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Dr David Lee, from Sleep Unlimited, sharing with Headway his expert advice on getting a good night's sleep following a brain injury.
This video summarises a lot of the information below in a brief format from a leading clinician in the area of head injury related fatigue and the impact of sleep.
How can an Occupational Therapist support with relaxation and sleep to combat fatigue?
Education
Revisit activity diary & rate how energy consuming your patient's activities are
Educate them on the importance of building in rest, pacing and energy conservation (as per previous sections)
Encourage your patient to develop a day & night time routine - help with planning if required - to build in regular rest periods
Relaxation & Breathing Exercises
Some patients may respond well to relaxation exercises
There are a huge variety of relaxation and breathing exercises
There is limited evidence for breathing exercise use in fatigue management
Evidence is limited for the effectiveness of relaxation as a stand-alone treatment, however it is unlikely to make the condition worse and self-reports from patients tend to be favourable when used with other treatments
Factors which can affect sleep quality
Environment:
Too hot
Too cold
Thoughts:
Thoughts going through your head “I’m not going to be able to get to sleep”
Emotions:
Feeling low in mood
Feeling anxious
Behaviours:
Watching TV in bed
Drinking alcohol or caffeine before bed
Dozing in the evening
Physical:
Pain
Bladder or bowel problems
Eating or drinking in large amounts
Sleep Hygiene
Use your bed for sleep (and sex) only
Re-establish a regular sleep pattern
Establish bedtime rituals
Make your bed and bedroom as comfortable as possible
Write down any worries or things to do before bedtime
Reduce day time sleep gradually
Take regular exercise
Avoid tea, coffee, fizzy drinks, smoking or alcohol in the evenings
Avoid anything physically or mentally taxing before bed
Avoid going to bed when you don’t feel sleepy
Avoid napping in the evening or late afternoon
Avoid staying in bed to catch up on sleep
Try a relaxation technique if you cannot sleep (ask your therapist for more details if you are interested in this)
Try a repetitive mental exercise if you cannot sleep e.g. go through the alphabet and think of a country that begins with each letter
If you can’t sleep within 20-30 minutes, get up and do something relaxing until you feel sleepy again
Activity Diary Revisited
Below is an example of an Activity Diary which may have been completed by the patient at the start of the OT's intervention. This has been highlighted. The colours represent how restful or energy consuming the activities are. Red means an activity is very energy consuming, Yellow means the activity is less energy consuming and Green means the activity is restful, or restores some energy.
On the left hand side, the patient has completed their pre-intervention activities as they would normally complete them in a day. They have then rated each activity in terms of energy consumption.
The planner to the right represents a plan the patient may have created following education from their OT. Notice how much more frequent the green activities are and how much more spread out the red and yellow activities are.
The next step would be for the patient to follow their new plan and evaluate what their fatigue levels are like afterwards.
Click on the image on the left hand side. This link will take you to the website of the Royal College of Psychiatrists which has tips you can use to help your patients sleep better.
Activity
Using the above information and the articles in this section, plan an evening timeline which would be suitable for your patient to wind down before bedtime.
You can use a table like the one to the right hand side to start you off.
Choose a time that you will go to bed and plan the activities directly before and after.
Evidence Based Practice
Occupational Therapy practice needs to be led by evidence.
This is a list of relevant scientific research and articles relevant to sleep in fatigue management.
Please take the time to familiarise yourself with the research base in order to provide the most up-to-date care to your patients.
Relevant articles
Relevant articles
Akbarfahimi, M., Nabavi, S. M., Kor, B., Rezaie, L., & Paschall, E. (2020). The Effectiveness of Occupational Therapy-Based Sleep Interventions on Quality of Life and Fatigue in Patients with Multiple Sclerosis: A Pilot Randomized Clinical Trial Study. Neuropsychiatric Disease and Treatment, 16, 1369–1379. https://doi.org/10.2147/NDT.S249277
Poole, J. L. & Siegel, P. (2017). Effectiveness of Occupational Therapy Interventions for Adults With Fibromyalgia. The American Journal of Occupational Therapy, 71 (1), 71011800401-710118004010. doi: 10.5014/ajot.2017.023192.
Cooper, J. (2014). What is the cancer patient’s own experience of participating in an occupational therapy led relaxation programme? Progress in Palliative Care, 22(4), 206–211. https://doi.org/10.1179/1743291X13Y.0000000081
Kneebone, I. I., Van Zanden, B. E., Dorstyn, D. S., Roberts, R. M., Lord, S. R., Querstret, D., Theadom, A., Kennedy, D. S., Raman, J., & Nair, R. das. (2022). Relaxation and related therapies for people with multiple sclerosis (MS): A systematic review. Clinical Rehabilitation, 36(7), 883–899. https://doi.org/10.1177/02692155221091509
Ho, E. C. M., & Siu, A. M. H. (2018). Occupational Therapy Practice in Sleep Management: A Review of Conceptual Models and Research Evidence. Occupational Therapy International, 2018, 8637498–12. https://doi.org/10.1155/2018/8637498
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