Sleep Hygiene and Complimentary and Alternative Medicine

Sleep Hygiene

Practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness

What is healthy sleep important for?

Physical and mental health

What can healthy sleep improve?

Productivity and overall quality of life

Who can benefit from practicing good sleep habits?

Everyone

What can sleep issues be caused by?

Any combination of acute or chronic problems

Examples of Sleep Issues

Prolonged sleep onset latency (takes longer to fall asleep)

Excessive wake after sleep onset (wake up and can't fall back)

Short total sleep time (sleeping less than 3 hours a night)

Low sleep efficiency (waking up and feeling tired)

Poor sleep quality (based on subjective and objective data)

5 Stages of the Sleep Cycle

Stage 1: Light sleep (e.g. can be easily awakened)

Stage 2: Eye movement and brain waves slow down

Stage 3: Delta waves begin to appear

Stage 4: Deep sleep (e.g. difficult to wake up)

Stage 5: Rapid eye movement (e.g. rapid/irregular breathing)

Signs of Poor Sleep Hygiene

Falling asleep at inopportune times

Memory issues

Mood changes

Trouble concentrating

Decreased immune function

Accidents

High blood pressure

Weight gain (e.g. calories are typically loss during sleep)

Lowered libido

How much of the American population has sleep problems as compared to Western Europeans and Japan due to drive to achieve (e.g. hustle culture)?

More than half

Most Americans (61-79%) did not meet clinical diagnostic criteria for what condition based on self-reported symptoms?

Insomnia

Why are sleep problems of growing concern to global public health?

Associated with impairments in motivation, emotion, cognition

Increased risk for serious medical conditions

All-cause of mortality

What is poor sleep associated with?

Impairments in:

Motivation

Emotion

Cognitive functioning

What does poor sleep cause an increased risk for?

Medical conditions (e.g. diabetes, cardiovascular disease, cancer)

What can poor sleep lead to even when the symptoms are below the threshold for clinical sleep disorders?

Mortality

What can happen after one night of no sleep?

Become more emotional

Decline in hand-eye coordination

Impaired concentration

Equivalent to 0.1% blood alcohol content (e.g. hungover)

What role does sleep play in proper functioning of body systems?

Immune function

Tissue healing

Pain modulation

Cardiovascular health

Cognition (e.g. learning, memory)

What is the recommended amount of sleep per night for individuals 18 years and older?

7 hours

Tips for Getting a Better Night Sleep

Practice a relaxing bedtime ritual

Turn off electronics

Exercise daily

Keep a consistent sleep schedule

Avoid heavy foods, alcohol, and caffeine several hours before

What is the immune system synchronized with?

The body's sleep-wake cycle (e.g. circulation, hormones)

When does the number of immune cells increase in circulation? Why?

During wake hours to combat antigens in a period when the body is more likely to encounter foreign bodies and during sleep

What does the upregulation of immune cells with increased secretions of endocrine hormones (e.g. growth hormone, prolactin, melatonin, leptin) and pro-inflammatory cytokines enable?

Adaptive immune response to be very active during sleep

Sleep regulation is controlled by similar neural mechanisms of what physiological function?

Pain modulation

What neural mechanism controls both sleep regulation and pain modulation?

Central serotoninergic neurotransmission

What does decreased slow-wave sleep lead to in terms of pain?

Increased sensitivity to pain

Increased neuronal sensitivity

When are occupational therapist's supposed to ask about pain?

Throughout the session, making appropriate adjustments or referrals as needed

Regulation of what 2 physiological functions occurs during sleep?

1. Sympathetic nervous system

2. Hypothalamus-pituitary-adrenal axis

What does sleep deprivation lead to?

Changes in the immune response

What does sleep deprivation alter?

Body's healing properties

What is too much (>9 hours) or too little (<5 hours) sleep associated with?

Increased mortality due to cardiovascular disease

Cycle of Obstructive Sleep Apnea

Sleep onset snoring

Airway collapses

Breathing stops

Sleep disrupted

What conditions does sleep apnea increase the risk of?

Cardiovascular disease

Ischemic heart disease

Arrhythmias

Systolic heart failure

Cerebrovascular accident

What can occupational therapists do to address heart disease from lack of sleep?

Basic screens (e.g. take blood pressure)

What 2 mental health conditions may sleep disturbances contribute to?

1. Depression

2. Anxiety

What percent of people with depression experience insomnia?

