Mohamud Complete Thesis

DECLARATION
We hereby declare that this work is our own work and effort and that it has not been
submitted anywhere forward.
Candidates ‗names
Mohamud Mohamed Abdi, ID: 8508
Signature: . Date / / 2023
Ibrahim Abdi Mohamed, ID: 8510
Approval
Supervisor’s name: Dr. Ali Dhuhulow
Dean faculty of Health Science
Dr. Mohamed Mohamud Shobow
Signature . Date / / 2023
i
DEDICATION
We dedicated this hard work to our parents who have been with us in every step in our life
through good and bad times. And we give our thanks to all who supported us either
psychological or financial that helped us to become confident and successful.
We also dedicated this thesis to our all brothers and sisters who have been supportive
financially and spiritually which has enabled us through this study.
ii
ACKNOWLEDGEMENTS
Praise be to ALLAH(Alhamdulillah) the master, the provider, the guider, and the sustainer of
the universe who gave us the opportunity to complete this project successfully. We won‘t
find a successful person made his way to the top, without a support. Each one of us is debt to
known from unknown.
We would like to thank our parents for their love and support, throughout our lives. Without
them, this day would not have been possible. We would also like to thank our entire families
for the good times in our lives.
We are grateful to Salaam University for supporting us with quality education and helping
us to be part of the students and finally we thank all Salaam university family for their
generosity during the three years of the study.
We thank to all our lecturers and special thanks to our dearest supervisor Dr. Ali Dhuhulow
for providing the guidance required in completing the thesis successfully, without his
precious guidance, help; we couldn‘t be able to accomplish this thesis.
Finally, we thank to all our classmates with much love, for their efforts and sacrifices and
there for being supportive to us spiritually, emotionally, morally, and even more they
provided us friendly in our academic years.
iii
ABSTRACT B (ENGLISH)
Background: Insomnia is defined as the experience of problems to fall asleep, to maintain
sleep or to suffer from early morning awakening.. These symptoms must occur at least three
times a week over a period of at least 3 months to be diagnosed as insomnia disorder
(Riemann et al., 2019).
Objectives: The main objective of the study is to examine factors contributing to insomnia
among elders above 40 years old visiting at Kalkal hospital in Hodan district, Mogadishu,
Somalia. The specific objectives of the study were to examine psychological, environmental,
and lifestyle factors contributing to insomnia.
Methodology: The study design used for this study was descriptive-cross sectional. The
sample size of this study was selected 92 respondents of male youths, the sampling technique
used was probability sampling especially simple random sampling, the main instrument used
to collect data for this study was questionnaire and data was analyzed SPSS-version 20.
Results: the maximum numbers of the respondents 73 (79.35) were experienced sleeping
problem (insomnia) followed by that the majority of the respondents 45 (48.9%) and 67
(72.8%) were believed that stress and anxiety can cause insomnia respectively. As well as the
most of the respondents 74 (80.4%) were believed that noise can contribute insomnia
followed by that the majority of the respondents 33 (35.9%) believed that sleeping was not
good in a host places. In addition, the maximum numbers 63 (68.5%) were agreed that
substance can contribute insomnia followed by that the most of the respondents 67 (72.8%)
were believed that irregular sleep schedule can contribute insomnia. As well as the most of
the respondents 72 (78.3%) were believed that death of loved ones can contribute insomnia.
Conclusion: based on the final findings, the majority of the respondents believed that there
were psychological, environmental and lifestyle factors contributing to insomnia.
Recommendations: According to the final findings of the study about factors contributing
insomnia, the researchers suggested the following recommendations.
 The researchers recommended that people with insomnia and all other people to stick to a
sleep schedule to prevent insomnia.
 The researchers recommended people to stay active. Regular activity helps promote a
good night’s sleep. Schedule exercise at least a few hours before bedtime and avoid
stimulating activities before bedtime.
 The researchers recommended people using medications to check their medications.
 The researchers recommended to avoid or limit caffeine and alcohol and don’t use
nicotine.
 The researchers recommended avoiding large meals and beverages before bed time.
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ABSTRACT A (SOMALI)
Asaaska; Hurdo la’aanta waxa lagu qeexaa in dhibaato lagala kulmo in helitaanka,
joogteenta hordada ama qofka in uu ka cawdo in uu xilli hore hurdada ka soo tooso
calaamadahaan waa in ay dhacaan usbuucii 3 mar iyo wax ka badan ama mudo 3 billod ah
si loo dhaho qofkaan waxa haya hurdo la’aan (insomnia) (Riemann et al., 2019).
Ujeeddooyinka: Ujeeddada ugu weyn ee cilmi-baaristaan waxay aheyd in la baaro

waxyaabaha ka qayb qaata hurdo la’aant (insomnia) waxaan ka qayb qaatay odayaasha
da’dooda 40ka ay ka weyntahay ee ku sugan isbitaal kalkaal, degmada Hodan ee
magaallada Moqdisho.Ujeeddooyinka gaarka ah ee cilmi-baaristaan waxay aheyd in la
baaro waxyaabaha maskaxeed (psychological), mida deegaan (environmental),iyo mida hab-
nololeed ee ka qayb qaata hurdo la’aanta (insomnia).
Habka cilmi-baarista: Naqshadda cilmi-baaristaan (research design) waxay aheyd mid

78sharaxaad leh (descriptive) oo waqti kooban ah, cabirka tijaabada/muunada baariseed
(sample size) waxa loo xushey 92 ka qayb gale. Farsamadii muunad/tijaabo qaadista loo
marey waxay aheyd muunad ixtimaal ah (probability sampling) khaasatan muunad fudud oo
aan kala sooc lahayn (simple random sampling), aaladda ugu weyn ee loo adeegsadey
ururinta xogta waxay aheyd xog-wareysi (questionnaire) xogtana waxa lagu falanqeeyey
SPSS version20.
Natiijooyin: inta ugu badan ka qayb-galayaasha oo ah 73 (79.35) waxay la kulmeen

