Sleep is part of what is called the sleep-wake cycle. This cycle, which consists of roughly 8 hours of nocturnal sleep and 16 hours of daytime wakefulness in humans, is controlled by a combination of two internal influences: sleep homeostasis and circadian rhythms. The National Sleep Foundation and consensus statement of the American Academy of Sleep Medicine and Sleep Research Society suggest that adults should sleep 7 or more hours per night on a regular basis to promote optimal health. As per the expert panel report published in Sleep Health-The Journal of the National Sleep Foundation 2015, in younger adults (18-25) the Sleep range is 7-9 hours [1,2].

Several sleep hygiene behaviors have been reported to determine good quality sleep. Avoiding long naps during daytime and doing adequate physical exercise are positive sleep hygiene behaviors. Taking a warm bath, listening to soft music and reading can relax a person and encourage sleep [3,4].

Alcohol consumption, smoking, vigorous physical activity, loud music or taking a nap after 6 o’clock in the evening can reduce sleep quality. Using electronic gadgets for watching movies, gaming, viewing television (TV), talking on the phone and text messaging have all been shown to adversely affect sleep patterns and quality. Several other factors, like social and customs, cultural and climatic factors, appear to affect sleep duration in adults. Activities in bed, such as reading or watching television, have also been associated with subjective measurements of poor sleep [5,6].

Other lifestyle habits affecting sleep is cigarette smoking. It leads to sleep problems like having difficulty in falling asleep and maintaining asleep. Caffeine intake lengthens sleep latency, reduces sleep efficiency, and decreases sleep duration in adults. Pattern of sleep varies according to various factors like age, type of employment, physiological characteristics, mental status and other associated physical disease. The cut throat competition, escalating level of stress, hectic schedule and expectations by family members affects our health and also the normal physiological process like sleep. Therefore, good quality sleep and adequate amount of sleep are important in order to have better cognitive performance and avoid health problems and psychiatric disorders [7-8].

While the majority of sleep studies have been conducted in affluent countries, little is known about sleep duration in developing countries. Adults in Shimla have been reported to have inadequate sleeping duration. As a result, we designed this study to evaluate the sleep duration among Adult Population of Shimla city and its associated factors.

Aims and Objectives

To evaluate the sleep duration among Adult Population of Shimla city and its associated factors.

Study Design

It was a Cross-sectional community based study.

Study Area

The study was conducted in Shimla which is the capital city of Himachal Pradesh located in the south-western ranges of the Himalayas at 31.61°N 77.10°E. It has an average altitude of 2,206 meters (7,238 ft) above mean sea level.

Study Period

The time Duration for the study was 6 months i.e Nov 2021- April 2022.

Study Population

Adult population having age between 18-60 years of Shimla city were included in the study.

Sample Size Calculation

Though data was available data on the sleeping pattern in non-hilly area, but there was a paucity of data regarding the same in hilly area like Shimla. So, the sample size was calculated by assuming that 50% of the adult population of Shimla city have adequate Sleeping pattern, 5% Absolute error, 95% Confidence level, our sample size came out to be 384. By taking 5% Non-Response Rate, our total sample size came out to be 408. So, the total sample size of our study was 408. The equation for calculating sample size is as follows:

N = Z² P (1-P)/ e2

• Z = level of confidence (1.96)

• P = Prevalence of the disease

• e = margin of error or precision

Sampling Technique

There is total 34 Municipal wards in Shimla city. We equally divided the sample size according to municipal wards i.e.12 Adult persons from each municipal ward. We took 12 Adult persons from each municipal ward by simple random sampling. For this we selected first house from each ward by simple random sampling. Then we went in anticlockwise direction to select next household to complete sample size of 12 Adult persons from each ward. From each household we selected only one adult person by simple random sampling.

Study Tool

A pre-tested self-administered, anonymous, semi-structured questionnaire was used to evaluate the interrupted sleep pattern and sleep habits among adult population of Shimla city. 

• Included close ended questions to elicit information regarding basic Socio-demographics of study population including age, sex, education, family type, occupation etc

• Included close ended questions regarding sleep duration and habits

Data Collection Procedure

We provided participant information sheet to every selected adult and also explained them the purpose and objectives of the study. We ensured them for anonymity and confidentiality. After that we administered them the study questionnaire and we advised them to read every question carefully and answer accurately. We also provided them any help if they had any problem in understanding any question. Then we gave 15 minutes to the study participants complete the questionnaire. After completing the questionnaire, we collected it and kept it in safe and secure manner.

