GERIATRIC SLEEP HYGIENE

Scholarly Agenda
Alexis Ferrari, OTS

INTRODUCTION
Population:
Older adults (65+)

PIO:
What interventions (I) can occupational therapy practitioners utilize
to improve sleep hygiene (O) in the geriatric population (P)?

WHY THIS IS IMPORTANT

EVERYONE NEEDS SLEEP!

Sleep is considered a core occupation according to the

Occupational Therapy Practice Framework: Domain and Process, 3rd Edition
vSleep an extremely important occupation that is often overlooked.
Influences occupational performance in daily life

vPoor sleep leads to decreased daytime activities, which can also lead to overall poor
health (Leland et al., 2016).
vBy OTs addressing sleep problems in older adults, their occupational performance
may increase in other meaningful activities.
(American Occupational Therapy Association, 2014)

SEARCH STRATEGY

Methods

Search terms:

Older adults
Sleep hygiene
Naps
Sleep
Occupational therapy
Occupational-based interventions
Occupation

CINHAL
EBSCOhost
Medline
Cochrane Database

Inclusion criteria:

Older adults
Sleep
Occupational therapy
Peer-reviewed

Exclusion criteria:

Adults under 65 years old

Published no earlier than 2006

EVIDENCE
1. Sleep, Occupation and the Passage of Time
Scoping review Level V Qualitative

2. Napping and Nighttime Sleep:

Findings from an Occupation-Based Intervention
Secondary analysis of data originating from a randomized controlled trial (RCT).
Level II Clinical cohort

3. What is Occupation Therapys Role in

Addressing Sleep Problems Among Older Adults?

Scoping review / Systematic summary of literature Level V

#1
SLEEP, OCCUPATION AND THE PASSAGE OF TIME
Study Objectives:
Extent to which sleep has been
considered in occupational therapy
At this time (2008), debating whether
sleep is considered an occupation
Raise awareness that sleep is a
neglected intervention, as well as
issues related to sleep

(Green, 2008)

Methods:
Review existing information on sleep in
occupational therapy and occupational
science literature
Explore theoretical relationship between
sleep and occupation to determine
relevance of sleep to occupational
therapy
Overview of current knowledge of sleep
science as it relates to occupation and
the promotion of good sleep

#1
SLEEP, OCCUPATION AND THE PASSAGE OF TIME
Outcomes
Although sleep is not currently identified as an occupation, it is directly related to
occupational performance.
After two weeks of regular exercise combined with social activity, responses to
subjective sleep questions could improve among older adults.
Positive influences on sleep can in turn enhance daytime performance.
Promoting good sleep requires individuals need to keep regular hours, wind down
sufficiently before bedtime, and to keep waking activities separate from the sleeping
environment.
In 2008, the role of OTs addressing sleep and maintaining a balanced lifestyle was
up for debate.
(Green, 2008)

#2
NAPPING AND NIGHTTIME SLEEP: FINDINGS FROM AN
OCCUPATION-BASED INTERVENTION
Study Objectives:
Describe sleeping behaviors and trends
over time among an ethnically diverse
group of community-living older adults.
Evaluate the effectiveness of occupationbased interventions on the physical,
cognitive, and mental health of older
adults.

Methods:
Secondary analysis of a RCT.
Lifestyle Redesign Intervention (LR) broadbased, flexible, occupation-based intervention
with weekly small-group sessions led by OT/L.
Interventions = healthy lifestyle behaviors, including
sleep
10 individual, one hour sessions conducted in the home
or in a community setting.

Sleeping and napping behaviors were selfreported via an assessor-completed written

questionnaire and then analyzed.
(Leland et al., 2016)

Four napping categories were defined at follow-up:

1. Stopped napping, 2. Started napping,
3. Continued to nap, 4. Never napped

#2
NAPPING AND NIGHTTIME SLEEP: FINDINGS FROM
AN OCCUPATION-BASED INTERVENTION
Outcomes:
Discontinued daytime napping impacted the Lifestyle Redesign participants
by gaining nighttime sleep minutes.
Lifestyle Redesign group had a net gain in nighttime sleep and received OT
that promoted participation in meaningful activities.
Relationship may exist between occupation-based interventions and changes
in sleep behaviors in older adults.
Daytime sleep restrictions and engagement in daytime activity improve
nighttime sleep behavior.
OT screenings for sleep problems in older adults are warranted.
(Leland et al., 2016)

#3
WHAT IS OCCUPATIONAL THERAPYS ROLE IN
ADDRESSING SLEEP PROBLEMS AMONG OLDER ADULTS?
Methods:

Study Objectives:
Scoping review to highlight effectiveness
of sleep interventions for older adults.
Sleep interventions clearly aligned with
the OTPF.
Establish basis for evidence for
occupation-based sleep interventions to
improve health and quality of life of
older adults.

Scoping review to identify current evidence,

distinguish gaps in the literature, and outline
future research agenda.
Searched multiple databases for articles
addressing intervention efficacy in occupational
therapy.
Criteria:
Articles published in the past 15 years
Used specific search terms and inclusion, exclusion criteria

(Leland, Marcione, Niemiec, Kelkar, Fogelberg, 2014)

#3
WHAT IS OCCUPATIONAL THERAPYS ROLE IN
ADDRESSING SLEEP PROBLEMS AMONG OLDER ADULTS?
Outcomes:
A final sample of 34 articles represented four intervention areas in the scope of
occupational therapy.
1. Cognitive behavioral therapy for insomnia, 2. Physical activity,
3. Multicomponent interventions, and 4. Other intervention strategies

In all four intervention areas, there was an emphasis on modifying existing habits and
routines to support sleep quality, participating in physical activity, and initiating
engagement in activities that comply with predetermined limited sleep schedule.
Interventions fit into three sections of the OTPF, including: performance patterns,
context and environment, and supporting occupations, such as ADLs and IADLs
However, none of these interventions were led by OTs.
Lack of evidence of OTs addressing sleep hygiene, even though qualified to help older adults with this occupation

(Leland et al., 2014)

SUMMARY
vSleep is often neglected, even though it is an extremely important intervention topic.
vThere are several client-centered intervention techniques that address sleep hygiene
in the scope of OT.
vParticipating in meaningful occupations during the day may increase the quality of
nighttime sleep in older adults.
vMaintaining a sleep routine and a balanced schedule, conditions the body to
prepare for a good nights sleep.
vOT practitioners are qualified to address sleep problems with older adults in a
holistic manner in order to promote overall health and a good quality of life (Leland
et al., 2014).

SWEET DREAMS

REFERENCES
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.).
American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48. doi:10.5014/ajot.2014.682006
Green, A. (2008). Sleep, occupation and the passage of time. The British Journal of Occupational Therapy, 71(8), 339-347.
Leland, N. E., Fogelberg, D., Sleight, A., Mallinson, T., Vigen, C., Blanchard, J., . . . Clark, F. (2016). Napping and nighttime sleep:
Findings from an occupation-based intervention. American Journal of Occupational Therapy, 70, 1-7.
http://dx.doi.org/10.5014/ajot.2016.017657
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(3), 141-149.
doi:10.3928/15394492-20140513-01