Occupational Therapy’s Role in Sleep

Don’t Sleep on Occupational Therapy’s Role in Sleep

Should occupational therapists be addressing sleep in their practice? 

YES!

But how can sleep be considered an OT’s role? 

Here’s how…

Sleep is considered a restorative occupation, and sleep insufficiency has a direct impact on all of your other occupations. Sleep’s main purpose is to help us recover and recuperate from daytime occupations and build up energy to engage in tasks that are meaningful to us. It directly impacts occupational performance and participation, and therefore it is very necessary that occupational therapists are involved in sleep. 

Let’s delve into this deeper.

At some point in our lives, we have all had some difficulty with our sleep. Be it from anxiety, having a newborn baby/young child, bladder issues, or insomnia. I am sure you noticed the aftereffects of your sleeping problems: feeling sluggish, struggling to concentrate, or feeling irritable.

Sleep is integral for our health and well-being. This article will give you greater insight into sleep and occupational therapy’s role in sleep.

What is considered a sleep problem?

You have a sleep problem if you have difficulty initiating or maintaining sleep or if you are experiencing non-restorative sleep that is followed by functional impairments during the day. It is integral that OTs upskill themselves in sleep disorders, as studies have shown that between 20-41.7% of the general population are experiencing sleep difficulties (1).

The Sleep Foundation goes into great detail in this article on the different types of sleep disorders. These include insomnia, sleep apnea, narcolepsy, restless leg syndrome, excessive sleepiness, shift work disorder, parasomnias, and non-24-hour sleep wake disorder. 

What does the research say?

It has been proven time and time again that sleep is a critical component of emotional, cognitive, and physical health. In fact, adults who sleep too little or too much present with accelerated cognitive aging! (2)

Furthermore, a study done in the US shows that one in six adults with diagnosed sleep disorders use sleep aids (medication), and one in eight adults has trouble sleeping (3). This further shows the need for occupational therapists to address sleep to avoid people overusing sleeping aids. 

How much sleep should one get?

The National Sleep Foundation used over 300 research publications to provide us with guidelines on the amount of sleep needed by each age group. Let this guide you in your education with your patients, based on their age (4).

Children:

  • Newborns (0-3 months): 14–17 hours per day. 
  • Infants (4-11 months): 12–15 hours per day
  • Toddlers (1-2 years): 11–14 hours per night.
  • Pre-schoolers (3-5 years) need 10-13 hours per night.
  • School-age children (6-13 years): 9–11 hours per night.

Adults:

  • Teenagers: (14-17 years):  8–10 hours per night.
  • Adults (18-64 years) should sleep at least 7 hours and no more than 9 hours per night.
  • Adults (older than 65 years) 7–8 hours per night.

How can occupational therapists assess sleep?

You can do an informal assessment by asking some questions. These are examples of questions you can ask your patient to gain a good understanding of their sleeping problem:

  1. How many hours per night do you sleep? 
  2. How long does it take you to fall asleep?
  3. Are you able to stay asleep once you’ve fallen asleep?
  4. Do you feel tired during the day? How is this impacting your work, leisure, and socializing?
  5. Do you drink caffeine, smoke, or take drugs?
  6. Are you taking any sleeping aids?
  7. Describe to me your sleeping environment?
  8. Do you sleep at regular times daily?
  9. What do you do for the hour before you go to bed?

Sleep screening tools/questionnaires:

There are multiple questionnaires that you can use to assess your patients’ sleep. Choose one of the below based on what you are wanting to assess.

  1. Pittsburgh Sleep Quality Index (PSQI). This assesses subjective sleep quality and sleep habits. 
  2. Patient-Reported Outcomes Measurement Information System (PROMIS). This assesses self-reported sleep quality, depth, and satisfaction with sleep. 
  3. Epworth Sleepiness Scale (ESS). This assesses subjective daytime sleepiness. 
  4. Functional Outcomes of Sleep Questionnaire (FOSQ). This assesses the impact that excessive sleepiness has on daily activities and quality of life. 

For assessing insomnia:

  1. Consensus sleep diary (CSD). Insomnia experts collaborated and created a standardized sleep diary. You can also download the app. 
  2. Insomnia Severity Index (ISI). This assesses the severity of and the impact of insomnia. 

If you want to read more about the above screening tools, you can find more information here.

Sleep Interventions for OTs

There are many tools in an OT’s toolbox to help improve sleep! Here are brief explanations of some of the interventions we can offer our patients with sleeping problems. 

  • Underlying impairment: Address underlying impairment that is impacting sleep, such as: pain, anxiety, or depression. 
  • CTB-I (cognitive behavioral therapy for insomnia): Currently the most accepted, evidence based intervention for those with insomnia. This involves cognitive, behavioral and psychoeducational interventions. There are increasing numbers of OTs are undergoing training in this. You can learn more about it here
  • Adjusting their routine during the day: Guide your patient on how to restructure their daytime activities with a focus on occupational balance. Having a daily routine where you are active can help your patient stick to a sleep schedule. Too much or too little activity during the day is closely related to sleep patterns at night (5). 
  • Exercise: Several studies have shown a link between exercise and improved sleep at night (in particular, aerobic exercise).
  • Adapting the environment: Advise your patient to adjust the light, temperature, noise, or bedding. 
  • Assistive devices or equipment: You can introduce certain assistive devices to your patients that may improve their sleep quality. These can include a weighted blanket, masks, earplugs, white noise machines, or a Dreampad pillow (5).
  • Sleep hygiene: Help your patient form healthy habits and behaviors before going to sleep. You can read OT flourish’s article on sleep hygiene tips here.
  • Managing nocturia: Waking up frequently at night to urinate can be a major hindrance to getting good restorative sleep. Targeting their nocturnia by advising your patient to restrict their fluid intake, do pelvic floor exercises, practice delayed voiding and urge suppression and education can improve the nocturia. You can read more about OT’s role in this here.
  • Keeping a sleep diary: This can help yield greater information and insight into the amount of hours slept, what affected the sleep and your patient’s energy levels the next day. Therapist Aid has created a free ‘sleep diary’ worksheet you can print out.
  • Medication, deep breathing, and yoga: A study done on meditation found that it resulted in statistically longer sleep than sleep hygiene education done in isolation (5). We love Insight Timer’s free meditation app.

Further resources to help you: 

  • You can ask questions and read prior posts on the ‘Sleep4OT’ Facebook group.
  • You can check out the ‘Sleep OT’ website. These are occupational therapists who have a special interest in sleep and have created this website to facilitate OT’s learning in sleep. 

 

We hope that you can now see that there are many ways that we can assess and treat sleep to help our patients. By targeting their sleep, we can directly improve their occupational performance during the day.

Occupational therapists have a large role to play in targeting sleep in order to improve our patients’ physical, mental, and emotional wellbeing.

References:

  1. Ohayon. M, “Epidemiological Overview of Sleep Disorders in the General Population”, Sleep Medicine Research, Volume 2 (1), 2011.
  2. Ferrie. J, Shipley. M, Akbaralay. T, Marmot. M, Kivimake. M, Singh-Manoux. . “Change in Sleep Duration and Cognitive Function: Findings from the Whitehall II Study”, Sleep, Volume 34, Issue 5, 2011, p.565-573.
  3. Chong. Y, Fryar. C, Gu.G. “Prescription Sleep Aid Use Among Adults”, CDC, 2013, https://www.google.com/search?q=how+to+reference+website+oxford&rlz=1C5CHFA_enZA757ZA757&oq=how+to+reference+website+oxford&aqs=chrome..69i57j0i22i30l9.13076j0j15&sourceid=chrome&ie=UTF-8, Accessed 31/01/2022.
  4. Sune. E, “How Much Sleep Do We Really Need?”, Sleep Foundation, 2022, https://www.sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need
  5. Ho. E, Siu. H, “Occupational Therapy Practice in Sleep Management: A Review of Conceptual Models and Research Evidence”, Occupational Therapy International, Volume 2018, 2018.

You may also like

One comment

  • Hayley von Bentheim February 6, 2023   Reply →

    thank you, good summary and informative.

Leave a comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.

myotspot.com