Wake up to the occupation of sleep: Its importance in the older adult

Wake up to the occupation of sleep: Its importance in the older adult

by: Anette Bullard, MEd, COTA/L and Anjali Parti, OTD, OTR/L 

WAKE UP TO THE OCCUPATION OF SLEEPEveryone has experienced having to power through the day after a night of not sleeping well with every aspect of the day feeling more challenging due to your lack of sleep. The National Institute of Health (2017) identifies sleep as one of the most important occupations for maintaining all aspects of health. In fact, the Centers for Disease Control and Prevention (2018) has recognized sleep deprivation as a public health problem with broad, negative effects on safe occupational performance. For the older adults the challenges brought on by age compounded with a lack of sleep can further decrease successful occupational performance. Many age-related changes tend to disturb patterns of sleep and the myth that older adults need less sleep is actually incorrect (Suni, 2022b). The older adult is confronted with additional sleep obstacles such as, chronic conditions, medications, diminished physical activity, and decreased cognitive exercise, all of which have all been associated with decreases in sleep satisfaction. The resulting downward spiral of poor sleep results in less successful occupational engagement. The Occupational Therapy Practice Framework includes ‘rest and sleep’ as an area of occupation and defining occupational therapy practitioners as qualified professionals to assist clients with the occupation of rest and sleep (American Occupational Therapy Association, 2020). This brief article seeks to assist practitioners with identifying resources and awareness for more consistently addressing the occupation of sleep in the older adults. 

With age-related changes negatively impacting sleep patterns, the quality and quantity of sleep is also influenced. Older people tend to wake more frequently through the night resulting in less nighttime sleep and more daytime, fractured sleep (Suni, 2022a). According to the work by Leland et al. (2014), occupational therapy is well equipped to address sleep problems by targeting the areas that may contribute to poor sleep, like context and environment, performance patterns, and limited engagement in activities during the evening. Assessment tools include informal assessment of sleep, patient self-report measures, and/or recommendations for objective assessments, such as polysomnography or actigraphy (SleepOT, 2016). By utilizing the Modified Interest Checklist and asking when current occupations are usually participated in may assist occupational therapy practitioners in better understanding a client’s daily patterns and exploring recommendations for better rest and sleep (Klyczek, 1997).

An evidence-based literature review by the American Occupational Therapy Association (2017) provides the results of several research projects in order to inform practitioners with proven intervention techniques for improving rest and sleep. Some of the examples include specific physical activities, sleep schedules, and modified routines (American Occupational Therapy Association, 2017). Strong evidence supports cognitive behavioral intervention strategies for older adults like relaxation, sleep hygiene education, problem solving, and physical exercise, among others, which can be delivered one-on-one or in a group. Routine use of these interventions is recommended (Smallfield, 2018). Another article describes a unique form of combined physical/cognitive exercise also known as Tai Chi Chuan, which is based on the relationship between physiological and psychological gain associated with activity (Hogan, 2005). This intervention program specifically combines physical exercise, cognitive exercise, and relaxation into a single program designed to promote resilience in older adults (Hogan, 2005). Another great resource for professionals is a resource with the perspective of occupational therapists from around the world interested in sleep as an occupation. This website provides information on normal sleep, sleep problems, assessments of sleep, and specific OT interventions for sleep and rest (SleepOT, 2016).

In conclusion, occupational therapy practitioners are encouraged to include the considerations of rest and sleep when analyzing occupational occupational performance with all clients, but especially the older adult population. More research on the domain of rest and sleep with the focus on its impact on occupations is needed in order to support engagement in meaningful activities and provide additional evidence of effective interventions to include in treatment. 


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Suni, E. (2022). How much sleep do we really need? https://

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