75%

What percent of individuals with insomnia have both depression and anxiety?

25%

What can occupational therapists screen patients with depression and anxiety for?

Sleep disturbances

What does sleep enhance the learning of?

Functional gross and fine motor tasks

What ability does a lack of sleep reduce?

Hand-eye coordination tasks

Performance of ADLs and IADLs

Decreased functional mobility

Process of Neuroplasticity

Early practice

Sleep

Skilled practice

What knowledge do occupational therapists have in regards to sleep?

Sleep physiology and disorders

Evidence-based sleep promotion practices

What do occupational therapists evaluate and address in regards to sleep?

The consequences of sleep insufficiency or sleep disorders on occupational performance and participation

How are sleep problems addressed and framed in occupational therapy?

From the perspective of health maintenance and health promotion

What do occupational therapists explore with families who have autistic children?

Impact of sleep deprivation on the family unit and the child's and caregivers' ability to function effectively during the day

What can occupational therapists address in families with autistic children?

Physical environment

Observation skills (e.g. to anticipate emotional reactions)

Calming activities (e.g. easy to facilitate and produce sleep)

How do occupational therapists help families with autistic children?

Bedtime routines

Habits

Patterns

Cognitive-Behavioral Interventions for Autistic Children

Strategies to address sensory avoiding and sensory seeking

Picture poster depicting bedtime routines

Stickers or consistent praise for sleeping through the night

Loose or tight pajamas

Lightweight or weighted blankets

What can occupational therapists working with older adults in long-term care address?

Sleep routine

Lighting (e.g. differentiate between day and night)

Noise level in the environment

Positioning (e.g. turning schedules, privacy needs)

Substance abuse

Mood disorders (e.g. anxiety, depression)

Dietary habits

What type of activities should occupational therapists working with older adults in long-term care encourage?

Daytime activities (e.g. exercise, socialization)

What do occupational therapists working with older adults in long-term care strive to reduce?

Daytime napping

What areas of sleep dysfunction do occupational therapists evaluate?

Sleep preparation and participation

Latency

Duration

Maintenance

Daytime sleepiness

Impact on life, school, work, and caregiving

Pain and fatigue

What should occupational therapists assess in terms of sleep?

Balance

Sensory systems (e.g. vision)

Vision

Strength

Skin integrity

Psycho-emotional status (e.g. depression, anxiety, stress)

Impact of stimulants (e.g. caffeine, nicotine, drugs)

Environment (e.g. acute care hospitals, long-term care, home)

Occupational Therapy Interventions for Sleep Hygiene

Education on cognitive-behavioral therapy

Address co-morbidities (e.g. decreased ROM, anxiety)

Encourage positive health behaviors (e.g. reduce caffeine)

Sleep routine establishment and maintenance

Pain management and fatigue

Target occupational performance deficits

Increase coping skills and stress management

Environmental modifications

Advocate for appropriate work schedules

Complementary and Alternative Medicine

A group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine

What is complementary medicine?

A type of medicine that is accessed in conjunction with allopathic medical practices

What is alternative medicine?

A type of medicine that is practiced in place of conventional medicine

What is integrated medicine?

A type of medicine that combines treatments from conventional medicine and complementary and alternative medicine for which there is high-quality scientific evidence of safety and effectiveness (e.g. acupuncture)

5 Domains of Complementary and Alternative Medicine

1. Alternative medical systems

2. Mind-body interventions

3. Biologically based treatments

4. Manipulative and body-based methods

5. Energy therapies

Alternative Medical Systems

Entire systems of health theory and practice that developed separately from conventional medicine (e.g. herbal remedies, manipulative practices)

What type of practices does alternative medical systems include?

Traditional Chinese medicine

Ayurvedic medicine

Naturopathy

Homeopathy

Traditional Chinese Medicine

A type of practice that is based on the belief that the uninterrupted flow of energy through 20 meridians is necessary for the maintenance of health (e.g. acupuncture, Qigong)

What does traditional Chinese medicine rely on?

Use of "energy" based practices

What populations has traditional Chinese medicine been utilized for?

Developmental disabilities (e.g. cerebral palsy, intellectual)

Attention-deficit hyperactivity disorder

Pain-related conditions (e.g. fibromyalgia)

Psychological disorders (e.g. anxiety, depression, PTSD)

Hormone imbalance

What is one of the oldest holistic healing systems?

