RELATIONSHIP BETWEEN SLEEP HYGIENE AND SLEEP QUALITY AMONG

ADOLESCENTS WHO LIVED IN ISLAMIC BOARDING SCHOOL

Anggi Setyowatia, Minhuey Chungb

a. Universitas Lambung Mangkurat, South Kalimantan, Indonesia
b. Taipei Medical University, Taiwan

ABSTRACT

Background: Sleep Hygiene has been described as the general rules of behavioral
practices and environmental factors such as diet, exercise, substance use, light,
temperature, noise and related with behavioral practices such as regularity of sleep
schedule, pre-sleep activities, efforts to try to sleep. That are consistent with good quality
of sleep. Poor sleep quality can affect their concentration, attention, memory, reduced
physical health and altered moods.
Aim: The aim of this study was to examine whether the relationship between sleep hygiene
(independent variable) that affecting sleep quality (dependent variable) for Indonesian
adolescents who live in Islamic boarding school.
Methods: This study used a cross-sectional and correlation design. The setting of this
study was Darul Ulum Islamic Boarding School in Jombang City, East Java. This study
used purposive sampling. The inclusion criteria were: Aged ranges 10-19 years and no
history of psychiatric or neurological disorders. Total sample of this study was 370.
Instrument to measure sleep hygiene was Sleep Hygiene Index (SHI) and Instrument to
measure sleep quality was Pittsburgh Sleep Quality Index.
Results: This study showed that significant positive correlation existed among total score
of PSQI (p value < 0.05). Higher score of SHI (maladaptive sleep hygiene), PSQI (sleep
quality) was significantly worse (poor sleep quality).
Conclusion: Better understanding about this relationship can educate adolescents about
good sleep quality.
Also develop sleep hygiene intervention was needed to maintain good sleep quality among
adolescents.

