How to cite:
Fajar Surahmi. (2022). The Effectiveness of Warm Water Foot Sound
with Salt and Lavender Flower Extract on Sleep Quality in Elderly
with Insomnia. Journal Eduvest. Vol 2(6): 1.108-1.114
E-ISSN:
2775-3727
Published by:
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Eduvest – Journal of Universal Studies
Volume 2 Number 6, June, 2022
p- ISSN 2775-3735- e-ISSN 2775-3727
THE EFFECTIVENESS OF WARM WATER FOOT SOUND
WITH SALT AND LAVENDER FLOWER EXTRACT ON
SLEEP QUALITY IN ELDERLY WITH INSOMNIA
Fajar Surahmi
Department of Nursing, Health Polytechnic of Ministry of Health Semarang, Indonesia
Email:
ARTICLE INFO ABSTRACT
Received:
May, 26
th
2022
Revised:
June, 13
th
2022
Approved:
June, 17
th
2022
Insomnia is a sleep disorder at night. Soaking feet in warm
water with a mixture of salt is a nursing action and non-
pharmacological method that can help a person to be more
relaxed and comfortable. Lavender (Lavandula angustifolia)
has a sedative effect because it has the main active ingredient,
linalool (C10H18O). The mechanism of lavender flower
aromatherapy (Lavandula angustifolia) which contains linalool
by stimulating an area in the brain, namely the nucleus raphe
which will secrete serotonin which can send a person to sleep.
The design of this research is a pre-experiment with a one
group pre test and post test design. The sample of this study
were 34 elderly respondents who were in Rampelsos Pucang
Gading Semarang. The results of the study: Most of the
characteristics of the elderly (70.6%) were aged 60 – 74 years.
Of the 34 respondents, dominated by male respondents, 23
were male respondents. The educational background of the
elderly respondents who became the object of most research
was Junior High School, which was 35.3%. Prior to treatment,
100% of respondents had poor sleep quality. After treatment,
91.2% of respondents had poor sleep quality and 8.8%
experienced good sleep quality. The results of the analysis
using statistical tests showed that p = 0.000 means that there
is an effect of soaking the feet in warm water with a salt
solution and a mixture of lavender flower extract on sleep
quality of elderly respondents.
KEYWORDS
Foot soak, salt mix, lavender extract, Sleep Quality, Elderly
Fajar Surahmi
The Effectiveness of Warm Water Foot Sound with Salt and Lavender Flower Extract
on Sleep Quality in Elderly with Insomnia 1.109
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International
INTRODUCTION
Insomnia is a sleep disorder at night (Martono, 2010).The quality of sleep in
someone who has insomnia has decreased and this has an impact on disrupting activities
during the day. This is because insomnia will cause sleepiness throughout the day the next
day. Lack of sleep can also have adverse consequences such as accidents, falls, decreased
cognitive activity, decreased matters related to independent health care, poor health status,
decreased quality of life, and ultimately increased mortality (Valizadeh et al., 2015). The
most common method for treating or overcoming sleep disorders is pharmacologically by
using sedative-hypnotic drugs such as the benzodiazepine group (Ativan, Valium, and
diazepam) (Widya, 2010). However, now many studies have examined the effect or
effectiveness of various non-pharmacological methods on sleep quality in the elderly.
Although the effect is slower, non-pharmacological methods do not have harmful drug side
effects such as dependence. One of the non-pharmacological methods that can be used to
treat insomnia is to soak the feet in warm water with a mixture of salt.
RESEARCH METHOD
This research is a pre-experiment with a one group pre test and post test design.
The design of this study used two groups of subjects who were observed before the
intervention, then observed again after the intervention. The sample in this study was 34
respondents, namely the elderly who were in Rampelsos Pucang Gading Semarang who
had previously been screened for the level of insomnia using a questionnaire and met the
criteria as a sample. Then the sample will be intervened for 20 minutes every day for a
week (seven days).
RESULT AND DISCUSSION
a. Respondent Age
Frequency distribution of respondents based on the age of the elderly at the Pucang
Gading Social Institution.
Table 1 Frequency distribution of respondents based on the age of the elderly at the
Pucang Gading Social Institution
No
Frequency (f)
%
1
2
3
24
9
1
70,6
26,5
2,9
34
100%
From the characteristics of the age of the respondents, it is dominated by the age
of 60-74 years, namely the elderly category with a total of 24 respondents (70.6%). While
in the elderly (old) 75-90 years there are 9 respondents (26.5%). And there is only 1
respondent (2.9%) in the very old age category (very old) above 90 years old.
b. Gender
Frequency distribution of respondents based on the gender of the elderly at the
Pucang Gading Social Institution
Eduvest – Journal of Universal Studies
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Table 2. Frequency distribution of respondents based on the gender of the elderly
at the Pucang Gading Social Institution
No
Gender
Frequency (f)
%
1
2
Male
Female
23
11
67,6
32,4
Total
34
100%
Distribution of respondents by gender, most of the respondents were male with a
total of 23 respondents (67.6%) while respondents with female sex were 11 respondents
(32.4%).
