Addressing sleep difficulties through the unique role of occupational therapy

Story by Rachel Sipes and Emmy Steele

“Sleep is just like a cat,” shared Natalie Rolle, occupational therapist in the Center for Community Partnerships at Colorado State University. “The more we focus on it and try to draw it toward us, the more it evades us. The more we ignore it, the more likely it is to find an opportune time to cuddle up close and find its way right next to us.”

According to a recent RAND article, people lose around 411 billion dollars a year in the United States due to sleep-related challenges, whether that is sleep itself, lack of productivity, car accidents, massive oil spills, etc. “We’re one of the worst countries in terms of productivity loss due to sleep related problems,” continued Rolle.

Addressing the sleep problem

Because sleep is such a common challenge in our country for so many people, Rolle and Aaron Eakman, associate professor in the Department of Occupational Therapy, are addressing this challenge by offering an annual training for occupational therapists to learn more about treating chronic insomnia.

When asked if it is appropriate for occupational therapists to inquire about sleep with clients, Rolle stated, “Yes, 100%. In all settings, occupational therapists should at least be asking about sleep and get the conversation going even if it is just something like, ‘Do you sleep pretty well?’” Rolle finds that the more she asks her clients about sleep the more they open up about other potential problems affecting their daily living. This is why Eakman and Rolle are so passionate about delivering the cognitive behavioral therapy for insomnia training to occupational therapists.

CBT-I training

CBT-I participants in group photoIn this past summer’s second annual CBT-I training, Eakman and Rolle saw an increase in the number of people that were able to attend from all around the United States. In addition, two CSU occupational therapy alumnae from 2019, Shea McCowen and Katie Quartieri, were sponsored to attend this training. This made it especially meaningful for these graduates as they begin their careers as occupational therapists.

In this two and one-half day training, CBT-I is designed for occupational therapists to learn about the sleep patterns that affect individuals which include the circadian rhythm, the sleep drive and the hyper-arousal fight or flight response. During the training, occupational therapists are introduced to a multicomponent cognitive behavioral therapy for insomnia treatment approach including sleep restriction, stimulus control, sleep hygiene (such as lowering the thermostat and reducing substances like caffeine and alcohol), as well as cognitive therapy to address dysfunctional thoughts.

Participants of the training also learn about various kinds of insomnia, different sleep diagnoses and how to use sleep diaries. Since they received the original program grant in 2015, Eakman and Rolle have been able to increase awareness surrounding the importance of sleep through various research studies and multiple sleep trainings. The CBT-I training dives into these sleep systems as well as techniques and intervention ideas to help clients be able to sleep better and in turn function better in their day-to-day lives.

“It is like the fog has cleared and they seem to be more passionate and excited about everything in their life,” commented Rolle referring to her clients after going through the behavioral sleep intervention. “People say that it feels like their life has almost been given back to them because they don’t think about sleep all day long anymore. Instead they are finally sleeping better so they can also have energy and time to do other things.”

Empowering recent graduates

McCowen, a recent CSU alumna, shared about the unique opportunity she had to learn about sleep when she first started the occupational therapy master’s program and had a fieldwork experience with Rolle in Fall 2017. Here, she was introduced to REST, a program in CCP designed to support veterans who have sleep difficulties that affect their day-to-day functioning. McCowen noted that since this experience, she developed an interest in promoting the importance of sleep, and after graduating in August 2019, she started working with CCP in the Opportunities for Postsecondary Success program.

She said, “I hope to continue providing supports and resources to students on campus and help them be able to better achieve their academic and professional goals. I am already seeing so many connections between the students with whom I am working, who have complex challenges and disabilities, and the connection with sleep difficulties that are also impacting these students’ lives.”

McCowen noted that this sleep training was a really good launching pad that will give her so many ideas and opportunities to grow as she begins her career. In addition, this training gave her the tools to be able to problem solve with clients on ways to sleep more effectively and therefore have more energy to engage in other occupations, like education, work and leisure activities throughout the day. “After all, sleep affects every single person and is a perfect gateway opportunity to talk with clients and students about their habits, routines and possible environmental stressors that impact sleep,” continued McCowen.

Quartieri, another recent CSU alumna, shared “”I thoroughly enjoyed attending the CBT-I training this past summer! The instructors were enthusiastic, knowledgeable, and highly qualified in the area of sleep which made the course very engaging. Not only did I learn how to accurately implement CBT-I interventions to safely treat insomnia, but I also took home valuable information about sleep habits that I am now able to apply when educating patients about sleep.”

Outreach in the community

“There is a huge window of opportunity,” added Rolle. “The more this training is delivered and the more the importance of sleep catches on, the more it can potentially be incorporated into the broader occupational therapy curriculum.”

In light of this increasing need, Eakman has been involved in spreading awareness about the effects of insomnia throughout the CSU community. Currently there are projects aimed at looking into sleep habits in firefighters, through one of the occupational therapy courses. Specifically, Eakman and a group of second-year students are collaborating with the Poudre Fire Authority to better understand the sleep challenges that firefighters currently face with the goal of developing interventions that could be delivered by an occupational therapist.

In addition, Eakman is interested in learning more about sleep habits in CSU students through a partnership with the CSU Health Network. Eakman hopes to advance research to develop preventative interventions in response to a CSU student survey revealing that almost 40% of respondents screened positive for primary insomnia driven by stress, anxiety, ineffective sleep behaviors and ineffective sleep beliefs. “By collaborating with the CSU Health Network, there is opportunity for occupational therapy to be a member of the health care team and address sleep behavior and related behavioral health concerns, as anxiety and stress are highly associated with sleep difficulties,” shared Eakman.

CBT-I training flyer for 2020Moving forward

As Eakman and Rolle continue to spread awareness about the importance of sleep and equipping occupational therapists with the necessary skills to help their clients, they look forward to next summer’s CBT-I training which will be held on June 11-13, 2020. For more information about this upcoming training as well as other sleep resources, please visit the REST website.

The Department of Occupational Therapy is part of CSU’s College of Health and Human Sciences.