Abstract
Insomnia is a sleep disorder that bothers millions of people around the whole globe. The reasons for insomnia vary from certain medical or psychiatric conditions to personal problems and poorly developed habits. Regarding the existing number of causes and outcomes of this disease, many treatments and alternatives can be offered to adults with insomnia. This paper will discuss the main aspects of insomnia and introduce Tai Chi as a possible treatment for patients. The goals of this project include the evaluation of the effectiveness of Tai Chi, the examination of its frequency and other sleep patterns, and the analysis of the recommendations that may be given to patients with insomnia. Not all medical facilities use Tai Chi as the main therapy for insomnia challenged patients, and it is necessary to investigate the cases for and against the chosen practice.
Introduction to Study
Insomnia is defined as one of the most prevalent disorders in the global population. It is defined as a subjective perception of difficulties that may occur during sleep initiation, duration, and quality (American Psychiatric Association, 2015). This disorder may be characterized by different complains and outcomes, therefore, multiple practices and approaches can be offered to help patients with insomnia, including psychological or pharmacological practices, stimulus control as a part behavioral interventions, or sleep hygiene as an example of education for patients (Qaseem, Kansagara, Forciea, Cooke, & Denberg, 2016). Problems with sleep may result in stress and unstable physical conditions that promote an increased possibility of inflammatory processes in the body. Tai Chi is used as one of the possible movement meditation types to reduce the level of inflammation in older adults (“Better sleep and tai chi,” 2015). It may have its positive and negative effects on people of different ages, and not many sources can be found at this moment to give clear explanations and evaluations of the chosen practice.
Research Problem
Insomnia is a problem for about a third of the US adults who report that they cannot meet the criteria of the recommended amount of sleep because of their chronic diseases and mental health problems (Centers for Disease Control and Prevention, 2017). To avoid negative outcomes of insomnia and promote good health, many adults find it helpful to practice different psychological and behavioral therapies, including Tai Chi (Liu et al., 2016). Still, the effects of Tai Chi on adults with insomnia remain unclear, and it is hard to understand if it is reasonable and effective to offer this practice as an option for all adults.
Research Question
The main research question that has to be answered in this research paper is if Tai Chi practice during 12 months can be effective for adults who suffer from insomnia. This research question can be divided into several sub-questions with the help of which a paper can be developed. These questions are as follows:
- What is the essence of Tai Chi practice?
- What are the effects of Tai Chi on adults with insomnia?
- What are the alternatives for Tai Chi in insomnia treatment?
- Who are the supporters of practicing Tai Chi?
Literature Review
Sleep is an important part of human life, and it has to be properly managed because the absence or lack of sleep can result in various disorders, as well as sleeping all the time can change the work of the body and the mind (Feldman & Christensen, 2014). The causes and outcomes of sleep problems may vary, and clinicians have to make a correct choice, investigate a patient, and treat people in regards to their demands, peculiar features, and health conditions. Sleep problems may be treated medically and psychiatrically (Smith & Shimp, 2014). Sometimes, it is enough to promote certain lifestyle changes and establish personal obligations (Bhalla, 2016). About 3-7% of patients receive medical prescriptions like doxepin or melatonin to deal with their sleep disturbance problems (Sateia, Buysse, Krystal, Neubauer, & Heald, 2017). In some cases, patients have to combine medications and physical exercises.
Tai Chi is one of the behavioral practices that can be offered to people who want to deal with their sleeping problems and improve the quality of their life. Positive effects of this practice have been already shown to the patients with Parkinson’s disease, chronic pain, breast cancer, and poor cardiovascular health (Irwin et al., 2014b; Raman, Zhang, Minichiello, D’Ambrosio, & Wang, 2013; Yang et al., 2015). Several attempts to investigate the effectiveness of Tai Chi as a treatment alternative has been already made by Abbott and Lavretsky (2013) who proved that the conditions of patients with mental disorders could be improved with the help of such invasive therapy. Still, the peculiar feature of past research is that authors combine sleep problems and Tai Chi with other diseases or health problems (Abbott & Lavretsky, 2013; Raman et al., 2013). Not much attention is paid to Tai Chi as a central method of treatment for patients with insomnia as the main complaint.