c. Level of education
Frequency distribution of respondents based on the education level of the elderly at the
Pucang Gading Social Institution
Table 3 Distribusi Frekuensi responden berdasarkan tingkat pendidikan lansia di Panti
Sosial Pucang Gading
No
Level of Education
Frequency (f)
%
1
2
3
4
5
No school
Elementary School
Junior High School
Senior High School
Colleg
5
8
12
7
2
14,7
23,5
35,3
20,6
5,9
Total
34
100%
d. Description of the sleep quality level of the elderly before doing a foot soak in warm
water with a mixture of salt and lavender extract
Table 4 Distribution of respondents' sleep quality levels before treatment
No
Sleep Quality
Frequency (f)
%
1
Poor Sleep Quality
34
100
Total
34
100%
The table above shows that 100% experienced poor sleep quality with an
Insomnia Rating Scale score >5
e. Description of the sleep quality of the elderly after a foot soak in warm water with
a mixture of salt and lavender extract
Table 5 Distribution of respondents' sleep quality levels before treatment
No
Sleep Quality
Frequency (f)
%
1
2
Poor Sleep Quality
Good Sleep Quality
31
3
91,2
8,8
Total
34
100%
The table above shows that there are 31 respondents (91.2%) who experience poor
sleep quality and 3 respondents (8.8%) who experience good sleep quality after treatment.
f. Analysis of the Effect of Warm Water Foot Soak with a Mix of Salt and Lavender
Extract on Sleep Quality in the Elderly
The Effectiveness of Warm Water Foot Sound with Salt and Lavender Flower Extract
on Sleep Quality in Elderly with Insomnia 1.111
The results of the analysis of Paired t test scores of sleep quality after giving a foot
soak in warm water with a mixture of salt and lavender extract at the Pucang Gading Social
Home in Semarang.
Variable
Mean
Std. Deviation
t
Signifikan (2-
tailed)
The effect of giving a foot soak in
warm water with a mixture of salt and
lavender extract on the sleep quality of
the elderly at the Pucang Gading Social
Home in Semarang
3,941
0,365
10,78
0,000
Table above describes the 2-tailed results or p = 0.000 so that the p value <0.05
indicates that there is an effect of foot soaking in warm water with a mixture of salt and
lavender extract on the sleep quality of respondents.
Discussion
From the research results, it is shown that the characteristics of respondents based
on age are mostly dominated by respondents aged 60-74 years with a total of 24
respondents (70.6%). According to WHO, the elderly are divided into four criteria: middle
age (middle age) is 45-59 years, elderly (eldery) is 60-74 years, old age is 75-90 years, very
old age (very old).is over 90 years old. This is in line with research conducted by Allehe
Seyyedrasooli, Leila Valizadeh, Vahid Zamanzadeh, Khadijeh Nasiri, and Hossein Kalantri
in 2013 which obtained data that of 50 respondents aged 60-75 years experienced sleep
disorders or insomnia and some were male.
From the analysis of the data before treatment was carried out on the respondent,
the respondent's sleep quality was measured using a PSQI (Pittsburgh Sleep Quality Index)
questionnaire in the questionnaire consisting of 7 question components regarding:
subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances,
habits use of sleeping pills and disruption of activities during the day. Of the 34 respondents
who were measured using the questionnaire, all respondents were categorized as having
poor sleep quality with a score of more than 5. This is in line with research conducted by
(Seyyedrasooli et al., 2013) which Obtaining data from 50 respondents who were tested
using the PSQI questionnaire all experienced sleep quality disorders.
The normal human sleep cycle consists of 2 phases, namely NREM (Non-Rapid
Eye Movement) and REM (Rapid Eye Movement). NREM is the initial phase which
consists of 4 stages. The first stage lasts 3-5 minutes. In the second stage the eyeballs do
not move and sleep deeper. The third stage of sleep is deeper and the last one is in the
deepest phase so that it is difficult to wake up. The NREM phase lasts for 70–100 minutes
followed by REM. This phase lasts for 5–30 minutes and reappears every 90 minutes and
it is during this phase that sleep dreams occur. In normal sleep, NREM and REM cycles
occur 4–7 times every night. Insomnia can be defined as both a disorder and a symptom.
Insomnia as a disorder is a condition in which a person has difficulty sleeping, has difficulty
maintaining sleep or poor sleep quality and is accompanied by complications (Valizadeh
et al., 2015)
Factors that cause sleep disorders. Based on the 3P theory, there are 3 factors of
insomnia, namely predisposing, precipitating and perpetuating. Predisposing factors
consist of biological characteristics, lifestyle, social characteristics and psychological
conditions. Precipitating factors include traumatic events that have been experienced, the
presence of chronic diseases and mental disorders. Perpetuating factors are the transitional
Eduvest – Journal of Universal Studies
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limits of acute and chronic insomnia which include sleep hygiene and sleep believe (N.
