Date Presented 4/20/2018
This study evaluated the effectiveness and perceptions of an occupational therapy–based sleep hygiene program to promote sleep behavior, sleep quality, and occupational performance in service members. The findings suggest that use of an occupational therapy approach to treat sleep difficulties in service members is beneficial.
Primary Author and Speaker: Yvette Woods
Additional Authors and Speakers: Robin Tennekoon
Contributing Authors: Stephen L. Turner
PURPOSE: Since the onset of the Global War on Terror, many SMs have reported difficulties with the quality of their sleep, which affects mission accomplishment. Few studies have evaluated the effectiveness of sleep hygiene in active duty SMs or the barriers to adherence faced when attempting to establish new sleep behavior patterns.
The purpose of this study was to evaluate the effectiveness and perceptions of an occupational therapy–based psychoeducational sleep hygiene program to promote sleep behavior, sleep quality, and occupational performance in active duty service members (SMs). The specific aim of this study was to determine how clinical sleep outcome variables (sleep latency, total sleep time, sleep efficiency, and sleep quality) were affected in a group receiving an occupational therapy–based sleep hygiene education intervention. Furthermore, this study set out to determine whether there was a relationship between sleep quality and perceived impact on occupational performance and to examine the factors that challenged sleep hygiene implementation and influenced sleep in SMs.
METHOD: For this mixed methods design case series, we recruited a convenience sample of active duty U.S. Army SMs in training who endorsed poor quality or quantity of sleep. Nine SMs with a primary complaint of poor sleep quality or quantity received two sessions of an occupational therapy–based sleep hygiene program in a group setting. Each SM was reassessed 3 wk posttreatment and invited to participate in a semistructured qualitative interview. An a priori power analysis was completed, and a sample size of 44 participants was determined necessary to detect a within-group effect size of .80 at the 7-wk endpoint. This calculation was based on a two-tailed significance level with alpha = .05 and allowing for a 30% loss to follow-up.
RESULTS: Significant baseline to follow-up changes in the hypothesized direction were found on the Insomnia Severity Index, Canadian Occupational Performance Measure Performance and Satisfaction scales, and Pittsburgh Sleep Quality Index Global, Sleep Quality, and Sleep Duration scores. Eight participants completed one-on-one semistructured follow-up interviews that yielded five emergent themes concerning the lived experience of SMs attempting to alter their sleep behaviors and practices: performance and quality of sleep, adapting to frequently shifting demands, the dual role of technology, sleep’s role in leadership, and navigating the military’s sleep culture.
CONCLUSION: Understanding the unique experiences of military SMs attempting to alter their sleep behaviors and practices can assist occupational therapy practitioners in altering their methods of delivering sleep hygiene interventions with this unique population. The significant changes found in this small sample suggest the benefit of an occupational therapy approach that uses education on environment modification, adoption of and engagement in stress-relieving activities, and establishment of performance-specific goals.
IMPACT STATEMENT: The results of this study may validate the use of an occupational therapy–based sleep hygiene approach to improve the short-term sleep quality and quantity of U.S. Army SMs. Further research is needed to determine whether this approach is more effective than the traditional sleep hygiene education typically used in military settings.
References
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