Skip to main content

Physiotherapists: Sleep Health Promoters

  • Chapter
  • First Online:
Clinical Cases in Sleep Physical Therapy

Abstract

As physiotherapists are well known for their health promotion role, sleep is no different from any other major aspect of health promotion in physical therapy. The importance of sleep extends beyond its impact on various body functions; it can impact rehabilitation outcomes among various populations commonly seen in the physical therapy practice. This chapter describes the role of physical therapists in promoting sleep health and wellness, and it describes conditions commonly seen in different physical therapy practice settings who suffer from poor sleep. It also discusses the evidence on the impact of sleep disturbances on rehabilitation outcomes, providing examples from various populations. The remaining sections in this chapter discuss the literature regarding common treatment strategies to improve sleep that can be utilized by physical therapists. There is much room for physical therapists to intervene in sleep management. With proper training and evidence-based practice, physical therapists are confidently capable of managing sleep disturbances among their patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Magnusson DM, et al. Population health, prevention, health promotion, and wellness competencies in physical therapist professional education: results of a modified Delphi study. Phys Ther. 2020;100(9):1645–58.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Siengsukon CF, Al-Dughmi M, Stevens S. Sleep health promotion: practical information for physical therapists. Phys Ther. 2017;97(8):826–36.

    Article  PubMed  Google Scholar 

  3. Albakri U, Drotos E, Meertens R. Sleep health promotion interventions and their effectiveness: an umbrella review. Int J Environ Res Public Health. 2021;18(11):5533.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bezner JR. Promoting health and wellness: implications for physical therapist practice. Phys Ther. 2015;95(10):1433–44.

    Article  PubMed  Google Scholar 

  5. Association, APT. The Role of the Physical Therapist and the American Physical Therapy Association in Sleep Health HOD P06-20-39-09. 2020.

    Google Scholar 

  6. Lloyd-Jones DM, et al. Life’s essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health: a presidential advisory from the American Heart Association. Circulation. 2022;146(5):e18–43.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Altevogt BM, Colten HR. Sleep disorders and sleep deprivation: an unmet public health problem. Washington, DC: National Academies Press (US); 2006.

    Google Scholar 

  8. Control, C.f.D. and Prevention. Insufficient sleep is a public health epidemic. 2015. http://www.cdc.gov/features/dssleep/index.html#References.

  9. Jahrami HA, et al. Sleep disturbances during the COVID-19 pandemic: a systematic review, meta-analysis, and meta-regression. Sleep Med Rev. 2022;62:101591.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Sheikh IN, Roth M, Stavinoha PL. Prevalence of sleep disturbances in pediatric cancer patients and their diagnosis and management. Children. 2021;8(12):1100.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Halstead EJ, et al. Sleep disturbances and patterns in children with neurodevelopmental conditions. Front Pediatr. 2021;9:637770.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cai H, Wang X-P, Yang G-Y. Sleep disorders in stroke: an update on management. Aging Dis. 2021;12(2):570.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Khot SP, Morgenstern LB. Sleep and stroke. Stroke. 2019;50(6):1612–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Minakawa EN. Bidirectional relationship between sleep disturbances and Parkinson’s disease. Front Neurol. 2022;13:927994.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Xu Z, et al. Progression of sleep disturbances in Parkinson’s disease: a 5-year longitudinal study. J Neurol. 2021;268:312–20.

    Article  PubMed  Google Scholar 

  16. Borges CR, et al. Alzheimer’s disease and sleep disturbances: a review. Arq Neuropsiquiatr. 2019;77:815–24.

    Article  PubMed  Google Scholar 

  17. Sunkaria A, Bhardwaj S. Sleep disturbance and Alzheimer’s disease: the glial connection. Neurochem Res. 2022;47(7):1799–815.

    Article  CAS  PubMed  Google Scholar 

  18. Foschi M, et al. Sleep-related disorders and their relationship with MRI findings in multiple sclerosis. Sleep Med. 2019;56:90–7.

