Sleep as an Occupation: Perceptions and Assessment Behaviors of Practicing Occupational Therapists

PURPOSE: The purpose of the study was to survey a wide representation of occupational therapists (OTs) and ascertain their beliefs and practices specific to viewing sleep as an occupation, along with the degree to which they habitually evaluate and document clients’ sleep performance and sleep dysfunction.

RATIONALE AND BACKGROUND: People spend a considerable portion of their lives engaged in a complex bioneurological state termed sleep, in which numerous physiological alterations take place, including changes in blood pressure, metabolic rate, and various hormonal regulations. Physiological benefits such as energy conservation, pain management, and immune function support have also been validated. Conversely, sleep loss, total or partial, has a potentially serious impact on biological, cognitive, and mood function.

Inclusion of sleep as a core component in occupational therapy, along with work, play, and rest, was first proposed by Adolf Meyer. Unfortunately, sleep as an occupation has received scant acknowledgment throughout the profession’s history. In addition, the profession gives the impression of having an unsolidified view of the placement and significance of sleep among all elements of the profession and clinical practice. Few studies have addressed the topic of sleep in occupational therapy or the role of OTs in the treatment of sleep disorders, and no study to date has assessed the opinions and behaviors of OTs regarding sleep and the address of sleep dysfunction in their practice.

DESIGN AND METHOD: This study incorporated a survey approach to data collection, targeting 250 OTs randomly selected from membership in the American Occupational Therapy Association (AOTA) to represent a cross-section of OTs from across the United States. Survey packets included a three-page self-report questionnaire based on a broad review of the literature within and outside of the profession. The survey included item statements focusing on components of sleep and sleep dysfunction and the assessment of sleep. Quantitative data were analyzed using IBM SPSS Statistics using descriptive and inferential statistics. A thematic analysis of an open-ended question allowed for formation of categories and listings.

RESULTS: Results reflected the gender, ethnic, and practice area breakdown of AOTA membership. It was found that the majority of OTs accepted sleep as an occupation and an important aspect of one’s health. However, while they appeared to accept the relevance of documenting and/or treating antecedents to and components of sleep dysfunction specific to their daily practice, they indicated that for the greater part, they did not do so. In addition, the majority of participants reported that their occupational therapy education was deficient in preparing them to treat these antecedents to and forms of sleep dysfunction. Correspondingly, the OTs acknowledged that they lacked confidence in their ability to provide specialized assessment and treatment in respect to sleep dysfunction.

IMPACT STATEMENT: Recognizing that people engage in the occupation of sleep for essentially one-third of their life, and noting the positive relationship between sleep and quality of life, research on sleep, including identification and treatment of antecedents to and symptoms of sleep dysfunction and consequential results of poor sleep performance, is warranted. Yet, advancements in such research continue to lack sufficient attention and representation within the profession. This research is the only study of which we are aware that has investigated the attitudes and behaviors of OTs in regard to perceptions of sleep as an occupation and the extent of assessment and documentation of sleep antecedents and sleep behaviors within clinical practice. The results mark a significant step in the continuing recognition and reestablishment of sleep as a fundamental life occupation as initially proposed by Meyer.

References

American Occupational Therapy Association. (2012). Occupational therapy’s role in sleep [Fact sheet]. Retrieved from http://www.aota.org/∼/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/HW/Facts/sleep.pdf

Faulkner, S., & Mairs, H. (2015). An exploration of the role of the occupational therapist in relation to sleep problems in mental health settings. British Journal of Occupational Therapy, 78, 516–524. https://doi.org/10.1177/0308022614564771

Lambert, A., Tessier, S., Rochette, A. C., Scherzer, P., Mottron, L., & Godbout, R. (2016). Poor sleep affects daytime functioning in typically developing and autistic children not complaining of sleep problems: A questionnaire-based and polysomnographic study. Research in Autism Spectrum Disorders, 23, 94–106. https://doi.org/10.1016/j.rasd.2015.11.010

Leland, N. E., Marcione, N., Niemiec, S. L. S., Kelkar, K., & Fogelberg, D. (2014). What is occupational therapy’s role in addressing sleep problems among older adults? OTJR: Occupation, Participation and Health, 34, 141–149. https://doi.org/10.3928/15394492-20140513-01