Keywords: Sleep hygiene, Sleep quality, Adolescents

Address for correspondence: Anggi Setyowati

School of Nursing, Faculty of Medicine
Universitas Lambung Mangkurat
+628563271269/anggisetyo@unlam.ac.id
2
 THE 2nd UDAYANA INTERNATIONAL NURSING CONFERENCE
A. INTRODUCTION
1. Background of The Study
Physical and social developments
in adolescents have effects to change the
sleep habit easily (Kaneita et al., 2009)
which can induce sleep disturbance
(Dahl, R. E., & Lewin, D. S., 2002).
Sleep disturbance in adolescents is not
rare (Danielsson, N. S., Harvey, A. G.,
MacDonald, S., Jansson-Fröjmark, M., &
Linton, S. J., 2013) and has related with
sleep quality (LeBourgeois, Giannotti,
Cortesi, Wolfson, & Harsh, 2005).
Adolescents in Europe, Asia, and the
United States have more than one of
behaviors that influence sleep quality,
such as difficulties on going to bed,
falling asleep, undisturbed sleep, and
wakefulness in the morning
(LeBourgeois, Giannotti, Cortesi,
Wolfson, & Harsh, 2004).
In this age sleep quality related
with behavioral sleep disturbance is
initial to maladaptive behavior (Yang,
Spielman, & Glovinsky, 2006).
Maladaptive sleep behavior has related
with sleep hygiene practices. Sleep
Hygiene has been described as the
general rules of behavioral practices and
environmental factors that are consistent
with good quality of sleep. Sleep
Hygiene defined as general health
practices (e.g., diet, exercise, substance
use), environmental factors (e.g., light,
temperature, noise), and related with
behavioral practices (e.g., regularity of
sleep schedule, pre sleep activities,
efforts to try to sleep) (Yang, Lin, Hsu,
& Cheng, 2010).
Based on previous study,
inadequate sleep quality can affect their
concentration, attention, memory,
reduced physical health and altered
moods, like increased depression,
irritability, and anxiety (Suen, Tam, &
Hon, 2010). If adolescent has partial
sleep less than 6 hours of sleep per night,
it has effect like those (Brown, Buboltz,
& Soper, 2002). Unfortunately they
often unaware of how poor sleep quality
influences their cognitive functioning.
Furthermore, there is one study about
sleep hygiene behavior among Balinese
adolescent (Nursalam et al., 2013). The
Balinese believe if someone is sleeping
in the early evening, then that person
will have a short life. Balinese
adolescents have different culture with
adolescents who live in Islamic
Boarding School.
2. Problem statement
The aim of this study was to
examine whether the relationship
between sleep hygiene (independent
variable) that affecting sleep quality
(dependent variable) for Indonesian
adolescents who live in Islamic boarding
school.
3. Research Purpose
This study examined whether the
relationship between sleep hygiene
(independent variable) that affecting
sleep quality (dependent variable) for
Indonesian adolescents who live in
Islamic boarding school.
B. METHODS
This study used a cross-sectional
and correlation design, using self-
reported questionnaire. The setting of this
study is Darul Ulum Islamic Boarding
School in Jombang City, East Java. The
researcher choose “Darul Ulum Islamic
Boarding School” due to approximately
3
 THE 2nd UDAYANA INTERNATIONAL NURSING CONFERENCE
5,000 students who live in this Islamic
Boarding School or live at dormitory and
this is one of the oldest Islamic Boarding
School in Indonesia, since 1885 (Ministry
of Religious Affairs of the Republic
Indonesia, 2013). This study used
purposive sampling. The inclusion
criteria were: Aged ranges 10-19 years
(WHO, 2014) and no history of
psychiatric or neurological disorders. The
exclusion criteria was students whose
parents disagree if their children
participate in this survey or the students
do not return the informed consent sheet.
Total sample of this study was 370 based
on Slovin Formula
Two instruments were used to
measure the variables being studied. First
instrument was The Sleep Hygiene Index
(SHI) is used to self-report assess the
practice of sleep hygiene behaviors. It is a
13-item self reported. Higher score
indicating maladaptive sleep hygiene
status. It is used 5-point scale (always,
frequently, sometimes, rarely, never).
Cronbach’s Alpha for the Sleep Hygiene
index was 0.66 (Mastin, D. F., Bryson, J.,
& Corwyn, R. , 2006). Second instrument
was Pittsburgh Sleep Quality Index
(PSQI). The PSQI is used to measure
self-report of sleep quality and sleep
disturbances during previous month.
Total score ranging from 0-21, with a
lower score (less than 5) indicating good
sleep quality (Buysse, D. J., et al., 1989).
All analyses use the SPSS version
18.0 for Windows (SPSS, Inc, Chicago,
IL) computer software (p value of < 0.05
wer considered to describe statistically
significant differences). A Pearson
correlation analysis will use to explore
the relationship between the scores of
SHI and PSQI.
Permission is granted by the
ethics committee in IRB LPPM
Universitas Airlangga Surabaya. Islamic
Boarding School were contacted through
formal written letters. The contents
explained the aim and the purpose of this
study and request for permission to
conduct research in their Islamic
Boarding School. Questionnaires were
distributed in sealed envelopes and asked
the participants to sit space apart.
Estimate to collect the data need 30
