Full Details Related to MH 020 :: Discussing Sleep Management and Fatigue with an Occupational Therapist | Helen Roome | Moulding Health | KITRIN
In this episode, we speak to Helen Roome, an Occupational Therapist based in South Africa. She discusses the topic of Sleep Management and Fatigue with us, from an occupational therapist perspective.
Link to Audio Episode about Sleep Management and Fatigue
Link to Video Episode about Sleep Management and Fatigue
Oliver :: Hi, welcome to the show. So we really glad to have you on board. And talking about an interesting topic, I would have never guessed this. But you know, that’s the beauty of doing this Moulding Health show is that I think therapists have such a wealth of knowledge to be talking about sleep and fatigue management, from an occupational therapist perspective. Welcome on board.
Helen :: Thank you so much, Oliver and Shaz for having me on your molding health podcast right to be with you.
Oliver :: So Shaz, I have to ask how did you even find Helen.
Shaz :: In fairness, last year, I started really just activating my LinkedIn profile and starting to reach out to healthcare practitioners. And I must admit, Helen is definitely one of the most active healthcare practitioners on LinkedIn. There’s always a new post, always something interesting, which was intriguing Because most of the healthcare practitioners seem to have like, a Facebook page or an Instagram page. But with Helen, there’s always something interesting or informative, and educational on her LinkedIn profile. So I reached out.
What made you decide to focus on sleep and fatigue management?
Oliver :: I love that. So going into the topic, why sleep and fatigue management ? Is there something around them that you found was probably lacking in terms of how people were were looking at it.
Helen :: So my personal involvement, more and more in sleep and fatigue comes through the channel of chronic pain management, actually. But I think if we just look at sleep, generally, over the years through people like Dr. Matthew Walker and others. We’ve seen sleep highlighted more and more. We’ve tended to take the other foundations of health, lack nutrition, and exercise and really promote those and get those nailed down for people. But we’ve forgotten this third, incredibly important foundation for health, which is the whole area of sleep.
So I think sleep has become a highlight over time. My personal connection, as I said is, through the area of chronic pain management where sleep and pain have this very interconnected relationship. And then of course, fatigue is potentially a spinoff of a problem sleep. But it is also a symptom of some of these more complex conditions.
Even as we were speaking just now about COVID, what we are seeing with what we call long COVID or post COVID syndrome, is that a large proportion of those people are struggling with fatigue. So sleep and fatigue are incredibly important in terms of how they impact our day function, our overall health, the incredible interrelated nature with so many aspects of health. So that’s why I’m, I’m glad we’re talking about it today. It’s a massive area of our overall well being.
Oliver :: It’s actually interesting that you say that, because that’s kind of what I associated with you, the whole pain management. And you know, obviously, when Shaz, came up with a topic, that’s actually interesting.
Could you explain the link between sleep and pain.
Helen :: Sure so looking at the relationship with sleeping pain. I think anyone who is living in pain would tell you that it affects their sleep. That they wake up with pain at night and can’t go back to sleep and so their pain affects their sleep. And that’s how we kind of always used to look at it. We thought, Okay, it’s a uni directional relationship. When you have pain, it affects your sleep. And that is horrible.
Then, number of years ago, we realized that actually it’s a bi directional relationship. In other words, it’s not just that pain affects sleep, but when you are not sleeping, it obviously will make pain worse. And your sense of suffering in the daytime with your pain is worse. What is even more interesting thing is a fairly recent discovery that, although it is a bi directional relationship in that relationship between sleep and pain, sleep is in fact, the more influential.
Some interesting studies have found that if you just deprive people of sleep, you mentioned that just now in terms of stress. The same is true of pain, though, if you just deprive someone of sleep even for one night, they can spontaneously develop pain, because of that lack of sleep. What we are finding now is that people can have sleep problems and sleep disturbances, sometimes many, years before the development of persistent pain. And sleep, and insomnia, no sort of problems are independent risk factors for developing pain so that’s the connection. So we’re not just saying, you have pain and so you have a problem sleeping, we saying, you can have a problem sleeping, and develop pain, without anything being physically damaged.
Where fatigue comes in is that fatigue is not always just experienced, because you haven’t slept well. We in fact call that daytime sleepiness. So it’s if you haven’t slept well, you are going to be tired and that is fatigue. But there is a kind of fatigue, similar to persistent pain, where it’s a sort of a standalone kind of thing. It’s a condition of itself, that can persist. And that fatigue is not relieved by rest, or by a good night’s sleep. It is a fatigue that is mental, emotional, physical, and produced by the brain as an alarm, just like pain.
