8 tips to help your patients learn sleep hygiene and have a better night's sleep | SeniorsFlourish.com

8 Tips for Sleep Hygiene in OT

Sleep. We all need it, but why is it such a struggle?

Professionals in occupational therapy call the basic habits and practices that enable us to sleep well on a day-to-day basis "sleep hygiene," but trying to figure out why we don't sleep or fall asleep well, is much harder than it sounds.

In addition, I am loving all the new research out there to address sleep, including using the PEOP model by using "occupation-based sleep intervention to focus on strategies to (1) minimize the influence of bodily function on sleep, (2) promote environment conducive to sleep, and (3) restructure daytime activity with a focus on occupational balance."

In this post, I will share 8 tips to teach your patients sleep hygiene, as well as a free sleep questionnaire that you can print off and use to dig into the roles, habits and routines of sleep.

<Click here to download the FREE Patient Handout: Sleep Questionnaire. Perfect way to figure out steps needed to help patients get a better night's sleep.>

8 Tips to Address Sleep Hygiene in OT

Sleep is an ADL! 8 tips to help your patients sleep like a baby tonight | SeniorsFlourish.com

1. What do you do to get ready for bed?

Believe it or not, pre-bed routines are a real thing and can definitely affect sleep patterns. Having a daily routine such as reading before bed, brushing your teeth, changing your clothes, etc tells your internal clock you are about to go to bed.


Tip: Start a routine!

Try winding down with some quiet time before you go to sleep and avoid over-stimulation -  because finishing up a stressful phone call, paying your bills or watching the news right before bed doesn't let your body prepare you for hitting the hay.


2. How long does it take you to actually go to sleep and why?

30 minutes is pretty average for a person without a "sleep disorder," but this varies from person to person. Consider things such as:

  • Are you worried about something?
  • Do you have a hard time turning your brain "off?"

Tip: Consider learning some deep breathing or meditation techniques to clear your mind.

• De-stress techniques to calm you down before bed will help you enter transitional sleep, which slows down your brain waves and helps begin the sleeping process.


3. How many hours do you get a night?

This number is variable - depending on your age. Recommended number of hours a night is 7-8.

Actually getting too much can actually be just as problematic as too little sleep!


Tip: Sleep trackers will track how long you are actually sleeping at night. It gives you a good idea if you are going into REM, or if you are constantly waking up throughout the night. Not only is this information can be valuable to figuring out the reason for insomnia, but if you keep track of it over a period of time, it will help determine if your quality of sleep has changed.


Sleep is an ADL! Using sleep trackers and apps can give insight into sleep patterns and behavior for patients having trouble with sleeping | SeniorsFlourish.com

Using sleep trackers and apps can give insight into sleep patterns and behavior.

4. Are you able to stay asleep?

How many times do you wake up a night and why? Do you have sleep apnea? Do you have an overactive bladder and have to go to the bathroom? Are you a light sleeper and noises keeping you awake? Are you worried about something?

Think about why you can't stay asleep and address it!


Tip:  Stop drinking water or coffee 3-4 hours before going to sleep prevents people from waking up at night to go to the bathroom.

• Medical problems such as sleep apnea, an overactive bladder or incontinence are subjects your physician can help you address that may be causing restlessness.

• Ear plugs can work wonders for people who are light sleepers.


5. Are you sleepy during the day?

 

This can be caused by the obvious - too little sleep at night, but it can also be caused by depression, anxiety, stress, and even boredom. Daytime sleepiness is a vicious fatigue/sleepiness cycle of being tired during the day, so you nap, then you cannot go to sleep at night, so you are sleepy the next day, etc, etc and the cycle continues.


Tip: The best way to stop this sequence of sleepy during the day and not tired at night is to stay occupied during the day - go for a walk, meet up with friends, work on a hobby.

• Do not nap! This is easier said than done when you are dragging during the day, but in the long run, it helps you have a more restful night's sleep, resulting in less daytime sleepiness.


 6. Is pain a factor?

Pain and insomnia go hand in hand. - it triggers poor sleep, therefore, triggering more pain.


Tip: Consult your physician regarding uncontrolled pain. Many people use painkillers or sleeping pills to control insomnia, which can be effective, but prolonged use may not be the answer.

• Occupational or physical therapists use methods such as manual techniques, strengthening, and modalities such as heat and ice or addressing pain from a biopsychosocial model, and other modalities including relaxation and visualization activities.

• Have you considered consulting with a pain specialist? There may be ways to treat the pain, not mask it.

• Alternative medicine professionals? Massage, relaxation and breathing techniques have also been used as pain control methods.


8 tips to help your patients learn sleep hygiene and have a better night's sleep | SeniorsFlourish.com

7. When and how much do you use stimulants or depressants?

Caffeine in the form of soda, chocolate, coffee or tea too late in the day can prevent you from falling asleep effectively due to it's stimulating nature. Alcohol can help you fall asleep, but it is common for it to awaken you after the alcohol metabolizes in your body during the second half of the night.