    Article  CAS  PubMed  Google Scholar 

  19. Kołtuniuk A, et al. Sleep disturbances, degree of disability and the quality of life in multiple sclerosis patients. Int J Environ Res Public Health. 2022;19(6):3271.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Uchmanowicz I, et al. The influence of sleep disorders on the quality of life in patients with chronic low back pain. Scand J Caring Sci. 2019;33(1):119–27.

    Article  PubMed  Google Scholar 

  21. Beetz G, et al. Relevance of sleep disturbances to orthopaedic surgery: a current concepts narrative and practical review. JBJS. 2021;103(21):2045–56.

    Article  Google Scholar 

  22. Miner B, Kryger MH. Sleep in the aging population. Sleep Med Clin. 2020;15(2):311–8.

    Article  PubMed  Google Scholar 

  23. Morse AM, Bender E. Sleep in hospitalized patients. Clocks Sleep. 2019;1(1):151–65.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Thomas KP, et al. Sleep rounds: a multidisciplinary approach to optimize sleep quality and satisfaction in hospitalized patients. J Hosp Med. 2012;7(6):508–12.

    Article  PubMed  Google Scholar 

  25. Hardin KA. Sleep in the ICU: potential mechanisms and clinical implications. Chest. 2009;136(1):284–94.

    Article  PubMed  Google Scholar 

  26. Meltzer LJ, Davis KF, Mindell JA. Patient and parent sleep in a children’s hospital. Pediatr Nurs. 2012;38(2):64.

    PubMed  Google Scholar 

  27. Young JS, et al. Sleep in hospitalized medical patients, part 1: factors affecting sleep. J Hosp Med. 2008;3(6):473–82.

    Article  PubMed  Google Scholar 

  28. Truong KK, et al. Timing matters: circadian rhythm in sepsis, obstructive lung disease, obstructive sleep apnea, and cancer. Annal Am Thorac Soc. 2016;13(7):1144–54.

    Article  Google Scholar 

  29. Rampes S, et al. Postoperative sleep disorders and their potential impacts on surgical outcomes. J Biomed Res. 2020;34(4):271.

    Article  CAS  PubMed Central  Google Scholar 

  30. Dobing S, et al. Sleep quality and factors influencing self-reported sleep duration and quality in the general internal medicine inpatient population. PLoS One. 2016;11(6):e0156735.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ünsal A, Demir G. Evaluation of sleep quality and fatigue in hospitalized patients. Int J Caring Sci. 2012;5(3):311–9.

    Google Scholar 

  32. Kim DE, Yoon JY. Factors that influence sleep among residents in long-term care facilities. Int J Environ Res Public Health. 2020;17(6):1889.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Valenza MC, et al. Nursing homes: impact of sleep disturbances on functionality. Arch Gerontol Geriatr. 2013;56(3):432–6.

    Article  PubMed  Google Scholar 

  34. Garms-Homolovà V, Flick U, Röhnsch G. Sleep disorders and activities in long term care facilities—a vicious cycle? J Health Psychol. 2010;15(5):744–54.

    Article  PubMed  Google Scholar 

  35. Kalmbach DA, et al. Poor sleep is linked to impeded recovery from traumatic brain injury. Sleep. 2018;41(10):zsy147.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Fleming MK, et al. Sleep disruption after brain injury is associated with worse motor outcomes and slower functional recovery. Neurorehabil Neural Repair. 2020;34(7):661–71.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Drerup M, et al. Therapeutic approaches to insomnia and fatigue in patients with multiple sclerosis. Nat Sci Sleep. 2021;13:201–7.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Iddagoda MT, et al. Post-stroke sleep disturbances and rehabilitation outcomes: a prospective cohort study. Intern Med J. 2020;50(2):208–13.

    Article  PubMed  Google Scholar 

  39. Devos H, et al. Real-time assessment of daytime sleepiness in drivers with multiple sclerosis. Mult Scler Relat Disord. 2021;47:102607.

    Article  PubMed  Google Scholar 

  40. Aricò D, et al. Effects of NREM sleep instability on cognitive processing. Sleep Med. 2010;11(8):791–8.

    Article  PubMed  Google Scholar 

  41. Kempler L, Richmond JL. Effect of sleep on gross motor memory. Memory. 2012;20(8):907–14.

    Article  PubMed  Google Scholar 

  42. DePietro RH, et al. Association between inpatient sleep loss and hyperglycemia of hospitalization. Diabetes Care. 2017;40(2):188–93.