minutes. The participants were allowed to
withdrawal in this study after looking the
questionnaires. At the end, the
participants were asked to return the
questionnaire in the envelope provided.
Envelope helps to ensure confidentiality
of answers.
C. RESULT
Table 1 showed that significant
positive correlation existed among total
score of PSQI. This table showed that
higher score of SHI (maladaptive sleep
hygiene), PSQI (sleep quality) was
significantly worse (poor sleep quality).
Table 1. Relationship between sleep
hygiene and sleep quality among
Indonesian adolescents
PSQI
SHI p value r
.02 .378
D. DISCUSSION
The result of this study was sleep
hygiene had positive association with
sleep quality (p< 0.05 r=0.378). Based on
previous study, significant factor that
affecting sleep quality is sleep hygiene
4
 THE 2nd UDAYANA INTERNATIONAL NURSING CONFERENCE
(Brick et al., 2010; Franklin C Brown et
al., 2002; LeBourgeois et al., 2005; Suen,
Tam, & Hon, 2010). Another study
mentioned that significant factor that
affecting sleep quality in Italians and
Americans is sleep hygiene (LeBourgeois
et al., 2005). Adolescents reported that
had more frequent daytime napping,
failed in maintaining sleep, due to sharing
a bed or bedroom in American
adolescence (LeBourgeois et al., 2005).
Sleep hygiene is for adolescents defined
as behavioral practice to get good sleep
quality, adequate sleep duration, and full
day time alertness (Noland et al., 2009).
The participants in this study live
in pesantren. Adolescents who live in
Pesantren is called santri. Santri learns
about Islamic, national curriculum and
also conduct the exam (Maslani, 2012).
The tight learning schedule lead to partial
sleep deprivation (less than 6 hours of
sleep per night), this will affect their
cognition function and related with stress
level. Santri has to live in dormitory, and
they have to share room with another
santri, which cause noise disturbance,
they use their bed for personal activities
and furthermore have they have time
schedule based on the schedule of prayers
(Maslani, 2012). These factors related to
behavioral factors, especially in sleep
hygiene practice, that may bother sleep
and has effect with sleep quality (Yang et
al., 2006).
D. CONCLUSION
There was a positive correlation
between sleep hygiene and sleep quality
among Indonesian Adolescents who lived
in Islamic Boarding School.
E. RECOMMENDATION
Better understanding about this
relationship can educate adolescents
about good sleep quality. Also develop
sleep hygiene intervention was needed to
maintain good sleep quality among
adolescents.
REFERENCES
Brick, C. A., Seely, D. L., & Palermo, T.
M. (2010). Association between
sleep hygiene and sleep quality
in medical students. Behav Sleep
Med, 8(2), 113-121.
Buysse, D. J., Reynolds III, C. F., Monk,
T. H., Berman, S. R., & Kupfer,
D. J. (1989). The Pittsburgh Sleep
Quality Index: a new instrument
for psychiatric practice and
research. Psychiatry research,
28(2), 193-213.
Danielsson, N. S., Harvey, A. G.,
MacDonald, S., Jansson-
Fröjmark, M., & Linton, S. J.
(2013). Sleep disturbance and
depressive symptoms in
adolescence: the role of
catastrophic worry. Journal of
youth and adolescence,42(8),
1223-1233.
Kaneita, Y., Yokoyama, E., Harano, S.,
Tamaki, T., Suzuki, H.,
Munezawa, T., . . . Ohida, T.
(2009). Associations between
sleep disturbance and mental
health status: a longitudinal
study of Japanese junior high
school students. Sleep Med,
10(7), 780-786.
LeBourgeois, M. K., Giannotti, F.,
Cortesi, F., Wolfson, A. R., &
Harsh, J. (2005). The relationship
5
THE 2nd UDAYANA INTERNATIONAL NURSING CONFERENCE
 between reported sleep quality and sleep hygiene in Italian and American
adolescents. Pediatrics, 115(1 Suppl), 257-265. doi:
10.1542/peds.2004-0815H LeBourgeois, M. K., Giannotti, F.,
Cortesi, F., Wolfson, A., & Harsh, J. (2004). Sleep hygiene and sleep quality in
Italian and American adolescents. Ann N Y Acad Sci, 1021, 352-354. doi:
10.1196/annals.1308.044 Maslani. (2012). Multicultural –Based
Education in the Islamic Boarding School. Advances in Naturall and Applied
Sciences, 6(7): 1109-1115.
Mastin, D. F., Bryson, J., & Corwyn, R. (2006). Assessment of sleep hygiene using the
Sleep Hygiene Index. J Behav Med, 29(3), 223-227.
Ministry of Religious Affairs of the
Republic Indonesia (2013).
Direktorat pendidikan Diniyah
dan Pondok Pesantren
Kementrian Agama Republik
Indonesia. Accessed 28 May
2014, from
http://www.pondokpesantren.net/
Noland, H., Price, J. H., Dake, J., & Telljohann, S. K. (2009). Adolescents' sleep
behaviors and perceptions of sleep. J Sch Health, 79(5), 224-230. doi:
10.1111/j.1746-
1561.2009.00402.x
Nursalam, M., Apriani, N. K., Has, E. M. M. a., & Efendi, F. (2013). Sleep hygiene
behavior among Balinese adolescent. Journal of Nursing
 Education and Practice, 4(3), p155.
WHO (2014). Adolescent health. Accessed 28 May 2014, from
http://www.who.int/topics/adolesc ent_health/en/.
Yang, C. M., Lin, S. C., Hsu, S. C., & Cheng, C. P. (2010). Maladaptive sleep hygiene practices
in good sleepers and patients with insomnia. Journal of health psychology, 15(1), 147-
155.
Yang, C. M., Spielman, A. J., & Glovinsky, P. (2006). Nonpharmacologic strategies in the
management of insomnia. Psychiatr Clin North Am, 29(4),
895-919; abstract viii. doi: