Everyone has to sleep - sleep is a natural state of rest where the body is inactive, the mind unconscious, and the eyes are closed. However, for many people living with a wide variety of medical conditions and diagnoses, restful sleep can be elusive, leading to compounding health issues, and challenges for their caregivers.

Nighttime can pose a serious safety risk for those prone to sleepwalking, battling dementia or with conditions that make them susceptible to falling out of bed. Fortunately in the complex rehabilitation community, there is research being conducted, and equipment being developed, to help people improve the length, quality and safety of their sleep.

Why is sleep so important?
Sleeping is a basic, necessary human function. The lack of sleep can lead to physical and mental health problems, injuries, loss of productivity and a greater risk of death (NHLBI 2017). When we experience a lack of or poor quality sleep, we have trouble thinking and functioning.

What is sleep?
Sleep is divided into two types: Rapid Eye Movement (REM) which is where dreaming occurs, and non-REM, known as deep sleep or slow wave sleep. These two types of sleep occur between three to five times a night in a cyclic pattern. Our ability to function, and our wellbeing, depends on whether we are getting adequate quality and quantity of the two types of sleep.

In addition, we have an internal body clock known as the circadian rhythm, which controls when we wake up and when our bodies are ready for sleep. The circadian rhythm follows a 24-hour repeating cycle and has an influence on every cell, tissue and organ in the body.


What is sleep deficiency?
Sleep deficiency is classified as a public health issue, and is marked by an inadequate amount of good quality and quantity of sleep over a period of time. Sleep deficiencies can impact anyone; all ages, races and ethnicities. However, certain population groups are more prone to sleep deficiencies - including caregivers, shift workers, individuals with undiagnosed and diagnosed medical conditions, and those taking medications that may interfere with sleep. In the complex rehabilitation community several conditions that have been associated with sleep difficulties include Angelman’s Syndrome, Autism, Brain Injury, Cerebral Palsy, Dementia, Epilepsy, and Sleepwalking or Smith Magenis Syndrome (SMS).

Evidence shows that individuals who are sleep deprived, may be at higher risk of vehicle crashes, obesity, psychological disorders (anxiety and depression), musculoskeletal disorders and diminished immune responses. They are also more susceptible to chronic diseases including hypertension, cardiovascular disease, gastrointestinal disease, cancer and diabetes (CDC 2018).

How do sleep deficiencies influence our bodies?
Hormones: Individuals who have sleep deficiencies experience an irregular secretion of insulin and are unable to process glucose efficiently. This results in a higher risk of developing type 2 diabetes and obesity. Reduced sleep also has a direct negative influence on the amount of cortisol, and growth hormones released. During deep sleep growth hormone is released, which is essential for building muscle mass, and the repair of cells and tissues.


In addition, our immune system is reliant on adequate sleep. Individuals who are sleep deficient may be more susceptible to common infections.

Many people we work with in the Complex Rehab community have a health condition, and those conditions are further compounded by sleep difficulties - causing a negative impact on overall wellbeing. If we can modify and address sleep difficulties we may be able to positively influence hormones and brain functions.

Brain: Inadequate sleep impacts our ability to concentrate and focus. Sleep deprivation negatively influences our working memory - which may result in human errors of a catastrophic nature, or simply make it difficult for a child to learn in school.

The combination of a disability, and sleep deprivation, may result in a child struggling even more at school. The appropriate quality and quantity of sleep allows our brain to form new pathways and remember information, which enhances our ability to learn and problem solve.

Helpful Interventions to Promote Sleep
Occupational Therapists make use of several sleep interventions to promote good sleep. These interventions include establishing bedtime routines, modifying the sleep environment, and addressing sensory needs. Below are detailed tips on how to create healthy bedtime routines (AOTA 2017).

  • Establish specific bedtimes and routines that include a regular predictive sequence of events leading up to bedtime.

  • Prepare for bedtime by avoiding stimulating activities, and implement inhibitory stimuli such as calm, soothing music.

  • Create a comfortable bedtime routine by implementing sensory experience bedtime stories, ensure the temperature is appropriate, eliminate bright light, and ensure that the bed environment is safe.

Emerging Product Solutions
There are emerging product solutions becoming available that can help children and adults who struggle to stay in a conventional bed, and are at risk of wandering. These products help create a safe place to sleep, and assist in establishing a bedtime routine. The modified sleeping environment provides tremendous sleep benefits to the user, and provide peace of mind for the user’s caretakers.

These products are tent-like systems that prevent the user from easily climbing or falling out of bed. The set-up helps limit visual stimulation, and enhances the ability to sleep. They are often easily portable, and can be taken when traveling to create a consistent sleep environment for the user - even in an unfamiliar place.


The importance of sleep is hard to overstate. Consistent, restful sleep is critically important to the health of every human being - especially those with medical conditions that make sleep challenging. By establishing a regular bedtime routine and utilizing innovative new equipment – safe, healthy sleep is possible. For more information, consult your healthcare provider, or the references listed in this paper.

References

Sleep Disorders
https://www.howsleepworks.com/disorders_other.html 

Sleep Deprivation
https://www.sleepassociation.org/sleep-disorders/sleep-deprivation/

 
Sleep Deficiency 
https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency

 
Association of Occupational Therapists of America (AOTA): Occupational Therapy’s role in Sleep. https://www.aota.org/About-Occupational-Therapy/%20Professionals/HW/Sleep.aspx
 
Association of Occupational Therapists of America (AOTA): Establishing bedtime routines for children https://www.aota.org/About-Occupational-Therapy/Patients-Clients/ChildrenAndYouth/Bedtime-Routines.aspx
 
Autism and sleep disorders
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770638/

 
Centers for Disease Control and Prevention (CDC) 2018 https://www.cdc.gov/sleep/index.html

Lee Ann Hoffman, OT, ATP

Author

Lee Ann Hoffman, OT, ATP

Lee Ann Hoffman is a certified assistive technology professional with a background in occupational therapy. As a Clinical Educator at Numotion, she is passionate about 24-hour posture management for individuals with complex rehab needs and is a regular presenter at industry conferences. Prior to joining Numotion, Lee Ann worked in multiple advisory roles for medical equipment companies and has practiced occupational therapy in the United Kingdom and South Africa. She holds a master of science degree in rehabilitation with a concentration in posture management from Oxford Brookes University and completed her occupation therapy training at the University of Pretoria.

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