EFFICACY OF COGNITIVE BEHAVIOUR AND RELAXATION TECHNIQUES ONINSOMNIA AMONG STUDENTS

CHAPTER ONE

INTRODUCTION

1.1         Background to the Study

Higher institutions of learning like the universities are dominated in number by young adult students,transiting to a world of relative freedom, new experiences and choices, and based on the choices they made, their campus and off-campus experiences can contribute to health or disorder promoting lifestyles and ultimately relate to their quality of lives and school activities.

National Sleep Foundation (2005), reported that young adults are at greater risk than other age groups for developing first onset psychopathology (mental/behaviour disorder), which may lead to lower social and academic performance, lethargy and worse long-term outcomes such as school dropout and possibly poor productivity at work or school. The foundation also noted that majority of students due to new environment; life experiences and choices at school receive significantly less sleep. A survey in 26 of 36 States in Nigeria on the prevalence of insomnia showed that 25.68% of people aged 18 – 30 years had insomnia (Gureje, Oladeji, Abiona, Makanjuola &Esan, 2011). A national survey in US byHicks and Pellegrini (2001), showed that 68.3% of College students reported sleep problems, against 26.7% found in 1982.This suggests an upward trend. In 2009, Lund, Reider, Whiting and Prichard,found 60% of College students reported poor sleep quality. Approximately 35% of students‘ population with sleep problems have reported experience of insomnia during the course of a year in school (Walsh, Benca & Bonnet, 1999), 11.4% reported that their symptoms started when they were between 21 and 30 years old (Hardison, Neimeyer, & Lichstein, 2005). A study in Europe using randomly selected young adults ages 21-30 years found that 16.6% reported experiencing insomnia. About 45% of these young adults with insomnia continued to report sleep problems at a 3.5-year follow-up (Breslau, Roth, Rosenthal,& Andreski, 1996). Out of over 1,000 College students surveyed by Taylor and Bramoweth (2010), 6.8% of the students with insomnia used medication (either prescription or over the counter) to help them sleep and 11.4% used alcohol as a sleep aid.What precipitates and perpetuates insomnia among students‘ population may vary from medical to non-medical reasons.However, studies by Tagaya, Uchiyama, Ohida, Kamei, and Shibuti (2004), reported that pressure from academic workload was one of the reasons for sleep disturbance among students. Aside academic pressure, social activities, social pressures, and college cultures contributed to the problem.

Harvey (2000), stated that approximately 80% of individuals with insomnia reported an inability to ―empty their mind, and ―unwind their thinking‖ at bedtime. Harvey stressed that the thought content of people with insomnia is full of worries, emotionally arousing, and focused on daily and future concerns particularly, their consequences. In addition, Gellis and Lichstein (2009), reported that insomniac possess a number of behaviors that has to do with the frequency of ―worry, planning, or thinking about important matters at bedtime‖. This arousing pre-sleep cognitive activity is believed to be one of the causesof insomnia among students. When the condition persists, it taxes its sufferer mentally and physically, and can cause a lot of stress and distress for the individual(Vgontzas, Liao, Bixler, Chrousos, & Vela-Bueno, 2009; Byles,Mishra, Harris& Nair, 2003). However, despite the existence of several psychological treatment options for insomnia, people who experience sleep difficulties usually start with passive strategies. When surveyed, many insomnia patients reported that they read, watch television, or listen to the radio when they are unable to sleep. Many people with insomnia say that they ―do nothing‖ except lie in bed, tossing and turning, waiting for sleep to come. The first level of active treatment among sufferers is self-medication with alcohol, over-the-counter sleep aids, or natural/herbal dietary supplements. If people with insomnia eventually seek medical help for their condition, they are generally prescribed hypnotic drugs as a second level of active treatment (National Sleep Foundation, 2001).

Literature have shown that psychological approaches like cognitive behavioral techniques produced sustained benefits in management of insomnia without the risk for tolerance or adverse effects associated with pharmacologic approaches. Cognitive behaviour technique for insomnia (CBT) is a brief, sleep-focused, multimodal intervention that includes psychological and behavioural intervention such as stimulus control, sleep restriction, cognitive therapy, and education about sleep hygiene, and sometimes combined with relaxation technique (Morin & Benca 2012). Relaxation technique,which improves calmness,may include deep breathing exercise, progressive muscle relaxation, guided visualization among others (Ethan, 2014, 2008, NSF 2015). A combined approach is usually preferred because several dimensions of insomnia can be addressed(Morin & Benca, 2012). The techniques, when combined have shown high potency and are now commonly recommended as first-line psychological treatment for insomnia due to its success rateof 70 to 90% (Morin, 2004)

