L'expérience vécue des difficultés de sommeil dans la relation de couple au Canada et au Brésil : une étude interculturelle comparative entre les villes de Québec et de Fortaleza

Le sommeil est un phénomène naturel, biologique, individuel mais aussi socioculturellement organisé. Comprendre l’expérience vécue des difficultés de sommeil (DSom) dans la vie quotidienne de couples canadiens et brésiliens est l’objectif de cette thèse. L’étude, inscrite dans le paradigme interculturel-comparatif, s’appuie sur la méthode phénoménologique critique (Moreira, 2009). Cette approche vise à saisir le monde vécu des couples avec DSom à partir de la description des multiples contours (socio-économico-culturel) dans lesquels chaque partenaire, et le couple, sont entremêlés profondément au jour le jour. Onze couples hétérosexuels, sans enfant, âgés entre 24 et 47 ans, dont l’un ou les deux partenaires rapportent avoir des DSom ont été recrutés à Québec (N = 6) et à Fortaleza (N = 5). L’entrevue phénoménologique de couple et la rédaction de « rapports libres » sur le sommeil pendant sept jours consécutifs ont été utilisés, ainsi que deux questionnaires (IQSP/EAD-16). Quelle que soit la ville, les expériences vécues des DSom sont majoritairement associées au stress de la vie professionnelle et adulte ; elles se traduisent par des symptômes de l’insomnie et sont étroitement liées aux contextes socioculturels, économiques, environnementaux et familiaux. Les couples se disent habitués aux DSom ; ils emploient, généralement, des stratégies personnalisées et plus « santé » pour y faire face et préfèrent la convention sociale du partage du lit. La majorité des répondants était globalement satisfaite de leur engagement au moment de leur participation à cette étude. Le vécu de relations saines apparaît ainsi comme promouvant des comportements appropriés liés au sommeil, mais n’assure pas nécessairement une absence de DSom au sein du couple. Considérer le sommeil en contexte et reconnaitre son aspect social (et dyadique) peut contribuer à l’identification des DSom, à leur signification et à leur évaluation.Sleep is a natural, biological and individual phenomenon but also socioculturally organized. Understanding the lived experience of sleep difficulties (SD) in Canadian and Brazilian couples’ everyday life was the purpose of this thesis. The study, within in the comparative cross-cultural paradigm, is based on the critical phenomenological method (Moreira, 2009). This approach seeks to understand the lived world of couples with SD from the description of multiple contours (socio-economic and cultural) in which each partner, and the couple, are deeply intertwined day by day. Eleven heterosexual couples without children, aged between 24 and 47 years-old, with one or both partners self-reporting SD were recruited in Quebec (N = 6) and Fortaleza (N = 5). A couple’s phenomenological interview and “free reports” on sleep during seven consecutive days were used, as well as two questionnaires (PSQI/DAS-16). Regardless of the city, the lived experiences of SD were mostly associated with professional and adult lives’ stress that reflect symptoms of insomnia, and were closely linked to socio-cultural, economic, environmental and family contexts. The interviewed couples reported being used to their SD; they generally adopted personal and “healthy” strategies to cope with them and preferred the social convention of bed sharing. The majority of respondents were generally satisfied with their couple relationship at the time of their participation in this study. The experience of healthy relationships seems thus to promote appropriate behaviors related to sleep, but do not necessarily assure a lack of SD within the couple. Considering sleep in context and acknowledging its social (and dyadic) aspects could contribute to the identification of sleep difficulties, as well as their meaning and assessment

Qualitative studies of insomnia : current state of knowledge in the field

Despite its high prevalence and burden, insomnia is often trivialized, under-diagnosed, and under-treated in practice. Little information is available on the subjective experience and perceived consequences of insomnia, help-seeking behaviors, and treatment preferences. The use of qualitative approaches (e.g., ethnography, phenomenology, grounded theory) may help gain a better understanding of this sleep disorder. The present paper summarizes the evidence derived from insomnia studies using a qualitative research methodology (e.g., focus group, semi-structured interviews). A systematic review of the literature was conducted using PsycINFO and Medline databases. The review yielded 22 studies and the quality of the methodology of each of them was evaluated systematically using the critical appraisal skills programme (CASP) appraisal tool. Selected articles possess at least a very good methodological rigor and they were categorized according to their main focus: “Experience of insomnia”, “Management of insomnia” and “Medicalization of insomnia”. The main findings indicate that: 1) insomnia is often experienced as a 24-h problem and is perceived to affect several domains of life, 2) a sense of frustration and misunderstanding is very common among insomnia patients, which is possibly due to a mismatch between patients' and health care professionals' perspectives on insomnia and its treatment, 3) health care professionals pay more attention to sleep hygiene education and medication therapies and less to the patient's subjective experience of insomnia, and 4) health care professionals are often unaware of non-pharmacological interventions other than sleep hygiene education. An important implication of these findings is the need to develop new clinical measures with a broader scope on insomnia and more targeted treatments that take into account the patient's experience of insomnia. Greater use of qualitative approaches in future research may produce novel and more contextualized information leading to a more comprehensive understanding of insomnia

Sociocultural variations of coping strategies for sleep difficulties in couple relationships in Canada and Brazil

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