Understanding women's sleep management: beyond medicalization‐healthicization: A response to Simon Williams

Abstract

Williams is to be congratulated for bringing the sociology of sleep to our consciousness. Through his careful integration, reworking and extension of earlier writings (e.g.Aubert and White 1959a, 1959b, Schwartz 1970, Taylor 1993) and his contextualisation of these within existing concepts and debates such as healthicization-medicalization and embodiment (see for example, Williams and Bendelow 1998, Williams 2002), Williams has been successful in establishing a foundation for the sociological study of sleep. What he has failed to do, however, is to position his work within an empirical framework; a framework which explores and captures the everyday world of sleep as it is experienced on a night-to-night basis within the social context of the home. And it is precisely this which is both the focus and strength of our work on women's sleep. As the first sociological empirical study of women's sleep conducted in the UK11 This study forms part of the EU-funded Sleep in Ageing Women project (QLK6-CT-2000-00499). , our research breaks new ground. By recording and analysing women's experiences of sleep in the context of everyday life, our overall goal is to show how the lived experience of sleep holds up a mirror to illuminate fundamental issues associated with gender, ageing, health and illness, and lifecourse transitions (Hislop and Arber 2003a, 2003b, 2003c). In the absence of existing empirical studies, our article in Sociology of Health and Illness (Hislop and Arber 2003b) reported on input from 82 women who participated in 10 focus groups and from five GPs interviewed for the study. These data provided the first available insights into the nature of sleep disruption and management from the perspective of women and the medical profession. Williams’ description of our research as a ‘limited’, ‘small-scale study (from which generalisations should not be drawn)’ (Williams 2004: 453) is unjustified. Rather than limiting the development of a sociology of sleep, our research has enabled a broad exploration of the subject of women's sleep at an early stage in the development of the sleep research agenda, informing subsequent research design and providing new insights into the more theoretically-oriented work of Williams. Williams claims that our article represents ‘at best a partial and at worst a misleading portrayal of my own position on these dormant matters’. On the contrary. What we have tried to do in this article is not to critique or undermine Williams’ exploration of sleep in the context of the healthicization-medicalization debate, but empirically to investigate aspects of this debate from the point of view of the lay population. We adopt the healthicization-medicalization model as a means of exploring and conceptualising the realities of women's sleep management, proposing that women's sleep management can be understood as the interplay between a core of personalized activities linked to strategies associated with healthicization and medicalization (Hislop and Arber 2003b). Women's choice of strategy is mediated by the constraints associated with gendered roles and relationships, as well as by socio-cultural shifts in attitudes and beliefs about health and wellbeing. We do not propose that our alternative model is the ‘only’ or the ‘correct’ interpretation of the highly complex issue of sleep management. Instead, we present it as a reflection of what women report happens in their everyday world of sleep and, as such, it is a viewpoint worthy of consideration. Williams raises a number of points related to current issues in sleep research, including a detailed discussion of the role of the media, the paucity of sleep training for doctors, the recent work of Kroll-Smith (2003) on daytime sleepiness, and the need for a ‘proper historical context’ through which to examine the concepts of healthicization-medicalization. These issues are important and deserve attention. In the context of Williams’ rejoinder, however, they serve more as a platform for promoting Williams’ own research interests than as a critique of Hislop and Arber's work. In alluding to a previous article (Williams 2002), for example, Williams talks of ‘bio-tech breakthroughs which will eliminate the need for sleep altogether’. While acknowledging that in future the management of sleep disruption may well cease to be a concern, our research is about the here and now; it is about what women do, within the constraints of their social circumstances, to help overcome sleep problems which interfere with their wellbeing and quality of life. Despite Williams’ concerns, the strategies which we report are ‘personalised’; they reflect individual responses to poor sleep which utilise the resources available to women within their respective sleeping environments. We examine women's own perceptions of what works and what doesn't in terms of improving their own sleep outcomes. In the bedrooms of the majority of women in the UK, it is not a question of what new breakthroughs may or may not happen in the future or even a question of whether sleep can be discussed in terms of the healthicization-medicalization debate. It is about women being active in formulating their own strategies by finding out what works for them and for other women, be it a warm bath, listening to the radio, lavender pillows, sleeping pills or relocating to another room to avoid a partner's snoring. We recognise that the research reported in our article (2003b) presents only one side of the story – the perspective of women – and it is important to consider how gender roles and relationships impact on the strategies which men may use to improve their sleep. This is a goal of our current research on negotiating sleep among couples22 ESRC funded (RES-000-23-0268). ; a study which involves in-depth interviews with both partners in a couple, and the use of audio sleep diaries and actiwatches33 Watch-like devices which measure movement. to examine the interrelationships between the sleep patterns of partners. Thus, rather than creating a ‘straw man’ as Williams asserts, we have moved the sleep research agenda forward by incorporating an empirical dimension which examines women's own ideas, beliefs and experiences of sleep and the management of sleep disruption. And this is indeed in line with Williams’ assertion (2002: 192) of the importance of identifying ‘the salience and significance of sleep in lay culture, and its links to concepts and ideas about health and illness’. That there are ‘other important chapters on sleep’ to be written is beyond contention.