sleep and occupational therapy

Sleep in acute care

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Occupational therapy intervention and sleep in acute care

 Sleep is considered an occupation according to the OT Practice Framework (3rd Ed.)(AOTA, 2014).  In a previous blog, I discussed sleep in general and how/why OTs should be addressing sleep – check it out here. In this particular blog, I discuss sleep as it relates to clients in acute care environments.

Acute and ICU environments can lead to sleep disturbances and lack of sleep can effect healing and recovery.

Why does sleep matter?

  • Lack of sleep can result in:
    • Declines in function
    • Increased risk of falling
    • Impaired cognitive function
    • Increased morbidity and mortality
    • Poor recovery and mood


  • In ICUs in particular, inadequate sleep can result in:
    • Immune system dysfunction
    • Decreased resistance to infection
    • Impaired wound healing
    • Increased risk of delirium


Causes of Poor Sleep in Acute Care Settings:

Procedures that occur in early morning hours (medication administration) or those that take an excessive amount of time to complete (diagnostic procedures), limit the amount of time available for sleep.  Scheduling these procedures also forces patients to release control of their schedule, making it difficult to main adequate sleep hygiene.

Common noises in a hospital:

  • Phones/pagers, bedside phone, television, medical equipment, alarms, lighting

Other environmental factors:

  • Room Temperature (clients are unable to control; lack of fresh air)
  • Lack of windows – no clues for day versus night which can disrupt the circadian rhythm
  • Lighting

Psychological factors can also impact sleep:

  • Anxiety
  • Depression
  • Unrealistic expectations of sleep

Finally, physiological factors that can impact sleep in the hospital:

  • Pre-existing sleep difficulty
  • Changing sleep structure with age
  • Pain
  • Medications
  • Disease processes
    • Renal Failure- results in insomnia and daytime sleepiness
    • Rheumatoid Arthritis- fragmented sleep, reduced pain threshold
    • Neuromuscular conditions- poor sleep due to periodic leg movements and muscular contractions
    • Heart attack- poor sleep due to increased arousal and reduced time in REM sleep
    • COPD- hypoxia negatively impacts sleep
    • Left Ventricular Failure- results in paroxysmal nocturnal dyspnea

Occupational Therapy Interventions to Address Sleep:

  • Positioning (position for comfort and healing)
  • Teach relaxation techniques (meditation, relaxed breathing, progressive muscle relaxation)
  • Pain reduction techniques (discuss timing of medications, positioning for sleep)
  • Sleep hygiene (help client discover ways to safely perform sleep hygiene in hospital and/or explore ways that typical sleep hygiene routine can be performed)
  • Environmental cues:  move bed towards window if able, sun and moon signs on room wall to indicate day and night, be sure that client can view a clock
  • Use bedside lamp instead of overhead lights during evening hours
  • Suggest wearing ear plugs and eye mask to provide an environment conducive to sleep;  help client position these items for use and practice putting them on or instructing family or nursing to help.

Sleep is an occupation!  Occupational therapists who routinely assess and treat sleep in acute care environments help their clients heal.

Check out my blog on sleep and OT for more details about assessment and evidence-based interventions!

Acknowledgement: This blog post would not be possible without the help of Andrea Matanovic, a student in the MOT program at CSU when this was written. She has a passion for acute care and hopes to be working in an acute care setting soon!

Cover photo courtesy of Pixabay.


Leland, N. E., Kelkar, K., Marcione, N., Schepens Niemiec, S. L., & Fogelberg, D. (2014). What is occupational therapy’s role in addressing sleep problems among older adults? OTJR: Occupation, Participation and Health, 34(3), 141–149. doi:10.3928/15394492-20140513-01

Reid E. (2001). Factors affecting how patients sleep in the hospital environment. British Journal of Nursing, 10(14), 912–915.


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