Title

Experience of sleep in individuals with spinal cord injury

1

Location

Regency Room

Start Time

30-9-2016 8:30 AM

End Time

30-9-2016 10:00 AM

Session Type

Research Paper

Abstract

Statement of Purpose: Poor sleep contributes to adverse health outcomes (Knutson & Van Cauter, 2008) making it important to understand sleep in marginalized populations, including those with spinal cord injury (SCI). However, little attention has been paid to circumstances specific to SCI that may negatively impact sleep, or consequences of poor sleep in this population. The purpose of this study was to examine the experience of sleep among individuals with SCI and a history of pressure ulcers (PrU).

Methods: A secondary analysis was conducted on qualitative data from an ethnographic study of 20 community-dwelling adults with SCI and a history of at least one medically serious PrU. Participants in the parent study were recruited from a rehabilitation facility that specializes in treating individuals with SCI. Data were collected over an average of 18 months through unstructured interviews and naturalistic observation sessions. In the current secondary analysis, all transcripts and field notes were reviewed, and sections relating to sleep were extracted and formally coded in two stages: open and focused coding. Transcripts were reviewed and independently coded by at least two researchers. The research team then discussed the codes and identified overarching themes. After the coding scheme was finalized, transcripts were reviewed and re-coded as needed.

Results: Sleep-related data were found in transcripts for 90% of the sample. Participants described diminished sleep duration and irregular sleep patterns. Several factors contributing to poor sleep were identified, including SCI-related circumstances and sleep environment. Participants also discussed how poor sleep affected occupational engagement. A significant and unexpected finding was that several participants reported using daytime sleep to pass time and escape boredom resulting from limited options for occupational engagement.

Implications related to occupational science: The pivotal role that the occupation of sleep plays in maintaining health, function, and quality of life has been established through an extensive body of research (Colten & Altevogt, 2006). Sleep disturbance after SCI is highly prevalent and may contribute to adverse health. The narratives included in this study provide an important phenomenological contribution to the literature on sleep dysfunction after SCI and highlight the need for more research to better understand the occupation of sleep in individuals with SCI and the impact of sleep on other occupations.

Discussion questions to further occupational science concepts and ideas:

  1. What can we learn from qualitative examination of sleep, and how might this be different from results obtained using standardized quantitative sleep assessments?
  2. Discuss the nuances of sleep as an occupation. For example, napping can be restorative for some, but for others, it can inhibit nighttime sleep. Another example is from this study – a few participants used sleep as an escape from the challenges of everyday life, yet others reported that sleep deprivation at night caused them to sleep in the daytime, thus inhibiting their participation in other valued occupations.
  3. What other areas of sleep research should occupational scientists explore? Possible opportunities for future sleep research might include different populations, cultural issues, and patients’ responses to sleep intervention by occupational therapists.

Key words: sleep, spinal cord injury, occupational engagement

References

Knutson, K. L., & Van Cauter, E. (2008). Associations between sleep loss and increased risk of obesity and diabetes. Annals of the New York Academy of Sciences, 1129(1), 287-304.

Colten, H. R., & Altevogt, B. M., Institute of Medicine (U.S.). (2006). Committee on Sleep Medicine and Research. Sleep disorders and sleep deprivation: An unmet public health problem. Washington, DC: National Academies Press.

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Sep 30th, 8:30 AM Sep 30th, 10:00 AM

Experience of sleep in individuals with spinal cord injury

Regency Room

Statement of Purpose: Poor sleep contributes to adverse health outcomes (Knutson & Van Cauter, 2008) making it important to understand sleep in marginalized populations, including those with spinal cord injury (SCI). However, little attention has been paid to circumstances specific to SCI that may negatively impact sleep, or consequences of poor sleep in this population. The purpose of this study was to examine the experience of sleep among individuals with SCI and a history of pressure ulcers (PrU).

Methods: A secondary analysis was conducted on qualitative data from an ethnographic study of 20 community-dwelling adults with SCI and a history of at least one medically serious PrU. Participants in the parent study were recruited from a rehabilitation facility that specializes in treating individuals with SCI. Data were collected over an average of 18 months through unstructured interviews and naturalistic observation sessions. In the current secondary analysis, all transcripts and field notes were reviewed, and sections relating to sleep were extracted and formally coded in two stages: open and focused coding. Transcripts were reviewed and independently coded by at least two researchers. The research team then discussed the codes and identified overarching themes. After the coding scheme was finalized, transcripts were reviewed and re-coded as needed.

Results: Sleep-related data were found in transcripts for 90% of the sample. Participants described diminished sleep duration and irregular sleep patterns. Several factors contributing to poor sleep were identified, including SCI-related circumstances and sleep environment. Participants also discussed how poor sleep affected occupational engagement. A significant and unexpected finding was that several participants reported using daytime sleep to pass time and escape boredom resulting from limited options for occupational engagement.

Implications related to occupational science: The pivotal role that the occupation of sleep plays in maintaining health, function, and quality of life has been established through an extensive body of research (Colten & Altevogt, 2006). Sleep disturbance after SCI is highly prevalent and may contribute to adverse health. The narratives included in this study provide an important phenomenological contribution to the literature on sleep dysfunction after SCI and highlight the need for more research to better understand the occupation of sleep in individuals with SCI and the impact of sleep on other occupations.

Discussion questions to further occupational science concepts and ideas:

  1. What can we learn from qualitative examination of sleep, and how might this be different from results obtained using standardized quantitative sleep assessments?
  2. Discuss the nuances of sleep as an occupation. For example, napping can be restorative for some, but for others, it can inhibit nighttime sleep. Another example is from this study – a few participants used sleep as an escape from the challenges of everyday life, yet others reported that sleep deprivation at night caused them to sleep in the daytime, thus inhibiting their participation in other valued occupations.
  3. What other areas of sleep research should occupational scientists explore? Possible opportunities for future sleep research might include different populations, cultural issues, and patients’ responses to sleep intervention by occupational therapists.

Key words: sleep, spinal cord injury, occupational engagement