sleep is essential for everybody and any disturbance in the natural sleep patterns can cause mental problems , and diminish the function of the brain . although sleep disorder may be seen at any age , the elderly usually experience more problems . as a matter of fact , the prevalence of sleep disorder is estimated to be about 10 - 20% in the general population . sleep disorders significantly influence the individuals quality of life resulting in a noticeable decrease in the physical , emotional and social aspects of their daily functions . the effect of sleep disorders and the illnesses they cause are seen more amongst the elderly compared to young people . the elderly often complain of problems such as difficulty in going to sleep , disintegration of sleep , short duration of sleep , low quality of sleep and drowsiness during daytime . the most common sleep disorder in the elderly is insomnia from which 50% of the elderly suffer . sleep disorder in the elderly results in short memory , concentration disorder , chronic fatigue , visual auditory and behavioral disorders , higher risk of falling down , disability in daily life activities , napping during daytime , depression , and high intake of sleep medications . diseases , medications , environmental factors , depression and anxiety are among the most common causes for hospitalized clients sleep disorders . studies have shown that insomnia can result in fatigue , irritability , aggression , and low tolerance to pain . since the elderly have the highest rate of incidence of hospitalization ( 38% ) , and the longest duration of stay in hospitals ( 45% ) , they experience the highest level of sleep disorder . sleep related changes are among the main concerns of the elderly and should not be underestimated . although the prevalence of sleep disorders grows by age , these problems are not inevitable . investigation of individuals sleep health necessitates close detection of sleep habits and behaviors as well as environmental factors affecting sleep . a comprehensive study of sleep behavior and appropriate interventions can help the elderly obtain their needed sleep and rest in order to have their highest function . therefore , the researcher decided to conduct a study on sleep related behaviors of hospitalized elderly people . the population studied comprised 300 elderly subjects , selected through convenient sampling , who were 60 years old and over , and were hospitalized in different hospitals in zahedan . the researcher frequently visited all wards of hospitals in zahedan , after obtaining the necessary official permissions , and selected the subjects based on the inclusion criteria until reaching the needed sample size . the data were collected with a questionnaire structured by the researcher . the validity ( content and face ) and reliability ( test - retest ) of the questionnaire were confirmed . the questionnaire , completed through interviews , included two sections of demographic characteristics , and sleep related behavior . descriptive statistical tests such as concrete and relative frequency , mean , sd and inferential tests ( x ) were employed to detect the association between the qualitative variables . about 54% of the elderly were male and 46% female with the mean age of 68.8(5.7 ) years . about 69.6% lived in urban areas and 30.4% in rural areas . with regard to marital status , 69.7% were married and 29.3% were widowed . about 70% of the subjects were illiterate , 4.3% had reading and writing literacy , 12% primary school , 5.7% a high - school education , and 3% an associate and bachelor 's degree . about 76.3% of the subjects suffered from more than one chronic disease , 17% from one , and 6.7% suffered from no chronic diseases . the hospitalization was due to a chronic disease for 72.4% and acute diseases for 27.6% . in the findings of this study showed that 62% of the subjects suffered from sleep disorder with a higher prevalence among female elderly subjects ( 68.1% ) compared to male subjects ( 56.8% ) ( table 1 ) . some other studies reported the prevalence of sleep disorder in the iranian elderly to be 67% which is consistent with the result of the present study . epidemiologic data show that 12 - 54% of the elderly suffer from sleep disorder which is more prevalent among women compared to men . in a study by mehra et al . on about 2400 elderly subjects , prevalence of insomnia was reported to be 54% in women and 36% in men . in this study just as the current study the percentage of women suffering from insomnia is higher than the men . association of sleep disorder with demographic variables of the hospitalized subjects in zahedan the study by foly et al . on over 9000 elderly people at ages of 65 and over found that , more than 42% of the subjects complained of a delay in going to sleep and sleep disintegration . ( 2006 ) showed that 390 hospitalized elderly in kashan had low sleep quality , with women having lower sleep quality than men . ( 2008 ) studied 115 subjects