Effect of hydrotherapy on sleep deficiency among older people in integrated community health services in Pandak I Bantul

The proportion of aging population is increasing rapidly year by year, and the deep influence of this phenomenon on the economic and social conditions has been studied using multilateral approaches, such as social, physical, and psychological aspects. Data from the Central Bureau of Statistics show that the number of aged persons in Yogyakarta has increased from 492,200 in 2015 to 505,100 in 2016.¹ Changes in the sleep pattern are experienced by older people. Bundlie² states that there are age-related changes in sleep, namely, increased sleep latency, reduced sleep efficiency, increased nocturnal awakening, increased early morning awakening, and increased daytime sleepiness. Sleep quality is essential for older people’s well-being and health. Sleep quality in older people can be influenced by environment, pain,³ lifestyle,³ diet,⁴ psychological condition,⁴ treatment, and cognitive disorders.^2,5

Relaxation technique is a nonpharmacological treatment that is applied to increase sleep efficiency and improve the quality of sleep. Hydrotherapy, a relaxation technique that uses warm water, can decrease stress,⁶ muscle stiffness,^2,5 and pain, in addition to warming the body.^7,5,8 The prevalence of sleep deprivation among older people in the Integrated Community Health Center, Pandak I Bantul, was found to slightly increase year by year. There is no previous study on water treatment for older people with sleep disorder in Bantul, Yogyakarta, Indonesia. This research aims to evaluate the effect of hydrotherapy on sleep deprivation among older people in the Integrated Community Health Center, Pandak I Bantul, Yogyakarta, Indonesia.

The data showed that the difference between the pretest and posttest scores for quality of sleep in the control group (0.42) with P= 0.059, which showed no significance. In addition, the research found that the mean pretest score for sleep quality in the intervention group was as high as 9.09 (SD: 2.57) and the posttest score was 4.42 (SD: 1.43). The mean score of the difference in sleep quality in the intervention group was 4.67. There was a significant difference in sleep quality before and after intervention using hydrotherapy, with P< 0.05.

Table 1 shows that before intervention, the respondents in the intervention group had poor sleep quality, with mean score = 9.09. After intervention, the mean score was 4.42. Meanwhile, the control group shows mean sleep quality scores as follows: pretest score was 7.51, and posttest score was 7.09.

Data in Table 2 show that the mean score for each component of sleep quality index in the intervention group was decreased after hydrotherapy treatment (posttest result).

The most noticeable change noted in Table 2 is that the use of medicines by the elderly in the intervention group decreased extremely, from a mean score of 0.39 to mean score of 0.00 (Table 3).

Table 4 shows a significant result in the intervention group, with P = 0.000 (P<0.05). The mean score for sleep quality index on the pretest was 9.09 (SD: 2.57), while the posttest mean score was 4.42 (SD: 1.43), with difference in the score being as high as 4.67. The difference between the pretest and posttest scores in the control group was 0.42. However, it showed no significant difference (P=0.059).

Hydrotherapy is the external or internal use of water, in the form of ice or warm water, at various temperatures and pressures, for various durations, and applied at different sites, for promotion of health or for treatment of various diseases.⁵ Hydrotherapy can improve blood circulation by expanding blood vessels. Analysis of the components of sleep quality in the intervention group shows significant difference before and after intervention: subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of medicines, and daytime sleepiness. Hydrotherapy affects the level of serotonin hormone and makes people more relaxed, reducing the sleep deprivation of people as a result.⁵ From the data, it was found that the sleep disorder decreased after hydrotherapy. Low score of sleep quality is an indicator of good sleep quality; therefore, the data obtained from the present study show that hydrotherapy can increase the quality of sleep among older people.

According to the findings of the present study, there is a significant difference in the sleep quality among older people before and after the intervention using hydrotherapy. It shows that hydrotherapy treatment is effective in reducing sleep deficiency among older people. A previous study also found that the quality of life was increased and the depression level was decreased among elderly women who received hydrotherapy treatment.¹⁰ Another study also found that sleep quality was increased after hydrotherapy intervention (indoor warm pool) among older people with fibromyalgia (P=0.0001).⁸

Overall, the results of the study show that hydrotherapy is effective in reduction of sleep deficiency. Therefore, hydrotherapy treatment is recommended because it is effective in reducing sleep disorders among the elderly.

According to the results of the present study, it appears that the hydrotherapy practice is effective in reduction of sleep disorders among older people and can be considered as an effective intervention method. Further studies are required to find the mechanism of hydrotherapy and its use in other conditions, using larger sample sizes.