How Can Occupational Therapists Help Improve Quality of Sleep?
Emily Hartney, MOT, OTR/L
Understanding Sleep Needs
Is your child getting enough sleep? Sleep is essential for overall health, yet the amount of sleep individuals need varies. Below is a breakdown of the recommended sleep durations by age:
Recommended Sleep Duration by Age
The Role of Occupational Therapy in Sleep
Occupational therapists (OTs) strive to enhance quality of life by promoting participation in meaningful occupations, including sleep. According to the American Occupational Therapy Association (AOTA, 2020), “Rest and sleep [are] activities related to obtaining restorative rest and sleep to support healthy, active engagement in other occupations” (p. 32). Sleep is a vital occupation because it restores the mind and body, supporting emotional regulation, cognitive function, and overall well-being. Lack of sleep can contribute to difficulties in attention, memory, and emotional regulation, impacting daily functioning at school, work, and home (Browning et al., 2017).
Children who go to bed too late may experience learning difficulties, fatigue, and even insomnia. As OTs, we aim to prevent these challenges by educating families on sleep hygiene and emphasizing how sleep directly affects daily life. While most school-aged children require 9-11 hours of sleep and adults need 7-9 hours, many individuals fail to meet these recommendations (Browning et al., 2017).
Occupational Therapy Strategies for Restful Sleep
Occupational therapists can implement various interventions to improve sleep quality:
Relaxation techniques -visual imagery, deep breathing, and mindfulness
Environmental modifications -adjusting lighting, noise levels, and bedding
Routine development -establishing consistent bedtime habits
Self-regulation techniques -incorporating sensory strategies to calm the nervous system
Identifying barriers -evaluating routines, sensory triggers, and environmental disruptions
Sensory Processing and Sleep
Sensory processing plays a crucial role in sleep regulation. Some children, especially those with autism spectrum disorder (ASD) or attention deficit disorder (ADD), experience sensory challenges that affect their ability to fall and stay asleep. Sensory processing difficulties have been linked to behavioral issues, hyperactivity, and impulsivity, all of which can disrupt sleep (Foitzik & Brown, 2018).
“Sensory processing challenges influence children’s performance in social participation, play, and self-care. Emerging evidence suggests that sensory processing factors influence sleep performance in all children, whether typically or nontypically developing” (Foitzik & Brown, 2018).
Signs of Sleep Struggles in Children
If a child is experiencing sleep difficulties, parents may notice:
Taking longer than 30-45 minutes to settle before sleep
Taking more than 15-20 minutes to fall asleep
Needing someone present to fall asleep
Restlessness and frequent position changes
Waking up frequently during the night
Inconsistent sleep patterns (e.g., sleeping 6 hours one night, 10 hours the next)
Sleeping less than 8 hours for children ages 3-5 or less than 7 hours for ages 6-13
(Chavez, 2016)
Sensory Modulation and Sleep
Sensory modulation refers to the brain’s ability to process and respond to sensory input appropriately. OTs can help children adapt their environments and routines based on individual sensory preferences.
Sensory-Based Sleep Strategies
(Chavez, 2016)
Creating an Optimal Sleep Environment
Environmental factors significantly impact sleep quality. According to the Sleep Foundation (2023), elements such as tactile stimulation, noise, and light can either hinder or enhance sleep.
Adjustments for Better Sleep:
Room Temperature: Maintain around 65ºF to support natural body cooling.
Noise Control: Use white noise machines, noise-blocking curtains, or a fan to reduce distractions.
Lighting: Dim indoor lights before bedtime and keep the bedroom as dark as possible. Use small nightlights if needed.
Scents: Lavender and other calming scents can have a sedative effect. Use essential oils or scented sachets.
Additional OT Strategies for Sleep Improvement:
Establish a Routine -Consistent bedtime routines (~20 minutes) help signal the body that it’s for sleep. Routines should have 3-4 soothing activities, such as putting on PJs, brushing teeth, a warm bath, and reading.
Set a Regular Bedtime -Consistency reinforces the body’s biological clock. Include a bedtime and a wake up time, even on the weekends.
Screen Curfew -Avoid screens at least 1 hour before bed to prevent blue light exposure. Blue light from screens suppresses melatonin, a necessary sleep hormone.
Daily Exercise -Encourage at least 1 hour of physical activity but avoid vigorous exercise within 2 hours of bedtime.
Limit Caffeine -No caffeine consumption within 6 hours of bedtime.
No Pets in Bed -Pets’ movements can disrupt sleep; consider having them sleep in another room.
Limit Scary or Intense Content - Exposure to frightening or violent media before bedtime can lead to nightmares and increased anxiety, making it harder for children to fall asleep. If your child enjoys spooky stories or intense shows, schedule them for earlier in the day to prevent bedtime distress.
Engage in Heavy Work Activities - Activities such as swinging, deep pressure exercises, and rocking help regulate sensory input before bedtime.
Vestibular Activities for Sleep Regulation:
Clock Rock: Have the child lie on their back on a swing or therapy ball and gently tip them backward so their head moves slightly below their body. Slowly rock them back and forth in a rhythmic motion for 30 seconds to promote calming input.
Side-to-Side Blanket Swing: Wrap the child securely in a blanket (like a hammock) and gently sway them side to side for 30 seconds, ensuring smooth, predictable movements.
Pillow Chops: Have the child stand and hold a pillow with both hands. Encourage them to raise it overhead and “chop” down in a controlled motion, repeating for 30-60 seconds to provide proprioceptive and vestibular input.
Rocking: Sit with the child in your arms or on a rocking chair and slowly rock them back and forth for 1-5 min to promote relaxation before bed.
Pillow Sandwich: Gently press two large pillows on either side of the child’s body for 60 seconds, applying firm but comfortable pressure to provide deep proprioceptive input.
Helpful Instagram Accounts for Sleep and Sensory Strategies:
@courtneyenglish.ot
@ot.devotee
Other resource:
https://thespiralfoundation.org/wp-content/uploads/2018/10/Sleep-and-SI-brochure_final.pdf
By tailoring sleep interventions to each child’s sensory needs, OTs can help families establish better sleep hygiene, leading to improved health, emotional regulation, and daily performance.
References
American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2). https://doi.org/10.5014/ajot.2020.74S2001
Browning, J., Quint, N., Evasco, T., Gardiner, K., & Sharbaugh, N. (2017, October 5). Sleep in pediatric occupational therapy practice: A family-centered approach. OccupationalTherapy.com. https://www.occupationaltherapy.com/E/3538/1410419/35d8d365cbca46664c
Chaves, J. (2016). The relationship between sensory processing and sleep. The Center for Connection. https://www.thecenterforconnection.org/blogarchive/2016/4/27/the-relationship-between-sensory-processing-and-sleep
Foitzik, K., & Brown, T. (2018). Relationship between sensory processing and sleep in typically developing children. American Journal of Occupational Therapy, 72(1), 7201195040p1–7201195040p9. https://doi.org/10.5014/ajot.2018.027524
National Sleep Foundation. (2020, October 1). How much sleep do you really need? National Sleep Foundation. https://www.thensf.org/how-many-hours-of-sleep-do-you-really-need/
Paavonen, E. J., Räikkönen, K., Pesonen, A. K., Lahti, J., Komsi, N., Heinonen, K., ... Porkka-Heiskanen, T. (2010). Sleep quality and cognitive performance in 8-year-old children. Sleep Medicine, 11, 386–392. https://doi.org/10.1016/j.sleep.2009.09.009
Sleep Foundation. (2023, November 8). Sleep strategies for kids. Sleep Foundation. https://www.sleepfoundation.org/children-and-sleep/sleep-strategies-kids