Inclusion Criteria 

• Adult person between 18 to 60 years of age. 

• Those who had given their consent to participate in the study. 

Exclusion Criteria 

• Those who refused to give consent to fill the questionnaire. 

Statistical Analysis

The collected Data was thoroughly screened and entered in Microsoft Excel spreadsheet 2007. Statistical analysis was done by using Epi Info 7. Descriptive statistics, frequency percentages were determined for categorical variables. Mean and standard deviation were determined for quantitative variables. The association of various factors associated with sleep pattern and habits was assessed with univariate analysis. To assess the differentials in relation to categorical variables, chi square test/fisher’s exact test was used. A p value of < .05 was taken as significant.

Ethical aspects

Objectives of study were explained to the participants during the visit. Informed consent was taken from all the adults participating in the study. Participants were fully assured regarding the confidentiality and anonymity of the information provided by them. Participation in the survey was voluntary, with neither reward nor penalty. All respondents were informed that they were free to continue or quit at any time, and the submission of the questionnaire would be regarded as consent to participate. Confidentiality of information gathered from study subjects was maintained in accordance with the principles embodied in the declaration of Helsinski and International guidelines for ethical review of epidemiological studies.

In the present study a total of 408 adults age between 18-60 years selected from all 34 municipal wards of Shimla city were participated with the objective to evaluate the interrupted sleep pattern and sleep habits.

Table 1 showed that a total of 408 participants responded to the survey. Out of which, 210(51.5%) were males and 198(48.5%) were females. Among those, 292 (71.6%) participants belong to 18-30 years old age group, 57(14.0%) in 31-40 years old age group, 30(7.4%) were 41-50 years old age group and 29(7.1%) were 51-60 years old age group. 141(34.6%) participants had graduate degree followed by 123(30.1%) participants were having postgraduate degree whereas 6(1.5%) participants were illiterate. According to Occupation status, 242 (59.3%) participants did not mention their profession i.e they chosen others group whereas 74 (18.1%) were employee, 44 (10.8%) were professional, 29 (7.1%) were businessmen, 18 (4.4%) were farmers and 1 (0.2%) were labourer. According to Religion, majority of the participants 379 (92.9%) were Hindus.

Table 1: Distribution of the Participants According to Socio-Demographic Characteristics 

Figure 1 shows that among the total 408 participants, 298 (73%) participants had adequate sleep duration of (6-8 hours) followed by 68 (16.7%) participants had inadequate sleep duration of >8 hours followed by 42 (10.3%) participants had inadequate sleep duration of <6 hours. In the present study, 130 (31.9%) participants went to bed for sleep on an average 10-11 pm, followed by 111 (27.2%) participants went to bed for sleep after 12 am. Similarly, 135 (33.1%) participants wake up after 8 am in the morning, followed by 105 (25.7%) participants wake up 6-7 am in the morning, 92 (22.5%) participants wake up by 7-8 am in the morning, 61 (15.0%) participants wake up 5-6 am in the morning and rest 15 (3.7%) participants wake up before 5 am in the morning (Table 2).

Table 2: Association of Sleep Duration with Sleeping Pattern 

In the present study, among 18-40 years, 98(28.08%) slept for adequate duration (6-8 hours) while 251(71.92%) slept for inadequate duration (<6/>8 hours) while among 41-60 years, 12(20.34%) slept for adequate duration (6-8 hours) and 47(79.66%) slept for inadequate duration (<6/>8 hours). There was no statistically significant difference in the sleep duration among both age groups. (P=0.216).

In the present study, 58(27.6%) males slept for adequate duration (6-8 hours) while 152(72.4%) slept for inadequate duration (<6/>8 hours) whereas 52(26.3%) females slept for adequate duration (6-8 hours) while 146(73.7%) slept for inadequate duration (<6/>8 hours). There was no statistically significant difference in the sleep duration among males and females. (P=0.758).

Similarly, there was no statistically significant difference in the sleep duration based on the different level of education. (P=0.056) (Table 3).

