Commentary: Restful Rehabilitation: Sleep’s Essential Role in Occupational Therapy Education, Intervention, and Research

Jason Browning, PhD, OTR/L

Assistant Professor, Radford University, 101 Elm Ave SE, Roanoke, VA, 24083, United States

Abstract

This commentary explores the critical role of sleep in occupational therapy, inspired by the article Restful Rehabilitation: Sleep’s Essential Role in Occupational Therapy Education, Intervention and Research by Browning et al. in 2024.   The author advocates for elevating sleep as a core occupation within the profession.  Despite its importance, sleep remains underrepresented in occupational therapy education, practice, and research.   This article calls for integrating sleep into the daily evaluations and treatment of clients within occupational therapy, revising current treatment models to include sleep and sleep health, and expanding empirical research to provide evidence-based treatments within the occupational therapy profession. By embracing sleep as a fundamental occupation, occupational therapy practitioners can better serve their clients and help fill a critical void in healthcare.   This commentary reinforces the urgency of positioning occupational therapy as a leader in sleep care and rehabilitation.

Introduction

The article “Restful Rehabilitation: Restful Rehabilitation: Sleep’s Essential Role in Occupational Therapy Education, Intervention, and Research by Browning et al.¹ explores the pivotal role of sleep in occupational therapy.  The article aims to change the sleep valuation² for occupational therapy practitioners and provide clear pathways to increase their sleep knowledge by increasing the presence of sleep in occupational therapy education, intervention, and research.  Sleep is an essential component of life, a biological necessity, and a critical determinant of health across the lifespan^3-5.  Adequate sleep supports emotional regulation, pain perception, injury recovery, enhances cognitive functioning, and promotes overall productivity and engagement in daily activities^6-9. These areas are often addressed in occupational therapy, making it essential for practitioners to prioritize sleep as a key occupation of their clients. The purpose of this commentary is to discuss the key points presented in the article, emphasizing the integration of sleep evaluation and treatment into occupational therapy.

Sleep's Infiltration into the Profession is Slow

Sleep is an occupational right of humans, and every human deserves restful and adequate sleep ¹.   Occupational therapy practitioners are well-equipped in their academic training to address many of those deficits but often do not view sleep as an underlying cause^10-12. Sleep is often viewed as a secondary concern in the therapeutic reasoning process due to limited sleep health education and available research to support sleep intervention within occupational therapy^10-13. An awareness of the link between sleep deficiencies and occupational deficits is growing, but many practitioners still lack the knowledge and confidence needed to effectively address sleep in their practice¹⁴. In the original article, we spoke to the importance of infiltration of sleep cognizance into the education of practitioners.  Establishing comfort in treating and evaluating sleep as an underlying cause of many occupational deficits would lead to increased sleep research within the profession of occupational therapy.

Education

A major concern, laid out within the original article, is that most occupational therapy practitioners report not being educationally prepared to address the occupation of sleep^10-12,14. As laid out in the article, sleep needs to be viewed and taught in educational programs as an underlying bodily function and a core occupation that impacts all other occupations¹¹. One recommendation from the original article was to emphasize the impact of sleep on occupational performance through the Accreditation Council for Occupational Therapy Education (ACOTE) standards.  Currently, sleep is not explicitly mentioned in these educational standards.  Given its significance as a fundamental occupation that affects everyone, I believe it is essential to highlight sleep in the standards to underscore its importance to human existence and in occupational therapy practice. Secondly, I feel that sleep should be a component of every course involving intervention or evaluation within occupational therapy programs.   According to Poole et al.¹⁴ entry level occupational therapy programs have approximately 2 hours of sleep education.  If sleep assessments and current evidence-based sleep treatment protocols were emphasized and threaded throughout intervention and evaluation courses, occupational therapy practitioners would be more equipped in evaluating and treating underlying conditions which are directly related to sleep.  Until this occurs, the benefits of sleep within occupational therapy practice cannot be fully addressed with clients across the lifespan. By incorporating sleep into evaluations and treatments, occupational therapists can provide more holistic care and empower clients to achieve their fullest potential. 

Treatment and Research

Sleep has been discussed in occupational therapy treatment since the profession's founding in 1917. Meyer argued that a natural rhythm of work, rest, sleep and play were foundational components for humans¹⁵. Unfortunately, after that initial introduction of the concept of sleep as a primary occupation, sleep faded away to an argument with in sleep medicine that sleep was an inactive phase both physically and neurologically¹⁶. This concept led the occupational therapy profession to address daytime, active occupations^12-13. Green¹³ argued that the lack of discussion may have come merely because of lack of interest from professional leaders.  I agree; historically, the Industrial Revolution shifted the perception of human performance to one primarily measured through the lens of productivity.  This reductionist vision drove healthcare to a medical model of treating illnesses and required a focus on active occupations or ones that increase productivity and less on overall health and wellness¹⁶.

The passiveness theory of sleep was debunked in sleep science with the discovery of rapid eye movement (REM) sleep in 1953¹⁷, and additional developments within sleep science have embraced the fact that sleep is a very active and necessary bodily function and occupation¹¹.    However, the passive sleep concept held strongly among occupational therapy scholars as sleep vastly disappeared from occupational therapy journals from the 1920s to the 1990s when sleep started to appear in literature again¹³.  The momentum has increased since the 1990s and more and more sleep-based articles appear in occupational therapy or rehabilitation journals.   This momentum of sleep science should catalyze occupational science and occupational therapy to prioritize sleep research and integrate sleep-focused, evidence-based models and interventions into practice. 

Implications of the Article

The Browning et al.¹ article highlights the importance of sleep and points out significant gaps in sleep concepts in occupational therapy education, intervention, and research. To address these concerns, the authors make a call to the accreditation council to integrate sleep-based evaluation and treatment statements into educational standards at all entry levels into the profession.   The authors encourage occupational therapy practitioners to seek educational opportunities outside of their degree by seeking continuing education opportunities, whether at occupational therapy-based or sleep-based conferences, or individual sleep-based courses (e.g., American Occupational Therapy Association National Conference, The SLEEP Conference-Jointly hosted by the American Academy of Sleep Medicine and Sleep Research Society or Colorado State University’s CBT-I Training for Occupational Therapy Practitioners). Because there are significant gaps in embracing the importance of sleep within the profession, I believe it is essential for individual practitioners to take personal responsibility for expanding their sleep knowledge to better serve their clients.   

The authors of the original article clearly articulate the role that occupational therapy practitioners play in sleep interventions. They advocate for developing standardized sleep and occupation-based assessments to evaluate sleep and evaluate the impact of sleep deprivation on daily occupations.  The authors encourage the practice of incorporating sleep questions into all client evaluations and recommend integrating sleep health concepts into existing occupational therapy practice models to enhance their clients’ outcomes. The authors also acknowledge the current lack of detailed guidelines for implementing sleep-focused strategies into practice. This is a wake up call for practitioners, educators, and researchers to participate in empirical research to demonstrate the effectiveness of sleep interventions for client populations commonly served by occupational therapy practitioners.  If these suggestions spark a move within occupational therapy practitioners, it will align the profession to be a key contributor in a healthcare space that is critically underserved¹⁸.  By actively responding to the authors’ call to action, occupational therapy practitioners can address critical gaps in care and enhance the overall health of their communities.

Conclusion

Restful rehabilitation is more than just a title. It is a vision for the future of occupational therapy.  By recognizing sleep as a core occupation, the occupational therapy profession can strengthen its role in promoting health, supporting meaningful occupations, and enhancing clients’ overall quality of life.  Sleep is not a luxury; it’s a necessity. 

Acknowledgement

I declare that no funding, grants, or other support were received during the preparation of this manuscript.  However, I would like to acknowledge the co-authors of the original article and their support and collaboration. 

References

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