The connection between those three things is that basically, they are interrelated, sleep is incredibly influential in the relationship, but you can have standalone fatigue, which is part of a different syndrome, and in a relationship, not as closely connected to sleep as you would think.
When you’re dealing with somebody with chronic pain, how do you help them with those sleep issues.
Helen :: Maybe if I can just take a step back in terms of what OT’s bring to any challenge. So whether it is someone in chronic pain or with sleep problems, or with chronic fatigue, that might be part of a syndrome. What OT’s bring to every challenge that a client might be facing is mainly three things.
We always have that clients centered approach. So that means that our intervention with someone will be unique for them. It depends on who they are and where they find themselves at the time. So helping someone manage pain or fatigue or sleep problems is going to be different if they are obviously a baby with sleeping problems versus an older adult. If it’s a CEO of a company versus a stay at home mom or a shift worker, it’s always unique. Our approach is always tailor made for that individual.
I think the second thing that OT’s bring to any of these challenges is what we call the biopsychosocial approach. OT’s are the only rehab professionals who are trained to assess and manage all these aspects of health. So from physical to cognitive to psychological to social sort of context, aspects of someone’s health. And so when are we looking at sleep or fatigue or pain? We as OT’s are going to look at those things from every angle. We’re going to look at the physical things that are contributing there, we’re going to look at the psychological aspects, we’re going to look at the cognitive or mental, the social, all of that.
And then the third thing that that I think is important to know about OT’s and how we might approach these problems is that we have that functional focus. So OT focuses on how someone’s ability to do life, is being affected. By whatever, the challenge is, whatever physical, meaningful emotional challenges or environmental challenges they are facing. And we call that someone’s functioning. And for us functioning is looking at the participation in work, caring for themselves, social, leisure etc these are important aspects.
So when it comes back to your question of helping someone in chronic pain deal with sleep. I would say that often someone’s night life starts in the day. So how well your day goes, will determine how well your night goes. A lot of the work around helping someone in pain with sleep is about incorporating some management in their day. And we can get into some detail but there are aspects like physical activity, managing space, bringing in mindfulness. All of these active coping strategies that if we can incorporate in someone’s day, will often add up to to a better night. We can talk about sleep hygiene separately, but I’m just giving you some idea of where we might need to start with someone.
How would a mixed sleeping pattern or routine affect someone over time.
Helen :: I think when we looking at sleep health we can talk about quantity or number of hours that you need. And we can talk about quality. So how well someone’s sleeping, and whether they are actually going through all the stages of sleep that are important for us to go through. Just briefly, we have four different stages of sleep, and some are deeper, and some are what we call REM sleep where we’re dreaming. So to deeper and shallow are sort of stages of sleep would would determine if the quality of sleep with me. But then the third thing is, is probably the consistency issues.
So what I would say is that just in terms of general health, firstly, I think we must pay attention to quantity. We do recommend that people get between seven and nine hours of sleep, not less than six. If you having six or less hours, you seriously making yourself vulnerable to developing not just persistent pain that a number of health issues mental and physical health issues. So we talked about quantity we say, okay, 7 to 9 hours is great. Some people do need a bit more, and some people manage with a little less, but that’s an average.
But what is interesting in the research is how important quality is. So you were asking earlier, is it just, one night of no sleep and you get pain? Well, what the research found there around persistent pain is that they took two groups of people, and I’m sorry, I can’t actually name the researchers names now.
But they took two groups of people, one group, they said, okay, you can sleep for five hours straight, we won’t interrupt your sleep, whatever, you just get five hours. The other group also had five hours but they woke them every, I think it was in the hour and a half or something like that, but they interrupted the sleep. What they found is that both groups developed pain. So in other words, quantity was a problem, we do need to get enough sleep. But more interestingly, the group that was working during that five hours actually reported more severe pain. So what we saying is quantity is important. But even more important is that quality of sleep.
In your case consistency, so you might get away with one night of bed sleep. The trick is not to try and catch that up, sort of all in one go over a weekend or something because you actually going to throw your whole sleep routine out. You’re going to disrupt it, it’s all going to sort of backfire on you. But rather sort of sticking with the next night’s sleep routine, your body and your brain will catch that sleep up. But we don’t want that happening a lot. It’s really not a great idea.