Table 3: Association of Sleep Duration with Sleeping Habits 

Among the participants who were professional/businessman/employee, 38 (25.9%) slept for adequate duration (6-8 hours) while 109(74.1%) slept for inadequate duration (<6/>8 hours) whereas among the participants who were farmer/labourer/student/other 72(27.6%) slept for adequate duration (6-8 hours) while 189 (72.4%) slept for inadequate duration (<6/>8 hours). There was no statistically significant difference in the sleep duration among professional/businessman/employee and farmer/labourer/student/others. (P=0.704).

According to area, there was no statistical significant difference in sleep duration among rural and urban participants (P=0.454) (Table 4).

Table 4: Association of Sleep Duration with Socio-Demiographic Variables

Inter group comparison shows that there was statistical significant difference in sleep duration among Hindu and participants belong to other religion. (P=0.0003).

Inter group comparison shows that there was statistically significant difference in sleep duration among participants who sleep between 9 pm -12 am and who sleep after 12 am (<0.0001). similarly, in the present study, there was statistical significant difference between wake-up time before 8am and after 8am in the morning. (<0.0001).

Among the participants, there was no statistical significant difference between the participants who read books or magazines and who did not read book or magazines before going to sleep in bed (P=0.535).

In the present study there was no statistical significant difference between the participants who have used mobile for chatting on social media/ playing games/ Inter group comparison shows that there was statistical significant difference between participants who have>120 minutes watching movie before going to sleep in bed and who did not use mobile for chatting on social media/ playing games/watching movie before going to sleep in bed (P=0.975). On the contrary, there was statistical significant difference between the participants who stay awake late at night and watched TV before going to sleep in bed and who did not awake late at night and watched TV before going to sleep in bed(P=0.014).

In the present study, there was no statistical significant difference between the participants who used 1-2 hrs mobile in a day and who used 2-4 hrs mobile in a day (P=0.69). Similarly, there was no statistical significant difference between the participants who watched TV/computer/laptop for 1-2 hrs in a day and who watched for 2-4 hrs in a day. (P=0.95) (Table 5).

In the current study, there was no statistically significant difference between the participants who slept alone and who slept with family members (P=0.411). Similarly, there was no statistical significant difference between the participants who did not wake up and who wake up 1-4 times in the middle of sleep at night. (P=0.94) time gap between eating and sleeping and those who have <120 minutes time gap (p = 0.0175).

Table 5: Association of Sleep Duration with Associated Sleeping Habits 

Figure 1: Distribution of Participants According to Sleep Duration

In the present study, there was statistical significant difference between the participants who had habit of day time sleeping and who did not have habit of day time sleeping. (p = 0.000).

In our study, there was no statistical significant difference between the participants who had interrupted sleep and those who did not have interrupted sleep (p = 0.90). Similarly, there was no statistical significant difference between the participant who had problem of dreams and who did not have problems of dream while sleeping. (p = 0.73).

In the current study, there was statistical significant difference between the participant who did not feel fresh and those who felt fresh after wake up in the morning(p = 0.001).

In our study, there was no statistical significant difference between the participant who took less than 2 cups of coffee or tea and those who took more than 2 cups of coffee or tea in a day (p = 0.63).

In the present study, there was statistical significant difference between the participant who used sleeping pills for sleep and who did not use sleeping pills or pills for mental/psychiatric disorder. (p = <0.05). Similarly, there was statistical significant difference between the participant who took pills and those who did not take pills for mental/psychiatric disorders (p = <0.05). Also, there was statistical significant difference between the participant who took pills and those who did not take pills for any other problems. (p = 0.000).

Inter group comparison shows that there was no statistical significant difference in sleep duration between the participant who smoke and those who did not smoke. (p = 0.359). Similarly, there was no statistical significant difference in sleep duration between the participant who took alcohol and those who did not consume alcohol (P = 0.729).

In the present study, there was statistical significant difference between the participant who done exercise regularly and those who didn’t have habit of regular exercise. (p = 0.006.) On the contrary, there was no statistical difference between the participants who did yoga regularly and those who did not have habit of yoga regularly (p = 0.162).

In the present study, there was no statistical difference between the participant who had trouble of going back to sleep once awake and those who didn’t have trouble of going back to sleep once awake (P = 0.169) Similarly, there was no statistical significant difference between the participant who easily awakened by noise and those who did not easily awakened by noise(P = 0.140).