1.2         Statement of the Problem

Insomnia, a sleep condition that is characterized by persistence difficulty in falling or staying asleep long enough to feel refreshed the next morning, with daytime side effects among young adult students studying in higher institutions of learning is taking a worrisome proportion particularly in this computer age and demanding 21^st century academic environment.It was reported that insomnia affects about a quarter of young people in Nigeria (Gureje, et al. 2011). As a common sleep, complain that makes restful and restorative sleep often a painstaking and exasperating experience, this condition if not mitigated could give rise to the development of other comorbid conditions.It has been reported that students who experience persistence insomnia might suffer from fatigue, reduced quality of life, and are likely to experience depression and engage in substance abuse to enable them sleep. Lack of sleep may also weaken students‘ daytime performance, leading to falling asleep in the class, lateness to lecture, lacking energy to perform academic tasks, poor concentration, inattentiveness, indolence, and absenteeism and can escalate tendency for memory deterioration, which might consequently affect negatively on students‘ school outcomes. Despite theseeffects however, the condition is still an under-recognized and under studied problem in this clime. Even empirical studies examining remediation among young adult students of Ahmadu Bello University,Zaria, Kaduna State, Nigeria are lacking.

Although, studies (Edinger & Sampson, 2003;Fornal–Pawłowska & Szelenerger, 2013), have supported the potency of cognitive behaviour technique in reducing insomnia but locally,studies investigating its relative effectiveness with relaxation technique among young adults in the university domiciling in the hotels are rare.Therefore, in view of the foregoing, and realizing the importance of good sleep quality, particularly to students‘memory, and learning outcome and other school activities, the need to address insomnia in a psychological way becomes very essential.

In the light of the above, this study finds out the efficacy of cognitive behavior and relaxation techniques on insomnia among students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria.

1.3         Objectives of the Study

The objectives of the study were to:

1. Determine the effect of cognitive behaviour technique on insomnia among students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria
2. Determine the effect of relaxation technique on insomnia among students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria

• Determine the relative effects of cognitive behaviour and relaxation techniques on insomnia among students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria

1. Examine the differential effects of cognitive behaviour technique on insomnia condition of male and female students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria
2. Examine the differential effects of relaxation technique on insomnia condition of male and female students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria

1.4         Research Questions

The study was tailored towards answering the following research questions;

1. What is the effect of cognitive behaviour technique on insomnia among students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria?
2. What is the effect of relaxation technique on insomnia among students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria?

• What is the relative effects of cognitive behaviour and relaxation techniques on insomnia among students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria?

1. What is the differential effect of cognitive behaviour technique on insomnia condition of male and female students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria?
2. What is the differential effect of relaxation technique on insomnia condition of male and female students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria?

1.5         Research Hypotheses

Based on the research questions, the following non-directional hypotheses wereused to guide the study;

1.6         Significance of the Study

The findings will help students suffering from sleep initiation/maintenance difficulty by providing them with tested techniques they can use to resolve such problem without resorting to sleeping pills or substance abuse, which can lead to dependence and addiction consequently. Using these techniques will help students have a good sleep quality and enhanced daytime performance. The study will also benefit school psychologists and counsellors by providing them with tested cognitive and behavioural techniques that can be used to help students who are suffering from insomnia or sleeplessness.It is hoped that when students sleep needs are address, attention and concentration in class will likely improve and teachers will need less effortin term of behavior modification or management in the class most especially among students who are fond of sleeping in the class while lecture is ongoing. The findings of this study will add to the existing body of literature and theories concerning behavioural and psychological interventions for management of Insomnia particularly among young adult students‘ population in Ahmadu Bello University, and the community as a whole. It will help create awareness to the public in general and provide government and non-governmental organizations with data about the existence and efficacy of psychological and behavioural techniques in managing insomnia. This information can help to improve public and mental health of students and the community in general.

When published, this study will provide future researchers, and readers with valuable information and findings regarding the effectiveness of using various psychological techniques and methods such as cognitive behaviour technique and relaxation technique in reducing insomnia.

The findings from this study can lead to new methods or strategies for dealing with insomnia and can shed more light on new findings, suggestions for improvements and useful recommendations.

1.7         Basic Assumptions of the Study

Based on available literature regarding the problem under investigation, the study assumes that;

1. Cognitive behaviour technique might be effective in reducing insomnia among students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria
2. Relaxation technique might be effective in reducing insomnia among students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria

• Cognitive behaviour technique might be more effective when compared to Relaxation technique in reducing insomnia among students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria

1. The effect of cognitive behavior technique on insomnia between male and female students of Ahmadu Bello University, Zaria, Kaduna State, Nigeriamight not differ
2. The effect of relaxation technique in reducing insomnia between male and female students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria might not differ

1.8         Scope and Delimitation of the Study

The scope of the study was all students of Ahmadu Bello University, Zaria, Kaduna State, Nigeria who show symptoms of primary insomnia. The study was delimited to assessing the efficacy of CBT (stimulus control instruction, sleep restriction, sleep hygiene education, and cognitive technique) and Relaxation technique(deep breathing exercise, progressive muscle relaxation, guided visualization meditation, and mindfulness technique). It was delimited because of prevalence of insomnia,which is caused by cognitive and behaviour problems among the target group. Another reason is the dearth of research in this clime targeting young adults in the universities,and to examine whether cognitive behaviour and relaxation techniques can be applied effectively in managing insomnia among young adults‘ university students of different demography domiciling mostly on university facilities