And yes that’s why we struggle when we have babies because we are getting months and months of poor quality sleep. That is why we see moms sometimes developing you know that perinatal depression, we get all sorts of things going on there. So all I’m saying Oliver is Yeah, I think we got to think of those three things, not just quantity, quality is important. But also that consistency of how can we over time actually maintain good sleep routine sleep health? Good quality overall?
Do sleeping tablets help with sleep issues
Shaz :: Helen, I really love the way that you put that, everybody always says you’re you need seven or nine hours sleep but a lot of time they forget it’s about that quality of sleep. So thinking back to last year, I was going through a bit of a rough patch and I was then put on calming meds and sleeping tablets.
And I found that even on sleeping tablets, although I was having the eight and a half hours sleep. I was waking up the next day still feeling tired and not rested. So I really get what you’re saying there about, you can have eight hours sleep. But if that’s interrupted, or just not good quality sleep, you’re still not going to feel great the next day.
Helen :: Unfortunately, what happens with any sleep medications, we have this with benzodiazepines and whatever is being used for sleep, is that it’s still not going to be natural sleep. And it’s so often the case that I have clients who are on something. They say, “you know, knocked me out. But I still woke up tired, I still woke up feeling un-refreshed”.
And it’s because it changes what we call that sleep architecture of those different stages. So you might just go into all the deep stages and not get any REM sleep, or the opposite. It’s really not great. And it’s really not our first line in terms of sleep, sleep management. And I know you’re now introducing sort of some some ideas of what is better seek management. So I would say to people, you know, please don’t go for the pills, there’s your first line, it’s really going, to not match natural sleep and potentially end up creating some long term some some long term problems.
Does screen time before going to bed effect a person’s quality of sleep.
Helen :: So we used to say to people, don’t use screens before bedtime. And that’s because we had concerns about that blue light. What we find now is that many devices have actually got built in filters for that. So the blue light is no longer as big a concern, although people should check these screens for that.
What seems to happen is it’s more about what someone is watching and how they’re engaging. So you can be reading on a Kindle, for example, before you go to sleep, and it can be fine, it’s not going to affect your sleep. But if you’re on your phone, on Facebook, or you’re reading something, and it’s getting you worked up or you starting to engage in the comment section, that is actually more the issue. When you are doing activities just before, bed that are stimulating in some way that is a problem.
Of course, we do still recommend all the usual principles, if you do want dim lights, you do want to monitor that there isn’t blue light coming from your device. That it is about what you choosing to engage in just before bed, in what we call your wind down time. That is that is more the important question.
What is your Cronotype
Helen :: We recommend seven to nine hours sleep for people, but we don’t necessarily think that needs to happen at the same time for everyone. So, we used to call people, not owls or early birds. But there’s actually a few different Crono types. In other words, a few different patterns of how people behave through the day and night.
And what we find is that some people need the early night and then the full sort of seven to nine hours and then they up early. Other people only go to sleep at midnight they are our wolves, they up late. They only go to sleep at midnight, and they might still get the eight hours but then they waking up later.
So so everyone is like is unique. We can’t We can’t generalize too much. And we need to just look at someone’s life and go well, what is this person like? What is the pattern and how do they function when their pattern is repeated? So in your case, Oliver, I don’t know you might be a wolf and not owl. And you still getting a certain number of hours of quality sleep and you functioning fine on that. So it’s all about each person’s independent or unique pattern for sleep. And making sure it is something that they functioning optimally on and investigating if they not.
Oliver :: What makes it really challenging Helen is so so our daughter, she’s 13. But she’s got my sleeping habits. She doesn’t want to wake up before 9 or 10 o’clock. And I think if we let her, she would wake up at 11. So it’s really challenging in the afternoon,and like at night to tell her actually, you need to go to bed. Because she has school and she has to wake up earlier. So almost like sympathize with that because that was me.
Whereas our son, he’s like, even on a Sunday up at six o’clock. He’s younger he’s 9, so we try to get him to bed or both of them by eight o’clock. But with him, we don’t have to go and wake him up, because six o’clock BING he’s up. And it’s interesting, so I’m glad you mentioned that.
How do dreams affect your sleep.
Well, that is that is important question we need to ask ourselves. Is whatever sleep we are getting how are we feeling within half an hour of waking up? I’m going to connect the dreams for two questions we can ask ourselves about our sleep.
