Written by Richard Harvey, Clinical Programmes Lead. 
Why we sleep?
Sleep is an essential process for the human body to be able function both mentally and physically. According to a survey completed by the NHS ‘In 2022, 34.0% of children aged 7 to 16 years had a problem with sleep 3 or more times over the previous 7 nights.’
For young minds to develop, sleep is essential. Sleep affects mood, resiliency, alertness and attention, cognitive performance, mood, language acquisition, learning and memory, in addition to having a direct impact on happiness, according to studies. Napping seems to be essential for the development of motor skills, executive function, and memory in toddlers. Growth is also significantly impacted by sleep, particularly in the early years of life (Zhou et al, 2015).
Children with neurodevelopmental disorders and autism frequently and persistently experience sleep difficulties. They have a significant impact on the child’s and the family’s quality of life. Sleep issues can be linked to detrimental effects for the child or young person. including challenging behaviour and impaired academic or professional achievement. Relationship issues due to increased stress can be frequent in the family. While behavioural techniques and medicine are frequently used in sleep disorder therapies. Sleep hygiene education is a crucial first intervention for behavioural sleep issues. This offers guidance to parents and carers on how to set up the best sleeping environment for their children and exposes them to activities and cues that encourage restful sleep at the right time (Bursting with potential).
The occupation of sleeping?
Frequently poor sleep amongst people with neurological impairments result in a medical complaint. Occupational Therapists should be involved in the assessment and screening of factors affecting an individual’s sleep. In order to assist or address engagement in the occupation of sleeping, understanding an individuals related routine, habits and barriers in sleeping can help to guide Occupational Therapy intervention. Helping to achieve greater outcomes in rehabilitation, promoting health and wellbeing and increasing quality of life (Tester & Foss, 2017).
The crucial function of sleep in occupational therapy was initially acknowledged by Adolf Meyer. In “The Philosophy of Occupational Therapy,” he put forth the idea that work and play are equally important to preserving health and well-being as sleep and rest (Meyer, 1922). The World Federation of Occupational Therapists (2012) defines occupations as the routine activities people engage in on a daily basis to occupy their time and give their lives meaning and purpose. Given the time context of sleep as well as the restorative qualities of sleep needed to operate and acquire meaning and joy from existence, sleep appears to be justifiable as an occupation (Tester & Foss, 2017). For those with neurological disability, sleep issues are frequently seen as secondary issues with unclear causes and few effective therapies. While health practitioners may view sleep problems as a secondary issue, they certainly exacerbate the limitations brought on by underlying diseases and are crucial to everyday functioning.
There are currently no standardised assessments for sleep in Occupational Therapy. Qualitative assessments that can be used to determine the client’s perception of sleep quality, sleep habits and routines, number and types of disturbances, and participation are among the tools that are available. Sleep diaries, logs, and interviews offer information on sleep patterns, and the Functional Outcomes of Sleep Questionnaire (Weaver et al., 1997) assesses the effects of daytime sleepiness on essential activities of daily life. These evaluations may be helpful in pinpointing sleep-related issues and devising therapeutic strategies. Energy conservation is one occupational therapy method used to address the effects of inadequate sleep in individuals with neurological disability. For those with multiple sclerosis, pacing techniques, rest periods, and timetables based on peak energy levels have been found to be effective (Matuska, Mathiowetz,&Finlayson, 2007; Vanage, Gilbertson, & Mathiowetz, 2003)
‘Although this strategy may be beneficial for severe fatigue, it does not directly address the occupation of sleep; instead, it is a compensatory strategy that limits life participation. In an effort to improve sleep and enhance engagement, occupational therapy practitioners should consider other interventions for clients with neurological impairment.’ (Tester & Foss, 2017)
Tester & Foss (2017) go on to mention the need to bolster and develop the role of Occupational Therapy in sleep, and suggest the following:
‘First, knowledge and skills related to sleep should be integrated into educational curricula. Learning objectives should incorporate an understanding of:
- Sleep as an occupational domain that affects health, well-being, and participation;
- The assessments that are currently available;
- The evidence base surrounding different interventions; and
- The need to develop standardized sleep assessments and interventions specific to our field.#
Helpful Sleep Strategies
For further help and strategies on sleep, please see the below information from Oxford Health NHS Foundation Trust, and the sleep council and sleep charity:
https://thesleepmanifesto.com/
Postural management and sleep
To find out more about the importance of night time positioning and the impact on sleep please refer to our previous article: 24 hour Postural Management – the Importance of Sleeping and Lying posture
If you would like to receive resources to help support the occupation of sleep or therapy practice please enter your details below to access our range of resources including:
- Dreama booklet with sleep diaries
- Quality of Life Questionnaire
- 24-Hour Movement Toolkit (UK focussed)
Click here to register and download Jenx Sleep Resources
References
NDRS. (n.d.). Part 2: Sleep, loneliness and health behaviours. [online] Available at: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2022-follow-up-to-the-2017-survey/part-2-sleep-loneliness-and-health-behaviours#:~:text=In%202022%2C%2034.0%25%20of%20children.