Prescription and over-the-counter medications can also have a great influence on sleep quality.


Tip: Cut out caffeine 3-4 hours before hitting the hay.

• Pay attention to how much alcohol you are consuming before bed - reduce or eliminate for a more restful night's sleep.

• Look at the side effects of your prescription or over-the-counter medication - consult your physician to see if it can be taken at a different time of day or alternative medication options.


8. What environmental factors affect your nighttime habits?

Looking at where you drift off for the night is just as important as looking at the things that are going on around you.

Are you sleeping in your own bed? Is it comfortable or do you need a new one? Have you thought about using pillows between your legs or a new pillow for better positioning? Is there a lot of noise in your bedroom? Is it too light?


Tip:  If sleep is starting to truly impact your daily life, it is time to make it a priority!

  • Try white noise machines, black out shades, eye masks or positioning pillows to increase your comfort.

<Click here to download the FREE Patient Handout: Sleep Questionnaire. Perfect way to figure out steps needed to help patients get a better night's sleep.>

Leave a comment below telling us your #1 tip.

Comments 6

  1. I really appreciate you talking about pre-bedtime routines and how they can really affect the way you sleep at night. My spouse has had some big issues with sleeping lately and she needs help. I’ll try to let her know that there are some medical experts that can help out and find out what’s going wrong.

  2. Mandy

    I appreciate that you brought attention to this overlooked Activity of Daily Living (ADL). In twenty years of OT practice, poor sleep is the most common complaint I get from older adults. Your tips for helping patients sleep has inspired me. I will be more deliberate about including sleep hygiene in my evaluations and treatment interventions. One channel on our TVs continually broadcasts nature scenery and relaxing music. Some patients use that to relax before bedtime. Do you have suggestions for implementing sleep routines with patients when you aren’t in the facility at bedtime?

    Thanks again,

    Kate Burke, OT

    1. Post
      Author

      That is definitely a whole additional post, isn’t it 🙂 I think a lot depends on the cognitive level (here is a podcast on sleep for people with dementia: https://seniorsflourish.com/podcastsleepanddementia/), but if you are in a SNF, you could write goals around it and focus on how lack of sleep if affecting their ADL (ex: LTG goal for independent eating and STG to include sleep hygiene or increasing stimulation during the day, etc). If it is a part of the goals, it could definitely be a part of their care plan. Maybe a checklist for staff to do before bed: dark room, ear plugs, reduce caffeine, etc) with a component of staff education. Just a few thoughts…

  3. Thanks for putting this together, Mandy. Sleep is SO important! Last year I became trained in Cognitive Behavioral Therapy for Insomnia and it really shifted the way in which I work with my patients on sleep. One thing that course taught me is that sleep hygiene is NOT an effective treatment for chronic insomnia. If someone has been having trouble falling asleep or staying asleep for 3 months or more and it’s causing them impairment (in mood, function, etc) they may meet criteria for chronic insomnia. Sleep hygiene unfortunately can’t address all of the dysfunctional thoughts/beliefs about sleep and habits that have built up over time with insomnia. I believe one study – can’t find the citation now, grr – even indicated that attempting to treat someone’s insomnia with sleep hygiene can make them more resistant to more effective treatments down the road because people will feel like they’ve “tried it all” and it didn’t work. A couple of great recommendations that I use with everyone include: no naps unless needed for safety (you nailed this one!), don’t get into bed until you’re tired, get out of bed if you can’t sleep within 15-20 minutes, only use the bed (and ideally bedroom) for sleep and sex, and spend about an hour before bed winding down (you mentioned this in routine).

    A couple more notes: caffeine has a half life of 3-7 hours; where you fall in this range really depends on the individual. However, the half life extends as we age. Therefore it may be more effective to limit caffeine at minimum 5-7 hours before attempting sleep. My patients like to tell me that coffee or soda doesn’t affect them and I like to teach them how studies have shown that while individuals may still fall asleep after ingesting caffeine, the quality of sleep – specifically the time they spend in deep, Stage 3 sleep – is reduced.

    Another good thing for us to remember is that a key factor in daytime sleepiness is sleep apnea. I’ve found that being able to do a STOPBANG with my patients and sharing positive results with providers has resulted in helpful referrals for sleep studies. The primary care docs with whom I work don’t always seem to have the time to do a screening and appreciate when I can provide this information. I also work with individuals to become confident in their use of a CPAP through graded exposure and education.

    Thanks again for sharing these tips and hope it’s okay to add to them with this information.

    1. Post
      Author

      Thank you Kera!! I love the insight and addition to the post – I appreciate you taking the time to add to these recommendations – love it!

  4. Pingback: Sleep Problems in Our Patients with Dementia | Seniors Flourish

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