Wzorzec-przegl d lekarski-XX-2001

Table II
Proportion reporting poor sleep on 4 or more nights a week by smoking, worries and health variables by
gender, age 16-74
Men Women Total
% n= % n= % n=
Cigarette Smoking
Current Smoker 19.0 1162 24.4 1402 22.0 2564
Ex Smoker 12.0 1808 18.3 1938 15.3 3746
Never Smoked 12.3 877 16.8 1383 15.0 2260
p= 0.000 0.000 0.000
Self-reported Worries
No 9.3 2612 12.5 2888 11.0 5500
Medium 14.6 591 22.2 825 19.0 1416
High 33.6 648 38.4 1014 36.5 1662
p= 0.000 0.000 0.000
Health worries
No 10.0 3228 15.3 3909 12.9 7137
Medium 28.4 342 33.7 466 31.4 808
High 45.6 281 49.7 352 47.9 633
p= 0.000 0.000 0.000
Self-reported Health
Very Good or Excellent 7.0 2111 12.3 2473 9.8 4584
Good 13.4 972 20.4 1253 17.3 2225
Fair or poor 35.1 767 37.4 999 36.4 1766
p= 0.000 0.000 0.000
Number of chronic illnesses
0 8.3 2108 12.7 2442 10.7 4550
1 16.7 1099 21.4 1296 19.2 2395
2 22.0 381 28.7 575 26.0 956
3 or more 40.0 260 44.0 411 42.5 671
p= 0.000 0.000 0.000
Source: Psychiatric Morbidity Survey, 2000 (authors' analysis)
Worries are implicated in the gender difference
in sleep problems. Women's sleep
is more likely to be disturbed by worries,
particularly associated with their gender role
as mothers or wives, and their concern for
the well-being of family members [13, 2, 31].
Previous sleep research has tended to view
'worries' as a mark of anxiety or psychological
problems, rather than embedded within
social roles and responsibilities. Worries
and concerns represent an important predictor
of sleep problems, but retain an independent
effect after controlling for health and
depression Table III, Model 5). In addition,
this analysis suggests that differences in
health status between men and women do
not explain the gender difference in sleep
problems. Indeed, the gender difference
becomes greater after adjusting for health
variables and depression (Table III, Model 5).
This research supports other studies
that have found poorer sleep quality among
those with low educational qualifications [15,
21, 24, 29], who are not working [22, 24],
and have low income [17, 9]. However, this
study goes beyond previous research in two
ways. First, by using representative national
data to simultaneously consider the independent
effects of four SES variables (education,
employment status, household income,
housing tenure). Second, it addresses previous
observations [24] that the higher prevalence
of insomnia among individuals with low
education, not working and with low income
may be confounded by poor physical and
mental health, through examining models
containing health measures and depression.
The relative importance of different sets
of factors in leading to sleep problems are
considered. 'Worries' are likely to be confounded
with socio-economic characteristics;
the relationships between sleep problems
and living on a low income or living in rented
housing were partially mediated through
worries and concerns. After adjusting for
smoking, worries, health and depression, a
significant independent association still remained
between sleep problems and both
low education and not being in paid work.
Lack of employment is linked to sleep problems
in two ways; for the unemployed, primarily
through its intrinsic relationship with
worries, while for the economically inactive,
primarily because of their poorer health status.
There is a much larger effect of marital
status on sleep problems among men than
among women, suggesting advantages
conferred by marriage for men in terms of
sleep quality. Divorced/separated men and
widowed men have particularly poor quality
sleep compared with married men. Although
losing a partner (whether through
divorce or death) has psychological consequences
which may adversely effect sleep
quality, this analysis shows that a major factor
explaining the higher rate of sleep problems
among the previously married is their
more disadvantaged SES.
Conclusions
A large part of the well-known gender
difference in reported sleep problems is
mediated by the more disadvantaged socioeconomic
status (SES) of women, casting
doubt on the primacy of physiological explanations
of this gender difference. In turn,
SES is shown to impact on psychological
distress and worries, which form part of the
mechanism through which disadvantaged
SES impacts on sleep problems.
There are gender differences in the association
of marital status with poor sleep
with greater effects of marital status for men
than women. Men who were previously married
(whether divorced or widowers) have
particularly poor sleep compared with their
married counterparts. Whereas for women,
these associations with marital status are
less strong. However, among both men
and women, a substantial proportion of the
higher reported sleep problems of the divorced
and widowed can be accounted for
by their more disadvantaged SES. These
findings that people with more disadvantaged
SES report greater sleep problems
need further consideration by health researchers.
Despite sleep being important for health
and well-being [3], previous research on
gender inequalities in health has hitherto
paid scant attention to gender differences
in sleep problems or to how women's disadvantaged
social position or gender roles
mediate these differences. This research
has shown strong linkages both between
socio-economic variables and reported
sleep problems, and between health variables
and sleep problems. This suggests
that low socio-economic status, family worries
and women's family roles, may potentially
be mechanisms that account for
women's greater experience of sleep disruption.
Acknowledgements
The author acknowledges funding from
the New Dynamics of Ageing initiative, a
multidisciplinary research programme sup-
58 Przegl¹d Lekarski 2012 / 69 / 2 S. Arber