1. Getting a good night sleep
By Vicky Crosbie and Lorna Collins
Rheumatology Occupational Therapists

2. The OT role in Rheumatology
Our role is to work with people with rheumatological conditions who are experiencing problems with Activities of daily living. We approach these problems through shared goal setting using;
Problem solving
Practical solutions
Education
Self management strategies
As OTs we look at patients holistically which means looking at them as a whole person, including them physically, psychologically, their environment and their routines. We can then provide support with strategies for managing sleep

3. Common sleep problems Getting to sleep Pain Discomfort
Waking up in the night
Waking up not feeling refreshed in the morning
Worrying thoughts
Sleep can be disturbed by many things, if we are feeling anxious, can find it difficult t get off to sleep, if feeling a bit low tend to wake up earlier in the morning. Pain, noise and cold similarly can all disturb sleep.

4. What is normal Sleep? Vital function Possibly: - rest and recovery
- Energy conservation
- Memory consolidation
- Brain development
- Discharge of emotions through sleep
No solid answer as to what ‘normal sleep is’ but we know it is a vital bodily function.

5. Normal sleep How much do we need?
Enough to feel refreshed and able perform daily tasks satisfactorily
Ideal world- go to bed when tired and sleepy, get up when refreshed without an alarm.
More to do now to keep us awake, resulting in sleep problems.
Average person hours sleep
Not consistent throughout history or other cultures.
All need different amounts of sleep.
Pre- industrialisation, sleep for 2 hours quiet wakefulness for 2 hours and then sleep another 2 hours.
Nap culture- siestas.
Churchill got by on 4-5 hours per night
Edison invented light bulb so people wouldn’t have to waste time sleeping.

6. Sleep cycles Drive to sleep builds up through out the day
Long enough time between sleep periods is needed.
At night we sleep in cycles, these are 90 minutes long.
Body gets a signal that it has long enough time between sleep periods to sleep.
Deep sleep comes early in the night, that is restorative for the body, REM sleep is dreaming sleep, and then light sleep. This is a 90 minute cycle. You can wake up in between cycles for approx 10 minutes, we don’t remember this.
We under

7. Sleep cycles Underestimate how much sleep we have had. Body clock
day light
Meal times
routine
Arousal levels need to be low to sleep e.g. if you anxious, excited and angry you will not get to sleep easily.
Only remember waking up, don’t remember sleeping.
Body clock influential in resetting sleep cycles, daily light, meal times and routine can all reset it.
In order to sleep arousal levels need to be low.

8. How do you get a good night sleep?

9. What can you do to sleep better?
Think and behave like a ‘good sleeper’
Helpful habits and routines
Appropriate associations
Adjust routine if difficulty sleeping.
That’s whey we need to have helpful habits and routines to aid sleep, behave like good sleepers.
Appropriate associations- bad experience of going to bed- wont sleep in bed. Don’t eat/work in bed, not a restful place then.
If you can sleep no problems despite any other distractions in the bedroom no changes need to be made, if you do have problems you need to change your routine.
Life style factors alone may not cure insomnia or sleep disturbance but may help promote sleepiness

10. Being a ‘good sleeper’ Get up at the same time every day
Environment; associate your bed with sleep not work, eating, T.V etc.
Appropriate sleeping conditions; Supportive mattress and pillow, temperature, lighting and noise.
Gentle Exercise helps reduce stress, depression and anxiety as well as many other health benefits - no later than early evening due to over-stimulation.
Same time get up-Regulates body clock
Rise black out blinds as soon as awakening to reset body clock.
Bath 1.5 hours before bed, internal body temp not too hot or cold.
Do something un-stimulating in low lighting.

11. Being a ‘good sleeper’ ‘wind down’ routine Relaxation/imagery.
In the evening avoid; Caffeine (tea/coffee/chocolate/medication)Nicotine and alcohol, heavy/spicy meals and sugar.
Regular meal routine.
Go to bed when ‘sleepy’
Avoid day time naps if not planned.
Note pad to write down ‘things on your mind’

12. Being a ‘good sleeper’ Medication routine.
Pain control e.g. Warmth, splints, massage, Light stretching
Low activity levels in the day time reinforces poor sleep- We need stimulation to encourage sleepiness
15 minute rule
Challenging negative thoughts.
Energy conservation/fatigue management.
Sleep/activity diary

13. Going forward…
Start by making a few adjustments rather than doing it all at once.
New habits/routines need to be tried for at least 4-6 weeks, giving up after a week is not giving your body chance to adjust properly.
Nobody ever died from lack of sleep. Your body will eventually find a way to get the rest it needs.
Convince self that being awake isn’t harmful, your body will catch up. The more worried the more aroused you become

14. Any Questions??