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Sleep: The Unconscious ADL

Sleep: The Unconscious ADL
Caryn Shore-Genack, MS, OTR/L
July 20, 2016

Introduction and Overview

I am Caryn Shore-Genack and I received my master’s in occupational therapy in 2011, after an extensive career in both education and fitness. I presented a webinar last year on OccupationalTherapy.com on the use of functional exercise for occupational therapists. I have many passions, one of which is sleep. Unlike therapeutic exercise, sleep is something that has always thwarted me. I was recently teaching OTAs at the college level. On the very first day of lecture (it was a mental health course), I was explaining how to use the GAF scale, and every student had a question or a goal related to sleep or time management (e.g., how to get more sleep, how to get a better quality of sleep). It became apparent that this was an area that not only related to myself, it extended to my students, to our participants, our patients, our clients, and our consumers. I realized that this was an area in which I wanted to develop an expertise. I approached OccupationalTherapy.com to see if this was something there would be a market for so that I would have an opportunity to do the research.

When I presented it to my class, it was as an IADL lab. It was performed as a small group intervention and every student had something to contribute to the conversation, which drove home to me how relevant this subject was. In my prior experience, how did the ADL of sleep relate to my practice as my occupational therapist? When I'd have a drowsy patient and I'd say to them, "What would you like to work on today," they would say, "I'd like to go to sleep." I would say, "Oh, interesting. That is occupational therapy, but we're not going to do that now." It is understandable that the inability to get a good night's sleep would negatively impact the patient’s ability to actively engage in skilled occupational therapy.

The Role of the OT in Sleep

As with all areas of occupation, it is important from the outset to understand the unique role of the OT and, more importantly, our unique perspective. How do we define sleep? Let's take a step back to our origins.

Sleep Defined

Adolf Meyer, who was one of the founding fathers of occupational therapy, was a neuropsychiatrist, and an advocate of occupational therapy early in the twentieth century. Adolf Meyer emphasized the importance of balance between four major areas in order to maintain good health: work, play, rest and sleep. It's especially important for us to distinguish between rest and sleep. In the table of changes to the OTPF framework, it is noted that the category of “rest and sleep” is no longer considered an activity of daily living, but rather it has been upgraded to an area of occupation. This is because of the importance of rest and sleep in supporting other areas of occupation. The rationale for the changes is explained in the OTPF II as such:

“Rest and sleep are two of the four main categories of occupation discussed by Adolf Meyer (1977). Unlike any other area of occupation, all people rest as a result of enhancing in occupations and engage in sleep for multiple hours per day throughout their lifespan. Within the occupation of rest and sleep, napping, dreaming, night-time care of toileting needs, night-time caregiving duties, and ensuring safety. Sleep significantly affects all other areas of occupation. (IT is) suggested that providing sleep prominence in the framework as an area of occupation will promote the consideration of lifestyle choices as an important aspect of participation and health.

As per the OTPF third edition, there are eight areas of occupation. Rest and sleep are grouped together and defined as activities related to obtaining restorative rest and sleep to support healthy, active engagement in other occupations. There are two stages of sleep: preparation and participation.

Sleep preparation (1) Engaging in routines that prepare the self for a comfortable rest, such as grooming and undressing, reading or listening to music to fall asleep, saying goodnight to others, and engaging in meditation or prayers; determining the time of day and length of time desired for sleeping and the time needed to wake; and establishing sleep patterns that support growth and health (patterns are often personally and culturally determined). (2) Preparing the physical environment for periods of unconsciousness, such as making the bed or space on which to sleep; ensuring warmth or coolness and protection; setting an alarm clock; securing the home, such as locking doors or closing windows or curtains; and turning off electronics or lights

caryn shore genack

Caryn Shore-Genack, MS, OTR/L

Caryn Shore-Genack worked for over a decade in the area of fitness as a group exercise instructor and master personal trainer for popular clubs like NYSC and Lucille Roberts before returning to school to pursue a degree in occupational therapy. Caryn graduated with her Master's degree in OT from SUNY Downstate and has been practicing in the field of physical dysfunction, specifically geriatrics in a sub-acute setting, while moonlighting in out-patient and delivering upper extremity care. Caryn has also taught as a professor for New York University's Master's program in occupational therapy and the OTA program at Eastwick College in Ramsey, NJ. Caryn is enthusiastic about incorporating her knowledge of exercise and fitness into occupational therapy.

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