over the age of 18 and reported that 59% had insomnia . about 67.9% of those aged 41 - 65 had insomnia with the highest frequency being in women ( 74.4% ) . they reported 60.9% sleep disorder in people over 65 years of age . in a study conducted by ohayon and lemoine , the prevalence of insomnia was estimated to be 20 - 40% in west europe with the highest level being in women and the elderly . in another study in japan , the level of sleep disorder amongst the hospitalized elderly in japan was reported to be 18.7% in men and 20.3% in women . the results of the above researches show a higher prevalence of sleep disorders among the iranian elderly possibly due to life style , socioeconomic and cultural factors , and low awareness of the importance of sleep and its role in elderly health . in a survey conducted by gallup on 1000 americans at the age of 50 and over ( 43% were 65 or over ) showed that 80% of the subjects believed sleep is important for elderly people 's health . about 45% believed they needed more sleep compared to the youth , and 25% had sleep problems . various studies as well as the present study showed higher rates of sleep disorder among women compared to men . based on former studies , women experience sleep disorder twice as much as men due to various factors such as stress , diseases , sleeping place and being over weight . sleep disorder in women can also be due to post hormonal changes especially estrogen . as women have more familial and social responsibilities , compared to men , the stress caused as a result of this can be another reason for higher prevalence of sleep disorder among women . impaired sleep patterns caused during pregnancy and breast feeding may cause disordered sleep patterns even at the age of menopause . the results of this study showed that there is a significant association between education and sleep disorders ( p = 0.048 ) ( table 1 ) . this means that less sleep disorders are seen among the elderly with a higher education compared to those with lower education . showed that the quality of sleep is poorer among the elderly with less literacy compared to those of other age groups . also concluded that there is a higher rate of sleep disorder among those with lower education . higher rate of sleep disorders among illiterate or low educated elderly people may be due to the effect of education on the level of awareness and efficient problem solving methods . low educated elderly people also face more socioeconomic problems and stress with a negative effect on their natural sleep habits , compared to those with higher education . based on the present study this finding is not in accordance with the results of izadi onji et al . which reported sleep quality to be better among the married compared to those divorced and widowed . this difference can possibly be due to having more family support that the widowed elderly receive after losing their spouses . the results of the present study showed that there is a significant association between residential area and sleep disorder ( p = 0.014 ) so that those who live in urban areas ( 66.3% ) complained more of sleep disorders compared to those who live in rural areas . this is possibly due to the difference between the urban life style of the elderly and its related stress versus rustic elderly life and its simple and low expectations ( table 1 ) . although sleep disorders increase by age , they are not necessarily a part of the aging process but are a result of secondary physical and mental diseases as well as their related medications . with regard to the high prevalence of sleep disorders and their complications and health related outcomes in the elderly , the main concern is the bilateral association between sleep disorder and physical diseases among them . hypertension , depression , cardiovascular diseases and cva put people at a higher risk of sleep disorders and vice versa ; therefore , one of the major reasons for sleep disorders of the studied elderly in this study can be chronic diseases . the results of the present study showed a significant association between hospitalization due to chronic and acute diseases and sleep disorders ( p = 0.01 ) so that the elderly hospitalized due to a chronic disease were reported to have more sleep disorders compared to those due to acute diseases . another finding of the present study is less complaint of sleep disorder among those with one chronic disease ( 51.1% ) compared to those with two or more ( 66.5% ) ( table 2 ) . association of sleep disorder with occupation , type of disease , number of chronic diseases in the elderly in hospitals of zahedan most of the elderly regularly take several medications for their chronic diseases which worsen their sleep disorder . these medications are : beta blocker , bronchial vasodilators , corticosteroids , anti congestive , diuretics and other cardiovascular medications , especially anti depressants . on the other hand , sleep disorder itself requires the elderly to take