Occupation is central to occupational therapy. In occupational therapy, occupations are the daily activities people engage in as individuals, families or communities to occupy their time and bring meaning and purpose to their lives (World Federation of Occupational Therapy, 2012). The new paradigm in occupational therapy is calling for a move away from impairment focus to an occupational focus (Machingura & Lloyd, 2017). Focusing on occupations such as sleep is therefore in line with this contemporary paradigm.
Sleep as an occupation:
There has been debate in occupational therapy about whether sleep is an occupation or not however the American Occupational Therapy Association Practice Framework now clearly identifies sleep as an occupation (AOTA, 2012). Sleep as an occupation is an emerging area of practice in occupational therapy (Watson, Garden, Swedlove, & Brown., 2014).
Sleep takes up a great amount of time in people’s daily lives and influences performance in occupations, making this an interesting and important topic for discussion.
Occupational therapy researchers have established that sleep is critical for optimal health, wellbeing, occupational performance and participation (American Occupational Therapy Association, 2012).
Occupational problems associated with sleep
Most adults need about 7 to 8 hours of sleep each day (Watson et al., 2014). There are, however people who are at risk of sleep occupational problems (described in figure 2) in communities who might benefit from occupational therapy interventions. These range from students to shift workers to people with caring responsibilities. Students often must juggle studies and other responsibilities they may have and as such are at risk of not having adequate sleep due to the lack of time to fit everything in. Drivers who drive long distances may not find enough time to sleep between their driving jobs. People who care for others and have jobs can also find it difficult to find time to sleep. Likewise, women with childcare responsibilities outside their day jobs could also find it difficult to find enough time to sleep. Some medical and psychiatric conditions make it difficult for people to sleep resulting in sleep deprivation.
Prisoners are another group of people who often suffer from occupational deprivation, alienation and marginalisation. Sleep can be a luxury in prison settings. Also, people in war zones, homeless people and those who are in institutions may all be at risk of sleep deprivation due to the environmental conditions they find themselves in.
Include sleep history in your occupational profile
Taking a detailed history that includes a sleep history will allow the occupational therapist to understand facilitators and barriers to sleep for the client. This is vital in formulating intervention strategies that will work for the client.
Use sleep as ‘ends’ and or ‘means’
As professionals, occupational therapists should be linking theory with practice. The Canadian Model of Occupational Performance and Engagement (CMOP-E) which describes occupation as a bridge between the person and the environment offers a practice framework to use when working with the occupation of sleep as a means and or ends. According to the Canadian Practice Framework, occupational therapists should enable occupation across the continuum including in individuals, groups, families and communities with potential occupational issues and the general population (Polatajko, Davis, Stewart, Cantin, Amoroso, Purdie, & Zimmerman., 2013).
Occupational therapists should address sleep problems in the following ways suggested in figure 1 below.
Figure 1: sleep occupational interventions
Figure 2: Explaining occupational problems
A way forward
Sleep as an occupation is certainly gaining momentum with some occupational scientists now turning their attention to helping NASA Astronauts in their preparation for long space exploration. (Davis, Burr, Absi, Telles, & Koh., 2017). This is fascinating however more research is also still needed on interventions that address occupational problems related to sleep.
- American Occupational Therapy Association. (2012). Occupational therapy’s role in sleep. Retrieved from http://www.aota.org/en/About-Occupational- Therapy/Professionals/HW/Sleep.aspx
- Davis, J., Burr, M., Absi, M., Telles, R., & Koh, H. (2017). The contributions of occupational science to the readiness of long duration deep space exploration. Work, 56(1), 31. Retrieved from https://search.proquest.com/docview/1867501764?accountid=26503
- Machingura, T., & Lloyd, C. (2017). Contemporary occupational therapy: disruption or transformation? International Journal of Therapy and Rehabilitation, 24(1): 5-6. 01/2017; 24(1):5., DOI:10.12968/ijtr.2017.24.1.5
- Polatajko, H. J., Davis, J., Stewart, D., Cantin, N., Amoroso, B., Purdie, L., & Zimmerman, D. (2013). Specifying the domain of concern: Occupation as core. In E. A. Townsend & H. J. Polatajko (Eds.), Enabling occupation II: advancing an occupational therapy vision for health, well-being & justice through occupation (2nd ed., pp. 13–36). Ottawa: Canadian Association of Occupational Therapists.
- Watson, M., Garden, J., Swedlove, F., & Brown, C. A. (2014). Back to the basics: Sleep and occupation. Occupational Therapy Now, 16(6), 8-10.
- World Federation of Occupational Therapists. (2012). Occupation. Retrieved May 13, 2016, from http://www.wfot.org/AboutUs/AboutOccupationalTherapy/DefinitionofOccupationalTherapy.aspx
Assistant Professor of Occupational Therapy Tawanda Machingura, 2018