The Effect Of Progressive Muscle Relaxation On Insomnia Among The Elderly: A Literature Review

Introduction: The term "elderly" refers to a stage of human existence characterized by a decline in the body's capacity to respond to external stress and a failure to maintain body equilibrium in physiological stress situations. Patients who are elderly are more likely to suffer from sleep difficulties, including insomnia, which is one of the effects they experience. Insomnia is a sleep disorder defined by a lack of capacity to establish or sustain regular sleep schedules; symptoms usually appear within a week. Material and Methods: This research is a review of the existing literature. The topic, articles from 2018 to 2023, were chosen from various online databases, including Science Direct, PubMed, and Google Scholar. The PRISMA approach was utilized by analyzing the literature review. Results: After sifting through 315 publications, only 16 studies were deemed suitable for analysis. The conclusion drawn from these studies is that PMT significantly decreases the prevalence of insomnia in the elderly. Conclusion: Progressive Muscle Relaxation has been shown in various studies to alleviate insomnia in the elderly.


Introduction
Elderly refers to the final stage of human life, where the body experiences a decreased ability to adapt to environmental stressors and struggles to maintain physiological and psychological balance.One of the impacts experienced by the elderly is the presence of sleep disorders, including insomnia.Sleep pattern disorder is when individuals experience or are at risk of experiencing a change in the quantity or quality of their rest patterns, which causes a sense of discomfort in the elderly (Royani & Siska, 2023).
The occurrence of sleep disorders in the elderly is very high, based on information known that there are 50% of the elderly at the age of 65 years and over who experience rest problems.In Indonesia, the incidence of sleep problems at the age of 60 years and over is very high, around 67%.This figure is obtained from the total population aged 65 years and over.Based on a gander, it was found that insomnia can occur in women aged 60-74 years, as much as 78.1% (Muhaningsyah et al., 2021).
Insomnia is a condition of difficulty initiating or maintaining a sleep pattern that occurs in less than seven days.Insomnia can occur at any age but can often be experienced at the age of 60 years and above (Februanti et al., 2019).This is in line with Silalahi & Astarani (2018) who say that someone with sleep disorders has several side effects, such as often waking up quickly during sleep at night, being unable to start falling asleep, and the body feeling tired when waking up in the morning.The elderly can increase their welfare by trying to achieve their fundamental requirements, which is one of the ways that they can do so.Sleep and rest are two of these fundamental requirements that must be met.
On the other hand, around sixty percent of senior people suffer from sleep difficulties or sleeplessness (Ayoubi-Mahani et al., 2023).
Various ways can be done to treat insomnia that occurs in the elderly, namely with pharmacological therapy and non-pharmacological therapy.Pharmacological therapy that can be used to treat insomnia, namely Benzodiazepines and Ramelton (Abad & Guilleminault, 2018).However, if you continue to use these drugs to help you sleep, drug dependence may occur.Therefore, non-pharmacological therapy can be used to treat International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License insomnia with the advantage that it can be used as a therapy that does not cause side effects and is relatively easy to use.Progressive muscle relaxation training is a nonpharmacological therapy that can effectively treat insomnia in the elderly.Progressive relaxation is a methodical process of achieving physical relaxation starting from the head and moving down to the feet.This technique includes ideas and visualizations to enhance the state of relaxation and is commonly employed in treating sleep disorders (Chun et al., 2021).

Research Design, Setting, and Sample
This research is a review study of the literature.Articles that fit the theme were selected from 2018-2023.Inclusion criteria were full-text articles, freely accessible, with RCT or experimental research designs (Huls et al., 2018).Exclusion criteria were conference papers, chapters, editorials, theses, and dissertations, and not open access.

Measurement and Data Collection
The sources of information for this investigation were the publications found in the electronic databases Science Direct, PubMed, and Google Scholar (Goossen et al., 2020).
The researcher employed the subsequent search method on each database, utilizing the terms Progressive Muscle Relaxation, Insomnia, and The Elderly.

Data Analytics
The researchers employed the PRISMA approach, as outlined in Figure 1, to adhere to the appropriate research protocol (Page et al., 2021).

Results And Discussions a. Result
Based on the search strategy and the selection criteria, sixteen studies were selected from three hundred fifteen publications and subjected to a comprehensive examination.In the end, only eleven research could be examined in their entirety.A representation of the selection procedure for this study may be found in Figure 1.