Modern people are concerned with some problems connected with their health, work, living conditions, family relationships, and other topics that have to be discussed. The solution to such problems leads to stress and other behavioral changes (Edinger et al., 2015). Insomnia is one of the main outcomes of stress and anxiety, and Tai Chi is a practice that can be offered by clinicians (Chan et al., 2016). It is a lifestyle intervention that can target both problems, stress, and inflammatory processes, reducing its complications at the cellular level (“Better sleep and tai chi,” 2015). Medical experts call this combination of cognitive-behavioral therapy and physical experiences as a successful contribution to the improvement of human health from the physical and psychological perspectives (Irwin et al., 2014b). Sleep duration cannot be ignored by people. Still, living conditions and social obligations may influence human health, and Tai Chi helps to reduce the number of outside social effects. However, as Feldman and Christensen (2014) state, physical experiences maybe not enough to deal with emotional problems. Therefore, medications and consulting with experts have to be combined to achieve the desired results.
Tai Chi is the practice that can improve the functional abilities of a person, prevent falls, and promote a supportive case that cannot be offered by the medical staff (Smith & Shrimp, 2014). Many patients confuse such therapies as yoga and Tai Chi or use them as synonyms to treat insomnia or other mental disorders (Feldman & Christensen, 2014). However, it is necessary to remember that in comparison to yoga where extreme movements and physical experiences may be offered to different patients regardless of their past medical history, Tai Chi includes calm and slow movements with breathing exercises that have to be controlled by a trainer or with the help of alarm or special programs.
It has been proved that such problems as insomnia or the inability to control the amount of sleep required for healthy life start bothering people with age (Irwin et al., 2014b). Age is also the factor that determines the quality of life and promotes the creation of new additional health problems and the necessity to deal with several supplementary diseases at the same time. As an example, Parkinson’s disease may be developed along with insomnia, hypertension, or depression (Yang et al., 2015). Panic and anxiety may be the outcomes of hard-working days or family conflicts, and a good portion of sleep is the solution that cannot be made (Bhalla, 2016). Tai Chi is an opportunity for people to improve their sleep habits, as well as to think about other aspects of life, which turns out to be a positive aspect of this therapy.
Significance of the Problem
It is necessary to admit that Tai Chi is a widely available practice for patients despite their age, geographical location, and gender (Irwin et al., 2014a). Therefore, millions of people can use this practice anytime they find it necessary. They have to be aware of their peculiarities, epistemology, and possible effects to make the right choice and be prepared for different outcomes. Tai Chi may change the quality of life and the relation between physical exercises and mental health (Chan et al., 2016). Also, insomnia in adults may be caused by different factors, including the environment, personal concerns, chronic disorders, or other diseases’ complications. Tai Chi makes people do slow physical movements, breathe deeply, and meditate (Clarke, Black, Stussman, Barnes, & Nahin, 2015). Such requirements may be challenging for patients with asthma, cardiovascular diseases, or problems with bones or joints. The clarification of the effects of Tai Chi on adults turns out to be a significant problem for discussion in terms of which the improvement of public knowledge is possible.
Methodology and Research Design
The choice of methods and research design for a future project is a crucial step that cannot be neglected. To evaluate the effectiveness of Tai Chi practices, an exploratory study will be used to provide a general picture of the practice, evaluate the results of earlier studies, and gather the opinions of different people on the same intervention. It is similar to a descriptive design with the only difference that lies in the necessity to prove the appropriateness of a hypothesis about the possibility for adult patients with insomnia to improve their sleep pattern with the help of Tai Chi practice. A quantitative research method, a questionnaire, will be developed and supported by the results obtained from the literature review. A questionnaire will consist of several specifically organized questions that allow gathering information on the topic (Creswell, 2014). The results of this method can be introduced in numbers and easily analyzed.
Setting/Sample Design
A questionnaire will consist of 15 close-ended questions with several answers for personal choice. It is expected to cooperate with adult patients. The main inclusion criteria are the nationality (the citizens of the United States), age (from 25 to 85), sleep disorder (insomnia), and treatment practice (Tai Chi and several alternatives). Several local hospitals and medical centers may be chosen for the analysis of patients, and their databases can be used to identify patients who suffer from insomnia. The desired number of participants is 40. Both male and female patients should be invited. Their social and marital statuses should not influence the choice. Still, this information can be helpful as a possible factor in insomnia development.
Confidentiality
First, research has to be approved by an appropriate research ethics committee to support initial contact with the participants. Then, hospital leaders and managers have to approve the use of their databases to choose people. Finally, after contact with potential participants, they will be asked to give their prior signatures to inform consent and prove their free will to participate in the study. All participants will receive similar agreements in terms of which their anonymity and confidentiality rights will be described. The participants may use their right to drop out of the research process any time they want, giving clear explanations. Anonymous information will be given in the description of the study.