dhibaatada hurdada, waxaa soo weheliya in badi ka qayb-galayaasha oo ah 45 (48.9%) iyo
67 (72.8%) waxay aaminsanaayeen in walbahaarka iyo walwalka ay ka qayb qaataan hurdo
la’aanta. Sido kale, inta ugu badan eek a qayb-galayaasha oo ah 74 (80.4%) ay
aaminsanaayeen in buuqa uu ka qayb qaato hurdo la’aanta. Waxaa soo weheliya in badi ka
qayb-galaashu oo ah 33 (35.9%) in ay aaminsanaayeen in hurdada aysan ku fiicneyn
meelaha kulkulul. Intaas waxa dheer, inta ugu badan ee ka qayb-galayaasha oo ah 63
(68.5%) ay aaminsanaayeen in waxyaabaha maanka dooriya ay ka qayb qaataan hurdo
la’aanta, waxa soo weheliya in badi ka qayb-galayaasha oo ah 67 (72.8%) ay
aaminsanaayeen in jadwalka hurdada oo aan hagaagsaneyn uu keeni karo hurdo la’aan.
Sidoo kale, inta ugu badan ka qayb-galayaasha oo ah 72 (78.3%) ay aaminsanaayeen in
dhimashada ehelka ay keeni karto hurdo la’aan.
Gunaanad: iyada oo lagu saleynayo natiijadii u dambeysey ee draasadaan, inta ugu badan
ka qayb-galayaashu waxa ay aaminsanaayeen in ay jireen waxyaabo maskaxeed
(psychological), kuwo deeggaaneed (environmental) iyo kuwo la xiriira hab dhaqanka oo ka
qayb-qaata hurdo la’aanta.
Talo soo jeedin: Si waafaqsan natiijada daarasada ku saabsan waxyaabaha ka qayb qaata
hurdo la’aanta ee dadka da’da ah, cilmi-baarayaashu waxay soo jeediyeen talooyinkaan;
 Cilmi-baarayaashu waxay ku taliyeen in dadka hurdo la’aanta ah iyo dadka kaleba in ay
jadwal saxan oo hurdo ay sameystaan si looga hortago hurdo la’aanta.
 Cilmi-baarayaashu waxay ku taliyeen in dadku ay fir-fircoonaadaan. Jimicsi ay sameeyaan si
hurdada habeenkii ah kor loogu qaado.
 Cilim-baarayaashu waxay ku taliyeen in dadka dawooyinka ay isticmaala ay ay iska hubiyaan
dawooyinka ay qaadanayaan.
 Cilmi-baarayaashu waxay ku taliyeen in laga fogaado cuntada badan xilliga jiifka ka hor.
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TABLE OF CONTENTS
DECLARATION........................................................................................................................i
DEDICATION...........................................................................................................................ii
ACKNOWLEDGEMENTS......................................................................................................iii
ABSTRACT B (ENGLISH)......................................................................................................iv
ABSTRACT A (SOMALI)........................................................................................................v
LIST OF TABLES..................................................................................................................viii
LIST OF FIGURES...................................................................................................................ix
CHAPTER ONE........................................................................................................................1
INTRODUCTION......................................................................................................................1
1.0 Introduction..................................................................................................................1
1.1 Background of the study..............................................................................................1
1.2 Statement of the problem.............................................................................................5
1.3 Research objectives.....................................................................................................5
1.3.1 Specific objectives................................................................................................6
1.4 Research questions.......................................................................................................6
1.5 The scope of the study.................................................................................................6
1.6 Significance of the study.............................................................................................6
1.7 Operational definitions................................................................................................7
1.8 Conceptual framework.................................................................................................8
CHAPTER TWO........................................................................................................................9
LITERATURE REVIEW...........................................................................................................9
2.0 Introduction..................................................................................................................9
2.1 Psychological Factors..................................................................................................9
2.1.1 Stress....................................................................................................................9
2.1.2 Anxiety...............................................................................................................10
2.1.3 Depression..........................................................................................................10
2.2 Environmental factors................................................................................................11
2.2.1 Noise...................................................................................................................11
2.2.2 Temperature........................................................................................................12
2.2.3 Light...................................................................................................................13
2.3 Lifestyle factors.........................................................................................................13
2.3.1 Substance abuse..................................................................................................13
2.3.2 Death of loved ones............................................................................................14
2.3.3 Shift Work..........................................................................................................15
CHAPTER THREE..................................................................................................................17
RESEARCH METHODOLOGY.............................................................................................17
vi
3.0 Introduction................................................................................................................17
3.1 Research Design........................................................................................................17
3.2 Study Area.................................................................................................................17
3.3 Target population.......................................................................................................17
3.4 Study population........................................................................................................17
3.5 Study unit...................................................................................................................17
3.6 Sample Size...............................................................................................................17
3.7 Sampling procedure/technique...................................................................................18
3.8 Research instrument...................................................................................................18
3.9 Data gathering procedure...........................................................................................18
3.10 Data analysis..........................................................................................................18
3.11 Limitations of the study.........................................................................................18
CHAPTER FOUR....................................................................................................................19
DATA PRESENTATION, ANALYSIS AND INTERPRETATION......................................19
4.0 Introduction................................................................................................................19
4.1 Background and socio-demographic characteristics..................................................19
4.2 Psychological factors contributing to insomnia.........................................................27
4.3 Environmental factors contributing to insomnia.......................................................33
4.4 Lifestyle factors contributing to insomnia.................................................................38
CHAPTER FIVE......................................................................................................................44
CONCLUSION AND RECOMMENDATIONS.....................................................................44
5.0 Introduction................................................................................................................44
5.1 Conclusions................................................................................................................44
5.1.1 Background and socio-demographic characteristics..........................................44
5.1.2 Psychological factors contributing to insomnia.................................................44
5.1.3 Environmental factors contributing to insomnia................................................44
5.1.4 Lifestyle factors contributing to insomnia..........................................................44
5.2 Recommendations......................................................................................................45
REFERENCES.........................................................................................................................46
APPENDIX A: RESEARCH QUESTIONNAIRE..................................................................50
APPENDIX B: RESEARCH WORK PLAN...........................................................................54
APPENDIX C: RESEARCH BUDGET ESTIMATION.........................................................55
APPENDIX D: HODAN DISTRIC MAP...............................................................................56
APPENDIX E: SOMALI MAP................................................................................................57
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LIST OF TABLES
TABLE 4.1-1 WHAT IS YOUR AGE?...........................................................................................19
TABLE 4.1-2 WHAT IS YOUR SEX?............................................................................................20
TABLE 4.1-3 WHAT IS YOUR MARITAL STATUS?......................................................................21
TABLE 4.1-4 WHAT IS YOUR EDUCATIONAL LEVEL?................................................................22
TABLE 4.1-5 WHAT IS YOUR OCCUPATION?.............................................................................23
TABLE 4.1-6 HAVE YOU EVER EXPERIENCED SLEEPING PROBLEM?.........................................24
TABLE 4.1-7 IF YES, FOR HOW LONG HAVE YOU BEEN EXPERIENCED?....................................25
TABLE 4.1-8 WHAT DID YOU THINK, WAS THE CAUSE OF YOUR SLEEPING PROBLEM?............26
TABLE 4.2-1 DO YOU BELIEF THAT STRESS CAN CAUSE INSOMNIA?........................................27
TABLE 4.2-2 HAVE YOU EVER ENCOUNTERED A STRESS THAT CAUSED YOU DIFFICULT
SLEEPING?.........................................................................................................................28
TABLE 4.2-3 ANXIETY CAN CONTRIBUTE INSOMNIA................................................................29

TABLE 4.2-4 ANXIETY IS MORE COMMON FOR ELDERS............................................................30
TABLE 4.2-5 HAVE YOU EVER FELT DEPRESSION?...................................................................31
TABLE 4.2-6 WE DO NOT BELIEVE THAT THE DEPRESSION CAN CAUSE INSOMNIA..................32
TABLE 4.3-1 DO YOU BELIEVE THAT NOISE CAN CONTRIBUTE INSOMNIA?..............................33
TABLE 4.3-2 WHICH THE FOLLOWING NOISE CAN CONTRIBUTE INSOMNIA?............................34
TABLE 4.3-3 SLEEPING IS NOT GOOD IN A HOT PLACE.............................................................35
TABLE 4.3-4 TOO MUCH COLD CAN CONTRIBUTE INSOMNIA...................................................36
TABLE 4.3-5 SLEEPING AT NIGHT IS BETTER WHEN THE LIGHT OF THE ROOM IS.....................37
TABLE 4.4-1 WHICH OF THE FOLLOWING SUBSTANCE CAN CONTRIBUTE INSOMNIA?.............38
TABLE 4.4-2 WHICH OF THE FOLLOWING SUBSTANCE CAN CONTRIBUTE INSOMNIA?.............39
TABLE 4.4-3 DO YOU BELIEVE THAT IRREGULAR SLEEP SCHEDULE CAN CONTRIBUTE INSOMNIA?
..........................................................................................................................................40
TABLE 4.4-4 WHAT IS THE BEST TIME TO SLEEP?....................................................................41
TABLE 4.4-5 DO YOU BELIEF THAT DEATH OF LOVED ONES CAN CONTRIBUTE INSOMNIA?....42
TABLE 4.4-6 IF YES, HAVE YOU EVER EXPERIENCED?..............................................................43
viii
LIST OF FIGURES
FIGURE 4.1-1 WHAT IS YOUR AGE?..........................................................................................19
FIGURE 4.1-2 WHAT IS YOUR SEX?..........................................................................................20
FIGURE 4.1-3 WHAT IS YOUR MARITAL STATUS?.....................................................................21
FIGURE 4.1-4 WHAT IS YOUR EDUCATIONAL LEVEL?..............................................................22
FIGURE 4.1-5 WHAT IS YOUR OCCUPATION?............................................................................23
FIGURE 4.1-6 HAVE YOU EVER EXPERIENCED SLEEPING PROBLEM?........................................24
FIGURE 4.1-7 IF YES, FOR HOW LONG HAVE YOU BEEN EXPERIENCED?...................................25
FIGURE 4.1-8 WHAT DID YOU THINK, WAS THE CAUSE OF YOUR SLEEPING PROBLEM?...........26
FIGURE 4.2-1 DO YOU BELIEF THAT STRESS CAN CAUSE INSOMNIA?.......................................27
FIGURE 4.2-2 HAVE YOU EVER ENCOUNTERED A STRESS THAT CAUSED YOU DIFFICULT
SLEEPING?.........................................................................................................................28
FIGURE 4.2-3 ANXIETY CAN CONTRIBUTE INSOMNIA...............................................................29

FIGURE 4.2-4 ANXIETY IS MORE COMMON FOR ELDERS...........................................................30
FIGURE 4.2-5 HAVE YOU EVER FELT DEPRESSION?..................................................................31
FIGURE 4.2-6 WE DO NOT BELIEVE THAT THE DEPRESSION CAN CAUSE INSOMNIA.................32
FIGURE 4.3-1 DO YOU BELIEVE THAT NOISE CAN CONTRIBUTE INSOMNIA?............................33
FIGURE 4.3-2 WHICH THE FOLLOWING NOISE CAN CONTRIBUTE INSOMNIA?...........................34
FIGURE 4.3-3 SLEEPING IS NOT GOOD IN A HOT PLACE............................................................35
FIGURE 4.3-4 TOO MUCH COLD CAN CONTRIBUTE INSOMNIA..................................................36
FIGURE 4.3-5 SLEEPING AT NIGHT IS BETTER WHEN THE LIGHT OF THE ROOM IS....................37
FIGURE 4.4-1 WHICH OF THE FOLLOWING SUBSTANCE CAN CONTRIBUTE INSOMNIA?............38
FIGURE 4.4-2 WHICH OF THE FOLLOWING SUBSTANCE CAN CONTRIBUTE INSOMNIA?............39
FIGURE 4.4-3 DO YOU BELIEVE THAT IRREGULAR SLEEP SCHEDULE CAN CONTRIBUTE
INSOMNIA?........................................................................................................................40
FIGURE 4.4-4 WHAT IS THE BEST TIME TO SLEEP?...................................................................41

