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Sleep is one of the few tasks that everyone participates in regularly, regardless of age, ability or environment. We all know that, without sleep, our physical, emotional and cognitive functions drastically decline. We need sleep! Despite sleep’s importance, many people remain unsatisfied with either how much sleep (sleep quantity) or how deep their sleep is (sleep quality) each night. In addition, specific conditions, including, but not limited to those listed below, can uniquely impact sleep satisfaction.

Sleep hygiene

Brain Health

Brain injuries ranging from traumatic to mild (concussion) can significantly impact a person’s sleep routine. Many people recovering from brain injury may experience increased fatigue and feel compelled to sleep for extended periods.

Chronic Pain

Chronic pain can impact every element of a person’s day, including sleep. Pain can understandably make it difficult to experience a restful night’s sleep. Alternatively, living with chronic pain can cause extreme fatigue, leading to excessive sleep throughout the day

Multiple Sclerosis (MS)

Many people progressive or relapsing MS experience extreme spasticity, which may make sleep uncomfortable and restless. Further, the extreme fatigue that often accompanies MS may cause excessive sleep throughout the day, leading to dissatisfaction in daytime productivity and a restless sleep at night.

Seizure Activity

Seizure activity and fatigue are often correlated in a vicious cycle with one another: not only can seizure activity increase with fatigue but seizure activity can also cause fatigue by disrupting regular sleep cycles. In addition, some types of seizures occur specifically during sleep, leading to disrupted rest.

Spinal Cord Injury

People with spinal cord injuries commonly experience disrupted sleep due to pain, spasticity or ongoing care needs, including catheterization or repositioning. In addition, people with high-level injuries can experience dysregulated breathing during sleep. These changes in sleep function not only limit sleep quality and quantity but, if not managed properly, can also pose a significant safety risk for secondary complications, such as infection, pressure injuries, falls from bed or blood pressure complications.


Adequate sleep quality and quantity can have a significant impact on the efficiency and effectiveness of stroke recovery. A restful night’s sleep supports neuroplasticity – or the brain’s ability to re-establish or create new learning connections – and ensures you have the physical and mental energy to engage in re-learning function.

For people who experience hemiplegia post-stroke, sleep positioning is also critical to physical recovery. Strategic sleep positions can limit the risk of developing contractures, joint subluxations and promote optimal comfort and safety while sleeping.

Mental Health

Challenges with mental health, as well as diagnosed mental illnesses, can have a significant, reciprocal impact on sleep. Not only can experiences with low mood or depression increase the urge for excessive sleep, but excessive sleep can also worsen depressive symptoms. Additionally, anxiety or invasive thoughts can cause sleep to become a stressful experience rather than restful.

Sleep hygiene_trouble sleeping

How can Occupational Therapy Support Optimal Sleep?

Optimizing sleep quality and quantity is a common goal amongst clients of all ages and conditions. Because sleep is a universal daily occupation, occupational therapy is uniquely suited to support you in reaching your sleep goals. If you would like to improve your sleep quality or quantity, your occupational therapist (OT) can support you in the following ways.

Sleep hygiene_sleep journal

Establishment of Sleep Routines

Occupational therapy can aid in finding patterns in your current sleep routine, then in looking for ways to modify your routine to best support your sleep needs. Often, your OT will begin supporting your sleep needs by asking you to complete a sleep journal. This journal provides an opportunity for you to record not only your sleep quality and quantity, but also your daily routines leading up to each night’s rest. A sleep journal can reveal whether specific tasks, and timing of such tasks, are contributing to your sleep. Based on this information, you and your OT can begin to develop a consistent bedtime routine which meets your needs and optimizes your sleep. This routine could include taking medications at the same time each night, controlling your food or drink intake prior to bed, preparing for sleep with quiet activities, and waking at the same time every day. You and your OT will work collaboratively to maintain this routine each night, and modify the routine to meet your sleep goals, as needed.

Environmental Adaptations

Occupational therapy can also support sleep routines through modifications of the sleeping environment. Environmental characteristics like light, noise and temperature can have a significant impact on sleep/wake cycles. With your OT, you can adapt your environment to be as restful as possible and encourage both physical and mental preparation for sleep. Environmental adaptations can also be made to support safety and comfort in bed. For instance, if you are experiencing paralysis or pain in certain areas of the body, your OT can make suggestions for sleep positioning to maximize recovery and mitigate the risk of falling from bed or exacerbation of pain.

Sleep hygiene_sleep positioning

CONTRIBUTED BY: Lauren Macartney, Occupational Therapist, MScOT



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