    Article  CAS  PubMed  Google Scholar 

  43. Watson PL, Ceriana P, Fanfulla F. Delirium: is sleep important? Best Pract Res Clin Anaesthesiol. 2012;26(3):355–66.

    Article  PubMed  Google Scholar 

  44. Leukoff S, Evans D, Liptzin B. Delirium: the occurrence and persistence of symptoms among elderly hospitalised patients. Arch Intern Med. 1992;152(2):334–40.

    Article  Google Scholar 

  45. Bolona E, Hahn PY, Afessa B. Intensive care unit and hospital mortality in patients with obstructive sleep apnea. J Crit Care. 2015;30(1):178–80.

    Article  PubMed  Google Scholar 

  46. Kaw R, et al. Postoperative complications in patients with obstructive sleep apnea. Chest. 2012;141(2):436–41.

    Article  PubMed  Google Scholar 

  47. Louis JM, et al. Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009. Sleep. 2014;37(5):843–9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Frange C, et al. Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines. Sleep Sci. 2022;15(4):515.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Hauri PJ. Sleep hygiene, relaxation therapy, and cognitive interventions. In: Case studies in insomnia. Boston, MA: Springer; 1991. p. 65–84.

    Chapter  Google Scholar 

  50. Sivertsen B, et al. Sleep problems in general practice: a national survey of assessment and treatment routines of general practitioners in Norway. J Sleep Res. 2010;19(1 Pt I):36–41.

    Article  PubMed  Google Scholar 

  51. Irish LA, et al. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev. 2015;22:23–36.

    Article  PubMed  Google Scholar 

  52. Cho S, Kim G-S, Lee J-H. Psychometric evaluation of the sleep hygiene index: a sample of patients with chronic pain. Health Qual Life Outcomes. 2013;11:1–7.

    Article  Google Scholar 

  53. Lin C-Y, et al. A cluster randomized controlled trial of a theory-based sleep hygiene intervention for adolescents. Sleep. 2018;41(11):zsy170.

    Article  Google Scholar 

  54. Dietrich SK, et al. Effectiveness of sleep education programs to improve sleep hygiene and/or sleep quality in college students: a systematic review. JBI Evid Synth. 2016;14(9):108–34.

    Google Scholar 

  55. Zengin L, Aylaz R. The effects of sleep hygiene education and reflexology on sleep quality and fatigue in patients receiving chemotherapy. Eur J Cancer Care. 2019;28(3):e13020.

    Article  Google Scholar 

  56. Herscher M, et al. A sleep hygiene intervention to improve sleep quality for hospitalized patients. Jt Comm J Qual Patient Saf. 2021;47(6):343–6.

    PubMed  Google Scholar 

  57. Chung K-F, et al. Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis. Fam Pract. 2018;35(4):365–75.

    Article  PubMed  Google Scholar 

  58. Drake CL, et al. Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. Sleep. 2019;42(2):zsy217.

    Article  PubMed  Google Scholar 

  59. Bogdanov S, Naismith S, Lah S. Sleep outcomes following sleep-hygiene-related interventions for individuals with traumatic brain injury: a systematic review. Brain Inj. 2017;31(4):422–33.

    Article  PubMed  Google Scholar 

  60. Xie Y, et al. Effects of exercise on sleep quality and insomnia in adults: a systematic review and meta-analysis of randomized controlled trials. Front Psychiatry. 2021;12:664499.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Lowe H, et al. Does exercise improve sleep for adults with insomnia? A systematic review with quality appraisal. Clin Psychol Rev. 2019;68:1–12.

    Article  PubMed  Google Scholar 

  62. Stutz J, Eiholzer R, Spengler CM. Effects of evening exercise on sleep in healthy participants: a systematic review and meta-analysis. Sports Med. 2019;49(2):269–87.

    Article  PubMed  Google Scholar 

  63. Park I, et al. Exercise improves the quality of slow-wave sleep by increasing slow-wave stability. Sci Rep. 2021;11(1):4410.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Hasan F, et al. Comparative efficacy of exercise regimens on sleep quality in older adults: a systematic review and network meta-analysis. Sleep Med Rev. 2022;65:101673.