Ayurvedic medicine

Ayurvedic Medicine

A type of practice based on Hindu philosophy that health and wellness depend on a delicate balance between mind, body, and spirit, using dietary or herbal remedies and various mind-body therapies

Where did Ayurvedic medicine originate?

India

What have studies of Ayurvedic medicine shown to help osteoarthritis patients with?

Reduce pain

Increase function in osteoarthritis patients

What have studies of Ayurvedic medicine shown to help type II diabetes patients with?

Manage symptoms

Why should patients consult primary care providers prior to using Ayurvedic medicine to treat a medical issue?

Because some treatment techniques may be toxic

What do mind-body interventions focus on?

The relationships among the brain, mind, body, and behavior, and their effect on health and disease

What do mind-body interventions encompass?

Hypnosis

Meditation

Yoga

Biofeedback (e.g. mirror)

Tai-chi

Visual Imagery

What do mind-body interventions integrate well into?

Cognitive-behavioral therapy

Group therapy

Conventional neurological interventions

What do biologically-based treatments refer to?

Substances found in nature, including herbs, foods, and vitamins otherwise known as dietary supplements

What do biologically-based treatments encompass?

Botox used for spasticity management

Amino acid therapy used in children with cerebral palsy

Red raspberry leaves to relieve menstrual pain

Ginger and turmeric for reducing inflammation

What do manipulative and body-based methods depend on?

Manipulation or movement of a body part

What do manipulative and body-based methods encourage?

Muscle strength and coordination

What manipulative and body-based methods are widely used for children and adults with physical disabilities?

Hippotherapy

Hydrotherapy (e.g. aquatics)

Chiropractic and spinal manipulation

Reflexology

Massage therapy

Tai Chi

Yoga

Energy Therapy

A type of practice based on the belief that energy blockages or imbalances can lead to illness and disease

What do energy therapies aim to create?

A state of balance, health, and peace in a person

What are the most popular forms of energy therapy?

Music therapy

Therapeutic touch

Reiki

Qigong

4 Pillars of Complementary and Alternative Medicine Research

1. Scientific promise

2. Extent and nature of practice and use

3. Amenability to rigorous scientific inquiry

4. Potential to change health practices

What are the key priority areas of complementary and alternative medicine in research currently?

Non-mineral

Non-vitamin

Natural products

Mind-body interventions (e.g. yoga, tai-chi, qigong, imagery)

Deep-breathing exercises

Progressive relaxation

Why are research studies encouraged for complementary and alternative medicine?

Insurance coverage for CAM therapies

Develop practice and referral guidelines

Conduct research about safety and efficacy of CAM practices

What must occupational therapists evaluate in order to determine whether to use complementary and alternative medicine in the delivery of occupational therapy services?

Evaluate the client's strengths and weaknesses in carrying out daily occupations

What must the occupational therapist measure to ensure that the use of complementary and alternative medicine will improve occupational performance?

Whether the use of them will result in positive outcomes

How is complementary and alternative medicine used in occupational therapy?

Address factors that influence occupational performance in daily life occupations, demands, and contexts/environments within which they are performed

How can occupational therapists use complementary and alternative medicine to facilitate the ability of clients to engage in their daily life occupations?

Preparatory method

Purposeful activity

Occupational-Therapy Based Complementary and Alternative Medicine Interventions

Sensory Integration (e.g. autism)

Constraint therapy (e.g. stroke)

Prescriptive exercises (e.g. depression)

Tai-chi (e.g. prevention of falling)

Mirror therapy (e.g. stroke)

Mindfulness (e.g. addiction)

Yoga (e.g. autism)

Animal assisted therapy (e.g. post-traumatic stress disorder)

Occupational Therapy Code of Ethics and Ethics Standards

Mandates safe and competent practice, holding occupational therapy practitioners responsible for maintenance of high standards of competence

According to the Occupational Therapy Code of Ethics and Ethics Standards, what may the use of complementary and alternative medicine require?

Training for effective delivery

According to the Occupational Therapy Code of Ethics and Ethics Standards, what must occupational therapy practitioners comply with when using complementary and alternative medicine?

Local, state, and federal laws

Payment for Occupational Therapy Services and Complementary and Alternative Medicine

Insurance coverage (e.g. varies by company)

Cost-effectiveness

Consumer demand

Demonstrated clinical efficacy

State mandate