The first is, within half an hour of waking up. How do I feel? Do I feel ready for the day? I feel like I have enough energy? Or am I feeling that I’m still tired. So you say you feel refreshed? Great. The second question we must ask ourselves is during the day, how am I functioning Mr. productive and functioning optimally? So anybody listening to this can say to themselves? How do I feel half an hour within waking up? How am I functioning during the day? And if my answers to those questions are not great, or do you need to look at my sleep? But I thought if I can answer those questions and go, Yeah, I’m okay, then I don’t need to get too hung up about the numbers. Maybe I’m only getting seven hours. But I’m okay, I’m actually functioning.
Now with the dreams and I think your wife. I think she’s probably is dreaming but not remembering her dreams. I mean, that can happen, dreams definitely come into what we call REM sleep. So we call it that because it’s rapid eye movements. And we just know someone’s in that stage of sleep because their eyes actually sort of flatter.
What we find is in the first half of someone’s night, the first half of the 7 to 9 hours is more the deep, you have a lot more of the deepest sleep. Then that second half is where we get a lot more of that REM sleep. And that’s when we dream. And why we often do you remember our dreams when we wake up because we’ve actually just been in that latter stage of sleep.
So I find dreams interesting and informational. Dreams can be just a total jumble of the day before and what events took place. But dreams are also sometimes the way our brain is sorting information and the way our brain is trying to process sometimes things that we are not consciously dealing with in the day. So obviously, as an OT, I’m interested in dreams sometimes as a reflection of someone’s mental state of their stress. You know, what are they dreaming about? What are the themes that keep coming up? And often my clients with with persistent pain and fatigue have high levels of anxiety and we find that reflected in the sleep and in the dream life in terms of that sort of anxious hyper vigilant the kind of dreams that they have.
Energy Drinks affect sleep and fatigue.
Oliver :: So I’m also assuming that when you say functioning during the day, you can’t cheat with Red Bull or Monster.
Helen :: That it’s such nasty stuff. I’m sorry, Red Bull, but this is not a promo for you. Look at I guess, you can get away with it once or twice. But obviously we would not want people relying on substances of any kind really, to get through the day. We always want to go back to basics. We always want people to be functioning optimally without the assistance of any added substances preferably.
Of course, medication has a role of course, these these other interventions have a role. But generally we want someone to be kind of managing those cornerstones of health, nutrition Exercise, getting enough sunshine, managing stress. Those are things that people can do for themselves that have very little side effects, and are not going to create new problems for them. So that that’s ideal.
Oliver :: Yeah, its so funny, because whenever we had a late night deadline, in the IT world. It was always we would go to the garage shop, and go get a packet of Red Bulls. That was our pick me up’s through the night. But, I could almost even at that time, I could feel how bad it was. Because the next day you just like, although you’re sleeping you know, you’re not sleeping well.
Helen:: Let’s rather not name and shame but let’s, let’s talk about caffeine. And I think we saying that some caffeine every day is actually fine. I have my one cup in the morning, up to two cups of caffeine still great. But I think if we are relying on something, whatever it may be, it’s creating probably a vicious cycle. And as you say, you can feel how caffeine would affect you. You start to get that edginess, if you’re already a slightly anxious person, and you have a lot of caffeine, because it’s a stimulant it just ramps that all up. It is going to affect your sleep, it’s actually going to rebound and make you more fatigued as well. And we know caffeine starts to affect pain too. So in that in that relationship of those three things it’s not great.
Can you tell us more about sleep hygiene and the three main areas to improve your sleep.
Okay, well, maybe what we can do is just talk more broadly about what we mean by good sleep hygiene. Because I think we touching on on it from different angles as we talking but caffeine use would fall into into one of these areas. As I said earlier, if someone is having sleep problems, fatigue problems, and they’ve maybe answered those two questions I gave earlier in sort of the negative. I would say, focus broadly on three main areas to improve your sleep.
Sleep Routine. Wake up Time. Wind Down Time.
The first is really your sleep routine. So whatever that might be for someone because we’ve said that it can be different for people, you might want to go to bed later than other people still getting your certain quantity of hours of sleep. But actually keeping a regular sleep routine is the first thing to focus on here.
Our bodies naturally work according to rhythms. And those rhythms are partly connected with sort of, the sunlight and nighttime and that. And so we need to keep regular sleep routines that our body can stay in that rhythm and various systems in our body that function according to those rhythms can can be predictable and can be stable. So the first thing that people can look at is that sleep routine, have a set waking up and a set sleep time. And then around those two times focus on what you’re doing.