Sayekti & Hendrati, 2015). Sleep hygiene is one of the important factors in the emergence
of cases of insomnia. Sleephygiene consists of the sleep environment and habits or
behaviors that are carried out before bedtime. Changes in sleep hygiene to a better direction
can improve the quality and quantity of sleep. Improper application of sleep hygiene will
actually cause a person to experience insomnia (N. P. I. W. Sayekti & Hendrati, 2015)
Experts have researched a lot about the impact of insomnia specifically on the
elderly. In addition to increasing the risk of generative diseases such as hypertension and
heart disease, depression and stress are also manifestations of this sleep disorder (Plante et
al., 2012). Insomnia also increases the risk of falls in the elderly (Díaz & Ruano, 2011) as
well as suicidal ideation and drug abuse (Brook et al., 2015) The long-term impact of
insomnia is to change a person's sleep patterns. At the age of about 50 years, the wave of
sleep begins to decrease so that in old age the quantity of deep sleep in a person will
decrease (Cooke & Ancoli-Israel, 2011). Several diseases that are often associated with
insomnia but can also be the cause of insomnia are arthritis, hypertension, cancer and
diabetes (Hellström, 2013)
After being treated with a foot soak in warm water with a mixture of salt and
lavender extract, it was found that there were 31 respondents (91.2%) who experienced
poor sleep quality and 3 respondents (8.8%) who experienced good sleep quality after the
treatment. There was a decrease in the score on the PSQI questionnaire which indicated
better sleep quality. And a statistical test was carried out using the Paired T Test to get the
results of p < 0.05 which can be concluded that there is an effect of soaking the feet in
warm water with a solution of salt and lavender extract on the sleep quality of the elderly.
From research conducted by (Seyyedrasooli et al., 2013), it was found that foot soaking
with warm water is effective on the sleep quality of the elderly and can improve the quality
of sleep in the elderly sleep duration. One way to overcome insomnia is by non-
pharmacological methods. There are many non-pharmacological therapies, one of which is
hydrotherapy. where in this technique utilizes water to heal and relieve various complaints
so it is known as a therapeutic method with a low-tech approach that relies on the body's
responses to water. This form of therapy can help a person to reduce various complaints,
one of which is by soaking the feet (Sulaiman, 2009). Foot soak therapy (foot hydrotherapy)
also helps improve blood circulation by widening blood vessels so that more oxygen is
supplied to the tissues. Improved blood circulation also facilitates lymph circulation so that
it cleanses the body of toxins (Wulandari, 2016)
Changes in skin temperature and core body temperature have functions related to
sleep and wake cycles. There is a negative relationship between core body temperature and
sleep tendencies. When core body temperature decreases, sleep onset is easier. The fall in
core body temperature before and during sleep is associated with dilation in the peripheral
blood vessels and it can move heat from the core body to the peripheral blood vessels.
Therefore, foot soaks in warm water with a mixture of salt can increase peripheral body
temperature without increasing or decreasing core body temperature and can improve sleep
quality and facilitate sleep initiation (Liao et al., 2008). This is supported by research
conducted by (Khotimah, 2012) that warm water bath therapy on the feet improves blood
vessel mycocirculation and vasodilation thereby increasing the quantity of sleep. In
addition, we can add aroma as part of the body's response to relaxation. The scent of
lavender flowers is not only distinctive, but also calming. The aroma contains anti-
neurodepressive which can provide a relaxing effect that provides calm. Even the sedative
effect of using lavender aromatherapy at night can help you fall asleep faster.
Fajar Surahmi
The Effectiveness of Warm Water Foot Sound with Salt and Lavender Flower Extract
on Sleep Quality in Elderly with Insomnia 1.113
CONCLUSION
Characteristics of the elderly who followed the foot soak in warm water with a
solution of salt and a mixture of lavender flower extract, most of them (70.6%) were 60 –
74 years old. Of the 34 respondents, dominated by male respondents, 23 were male
respondents. The educational background of the elderly respondents who became the object
of most research was Junior High School, which was 35.3%. Prior to the treatment of foot
soak in warm water with a salt solution and a mixture of lavender flower extract, 100% of
respondents had poor sleep quality. After the foot soak treatment in warm water with a salt
solution and a mixture of lavender flower extract, 91.2% of respondents had poor sleep
quality and 8.8% had good sleep quality. The results of the analysis using statistical tests
showed that p = 0.000 means that there is an effect of soaking the feet in warm water with
a salt solution and a mixture of lavender flower extract on the sleep quality of elderly
respondents.
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