Zhou, Y., Aris, I. M., Tan, S. S., Cai, S., Tint, M. T., Krishnaswamy, G., Meaney, M. J., Godfrey, K. M., Kwek, K., Gluckman, P. D., Chong, Y. S., Yap, F., Lek, N., Gooley, J. J., & Lee, Y. S. (2015). Sleep duration and growth outcomes across the first two years of life in the GUSTO study. Sleep medicine, 16(10), 1281–1286.
Bursting with Potential. (n.d.). Children’s Support and Therapy Interventions In Peterborough. [online] Available at: https://www.burstingwithpotential.co.uk/.
Tester, N.J. and Foss, J.J. (2017). Sleep as an Occupational Need. American Journal of Occupational Therapy, 72(1), p.7201347010p1. doi:https://doi.org/10.5014/ajot.2018.020651.
Meyer, A. (1922). The philosophy of occupational therapy. Archives of Occupational Therapy,
World Federation of Occupational Therapists. (2012). Definition of occupational therapy. Retrieved from http://www.wfot.org/AboutUs/AboutOccupationalTherapy/DefinitionofOccupationalTherapy.aspx
Weaver, T. E., Laizner, A. M., Evans, L. K., Maislin, G., Chugh, D. K., Lyon, K., Dinges, D. F. (1997). An instrument to
measure functional status outcomes for disorders of excessive sleepiness. Sleep, 20, 835–843. https://doi.org/10.1080/00273171.2014.958211
Matuska, K., Mathiowetz, V., & Finlayson, M. (2007). Use and perceived effectiveness of energy conservation strategies for managing multiple sclerosis fatigue. American Journal of Occupational Therapy, 61, 62–69. https://doi.org/10.5014/ajot.61.1.62
Vanage, S. M.,Gilbertson, K. K.,&Mathiowetz,V. (2003). Effects of an energy conservation course on fatigue impact for persons with progressivemultiple sclerosis. American Journal of Occupational Therapy, 57, 315–323.
https://doi:10.5014/ajot.57.3.315
About the author – Richard Harvey
Richard has gained a wealth of experience working in the postural management industry since 2016 in both product roles and educational and training positions. In this time he obtained a Post Graduate Certificate in Posture Management for People with Complex Disabilities from Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust. Prior to this he held several positions as a Therapy Technical Instructor over an 8 year period, specialising in paediatrics and complex needs.
In 2023, Richard completed his training to become a qualified Occupational Therapist at London South Bank University. His ambitions are to use his experience and knowledge to help to develop clinical practice of posture management, whilst empowering the profession of Occupational Therapy to be leaders in this field. Richard has a passion for supporting and advocating for children and adolescents to engage and participate in meaningful occupations and activities. To contribute in breaking down barriers and challenging ableism that prevents any child from reaching their full potential.
Richard enjoys being active and has a number of hobbies outside of work including Crossfit and Badminton. In 2020 Richard became a qualified Level 2 Badminton England coach, and enjoys teaching and sharing his passion for the sport.