    Article  PubMed  Google Scholar 

  65. Wang F, Boros S. The effect of physical activity on sleep quality: a systematic review. Eur J Physiother. 2021;23(1):11–8.

    Article  CAS  Google Scholar 

  66. Youngstedt SD, O’connor PJ, Dishman RK. The effects of acute exercise on sleep: a quantitative synthesis. Sleep. 1997;20(3):203–14.

    Article  CAS  PubMed  Google Scholar 

  67. Szuhany KL, Bugatti M, Otto MW. A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor. J Psychiatr Res. 2015;60:56–64.

    Article  PubMed  Google Scholar 

  68. Hartescu I, Morgan K, Stevinson CD. Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial. J Sleep Res. 2015;24(5):526–34.

    Article  PubMed  Google Scholar 

  69. Sellami M, et al. The effect of exercise on glucoregulatory hormones: a countermeasure to human aging: insights from a comprehensive review of the literature. Int J Environ Res Public Health. 2019;16(10):1709.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Kubitz KA, et al. The effects of acute and chronic exercise on sleep: a meta-analytic review. Sports Med. 1996;21:277–91.

    Article  CAS  PubMed  Google Scholar 

  71. Riemann D, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675–700.

    Article  PubMed  Google Scholar 

  72. Buric I, et al. What is the molecular signature of mind–body interventions? A systematic review of gene expression changes induced by meditation and related practices. Front Immunol. 2017;8:670.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Wang W-L, et al. The effect of yoga on sleep quality and insomnia in women with sleep problems: a systematic review and meta-analysis. BMC Psychiatry. 2020;20:1–19.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Ai J-Y, et al. Effects of multi-component exercise on sleep quality in middle-aged adults. Int J Environ Res Public Health. 2022;19(23):15472.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Aiello KD, et al. Effect of exercise training on sleep apnea: a systematic review and meta-analysis. Respir Med. 2016;116:85–92.

    Article  PubMed  Google Scholar 

  76. Stavrou VT, et al. Obstructive sleep apnea syndrome: the effect of acute and chronic responses of exercise. Front Med. 2021;8:806924.

    Article  Google Scholar 

  77. Lins-Filho OL, et al. Effect of exercise training on subjective parameters in patients with obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med. 2020;69:1–7.

    Article  PubMed  Google Scholar 

  78. Memon AA, Coleman JJ, Amara AW. Effects of exercise on sleep in neurodegenerative disease. Neurobiol Dis. 2020;140:104859.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Tai D, et al. Can exercise training promote better sleep and reduced fatigue in people with chronic stroke? A systematic review. J Sleep Res. 2022;31(6):e13675.

    Article  PubMed  Google Scholar 

  80. Al-Sharman A, et al. The effects of aerobic exercise on sleep quality measures and sleep-related biomarkers in individuals with Multiple Sclerosis: a pilot randomised controlled trial. NeuroRehabilitation. 2019;45(1):107–15.

    Article  PubMed  Google Scholar 

  81. Siengsukon CF, et al. Randomized controlled trial of exercise interventions to improve sleep quality and daytime sleepiness in individuals with multiple sclerosis: a pilot study. Mult Scler J Exp Transl Clin. 2016;2:2055217316680639.

    PubMed  PubMed Central  Google Scholar 

  82. Tse AC, et al. Effects of exercise on sleep, melatonin level, and behavioral functioning in children with autism. Autism. 2022;26(7):1712–22.

    Article  PubMed  Google Scholar 

  83. Kreutz C, Schmidt ME, Steindorf K. Effects of physical and mind–body exercise on sleep problems during and after breast cancer treatment: a systematic review and meta-analysis. Breast Cancer Res Treat. 2019;176:1–15.

    Article  PubMed  Google Scholar 

  84. Eadie J, et al. Physiotherapy for sleep disturbance in people with chronic low back pain: results of a feasibility randomized controlled trial. Arch Phys Med Rehabil. 2013;94(11):2083–92.