Preexperiment
The respondents, aged 45-90 years old, had progressive muscle relaxation therapy for 15 minutes daily for three weeks.The therapy sessions were conducted in the morning, afternoon, and evening, based on the respondents' availability.
The p-value of 0.000, below the significance level α of 0.05, indicates a significant difference.This suggests that there is a noticeable effect on lowering insomnia before and after progressive muscle relaxation therapy.
11 (Seyedi Chegeni   et al., 2018)   Iran RCT PMR training sessions will be held twice a day, every weekday for eight weeks.The patient is instructed to relax and contract sixteen significant muscles.Patients were instructed by the researcher and instructed to practice the exercises for twenty minutes.Based on Table 1, four studies used RCT research design, five studies were quasiexperimental, and two studies used pre-experimental.All of them were intervention studies.

b. Discussion
With increasing age, the aging process will affect the time and quality of one's sleep, especially in old age, which will cause degeneration of cells and organs that can affect the function and mechanism of sleep.One of the things that can affect sleep is age, health status, environment, motivation, psychological stress, diet, lifestyle, and medication.
It is imperative to address insomnia in older individuals in order to prevent its adverse effects on daily functioning and overall well-being.The aged individuals who have insomnia will endure several consequences, including heightened daytime tiredness, sadness, cognitive decline, and reduced overall well-being.
Progressive Muscle Relaxation is a method for developing the skill of consciously relaxing all of the body's muscles.Loosening and relaxing all muscle groups and distinguishing between relaxed and tense will accompany a relaxed mentality to help The quality of sleep is one of the factors that influences senior citizens' experience.
These factors include the influence of pharmaceuticals that are used, the presence of other diseases, excessive activity, smoking, inadequate diet, and psychological issues such as stress and a lack of physical activity (Bollu & Kaur, 2019).This is in line with the research of Ainun et al (2020)

Conclusion
A literature evaluation was conducted to provide a comprehensive understanding of the effectiveness of Progressive Muscle Relaxation (PMR) as a treatment for insomnia in older people.Research studies suggest that Progressive Muscle Relaxation can effectively treat insomnia in the elderly.

Figure 1
Figure 1 Selection Process of Studies Based on PRISMA (Haddaway et al., 2022)

Specifically
someone fulfill their sleep needs.According to the theory of Edmund Jacobson) progressive muscle relaxation techniques performed in 20-3 minutes, once regularly, effectively reduce insomnia.The study conducted by Seyedi Chegeni et al., 2018) demonstrates that Progressive Muscle Relaxation (PMR) positively impacts various aspects of sleep quality, including subjective sleep quality, sleep latency, sleep duration, and sleep habit efficiency.
on the causes of older adults who sleep excessively during the day, lifestyles such as (consuming liquor, drinking coffee, smoking drugs, and sporadic working time), mental factors (mental disorders), actual diseases (asthma, sinusitis, and influenza), mind factors (stressed), and environmental factors.Meanwhile, according to the results of research (Himani et al., 2018), there are several factors associated with insomnia that occurs in the elderly, such as increasing age, gender, marital status, employment status, average monthly income, education level, and BMI (body mass index) which does not significantly affect.The elderly experience similar insomnia symptoms, including numerous awakenings throughout the night, trouble initiating sleep, excessive sleepiness during the day, and weariness.The consequences of these concerns are that the elderly encounter disruptions in their activities and social engagements.Therefore, in this problem, it is imperative to address insomnia in the elderly in order to combat the sleep disorder effectively.Stimulating and motivating sleep can be achieved through relaxation, which involves specific actions.The act of moving the limbs to induce relaxation facilitates the relaxation of specific muscle groups in the body through the use of progressive muscle relaxation techniques.This enables the elderly to discern the contrasting sensations of tense and relaxed muscles.Progressive muscle relaxation techniques are very effective in fulfilling the elderly's sleep needs and reducing sleep disturbances.PMR is an intervention to increase relaxation to meet elderly sleep needs.Relaxation therapy is the cheapest and most accessible, so it can be done anywhere and anytime to stretch tense muscles to reduce sleep disturbances and stress.

Table 1 .
Result of article analysis International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License Publish : Association of Indonesian Teachers and Lecturers International Journal of Health Sciences (IJHS) Journal Homepage : https://jurnal.agdosi.com/index.php/IJHS/indexVolume 1 | Number 3 | September 2023 |