FIGURE 4.4-5 DO YOU BELIEF THAT DEATH OF LOVED ONES CAN CONTRIBUTE INSOMNIA?...42
FIGURE 4.4-6 IF YES, HAVE YOU EVER EXPERIENCED?.............................................................43
ix
CHAPTER ONE
INTRODUCTION
1.0 Introduction
This chapter highlighted the following sections: Background of the study, statement of the
problem, research objectives, research questions, the scope of the study, significance of the
study, operational definitions of variables and conceptual framework.
1.1 Background of the study
Insomnia is defined as the experience of problems to fall asleep, to maintain sleep or to suffer
from early morning awakening. These sleep symptoms must be coupled with daytime
impairments, like decreased attention or problems in concentration. These symptoms must
occur at least three times a week over a period of at least 3 months to be diagnosed as
insomnia disorder (Riemann et al., 2019).
Globally: Globally, around one-third of people experience unsatisfying sleep1. If sleeping
difficulties meet certain criteria, they are diagnosed as the sleep disorder insomnia.
Since insomnia can reduce cognitive ability, decrease quality of life, and potentially lead to
other health issues, treatment is important. We explore what insomnia is and the disorder‘s
various subtypes, symptoms, causes, and treatments (Suni, 2022).
Global insomnia statistics: Researchers found that 1 in 5 US adults struggle to sleep every
single night (22%),Half of US adults experience insomnia once a month or more (50%), On
top of that, over 1 in 4 18-24 year old experience insomnia nightly (29%), the highest rate of
insomnia out of any age group in the US, Adults over the age of 65 are the least likely age
group to suffer from nightly insomnia (17%), 59% of adults in the West suffer from insomnia
at some point or another, making it the most susceptible region in the US, The Midwest is the
region with the least sleep issues in the US, with just under half of adults (49%) saying that
they never have trouble sleeping, People in Japan searched the most for the phrase ‗can‘t
sleep‘, with 54 searches per 100,000 people, Norway had the highest search rate for
‗melatonin‘ in the world in 2021, with Norwegians searching 520 times per 100,000 people
(Helsestart, 2022).
The present study was done to determine the prevalence of chronic insomnia in the adult
population in a family medicine outpatient clinic, in this study, the prevalence was found to
be 33% with statistically significant correlation with increasing age and diabetes. A similar
study conducted in South India found a prevalence of 18.6% among healthy adults attending
a tertiary hospital, another Indian study identified 15.4% prevalence of insomnia; Incidence
1
was high in persons with comorbid chronic physical illness (28.1%) compared to persons free
from that (10.9%), also higher among people living in joint families than those living in a
nuclear family and increasing significantly with increasing age. A recent study among
corporate employees in India showed a prevalence of insomnia in 13.8% of participants, of
which undiagnosed population was 96.4%. The common comorbid conditions associated
with insomnia were anxiety, hypertension, and depression, and alcohol consumption was
observed to be significantly higher in the sufferers of insomnia, our study showed a much
higher prevalence rate compared to the above three Indian studies (Bhaskar et al., 2016).
A multinational study done in Latin American countries using Athens Insomnia Scale and
other sleep scales in middle-aged females showed 56.6% of surveyed women suffered from
either insomnia, poor sleep quality, or both, the prevalence of insomnia increased with age
and menopausal stage. Increasing age, the presence of chronic disease, troublesome drinking,
anxiety, depression, vasomotor symptoms, and drug use (hypnotics and hormone therapy)
were significant risk factors related to the presence of sleep disturbances. Higher educational
level related to less insomnia and better sleep quality. Many other international studies have
also shown insomnia to be more common in women and elders (Bhaskar et al., 2016).
An online-based cross-sectional survey was conducted during the second wave of the
pandemic (within April 1-13, 2021) and collected information on sociodemographic,
behavior and health, COVID-19 risk, fear of COVID-19, depression, anxiety, suicidality, and
insomnia. A total of 756 data from Bangladeshi young adults (22.24 ± 4.39 years) were
finally analyzed, about 13% of the participants (n = 98 out of a total of 756) had the
symptoms of insomnia. Insomnia had a significant gender difference, where females were
more prone to be insomniac. Besides, middle class, urban residence, smoking status, not
engaging in physical exercise, poor health status, and multi-comorbidities were also
profoundly associated with insomnia. In addition, fear of COVID-19, COVID-19 risk, and
mental health problems (i.e., depression, anxiety, and suicidality) showed a significant
relationship in terms of insomnia. A total of 31.2% variance predicting insomnia was
identified considering all the studied variables, the prevalence of insomnia reported herein
seems relatively lower than the prior studies, but this figure is not neglectable. Thus, the
identified associated factors are highly suggested to consider in policy actions with a special
focus on mental health problems to elevate the risk of sleep problems (Hasan et al., 2021).
2
Insomnia is the most prevalent sleep disorder and affects a large proportion of the population
on a situational, recurrent, or chronic basis. Note Insomnia is predominantly characterized by
dissatisfaction with sleep and difficulties initiating or maintaining sleep, along with
substantial distress and impairments of daytime functioning. Note Persistent insomnia has
been associated with adverse health outcomes, including reduced quality of life and physical
and psychological morbidity. OneNote In Canada, the individual economic burden of
insomnia is estimated at $5,010 per person per year, with nearly 90% of this amount
attributed to indirect costs such as work absenteeism and reduced productivity. Note Despite
its high prevalence and burden, insomnia is often unrecognized and untreated because of
barriers to its assessment and management. Note There is a clear need to develop more cost-
effective, efficient, and accessible therapies for insomnia (Jean-Philippe Chaput, et al, 2018).
The prevalence of insomnia in epidemiological studies can range from 6% to 48% depending
on the definition used (i.e., insomnia symptoms, with or without daytime consequences,
dissatisfaction with sleep, and insomnia disorder).Note 4Note 5Note 6 For example, it is
estimated that about 25% of adults are dissatisfied with their sleep, 10% to 15% report
symptoms of insomnia associated with daytime consequences, and 6% to10% meet criteria
for an insomnia disorder. NoteNote 5Note 6Tjepkema reported that 13.4% of Canadian adults
aged 15 or older had nighttime symptoms of insomnia in 2002; that is, they had difficulty
going to sleep or staying asleep most of the time or all of the time. Note However, it is
largely unknown whether nighttime insomnia symptoms have remained stable in recent years
in Canada. Furthermore, it is unknown whether school-aged children and adolescents in
Canada also report high prevalence of nighttime insomnia symptoms. The present article
aims to address this knowledge gap and builds on Tjepkema‘s study by also providing data
on the duration of nighttime insomnia symptoms among Canadians. A better understanding
of the epidemiology of insomnia symptoms in Canada is important to guide resource
allocation and inform the development of effective interventions. The Canadian Health
Measures Survey (CHMS) questioned Canadians between 2007 and 2015 on their sleep
habits. This article summarizes key findings on the prevalence of nighttime insomnia
symptoms among Canadians aged 6 to 79 to inform policy decisions (Jean-Philippe Chaput,
et al, 2018).
3
In Africa: The study aims to investigate the prevalence, and social and health correlates of
insomnia symptoms in a national population sample in South Africa. Data were analyzed
from the cross sectional ‗South African National Health and Nutrition Examination Survey
(SANHANES-1)‘ 2012, using a sample of 15,133 individuals (mean age = 36.9, SD = 16.5).
Measures included information on insomnia, sociodemographic, health status, health risk
behavior, and mental health. Results indicate that the overall prevalence of insomnia
symptoms was 7.1%, with 3.5% among 15- to 24-year-olds and 20.5% among 65 years and
older participants. In the adjusted logistic regression analysis, poorer health status (self-rated
health, functional disability, and cognitive impairment), having bodily pain, having
experienced three or more traumatic events, and having psychological distress and partial
posttraumatic stress disorder were positively associated with insomnia. A significant
proportion of South Africans have insomnia symptoms, and several risk factors were
identified that can help in guiding interventions (Karl Peltzer and Supa Pengpid, 2019).
In Ethiopia, insomnia is one of the most common sleep problems throughout the world and a
major public health concern among adults in the general population. The aim of this study
was to assess the prevalence of insomnia and its associated factors among town adult
residents in Ethiopia. Methods. Community-based cross-sectional study was done among 840
randomly selected adult participants by using standardized and pretested Athens insomnia
scale (AIS) to assess insomnia. Systematic random sampling technique was used to get
samples of the study participants. Data were entered into Epi-Info and analyzed using SPSS
version 20. Descriptive, bivariate, and multivariate logistic regression models were used for
analysis. Adjusted odds ratio (AOR) with 95% Confidence Interval (CI) was used to show the
odds, and P value < 0.05 was considered as statistically significant. Results. The prevalence
of insomnia was found to be 42.9%. Sleep problems were associated with female sex [AOR
=2.74, 95% CI; (1.77, 4.24)], age above 48 years [AOR=4.67, 95% CI: (2.32, 9.40)], being
single [AOR=2.81, 95% CI (1.59, 4.95)] and widowed [AOR=4.20, 95% CI; (1.60, 11.01)],
khat chewing [AOR=1.76,95% CI; (1.19, 2.60)], current tobacco smoking [AOR=3.13, 95%
CI; (1.64, 5.95)], caffeinated beverage use [AOR=1.67, 95% CI; (1.12, 2.49)], comorbid
medical-surgical disorders [AOR=2.03, 95% CI; (1.18, 3.48)], common mental disorders
[AOR=8.92, 95% CI; (5.93,13.44)], and noise at bed time [AOR=2.13 95% CI; (1.20,
3.78)]. Conclusion. The prevalence of insomnia must be found high and associated with
many areas related factors. It is important to pay attention in urban settings and large-scale
studies recommended (Ali et al., 2019).
4
A literature search for publications on sleep studies performed in African countries in major
electronic databases (PubMed and Google Scholar) was conducted in English from August to
September 2020. The following key search terms and logic were used: [Africa or name of the
country] + [sleep disorder or sleep medicine society] + [training programs]. Publications
considered were limited to the last 10 years, our search yielded 566 publications in Africa on
sleep disorders in the last 10 years, with a distribution across 18 countries as data were also
obtained from the available sleep societies in Africa. Only 4 out of the 54 countries in Africa
(7.4%) have an established sleep society. However, no articles were published about sleep
societies or laboratories in most of the countries in Africa (Komolafe et al., 2021).
In Somalia: in Somalia, no-studies related to insomnia have been found.
1.2 Statement of the problem

It is believed that between 30% and 48%20 of older adults suffer from insomnia. Women
have a lifetime risk of insomnia that is as much as 40% higher21 than that of men. As many
as 15-30% of males22 and 10-30% of females23 meet a broad definition of obstructive sleep
apnea (OSA) (Suni, 2022).
Primary causes of insomnia include: Stress related to big life events, like a job loss or change,
the death of a loved one, divorce, or moving, Things around you like noise, light, or
temperature, and Secondary causes of insomnia include: Mental health issues
like depression and anxiety, Medications for colds, allergies, depression, high blood pressure,
and asthma, Pain or discomfort at night, Caffeine, tobacco, or alcohol use, as well as use of
illicit drugs, Pregnancy, Alzheimer's disease and other types of dementia (WebMD, 2021).
In Somalia, no studies have examined factors contributing to insomnia. There is a need to

document of such findings to provide information of the factors contributing to insomnia.
Therefore, this study is aimed at examining the factors contributing to insomnia among elders
above 40 years old visiting at Kalkal hospital in Hodan district, Mogadishu, Somali
1.3 Research objectives

General objective
The overall objective of this study is to examine factors contributing to insomnia among
elders above 40 years old visiting at Kalkal hospital in Hodan district, Mogadishu, Somalia.
5
1.3.1 Specific objectives
 To examine the psychological factors contributing to insomnia among elders above 40
years old at Kalkal hospital in Hodan district, Mogadishu, Somalia.
 To investigate environmental factors contributing to insomnia among elders above 40
years old at Kalkal hospital in Hodan district, Mogadishu, Somalia.
 To find out the lifestyle factors contributing to insomnia among elders above 40 years
old at Kalkal hospital in Hodan.
1.4 Research questions

 What are the psychological factors contributing to insomnia among elders above 40
years old at Kalkal hospital in Hodan?
 What are the environmental factors contributing to insomnia among elders above 40
years old at Kalkal hospital in Hodan district, Mogadishu, Somalia?
 What are the lifestyle factors contributing to insomnia among elders above 40 years
old at Kalkal hospital in Hodan?
1.5 The scope of the study

Content scope: this research will be carried out factors contributing to insomnia among
elders. The study was covered psychological factors, environmental factors and lifestyle
factors contributing to insomnia.
Time scope: this research will be conducted from December to July 2023
Geographical scope: this research will be conducted at Kalkal hospital in Hodan district,
Mogadishu, Somalia.
1.6 Significance of the study
This study will be useful for future researchers because it will act as source of information
and guideline for them to follow in the subsequent studies related to same problem under
investigation.
The study will also be useful for institutions both public and private because it makes them
aware of the existing issues and prober ways to come up with long lasting solutions for the
researched problems.
The study will be benefited by the local community because it will create conscious
Awareness of the severity of a particular problem and the urgency of the need for a solution.
6
1.7 Operational definitions
Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep,
or cause you to wake up too early and not be able to get back to sleep.
Psychological factors are the elements of your personality that limit or enhance the ways
that you think.
Environmental factors are external to the individual and can have a positive or negative
influence on a person's participation as a member of society, on performance of activities, or
on a person's body function or structure.
Lifestyle factors are the modifiable habits and ways of life that can greatly influence overall
health and well-being, including fertility.
7
1.8 Conceptual framework
INDEPENDENT VARIABLE (IV). DEPENDENT VARIABLE (DV)
PSYCHOLOGICAL FACTORS
 Stress
 Anxiety
 Depression
ENVIRONMENTAL
FACTORS INSOMNIA
 Noise
 Temperature
 Light
LIFESTYLE FACTORS
 Substance abuse
 Death of loved ones
 shiftwork
8
CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
Insomnia is a prevalent complaint in clinical practice that can present independently or
comorbidly with another medical or psychiatric disorder. In either case, it might need
treatment of its own. Of the different therapeutic options available, benzodiazepine-receptor
agonists (BzRAs) and cognitive-behavioral therapy (CBT) are supported by the best
empirical evidence. BzRAs are readily available and effective in the short-term management
of insomnia, but evidence of long-term efficacy is scarce and most hypnotic drugs are
associated with potential adverse effects. CBT is an effective alternative for chronic
insomnia. Although more time consuming than drug management, CBT produces sleep
improvements that are sustained over time, and this therapy is accepted by patients. Although
CBT is not readily available in most clinical settings, access and delivery can be made easier
through use of innovative methods such as telephone consultations, group therapy, and self-
help approaches. Combined CBT and drug treatment can optimize outcomes, although
evidence to guide clinical practice on the best way to integrate these approaches is scarce
(LANCET, 2012).
2.1 Psychological Factors
2.1.1 Stress
Stress and sleep have a reciprocal relationship. High levels of stress can contribute to trouble
sleeping, and poor-quality or insufficient sleep can lead to maladaptive changes to the stress
response. Understanding the connection between stress and sleep is the first step to breaking
this frustrating loop (Breus, 2022).
Chronic stress causes dysregulation of the sleep-wake cycle, the internal clock that tells the
body when it is time to sleep and when it is time to be alert. When people experience stress
during the day, they are more likely to have trouble falling asleep and report poor sleep
quality that night. Stress may reduce deep sleep and rapid eye movement (REM) sleep, both
of which are important for mental and physical health. Stress can color the patterns and
emotional content of dreams; the level of the stress hormone cortisol has important
implications for the sleep-wake cycle. While cortisol usually decreases at night in preparation
for sleep, studies have found that people with insomnia have higher levels of cortisol in the
evening, which are linked in turn to a greater number of nighttime awakenings. However,
more research is needed to know whether high cortisol levels cause insomnia or whether
sleep problems increase cortisol levels, some researchers have defined one cause of short-
9
term insomnia as a response to a stressful event, seeing the inability to sleep as a natural
reaction to a potential threat. The fight-or-flight response enacts immediate physiological
changes that may make it hard to sleep (Breus, 2022).
2.1.2 Anxiety
Anxiety is frequently connected to sleeping problems. Excess worry and fear make it harder
to fall asleep and stay asleep through the night. Sleep deprivation can worsen anxiety,
spurring a negative cycle involving insomnia and anxiety disorders, anxiety disorders are the
most common mental health problem in the United States, and insufficient sleep is known to
have swept negative implications for overall health. As a result, understanding and
addressing the links between anxiety and sleep can be fundamental to physical and emotional
wellness (Suni, 2022).
Constant worry during the day often carries over into night. That can cause ―mental
hyperarousal,‖ which can keep you from falling asleep, once you do get to sleep, an anxiety
disorder also can prevent you from staying asleep long enough to feel fully rested. Anxiety
has been compared to your body‘s alarm system -- it can help keep you safe and out of
potentially dangerous situations. But if that alarm goes off all the time and for no real reason
-- as it does with an anxiety disorder -- it can keep you from getting enough deep sleep, all of
this can create stress over not being able to get to sleep or get enough sleep. And that can lead
to even more anxiety, researchers have also found evidence that a chronic lack of sleep can
affect your emotional health. Studies show that people who have obstructive sleep apnea,
which makes you wake up continually through the night, are more likely to have mental
health conditions like anxiety, panic disorder, and depression (Cooper, 2021).
2.1.3 Depression
Depression and sleep problems are closely linked. People with insomnia , for example, may
have a tenfold higher risk of developing depression than people who get a good night‘s sleep.
And among people with depression, 75 percent have trouble falling asleep or staying asleep,
which comes first? ―Either one can be the starting point,‖ says Johns Hopkins sleep
researcher Patrick H. Finan, Ph.D. ―Poor sleep may create difficulties regulating emotions
that, in turn, may leave you more vulnerable to depression in the future—months or even
years from now. And depression itself is associated with sleep difficulties such as shortening
the amount of restorative slow wave sleep a person gets each night. ―If you have depression
, daily stresses—such as financial worries, an argument with your spouse, or a jam-packed
evening commute—could also lead to more nighttime wake-ups and more trouble getting
10
back to sleep than someone without depression would experience, understanding the
relationship between insomnia and depression can help you spot risks early, get the right
help, and recover more fully if you are experiencing both. You‘ll feel healthy, well-rested,
and able to enjoy life again. Here‘s what you need to know about depression and sleep (Johns
Hopkins, 2021).
2.2 Environmental factors

2.2.1 Noise
To clarify the relationship between traffic noise and insomnia, the authors conducted a survey
and measured the actual sound level of noise in an urban area. Questionnaires were
distributed to adult women who lived within 150 m from two major roads and were
completed by 648 of the 1286 subjects (50.4%). The area was divided into three zones
according to distance from the road (more than 50, 20–50 and 0–19.9 m). Fifty-seven
subjects (8.8%) were classified as having insomnia. Average values of sound level at
distances of 20, 50, and 100 m from the major road were 64.7, 57.1, and 51.8 dBA,
respectively. Overall, there were no significant differences among the three zones in the
prevalence of insomnia and no association between distance from the road and insomnia.
However, the result from a sub-data set of the subjects who lived in the areas that showed
decreasing noise level as the distance from the main road increased showed that distance
from the road was associated with insomnia. This study suggests that researchers should
consider the actual traffic situation and its sound level in epidemiological studies about the
effects of traffic noise on insomnia (ScienceDirect, 2004).
Despite the increasing knowledge on the association between neighborhood and health, few
studies have investigated sleep disorders in Japan, particularly the impact of neighborhood
noise on sleep. Thus, this study aimed to investigate the associations between insomnia
symptoms and annoyance because of traffic and neighborhood noise in Japan, which has
different neighborhood conditions compared with those of the western societies.
Neighborhood built and socioeconomic environments roles were also examined. We used
nationwide cross-sectional data collected through a 2015 online survey of Japanese adults
aged 20–64 years (n = 4,243). Adjusted prevalence ratios for insomnia according to the
exposures were estimated using the multilevel Poisson regression models. The results showed
that having insomnia was significantly associated with experiencing neighborhood and
traffic-noise annoyance. Neighborhood noise had a stronger and independent association with
11
insomnia. However, the neighborhood environmental variables, including population density,
deprivation index, and access to commercial areas, were not associated with insomnia. In
conclusion, noise annoyance, particularly that sourced from neighbors, is an important factor
in relation to sleep health. Health and urban-planning policymakers should consider
neighborhood noise, in addition to traffic noise, as health-related issues in residential
neighborhoods (Tomoya Hanibuchia, et al, 2021).
2.2.2 Temperature
Primarily, two types of studies can be conducted to examine the effects of cold on human
beings. Some studies are conducted in the laboratory while others are carried out in naturally
cold atmospheres, such as the Antarctic region. We will try to review the results of these
studies briefly (Ahmed Bahammam, 2020).
The studies have shown that the impact of cold weather on sleep is directly proportional to
the time spent in the cold. Although the human body has a mechanism for adapting to the
weather, in general, we often experience unstable sleep during colder weathers.
It has been recorded that although the cold weather does not affect the deep sleep stages
(stages two and four), it reduces the REM (rapid eye movement) stage. This REM stage is
vital for the brain to relax, and this helps clear the mind as well as increase concentration
during the day.
The reasons for the disturbed sleep are an increase in the need to urinate and the secretion of
stress hormones such as adrenaline. Due to the rise in the secretion of these hormones, there
is a rise in the tension and stress, and even the blood pressure, which is otherwise at its lowest
level during sleep. Thus, it can be concluded that the cold weather changes the physiology of
sleep. This helps us explain the rise in infections during winters.
However, it has been observed that many of these symptoms disappear when a person gets
used to sleeping in the cold weather (Ahmed Bahammam, 2020).
Temperatures above around 32°C can also disrupt your sleep, especially interfering with how
much deep sleep you get. The humidity of the air is also important. High humidity values,
particularly in hot climates, can reduce how much deep sleep you get and can increase
wakefulness. (Dr Raminder Mulla, 2022)
12
2.2.3 Light
A new study is the first population-based investigation to report a significant association
between artificial, outdoor light exposure at night and insomnia, as indicated by older adults'
use of hypnotic drugs, results show that increasing nighttime levels of artificial, outdoor light
exposure, stratified by quartile, were associated with an increased prevalence of hypnotic
prescriptions and daily dose intake. Furthermore, older adults exposed to higher levels of
artificial, outdoor light at night were more likely to use hypnotic drugs for longer periods or
higher daily dosages, "This study observed a significant association between the intensity of
outdoor, artificial, nighttime lighting and the prevalence of insomnia as indicated by hypnotic
agent prescriptions for older adults in South Korea," said Kyoung-bok Min, PhD, an associate
professor in the Department of Occupational and Environmental Medicine at Seoul National
University College of Medicine in South Korea. "Our results are supportive data that outdoor,
artificial, nighttime light could be linked to sleep deprivation among those while inside the
house." (American Academy of Sleep Medicine, 2022).
2.3 Lifestyle factors
2.3.1 Substance abuse
Insomnia is a common complaint among people with substance use disorders. The
relationship between sleep problems and substance abuse is bidirectional: People who have
trouble sleeping may medicate with alcohol or illicit drugs or misuse prescription
medications. And taking certain substances can interfere with sleep. This article reviews that
relationship and presents information about the two evidence-based treatments for insomnia:
prescription sleep medications and cognitive behavioral therapy for insomnia. Clinicians
treating people with a substance use disorder or insomnia should be aware of the risks of
comorbidity, and they should understand the risks and benefits of treatment for the insomnia
(Mark Rosenblum, 2017).
Did you know that the most common sleep diagnosis associated with substance addiction is
insomnia? Or, that most mental health disorders, including substance use disorders, are linked
to troubled sleep patterns? The problem is twofold: On one end, lack of sleep can trigger
emotional and physical issues in people and lead them to cope with drugs and alcohol.
Conversely, substance abuse can lead to insomnia, due to its negative effects on the body and
brain if your loved one is struggling to sleep at night, and/or is facing a substance abuse
problem, he or she may be at risk for this dual diagnosis. Insomnia and substance addiction
often co-occur, and can cause lasting, detrimental effects on a person‘s physical and
13
emotional well-being. Below, we explore what insomnia and addiction might look like in an
individual, and what you can do to help (Tadmin, 2021).
2.3.2 Death of loved ones
Losses of family members or close friends can also be very traumatic, depending upon the
nature of the death and/or the vulnerability of the individual. Most people experiencing grief
from bereavement find that there is a lessening of the intensity of the grief as time progresses.
For a majority, five emotional and cognitive stages of grief arise, peak, and dissipate within 6
months, However, those who continue to show elevated cognitive and affective symptoms 6
months postloss at are at higher risks for poor health outcomes, and require further
intervention. For instance, complicated grief (CG), also referred to as prolonged grief
disorder or traumatic grief, has recently gained acceptance in individuals for whom the usual
time-limited course of emotional recovery from the loss event does not occur, and the
associated emotional distress and functional impairments persist. Six-month postloss, a score
of > 25 on the Inventory of Complicated Grief (ICG)2 is used to indicate CG, The literature
on sleep and bereavement is limited. This review focuses on two areas for which there are
some findings to report, namely LLSB and CG. For LLSB, we will include the loss of a life
partner of the same generation, whether or not the two people were formally married. One
can regard LLSB and CG as bereavement situations for which sleep disruptions are likely to
be maximal (Monk et al., 2008).
There is fairly strong evidence that being widowed leads to impairments in sleep, in addition
to its effects on sleep, LLSB is a risk factor for increased mental and physical morbidity,
including increased medication use and nursing home placement, as well as increased
mortality; and thus constitutes a major public health issue. In a similar vein, other studies2
have shown that when spousal bereavement leads to CG it can be associated with various
negative health outcomes, including cancer, heart trouble, high blood pressure, and changes
in eating habits at 13- or 25-months post loss (Monk et al., 2008).
With regard to the justification for the treatment of LLSB-related sleep disorders, it is
becoming generally clear that improvements in sleep may also be associated with
improvements in health and functioning, especially in the senior years.9 In a longitudinal
14
follow-up study of 185 healthy older adults, Dew, Reynolds, and colleagues10 have shown
that after controlling for age, gender, and baseline medical burden, individuals with sleep
latencies (time taken to initially fall asleep) greater than 30 minutes (as measured by
objective, polysomnographic measures) were at a 2.14 times greater risk of death (P < .005,
95% CI= 1.25–3.66), Those with sleep efficiency less than 80% (ie, spending less than 80%
of their ―night‖ actually asleep) were at a 1.93 times greater risk of death (P = .014, Cl =
1.14–3.25). On the other side of the coin, there is evidence that maintenance of good sleep
quality accompanies ―successful‖ bereavement,11 ie, bereavement not accompanied by
psychiatric difficulties or functional impairments. Thus, improvements in widow(er)s‘ sleep
may lead to gains in other domains. Therefore, it behooves clinicians to take sleep disruptions
related to LLSB seriously and to provide appropriate treatment wherever possible (Monk et
al., 2008).
2.3.3 Shift Work
It has been observed that shift-workers suffer from insomnia when attempting to sleep and
excessive sleepiness when attempting to remain awake. This is important since the number of
people working in shifts has been increasing steadily for decades, There is not much Indian
research carried out on shift-work disorders. This study evaluates different domains of
insomnia in shift-workers (Ambekar & Chatterjee, 2017).
Shift work sleep disorder is characterized by insomnia and excessive sleepiness lasting for at
least 3 months in association with fluctuating work schedules. Patients who have this disorder
experience an overall decreased amount of sleep. As defined by the International
Classification of Sleep Disorders, the condition also known as circadian rhythm sleep-wake
disorder, shift work type or circadian rhythm sleep disorder (in DSM-5) is estimated to affect
between 2% to 5% of adults Because the inherent circadian rhythm is largely regulated by the
24-hour light/dark cycle, people who work overnight generally feel sleepier at night than
during the day, even when they are at work or have slept during the day. Patients who work
schedules with some or all shifts during the night when they would otherwise be sleeping
may consequently experience disruptions in their circadian rhythm. These disruptions affect
one‘s ability to get adequate sleep, even when they have enough time to sleep. Most people
who have shift work sleep disorder have difficulty sleeping at night and during the day
(Heidi Moawad, MD, 2020).
15
Sleep disruption is also associated with behavioral manifestations of mood changes, such as
irritability and social withdrawal. In addition to fatigue as a contributing factor, when mood
changes like depression and anxiety are associated with shift work sleep disorder, they are
thought to be caused by molecular alterations linked to circadian rhythm disruption. Research
suggests that the circadian clock is likely to regulate monoaminergic signaling, which
mediates changes in dopamine, serotonin, and noradrenaline levels throughout the day.3 A
disturbance in the circadian rhythm causes deregulation of these hormones at the level of
molecular transcription, and this may result in symptomatic mood alterations (Heidi Moawad,
MD, 2020).
Many shift workers are unable to adjust their circadian rhythm to their altered sleep wake
schedules. This is evidenced by samples of salivary melatonin concentration, which normally
corresponds to a person‘s circadian phase, The diagnosis of shift work sleep disorder is a
clinical diagnosis based on a patient‘s medical history. The combination of insomnia,
excessive sleepiness during waking hours, lack of sleep, and chronic shift work that is
inconsistent with a regular day/night wake/sleep schedule leads to the diagnosis. Research
suggests that between 10% to 30% of shift workers fit the criteria for shift work sleep
disorder, and it unclear why some shift workers are more prone to the condition than others.,
Many pharmacological treatment strategies have been used to treat this acquired sleep
disorder, including melatonin, zopiclone, lormetazepam, and modafinil. For example, one
study that was fairly representative of the effects of medications on the condition showed that
pharmacological therapies increased sleepiness in some patients but did not improve overall
sleep for the majority of patients.4 Non-pharmacological interventions include sleep
education, use of bright light, napping, and physical exercise. These approaches also have not
been consistently effective (Heidi Moawad, MD, 2020).
16
CHAPTER THREE
RESEARCH METHODOLOGY
3.0 Introduction
This chapter presented different units of methodology. It highlighted the general direction of
the study. It consists of the research design, study area, target population, study population,
study unit, sample size, sampling procedure, research instrument, data gathering procedure,
data analysis, limitations of the study
3.1 Research Design

The study will be descriptive-cross-sectional, the study will also quantitative in design.
Quantitative design is a numerical value to a particular issue in a particular time.
3.2 Study Area

Kalkal specialist hospital in Hodan district, Mogadishu, Somalia. Kalkal is a private hospital
located in Digfer road which is between Benadir junction and Erdigan /ex-Digfer Hospital.
Hodan District (Somali: Degmada Hodan) is a district in the southeastern Banaadir region
of Somalia. It is a neighborhood in the northwestern part of Mogadishu. Hodan is one the
largest districts in Mogadishu and it is a home for many private hospitals, Schools, and
Universities as well as many business centers.
3.3 Target population

All Somali elders of above 40 years old will be the target population of this study.
3.4 Study population

During data collection, the researcher will target elders above 40 years old at Kalkal
Specialist Hospital in Hodan district, Mogadishu Somalia. These groups will be regarded as
the study population of this study.
3.5 Study unit

The researcher‘s study unit will be one of the elders of above 40 years old who suffered
insomnia.
3.6 Sample Size

Sloven‘s formula will be used to determine sample size of the total in 120 of study
population.
n= N/1+Ne^2 n= 92
n= 120/1+(120)(0.05)^2 n= sample size
n= 120/1+(120)(0.0025) N= Study population
n= 120/1+0.3 e= error
17
3.7 Sampling procedure/technique
During sampling, probability sampling will be used specially, simple random sampling to
select participants from the target population. In this type of sampling, the researcher‘s target
has an equal chance of being include the sample.
3.8 Research instrument

Closed questionnaire will be used to collect research data. Respondents will brief about the
study and its objective. The content of the questionnaire will be explained for them and will
also be requested to answer the questions as honest as possible.
3.9 Data gathering procedure

The process of data collection will be by hand questionnaire to the respondents.
3.10 Data analysis

Data will be analyzed using statistical package for social science – SPSS-20 version.
Descriptive analysis will be done and then frequency tables and charts will be used to present
study results for easy understanding.
3.11 Limitations of the study

First, the major expected limitations of this study will be the following, the study will be
used only one method of data collection which is modified Questionnaire which may bring
different results if used another technique.
Second, the study was used a small sample size which may limit conformity of the result.
The third, language barrier was also another obstacle which does not allow the respondents
easily fill the questionnaire because some of the respondents were not good in understanding
English language, therefore we as the research team was facilitated and interpret into Somali
language.
18
CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND INTERPRETATION
4.0 Introduction
This chapter presented the results of the data analysis and its interpretation. Descriptive
analysis was done using frequency tables and charts.
4.1 Background and socio-demographic characteristics
Table 4.1-1 What is your age?
What is your age? Frequency Percent

40-45 27 29.3%
45-50 45 48.9%
50 above 20 21.7%
Total 92 100.0%
As the above table 4.1 indicates that around two third of the respondents 45 (48.9%) were
aged 45-50 years old, 27 (29.3%) were aged 40-45 years old and 20 (21.7%) were aged above
50 years old. This implies that the majority of the respondents were aged 45-50 years old.
Figure 4.1-1 What is your age?
19
Table 4.1-2 What is your sex?
What is your sex? Frequency Percent

male 72 78.3%
female 20 21.7%
Total 92 100.0%
As the above table 4.1.2 indicates that around two third of the respondents 72 (78.3%) were
male and 20 (21.7%) were female. This implies that the majority of the respondents were
male.
Figure 4.1-2 What is your sex?
20
Table 4.1-3 What is your marital status?
What is your marital Frequency Percent

status?
single 9 9.8%
married 65 70.7%
divorced 18 19.6%
Total 92 100.0%
As the above table 4.1.3 indicates that around two third of the respondents 65 (70.7%) were
married, 18 (19.6%) were divorced and 9 (9.8%) were single. This implies that the majority
of the respondents were married.
Figure 4.1-3 What is your marital status?
21
Table 4.1-4 What is your educational level?
What is your educational level? Frequency Percent

primary level 37 40.2%
secondary level 15 16.3%
university level 10 10.9%
non formal education 30 32.6%
Total 92 100.0%
As the above table 4.1.4 indicates that around one third 37 (49%) were primary level of
education, 30 (32.6%) were non-formal education, 15 (16.3%) were secondary level of
education and 10 (10.9%) were university level of education. This implies that the majority
of the respondents were primary level of education.
Figure 4.1-4 What is your educational level?
22
Table 4.1-5 What is your occupation?
What is your occupation? Frequency Percent

employee 48 52.2%
unemployed 37 40.2%
student 7 7.6%
Total 92 100.0%
As the above table 4.1.5 shows that around fifty percent of the respondents 48 (52.2%) were
employee, 37 (40.2%) were unemployed and 7 (7.6%) were students. This implies that the
majority of the respondents were employees.
Figure 4.1-5 What is your occupation?
23
Table 4.1-6 Have you ever experienced sleeping problem?
Have you ever Frequency Percent

experienced sleeping
problem?
yes 73 79.3%
No 19 20.7%
Total 92 100.0%
As above table 4.1.6 shows that most of the respondents 73 (79.3%) were responded ―yes‖,
and 19 (20.7%) were responded ―no‖ when asked Have you ever experienced sleeping
problem? This implies that the most of the respondents were experienced sleeping problem.
Figure 4.1-6 Have you ever experienced sleeping problem?
24
Table 4.1-7 If yes, for how long have you been experienced?
If yes, for how long have you been
experienced? Frequency Percent
less than a week 27 29.3%

a week 42 45.7%
more than a week 23 25.0%
Total 92 100.0%
As above table 4.1.7 indicates that around fifty percent of the respondents 42 (45.7%) were
experienced a week, 27 (29.3%) were experienced less than a week and 23 (25%) were
experienced more than a week. This implies that the majority of the respondents were
experienced a week for sleeping problem.
Figure 4.1-7 If yes, for how long have you been experienced?
25
Table 4.1-8 What did you think, was the cause of your sleeping problem?
What did you think, was the cause
of your sleeping problem? Frequency Percent
Pain 55 59.8
work-shift 11 12.0
unknown 17 18.5
others 9 9.8
Total 92 100.0
As above table 4.1.8 indicates that around two third of the respondents 55 (59.8%) were
responded ‗pain‘, 17 (18.5%) were responded ‗unknown‘, 11 (12%) were responded
―work- shift and 9 (9.8%) were responded others What did you think, was the cause of
your sleeping problem? this implies that the majority of the respondents responded that their
sleeping problem caused by pain.
Figure 4.1-8 What did you think, was the cause of your sleeping problem?
26
4.2 Psychological factors contributing to insomnia
Table 4.2-1 Do you belief that stress can cause insomnia?

Do you belief that stress can cause
insomnia? Frequency Percent
Yes 45 48.9%
No 20 21.7%
not sure 27 29.3%
Total 92 100.0%
As the above table 4.2.1 indicates that around fifty percent of the respondents 45 (48.9%),
were responded ‗yes‖, 27 (29.3%) were responded ―no‖, 20 (21.7%) were responded ‗not
sure‖ when asked Do you belief that stress can cause insomnia? This implies that the majority
of the respondents believed that stress can cause insomnia.
Figure 4.2-1 Do you belief that stress can cause insomnia?
27
Table 4.2-2 Have you ever encountered a stress that caused you difficult sleeping?
Have you ever encountered a stress that
caused you difficult sleeping? Frequency Percent
Yes 49 53.3%
No 43 46.7%
Total 92 100.0%
As the above table 4.2.2 indicates that around fifty percent 49 (52.3%) were responded ‗yes‖
and 43 (46.7%) were responded ―no‖ when asked Have you ever encountered a stress that
caused you difficult sleeping? This implies that the majority of the respondents were
encountered a stress that caused you difficult sleeping.
Figure 4.2-2 Have you ever encountered a stress that caused you difficult sleeping?
28
Table 4.2-3 Anxiety can contribute insomnia.
Anxiety can contribute insomnia. Frequency Percent

agree 67 72.8%
Disagree 13 14.1%
strongly agree 8 8.7%
strongly disagree 4 4.3%
Total 92 100.0%
agreed, 13 (14.1%) were disagreed, 8 (8.7%) were strongly agreed, and 4 (4.3%) were
strongly disagreed when asked ―Anxiety can contribute insomnia.‖ This implies that the
majority of the respondents were agreed that anxiety can contribute insomnia.
Figure 4.2-3 Anxiety can contribute insomnia.
29
Table 4.2-4 Anxiety is more common for elders.
Anxiety is more common for elders.
Frequency Percent
Agree 40 43.5%
Disagree 11 12.0%
Total 92 100.0%
As above table 4.2.4 indicates that around fifty percent 40 (43.5%) were agreed, around one
third 32 (34.8%) were strongly agreed, 8 (8.7%) were strongly disagreed when asked Anxiety
is more common for elders. This implies that the majority of the respondents were believed
that anxiety is more common for elders.
Figure 4.2-4 Anxiety is more common for elders.
30
Table 4.2-5 Have you ever felt depression?
Have you ever felt depression?
Frequency Percent
yes 50 54.3%
No 42 45.7%
Total 92 100.0%
As above table 4.2.5 indicates that above fifty percent of the respondents 50 (54.3%) were
responded ―yes‖ and 42 (45.7%) were responded ―no‖ when asked Have you ever felt
depression? This implies that the most of the respondents were felt depression.
Figure 4.2-5 Have you ever felt depression?
31
Table 4.2-6 We do not believe that the depression can cause insomnia.
We do not believe that the
depression can cause insomnia. Frequency Percent
agree 10 10.9%
disagree 57 62.0%
Total 92 100.0%
As above table 4.2.6 indicates that around two third of the respondents 57 (62%) were
disagreed, 13 (14.1%) were strongly disagreed, 12 (13%) were strongly agreed and 10
(10.9%) were agreed when asked ―We do not believe that the depression can cause
insomnia. This implies that the majority of the respondents were disagreed depression can not
cause insomnia.
Figure 4.2-6 We do not believe that the depression can cause insomnia.
32
4.3 Environmental factors contributing to insomnia
Table 4.3-1 Do you believe that noise can contribute insomnia?

Do you believe that noise can contribute
insomnia? Frequency Percent
Yes 74 80.4%
No 18 19.6%
Total 92 100.0%
As above table 4.3.1 indicates that the most of the respondents 74 (80.4%) were responded
―yes‖, and 18 (19.6%) were responded ―no‖ when asked Do you believe that noise can
contribute insomnia? This implies that the majority of the respondents believed that noise can
contribute insomnia.
Figure 4.3-1 Do you believe that noise can contribute insomnia?
33
Table 4.3-2 Which the following noise can contribute insomnia?
Which the following noise can
contribute insomnia? Frequency Percent
car noise 26 28.3%

generators 22 23.9%
loudly speaking 44 47.8%
Total 92 100.0%
As above table 4.3.2 indicates that around fifty percent of the respondents 44 (47.8%) were
responded ―loudly speaking‖, 26 (28.3%) were responded ―car noises‖, and 22 (23.9%) were
responded ―generators‖ when asked Which the following noise can contribute insomnia? This
implies that the majority of the respondents were answered that loudly speaking can
contribute insomnia.
Figure 4.3-2 Which the following noise can contribute insomnia?
34
Table 4.3-3 Sleeping is not good in a hot place.
Sleeping is not good in a hot place.
Frequency Percent
Agree 33 35.9%
Disagree 16 17.4%
Total 92 100.0%
As above table 4.3.3 indicates that around one third of the respondents 33 (35.9%) were
agreed, 29 (31.5%) were strongly agreed, 16 (17.4%) were disagreed and 14 (15.25%) were
strongly disagreed when asked ―Sleeping is not good in a hot place.‖ This implies that the
majority of the respondents were agreed that Sleeping is not good in a hot place.
Figure 4.3-3 Sleeping is not good in a hot place.
35
Table 4.3-4 Too much cold can contribute insomnia.
Too much cold can contribute
insomnia. Frequency Percent
Agree 13 14.1%
Disagree 50 54.3%
strongly diagree 17 18.5%
Total 92 100.0%
As above table 4.3.4 indicates that above fifty percent of the respondents 50 (54.3%) were
disagreed, 17 (18.5%), 13 (14.1%) were agreed, 12 (13.0%) were strongly agreed when asked
Too much cold can contribute insomnia. This implies that the majority of the respondents
were disagreed that too much cold can contribute insomnia.
Figure 4.3-4 Too much cold can contribute insomnia.
36
Table 4.3-5 Sleeping at night is better when the light of the room is.
Sleeping at night is better when the
ligh of the room is. Frequency Percent
On 27 29.3%
Off 65 70.7%
Total 92 100.0%
As above table 4.3.5 indicates that above two third of the respondents 65 (70.7%) were
responded ―on‖ and 27 (29.3%) were responded ―off‖ when asked Sleeping at night is better
when the light of the room is. This implies that the most of the respondents answered that
Sleeping at night is better when the light of the room is on.
Figure 4.3-5 Sleeping at night is better when the light of the room is.
37
4.4 Lifestyle factors contributing to insomnia
Table 4.4-1 Which of the following substance can contribute insomnia?

substance abuse can contribute
insomnia. Frequency Percent
Agree 63 68.5%
Disagree 17 18.5%
Total 92 100.0%
agreed, 17 (18.5%) were disagreed, and 12 (13%) were strongly agreed when asked
―substance abuse can contribute insomnia.‖ This implies that the majority of the respondents
believed that substance abuse can contribute insomnia.
Figure 4.4-1 Which of the following substance can contribute insomnia?
38
Table 4.4-2 Which of the following substance can contribute insomnia?
Which of the following substance can
contribute insomnia? Frequency Percent
Khat 70 76.1%
Smoking 7 7.6%
prescription drugs 15 16.3%
Total 92 100.0%
―khat‖, 15 (16.3%) were responded ―prescription drugs‖, and 7 (7.6%) were responded
―smoking‖. This implies that the most of respondents believed that khat contributes to
insomnia.
Figure 4.4-2 Which of the following substance can contribute insomnia?
39
Table 4.4-3 Do you believe that irregular sleep schedule can contribute insomnia?
Do you believe that irregular sleep
schedule can contribute insomnia? Frequency Percent
Yes 67 72.8%
No 25 27.2%
Total 92 100.0%
As above table 4.4.3 indicates that around the most of the respondents 67 (72.8%) were
responded ―yes‖ and 25 (27.2%) were responded ―no‖ when asked Do you believe that
irregular sleep schedule can contribute insomnia? This implies that the most of the
respondents believed that irregular sleep schedule can contribute insomnia.
Figure 4.4-3 Do you believe that irregular sleep schedule can contribute insomnia?
40
Table 4.4-4 What is the best time to sleep?
What is the best time to sleep?
Frequency Percent
8:00PM 10 10.9%
9:00PM 54 58.7%
after 10:00PN 28 30.4%
Total 92 100.0%
responded ―9:00 pm, 28 (30.4%) were responded ―after 10:00pm, and 10 (10.9%) were
responded ―8:00pm when asked What is the best time to sleep? This implies that the
majority of the respondents believed that the best time to sleep is 9:00pm.
Figure 4.4-4 What is the best time to sleep?
41
Table 4.4-5 Do you belief that death of loved ones can contribute insomnia?
Do you belief that death of
loved ones can contribute Frequency Percent
insomnia?
Yes 72 78.3%
No 20 21.7%
Total 92 100.0%
―yes‖ and 20 (21.7%) were responded ―no‖ when asked ―Do you belief that death of loved
ones can contribute insomnia?‖ This implies that the most of the respondents believed that
death of loved ones can contribute insomnia.
Figure 4.4-5 Do you belief that death of loved ones can contribute insomnia?
42
Table 4.4-6 If yes, have you ever experienced?
If yes, have you
ever experienced? Frequency Percent
Yes 64 69.6%
No 28 30.4%
Total 92 100.0%
responded ―yes‖ and 28 (30.4%) were responded ―no‖ when asked If yes, have you ever
experienced? This implies that the majority of the respondents experienced death of loved
ones that contributed insomnia.
Figure 4.4-6 If yes, have you ever experienced?
43
CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
5.0 Introduction
This chapter presented conclusions, recommendations and further researches.