Procedure/Intervention
As soon as the chosen patients agree to participate in the study, a researcher should gather their contact information and discuss the most appropriate for the participant’s methods of communication. It is expected to send a questionnaire to all participants via email. Still, if some people refuse to give this information, do not have e-mail, or have some personal or physical problems that prevent using the Internet, it is possible to use written examples or receive oral answers to all questions. A questionnaire has to be developed in the way the information about sleep patterns, hours, treatment methods, and the level of knowledge about the practice and insomnia can be gathered.
Aligning Stakeholders
There are three main groups of stakeholders in this project. First, there is a researcher who has to establish clear goals, give informative explanations, and provide the participants with the expected guarantees. Second, there are hospitals and other medical facilities that can be used to find out the participants and get permission to cooperate with people. Finally, there are adult patients who suffer from insomnia and use Tai Chi as the main practice to treat this disorder. The rights of all stakeholders have to be aligned through the identification of rights and the explanation of duties. Adults as the main participants of the study and the only sources of primary information about the outcomes of Tai Chi on insomnia treatment should understand their responsibility and possible effects on the study. They have to give true answers and avoid the situations that may confuse a researcher.
Instruments/Scales and Measurement of Outcomes
Measurement of outcomes can be based on several scales developed at different periods. For example, Crönlein et al. (2013) introduce the RIS (Regensburg Insomnia Scale) to evaluate cognitive, emotional, and behavioral factors of insomnia. Sadeghniiat-Haghighi, Yazdi, and Firoozeh (2014) investigate the worth of the insomnia severity index and polysomnography as the two methods to evaluate sleep disorders. The scale that will be used in this research is based on the ideas developed by Edinger et al. (2015) about the necessity to consider pre- and post-treatment assessment and the frequency of use of Tai Chi practice. First, the number of hours of sleep before Tai Chi should be calculated. Then, the same issue should be evaluated after practice. The length of the practice has to be identified.
Data Collection and Data Analysis
In addition to some past studies and results obtained by different researchers, the data will be collected through a questionnaire that has to be developed with 40 participants. They have to give clear answers and avoid omissions. All answers have to be introduced in an electronic form even if the answers are gathered orally. The questions will be created in the way the participants can use the most appropriate for the participant’s answers. For example, the question will be “How long should a good and healthy sleep last?”, and the answers will be as follows “A –less than 5 hours, B – 6-7 hours, C – 8-9 hours, D – 9 and more hours”. Descriptive statistics will be used to analyze the data. It should be supported by graphs to give a clear visual representation of the information and make conclusions about the effectiveness of the chosen practice.
Significance of the Study
The significance of the study can be proved in several ways. First, this study will help to analyze the already developed investigations and results. Tai Chi and insomnia are frequently discussed questions if they are separated. It is necessary to promote the importance to combine these issues and identify the impact of Tai Chi on patients with insomnia. The second reason to investigate the effectiveness of Tai Chi is the possibility to focus on sleep patterns of adults and their understanding of healthy sleep habits. Finally, a questionnaire with different people will help to gather different opinions and compare the experiences based on different treatment methods. Tai Chi is the core approach to the analysis in this paper. Still, it is also important to understand what alternatives are available to adults with insomnia and if the benefits of Tai Chi prevail over other techniques.
Assumptions and Limitations
The results of this study can be used for the development of further research on insomnia and Tai Chi as the main practice for treatment. As soon as the effectiveness of the approach is proved, it will be possible to develop new methods of treatment based on Tai Chi, combine this practice with other treatments, and enlarge the knowledge of people about Tai Chi. The only limitation of the study is its sample. A small number of participants do not promote common outcomes. From a global point of view, people may use different techniques. Tai Chi is not the only option. Also, Tai Chi has Chinese origins, and the representatives of the Chinese culture or the citizens of China may be more helpful sources of information about the connection between insomnia and this practice.
Conclusion
In general, this research proposal shows how important the evaluation of the effects of Tai Chi on patients with insomnia can be. It is not enough to promote the usage of this practice to treat insomnia. It is necessary to explain the effects of Tai Chi on adults with insomnia. Communication with the participants and the analysis of past studies can help to develop certain conclusions and prove the necessity to investigate this practice from different perspectives, including the age and race of patients, the presence of other alternatives, and the period of the intervention.
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