. 7
Roepke, S. K., & Ancoli-Israel, S. (2010). Sleep Disorders in the elderly. Indian Journal of Medical Research, 131,302 -310.  Back to cited text no. 8
Shariati, A., Jahani, S., Hooshmand, M., & Khalili, N. (2012).The effect of acupressure on sleep quality in hemodialysis patients. Complementary Therapies in Medicine, 20(6), 417 - 423.  Back to cited text no. 9
Smyth, C. (2007). The Pittsburgh Sleep Quality Index (PSQI). Try this: Best Practices in nursing care to older adults. Retrieved from www.ConsultGeriRN.org.  Back to cited text no. 10
Sun, J. L., Sung, M. S., Huang, M. Y., Cheng, G C., & Lin, C. C. (2010). Effectiveness of acupressure for residents of long-term care facilities with insomnia: A randomized controlled trial. International Journal of Nursing Studies, 47(1), 798 -805.  Back to cited text no. 11
Yang, M. H., & Lin, L. C. (2007). Acupressure in the care of the elderly. The Journal of Nursing, 54(A), 10-15.  Back to cited text no. 12
Yeung, W. F., Chung, K. F., Poon, M. M., Ho, F. Y., Zhang, S. P., Zhang, Z. J., Ziea, E. T„ & Wong, V. T. (2012). Acupressure, reflexology and auricular acupressure for insomnia: A systematic review of randomized controlled trials. Sleep Medicine, 13(8), 971 -984.  Back to cited text no. 13


  [Figure 1]

  [Table 1]


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