5.1 Conclusions
5.1.1 Background and socio-demographic characteristics
The majority of the respondents were aged between 45-50 years old followed by that the
most of the respondents were female. As well as the maximum number of the respondents
were married followed by that the majority of the respondents were primary level of
education. As well as the majority of the respondents were employees. In addition, the
maximum numbers of the respondents were experienced sleeping problem.
5.1.2 Psychological factors contributing to insomnia
The majority of the respondents were believed that stress can cause insomnia followed by
that the most of the respondents were agreed that anxiety can contribute insomnia. As well as
the majority of the respondents were believed that anxiety is more common for elders. In
addition, around two third of the respondents were disagreed that depression cannot cause
insomnia.
5.1.3 Environmental factors contributing to insomnia
The maximum numbers of the respondents were believed that noise can contribute insomnia
followed by that the majority of the respondents agreed that sleeping is not good in a hot
place. As well as, more than fifty percent of the respondents believed that too much cold can
contribute insomnia. In addition, the maximum numbers of the respondents were believed
that sleeping at night is better when the light of the room is off.
5.1.4 Lifestyle factors contributing to insomnia
The majority of the respondents were believed that substance can contribute insomnia
followed by that the maximum numbers of the respondents were believed that irregular sleep
schedule can contribute insomnia. As well as, the most of the respondents were agreed that
death of loved ones can contribute insomnia and the most of them experienced sleeping
problem when their loved ones died.
44
5.2 Recommendations
According to the final findings of the study about factors contributing insomnia, the
researchers suggested the following recommendations.
 The researchers recommended that people with insomnia and all other people to stick
to a sleep schedule to prevent insomnia.
 The researchers recommended people to stay active. Regular activity helps promote a
good night‘s sleep. Schedule exercise at least a few hours before bedtime and avoid
stimulating activities before bedtime.
 The researchers recommended people using medications to check their medications.
 The researchers recommended to avoid or limit caffeine and alcohol and don‘t use
nicotine.
 The researchers recommended avoiding large meals and beverages before bed time.
Other researches
 To investigate effects of insomnia.
 To investigate diet and beverage factors contributing to insomnia.
45
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. ‫ مرض وال‬https://www.alnoum.com/index.php/en/encrecord/getEncRecord/513/492
Ali, T., Belete, H., Awoke, T., Zewde, F., Derajew, H., Yimer, S., & Menberu, M. (2019).
Insomnia among town residents in Ethiopia: A community-based cross-sectional
survey. Sleep Disorders, 2019, 1-7. https://doi.org/10.1155/2019/6306942
American Academy of Sleep Medicine. (2022, December 15). Light pollution may cause
insomnia in older adults: Artificial, outdoor light exposure at night is significantly
associated with hypnotic drug prescription.
ScienceDaily. https://www.sciencedaily.com/releases/2018/11/181130120446.htm
Bhaskar, S., Hemavathy, D., & Prasad, S. (2016). Prevalence of chronic insomnia in adult
patients and its correlation with medical comorbidities. Journal of Family Medicine
and Primary Care, 5(4), 780. https://doi.org/10.4103/2249-4863.201153
Breus, M. (2022, July 14). Sleep and stress. The Sleep
Doctor. https://thesleepdoctor.com/mental-health/stress-and-sleep/
Chang, J. J., Pien, G. W., Stamatakis, K. A., & Brownson, R. C. (2012). Association
between physical activity and insomnia symptoms in rural communities of
southeastern Missouri, Tennessee, and Arkansas. The Journal of Rural Health, 29(3),
239-247. https://doi.org/10.1111/j.1748-0361.2012.00447.x
Cooper, J. (2021, July 19). Anxiety vs. insomnia. WebMD. https://www.webmd.com/sleep-
disorders/anxiety-vs-insomnia
Dr Raminder Mulla. (2022). Best temperature for sleep - how temperature affects sleep.
Sleepstation - sleep improvement & insomnia
course. https://www.sleepstation.org.uk/articles/sleep-tips/sleep-and-temperature/
46
Hasan, M., Maliha, Z., Rahman, A., & Mamun, M. A. (2021). Insomnia in Bangladeshi
young adults during the COVID-19 pandemic: The role of behavioral factors,
COVID-19 risk and fear, and mental health issues. Sleep and Vigilance, 5(2), 315-
322. https://doi.org/10.1007/s41782-021-00161-5
Helsestart. (2022, November 28). Global insomnia statistics in 2022 & 2023. Helsestart -
Startsiden for helse. https://www.helsestart.no/news/global-insomnia-statistics
Jean-Philippe Chaput, Jessica Yau, Deepa P. Rao and Charles M. Morin. (2018). Prevalence
of insomnia for Canadians aged 6 to 79. statistics Canada: Health
reports. https://www150.statcan.gc.ca/n1/pub/82-003-x/2018012/article/00002-
eng.htm
Jiunn-Horng Kang and Shih-Ching. (2009). Effects of an irregular bedtime schedule on
sleep quality, daytime sleepiness, and fatigue among university students in Taiwan.
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Maryland. https://www.hopkinsmedicine.org/health/wellness-and-
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symptoms-and-causes
49
APPENDIX A: RESEARCH QUESTIONNAIRE
Dear respondents, we are graduating students of Health Science, department of Public Health
at Salaam University. This is a questionnaire prepared for data collection concerning factors
contributing insomnia among elders above 40 years old at Kalkal Specialist Hospiatal.The
purpose of this questionnaire is for academic reason. Your information will be kept
confidentially. Therefore, we kindly request you to answer these questions to the best of your
knowledge.
Instruction
 Do not write your name on this questionnaire
 The research is for academic purpose not money
 Your information will be private
Please circle your answer to the provided answers to the best of your knowledge.
SECTION ONE: BACKGROUND AND SOCIODEMOGRAPHIC
CHARACTERISTICS
Number Question Answer
1 What is your age? A. 40-45
B. 45-50
C. 50 above
2 What is your sex? A. Male

B. Female
3 What is your marital status? A. Single

B. Married
C. divorced
4 What is your educational level? A. Primary level

B. Secondary level
C. University level
D. Non-formal education
5 What is your occupation? A. Employee

B. Unemployed
C. Student
6 Have ever experienced sleeping problem? A. Yes

B. No
7 If yes, for how long have been experienced? A. Less than a week
B. A week
C. More than a week
8 What did you think was the cause of your A. Pain

sleeping problem? B. Work-shift
C. Unknown
D. Others, (stress, noise,
etc)
50
SECTION TWO: PSYCHOLOGICAL FACTORS OF INSOMNIA
9 Do you believe that stress can cause insomnia? A. Yes
B. No
C. Not sure
10 Have you ever encountered a stress that caused you A. Yes

difficult sleeping? B. No
11 Anxiety can contribute insomnia. A. Agree

B. Disagree
C. Strongly agree
D. Strongly disagree
12 Anxiety is more common for elders. A. Agree

B. Disagree
C. Strongly agree
13 Have you ever felt depression? A. Yes

B. No
14 We do not believe that depression can cause A. Agree

insomnia B. Disagree
C. Strongly agree
51
SECTION THREE: ENVIRONMENTAL FACTORS OF INSOMNIA.
15 Do you believe that noise can contribute A. Yes
insomnia? B. No
16 Which of the following noise is more likely to A. Car noise
cause insomnia? B. Generators
C. Loudly speaking
around you
17 Sleeping is not good in a hot place. A. Agree
B. Disagree
C. Strongly agree
18 Too much cold can contribute insomnia. A. Agree
B. Disagree
C. Strongly agree
19 Sleeping at night is better when the light of the A. On
room is B. Off
52
SECTION FOUR: LIFESTYLE FACTORS OF INSOMNIA
20 Substance abuse can contribute insomnia. A. Agree
B. Disagree
C. Not sure
21 Which of the following substance can contribute A. Khat
insomnia? B. Smoking
C. Prescription drugs
22 Do you believe that irregular sleep schedule can A. Yes
contribute insomnia? B. no
23 What is the best time to sleep? A. 8:00 pm
B. 9: 00 pm
C. After 10:00 pm
24 Death of loved ones can contribute insomnia. A. Yes
B. No
25 If yes, have you ever encountered? A. Yes
B. No
53
APPENDIX B: RESEARCH WORK PLAN
No Activity December January February March April May June

2022 2023 2023 2023 2023 2023 2023
1. Topic
selection
2. Concept
note
3. Proposal
writing
4. Proposal
defense and
re-
correction
5. Data
collection
and
analysis
6. Writing
conclusion
7. Thesis
submission
and defense
54
APPENDIX C: RESEARCH BUDGET ESTIMATION
No Task Estimated cost
1. Topic selection 9$
2. Printing proposal 25$
3. Data collection 20$
4. Transportation 80$
5. Thesis printing 50$
6. Airtime 10$
7. Internet 60$
8. Others 30
Total 284$
55
APPENDIX D: HODAN DISTRIC MAP
56
APPENDIX E: SOMALI MAP
57

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DECLARATION

Mohamud Mohamed Abdi, ID: 8508

Signature: . Date / / 2023

Ibrahim Abdi Mohamed, ID: 8510

Signature: . Date / / 2023

Supervisor’s name: Dr. Ali Dhuhulow

Signature: . Date / / 2023

Dean faculty of Health Science

Dr. Mohamed Mohamud Shobow

Signature . Date / / 2023

Ujeeddooyinka: Ujeeddada ugu weyn ee cilmi-baaristaan waxay aheyd in la baaro

Habka cilmi-baarista: Naqshadda cilmi-baaristaan (research design) waxay aheyd mid

Natiijooyin: inta ugu badan ka qayb-galayaasha oo ah 73 (79.35) waxay la kulmeen

TABLE 4.2-3 ANXIETY CAN CONTRIBUTE INSOMNIA................................................................29

FIGURE 4.2-3 ANXIETY CAN CONTRIBUTE INSOMNIA...............................................................29

FIGURE 4.4-4 WHAT IS THE BEST TIME TO SLEEP?...................................................................41

In Somalia: in Somalia, no-studies related to insomnia have been found.

1.2 Statement of the problem

In Somalia, no studies have examined factors contributing to insomnia. There is a need to

1.3 Research objectives

1.4 Research questions

1.5 The scope of the study

INDEPENDENT VARIABLE (IV). DEPENDENT VARIABLE (DV)

2.2 Environmental factors

2.3.2 Death of loved ones

2.3.3 Shift Work

3.1 Research Design

3.2 Study Area

3.3 Target population

3.4 Study population

3.5 Study unit

3.6 Sample Size

3.8 Research instrument

3.9 Data gathering procedure

3.10 Data analysis

3.11 Limitations of the study

What is your age? Frequency Percent

Figure 4.1-1 What is your age?

What is your sex? Frequency Percent

Figure 4.1-2 What is your sex?

What is your marital Frequency Percent

Figure 4.1-3 What is your marital status?

What is your educational level? Frequency Percent

Figure 4.1-4 What is your educational level?

What is your occupation? Frequency Percent

Figure 4.1-5 What is your occupation?

Have you ever Frequency Percent

Figure 4.1-6 Have you ever experienced sleeping problem?

less than a week 27 29.3%

Table 4.2-1 Do you belief that stress can cause insomnia?

Figure 4.2-1 Do you belief that stress can cause insomnia?

Anxiety can contribute insomnia. Frequency Percent

Figure 4.2-3 Anxiety can contribute insomnia.

Figure 4.2-4 Anxiety is more common for elders.

Figure 4.2-5 Have you ever felt depression?

Table 4.3-1 Do you believe that noise can contribute insomnia?

Figure 4.3-1 Do you believe that noise can contribute insomnia?

car noise 26 28.3%

Figure 4.3-2 Which the following noise can contribute insomnia?

Figure 4.3-3 Sleeping is not good in a hot place.

Figure 4.3-4 Too much cold can contribute insomnia.

Table 4.4-1 Which of the following substance can contribute insomnia?

Figure 4.4-1 Which of the following substance can contribute insomnia?