    Article  PubMed  Google Scholar 

  85. Akodu AK, Akindutire OM. The effect of stabilization exercise on pain-related disability, sleep disturbance, and psychological status of patients with non-specific chronic low back pain. Kor J Pain. 2018;31(3):199–205.

    Article  Google Scholar 

  86. Spiegel K, et al. Effects of poor and short sleep on glucose metabolism and obesity risk. Nat Rev Endocrinol. 2009;5(5):253–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Qaseem A, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–33.

    Article  PubMed  Google Scholar 

  88. Edinger JD, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(2):255–62.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Van Straten A, et al. Cognitive and behavioral therapies in the treatment of insomnia: a meta-analysis. Sleep Med Rev. 2018;38:3–16.

    Article  PubMed  Google Scholar 

  90. Hasan F, et al. Comparative efficacy of digital cognitive behavioral therapy for insomnia: a systematic review and network meta-analysis. Sleep Med Rev. 2022;61:101567.

    Article  PubMed  Google Scholar 

  91. Siengsukon CF, et al. Feasibility and treatment effect of cognitive behavioral therapy for insomnia in individuals with multiple sclerosis: a pilot randomized controlled trial. Mult Scler Relat Disord. 2020;40:101958.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Williams-Cooke C, et al. The impact of cognitive behavioral therapy for insomnia on sleep log and actigraphy outcomes in people with multiple sclerosis: a secondary analysis. Nat Sci Sleep. 2021;13:1865–74.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Luo F, et al. Efficacy of cognitive behavioral therapy on mood disorders, sleep, fatigue, and quality of life in Parkinson’s disease: a systematic review and meta-analysis. Front Psychiatry. 2021;12:793804.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Vitiello MV, et al. Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults with co-morbid insomnia and osteoarthritis. J Clin Sleep Med. 2009;5(4):355–62.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Kalmbach DA, et al. A randomized controlled trial of digital cognitive behavioral therapy for insomnia in pregnant women. Sleep Med. 2020;72:82–92.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Selvanathan J, et al. Cognitive behavioral therapy for insomnia in patients with chronic pain–a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2021;60:101460.

    Article  PubMed  Google Scholar 

  97. Martínez MP, et al. Cognitive-behavioral therapy for insomnia and sleep hygiene in fibromyalgia: a randomized controlled trial. J Behav Med. 2014;37:683–97.

    Article  PubMed  Google Scholar 

  98. Alshehri MM, et al. The effects of cognitive behavioral therapy for insomnia in people with type 2 diabetes mellitus, pilot RCT part II: diabetes health outcomes. BMC Endocr Disord. 2020;20(1):1–9.

    Article  Google Scholar 

  99. Redeker NS, et al. Effects of cognitive behavioral therapy for insomnia on sleep-related cognitions among patients with stable heart failure. Behav Sleep Med. 2019;17(3):342–54.

    Article  PubMed  Google Scholar 

  100. Ma Y, et al. Efficacy of cognitive behavioral therapy for insomnia in breast cancer: a meta-analysis. Sleep Med Rev. 2021;55:101376.

    Article  PubMed  Google Scholar 

  101. Chen H-Y, et al. Cognitive-behavioral therapy for sleep disturbance decreases inflammatory cytokines and oxidative stress in hemodialysis patients. Kidney Int. 2011;80(4):415–22.

    Article  CAS  PubMed  Google Scholar 

  102. Dantas DS, et al. Biopsychosocial model in health care: reflections in the production of functioning and disability data. Fisioterapia em Movimento. 2020;33:1.

    Article  Google Scholar 

  103. Nielsen M, et al. Physical therapist–delivered cognitive-behavioral therapy: a qualitative study of physical therapists’ perceptions and experiences. Phys Ther. 2014;94(2):197–209.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Aldughmi, M., Frange, C., Siengsukon, C.F. (2023). Physiotherapists: Sleep Health Promoters. In: Frange, C. (eds) Clinical Cases in Sleep Physical Therapy. Springer, Cham. https://doi.org/10.1007/978-3-031-38340-3_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-38340-3_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-38339-7

  • Online ISBN: 978-3-031-38340-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics