Every activity that we engage in has benefits and potential problems or risks that accompany it. Likewise, sleep has benefits to our health and well being and problems that can occur when we lack sufficient quality sleep. The benefits and problems are directly connected to how many hours of uninterrupted sleep that we attain on a daily basis, together with the nature of that sleep. For adults to be healthy, sleep takes up approximately one third of every 24 hour day. That is a major chunk of time that begs for our acknowledgement and attention For babies and children, obtaining sufficient hours of sleep has a direct relation to their development.
An important fact to take note of is that whether or not the hours of sleep were adequate and rejuvenating has a direct impact on our waking hours and our ability to effectively carry out our daily tasks. This is where occupational therapy (OT) has become recognized as having a role to play in the area of sleep and wellness. OT is a holistic profession that is part of the medical team. The OT is concerned with assisting our clients to function to the optimum in all areas of daily living, taking into consideration their age, stage of development, state of their health, skills, weaknesses, life roles and what tasks are important for that person to carryout.
There are several angles related to sleep, obtaining adequate sleep and the consequences of sleep deprivation that an OT is concerned about which creates a few possible avenues for OT intervention. OTs are involved in prevention, promotion of health and rehabilitation. Where possible, an OTs first goal will be that of prevention. As a result, an OT will use his / her knowledge of the benefits of effective sleep, sleep physiology and the negative effects of sleep deprivation to assist in preventing problems from arising. These problems could result in the risk of injury to the person or to others, risks of the potential to develop a chronic illness or health problem and a difficulty in carrying out their daily tasks effectively. An OT will therefore use observation, evaluation and interview in order to determine the factors that contribute to the sleep problem together with the impact that the sleep deprivation is having in the persons life. Possible consequences include:
- the persons level of function in activities of daily living
- the persons performance in school, work or life events
- the effect that this sleep deprivation has on the person's family and community
- any stress that the sleep deprivation is causing
Having obtained a holistic picture of the person, the quality of their sleep and how it impacts on their daily life, the OT will formulate a treatment plan. Every treatment plan is unique to the person and specific to their age, stage of development, any underlying health condition and any medication the person might be taking.
The areas that the OT will address include:
- Evaluating environmental factors e.g. temperature, adequate ventilation, light and noise and what modifications are necessary in order to promote good quality sleep
- Evaluating position at night which becomes particularly important for those with a condition that lengthy hours in bed or in one position would have an impact on. e.g. formulating resting splints to prevent morning stiffness for those with rheumatoid arthritis, positioning in bed e.g. for patients with neurological conditions so as to prevent deformities or contractures from developing.
- Assisting the person to develop healthy habits that promote sleep. Examples of health habits will include reducing caffeine intake, eliminating smoking, ensuring a balanced lifestyle, engaging in regular exercise and a healthy diet
- Helping the person to improve his / her lifestyle, routine and time management in order to ensure sufficient hours of sleep every night including weekends. Some examples here will include helping the person to develop a pre-bedtime routine that is calming and supports the body's physiological needs when preparing for bedtime and quality sleep
- Working with the person's psycho-emotional state to reduce depression, anxiety, stress including training in stress management techniques, grief and past traumas that could be preventing the person from getting to sleep and attaining the level of sleep they require.
- Education of a variety of skills, as indicated for each person, which can include relaxations skills, teaching parents how to massage their babies in order to promote a good sleep routine, training in sensory modulation techniques where indicated for those who experience sensory processing problems / disorders.
- Where problems have been identified that prevent a person from getting to sleep due to worry and stress, the OT will assist in developing appropriate goals and action plans to work towards a solution to whatever is causing the problem. e.g. if a person has anxiety over completing a specific course and or taking exams, the OT will evaluate if there are areas creating a learning difficulty that need to be addressed. In addition, the OT can assist the person to develop effective organization and other skills necessary to complete the course. Guided visualization, mindfulness and other techniques might be used to help to build the persons confidence and a sense of inner calm.
As mentioned, every treatment plan is unique to the patient and follows a doctors diagnosis and referral. Obtaining appropriate diagnosis is important for a few reasons. Firstly there are different types of fatigue and the type of intervention required will differ depending on the nature of the fatigue. Secondly, since there are now over 80 diagnoses of sleep disorders. The OT will need to use his / her knowledge of physiology, clinical sciences, psychology, psychiatry together with knowledge of occupational performance and what is required in order to carry out our daily tasks effectively in order to formulate appropriate goals that take into consideration any contra indication related to a specific condition.
In conclusion, sleep is a large part of our daily life and has an impact on our ability to carry out our activities of daily living effectively. The demands of modern living has had a major negative impact on the area of sleep which has resulted in sleep deprivation now reaching the level of being a health crisis, certainly in the US. Due to the effects to both our health and well being and our ability to function effectively, occupational therapists have an important role to play to assist our clients to develop a healthy balanced lifestyle that will promote adequate, quality sleep. Wherever possible, lifestyle redesign, education and other techniques to promote health and prevent injury or other problems from arising are the primary focus of OT intervention. Where an underlying condition is involved or sleep deprivation has already become chronic, rehabilitation will be indicated that will be specific to the diagnosis, age of the person, stage of development and effects to school, work, family and the community.
Agmon M, Shochat T and Kizony R; (2016) Sleep Quality is Associated with Walking Under Dual Task, but not Single Task, Gait Posture, June 18, 49: 127 - 131
Marger Picard M, (2012) Fact Sheet put out by the American Occupational Therapy Association (AOTA) on Occupational Therapy's Role in Sleep
Thiart H, Ebert DD, Lehr D, Nobis S, Buntrock C, Berking M, Smit F, Riper H (2016) Internet-Based Cognitive Behavioural Therapy for Insomnia: A Health Economic Evaluation, July 19, pii: sp-00062-16. (Epub ahead of print)
von Rosen P, Frohm A, Kottorp A, Friden C, Heijne A, (2016) Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes, Scandinavian Journal of Medicine and Science in Sports, Aug 19.