even more medication ( table 3 ) . frequency distribution of the subjects sleep and rest behaviors the results of the present study showed that 16% of the studied elderly always , 28.7% often , and only 16.7% never used to take sleep medications to go to sleep , reflecting the high intake of sleep medications among them . it increased by 60% in us within 2000 - 2006 , and american and european studies report 50% of sleep medications to be taken by those of 60 years of age and over . numerous studies have shown a vast number of side effects of sleep medications that can even increase mortality . therefore , physicians should avoid excessive prescription of sleep medications and the elderly should be given necessary education about their side effects , and the prevention of self medications . sleep health includes sleeping habits and behaviors as well as environmental factors that can affect sleep . having a regular schedule for sleeping and waking up is among the healthy behaviors affecting sleep . the findings of the present study showed that 16% of the studied elderly always , 28.7% often and 23.7% sometimes have a certain schedule for their sleeping and waking up while 15% seldom and 16.7% never had such a schedule . going to bed and getting up at a certain time is recommended ( table 3 ) . this seems to set ones sleep and waking up to a certain time and to decrease the delay in going to sleep . the findings of the present study show that from the 300 elderly people studied , 27.3% always , 27% often , 25.3% sometimes , 12% seldom , and 8.3% never took a nap during the day ( table 3 ) . foley states that an increase in age is not a direct cause of napping but it gives the elderly more chance and time to nap . a study showed that a nap during the day can complete night sleep with the only negative effect of causing a delay in going to sleep at night . izadi onji et al . reported no association between napping during the day and sleep quality , which needs further investigation . finally , the elderly are recommended against frequent and long naps during the day , and are advised to go to bed just for sleeping and having sex . the present study showed that 56.7% of the subjects were not involved in drug abuse , did not have a big diner , drink alcohol , or smoking cigarettes before sleep . however 21.3% used drugs , 7.7% smoked cigarettes and 4.7% had a big diner before sleeping ( table 4 ) . however , giving up this habit is very hard for the elderly , and needs education and a great deal of time . with regard to the important role of sleep in the quality of life of the elderly , it is crucial that we detect the causes of sleep disorders amongst them , and educate and motivate them to obtain appropriate behavior , and prevent them from inappropriate sleep behaviors . therefore , strategies should be taken so that the elderly regularly assess their sleep habits and behaviors as a part of their health and try to promote the quality of their sleep . since , nurses spend more time with the patients in hospitals compared to other health team members , they are in a better position to detect sleep disorders and educate the patients about healthy sleep behaviors . inappropriate sleep behavior seems to be due to lack of awareness which can be decreased or amended through the necessary education
background : sleep is an essential need in every individual 's life . a disorder in the natural sleep can cause physical and mental problems . 
 the elderly are usually faced with more sleep problems . 
 therefore , the present study aimed to define sleep behavior among the elderly hospitalized in zahedan.materials and methods : this is a descriptive analytical study conducted on 300 elderly people aged 60 years and over who were hospitalized in zahedan . in this research convenience sampling method was used and the research tool was a questionnaire . 
 the data were collected through interviews . 
 descriptive ( frequency distribution ) and inferential ( x2 ) statistical tests were employed to analyze the data.findings:the results showed that 62% of the hospitalized elderly people ( total of 300 ) had sleep disorder . 
 about 44.7%took sleep medication in order to sleep , and only 16.7% did not take sleeping medications . 
 about 44.7% had no special schedule for the time of their sleeping and waking up , and 4.3% were involved in drug abuse and smoking , and had a big dinner before sleeping . 
 there was a significant association between sleep disorder , gender , education , living in urban or rural areas , the cause of hospitalization , and suffering from a chronic diseaseconclusions : sleep disorder and inappropriate sleep related behaviors had a high prevalence among the elderly . 
 with regard to the important role of sleep in the quality of life of the elderly , detection of the reasons of sleep disorder , motivating them to practice an appropriate sleep behavior , and preventing them from having inappropriate sleep related behaviors are crucial issues .