In the present study, there was statistical significant difference between the participant who had problem of snoring and those who did not have problem of snoring. (P = 0.002).

In this study, 298 (73%) participants have adequate sleep duration of (6-8 hours) followed by 68 (16.7%) participants have inadequate sleep duration of >8 hours followed by 42 (10.3%) participants have in adequate sleep duration of <6 hours. Similar pattern was also seen in the study done [6]. Similar to our study, [2] reported 27.5 % participants go to bed for sleep after 12am. Similar to our findings, in the study done [9] 64.5% participants have 5 -8 hours of adequate sleep. Similar to our findings, 62.22% participants had adequate sleep hours (6-8 hours) in the study done [10].

In contrast to our study, only 41.6 participants had adequate sleep hours (6-8 hours) in the study done [11]. In a study conducted [12] 34.6% participants had adequate sleep [2]. reported in their study that 33.1 % participants wake up after 8am in the morning.

In this study, 130 (31.9%) participants on an average 10-11 pm go to bed for sleep, followed by 111 (27.2%) participants on an average after 12 am go to bed for sleep , followed by 88 (21.6%) participants on an average 11pm -12 am go to bed for sleep followed by 72 (17.6%) participants on an average 9-10 pm go to bed for sleep and 7 (1.7%) participants on an average before 9 pm go to bed for sleep. Inter group comparison shows that there was statistically significant difference in sleep duration among participants who sleep between 9 pm -12 am and who sleep after 12 am (p = 0.00001). Inter group comparison shows that there was statistical significant difference between wake-up time before 8am and after 8am in the morning(p = 0.0000).

Inter group comparison shows that there was statistical significant difference between the participants who stay awake late at night and watch TV before going to sleep in bed and who did not awake late at night and watch TV before going to sleep in bed(P = 0.014) In contrast to our findings, [5] reported that majority of adolescents64.1%, (345) watched TV in bed and about 23% (125) used their mobile phone in bed. 

In this study, 107 (26.2%) participants have 30-60 min time gap between eating and sleeping which was less as compared to study conducted [5] where about half the respondents had a heavy meal at dinner time and >75% went to bed within 1 hour of having dinner. Inter group comparison shows that there was statistical significant difference between participants who have >120min time gap between eating and sleeping and those who have 30min-120min/zero tome gap (p = 0.0175).

In this study, 156(38.2%) participants have habit of day time sleeping. Out of those, 88(21.6%) participants sleep for 1 hour in day, 68(16.7%) participants sleep for 1-2 hours in a day and 18(4.4%) participants sleep for > 2 hours in a day. Inter group comparison shows that there was statistical significant difference between the participants who have habit of day time sleeping and who did not have habit of day time sleeping (p = 0.000).

In contrast to our findings, in the study done [7] reported 52.1% participants have habit of day time sleeping and, in the study, done [13] 20.9% participants have habit of day time sleepiness.

The reported variations between different studies may be influenced by different socioeconomic demands and cultural habits among the different population groups. 

In this study, 12(2.9%) participants use any sleeping pills for sleep, 26(6.4%) participants were on medications for hypertension, 17(4.2%) participants for diabetes, 10(2.5%) participants take pills for mental/psychiatric disorder and 37(9.1%) participants usually take pills for any other disorder.

Inter group comparison shows that there was statistical significant difference between the participant who use sleeping pills for sleep and who did not use sleeping pills for sleep(p = 0.000).

Inter group comparison shows that there was statistical significant difference between the participant who take pills and those who did not take pills for mental/psychiatric disorder (p = 0.017). Inter group comparison shows that there was statistical significant difference between the participant who take pills and those who did not take pills for any other problem (P = 0.000). In contrast to our finding, the study done [11] reported that 8.5% participants were using sleeping pills and [12] reported that 23.7% participants were using sleeping pills.

Our study concluded that almost one fourth of study participants slept for inadequate duration. Mostly slept after 10pm and wake up after 8 am. In the present study, adequate sleeping duration pattern was significantly associated with the time to sleep and wake up, habit of watching TV/Laptop before sleep, day time sleeping, time gap between eating and sleeping, intake of sleeping or other pills, exercise and snoring habits.

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