So I talk to people about what I call your wake up time. So that’s probably that hour or two just after you’ve woken up. How do you want to wake up for the day you might be someone who needs to wake up, kind of slowly calmly sipping your cup of tea out in the garden. You might be someone who likes to wake up with a shower and having your coffee and some music playing. Everyone’s different but have, something routine around that wake up time little rituals you can bring in me.
Even more important is that wind down time at the end of the day. So have your set time that you are going to get into bed and probably be falling asleep soon after within half an hour probably of getting into bed. But then again the hour or two before that you want to be preparing to sleep. You want to be sending your body and brain, all these signals that okay, sleep is coming, get ready. So let’s dim the lights, have a nice hot bath, play some calming music, journal a little bit, whatever it is, those rituals that prepare you for sleep. The sleep routine is is the first thing.
The second thing I would ask people to think about and focus on is what I call your sleep sanctuary. So we actually all need to think of our bedrooms as a sanctuary kind of space a retreat. Let’s look at our bedrooms and think. Is this a space I can be peaceful in? Is it conducive to sleep? Or is it a place where I watch TV or fight with my partner? It’s noisy, it’s too light, it’s not comfortable? We pretty much say to people, your bedroom is for sleep and sex shouldn’t really be doing anything else in there.
And they’re definitely not working from your bedroom. So create a sanctuary, the kids must knock if they want to come in, but dogs must sleep elsewhere. Yeah, I mean, this is ideal,I know people have different preferences. But what do you need to do to make your bedroom a place that’s conducive for sleep? That is the question.
And then the third thing there Oliver that you bringing up with caffeine and Shaz brought up with the screentime is just general sleep sense. I call it so all of those little principles that we should practice in order to make sleep easier for ourselves. And online is there is plenty of information and quite a lot of good information.
But for example, people might not realize that to sleep, well, you actually need quite a cold bedroom or quite a cold environment. 21 degrees is the ideal temperature for sleeping well. So you can be all snuggie under your duvet and the environment is quite cool. And we found that that’s, great for sleep. It should be dark as dark as possible. You know, monitor for noise levels, some people need a little bit of noise to sleep well and other other people need silence.
So to summarize, and I’m saying to people, these are the things to think about first before you rush off to the doctor and start looking at medication. Yes, it can have a role. But this is the stuff to look at first, sleep routine sleep sanctuary, what is your bedroom like have a good look around at that space? And then thirdly, just basic sleep sense you know basic principles around the environment and around the temperature and aspects to do with those things.
How would somebody manage stress during the day to help them sleep better at night.
Helen :: This is a massive topic all on its own, isn’t it. And I would say that from an energy perspective, I would again, go back to how OTS approach things from their bio psycho social perspective. In other words, when it comes to stress management, we often tend to focus in on all the emotional, psychological side of stress. And obviously, that is part of it. And it’s important, but I want to just remind people that there is a very physical and physiological aspect to stress.
So, as an OT, we would be looking at physical aspects to stress, like someone’s sensory regulation. So, someone can be stressed because they are in a working environment, which is creating sensory overload for them, people are different in their sensory profiles. Some people can handle a lot of sensory input. In fact, they enjoy it and they crave it. Others are more sensory sensitive, and, might be in a work environment without being flooded. Flooded from sort of online work flooded with noise or light.
And so looking at some physical aspects of stress is part of what OT would do, and looking at environmental factors for stress. And then also looking at what is the person putting into their body and doing with the body that’s creating stress. So we talked about caffeine earlier. I mean, you can just be taking too much caffeine, and be over stimulating your nervous system and end up with the jitters as if you’ve got generalized anxiety. So what you’re putting in your body is a physical factor that can contribute to stress.
The other physical side of stress management is really about using up the stress hormones cortisol, adrenaline by getting enough of the connectivity. So what is that person doing in the day? Are they just sitting in front of a laptop all day, not really getting out the into the sunshine, getting physical activity, but very passive, incidentally, that is going to escalate stress. These are a whole lot of physical things that I think we sometimes don’t pay attention to with stress management.
We’re good at all the emotional things so probably what the psychologist will have shared is on the stress on the more emotional psychological side. And certainly OT’s would contribute there in terms of sometimes equipping people with different life skills for managing stress. Maybe someone needs to learn better boundaries, maybe they need to learn conflict management. There are many things people can do to actually make themselves more resilient.
We’ve been talking about fatigue and rest and and I just want to say that actually rest is what makes us resilient. Not pushing on not burning out, not carrying on, you know, so hard and long that, we just push past all the symptoms that are warning us. So creating a restful lifestyle. These are the things that I think we don’t always think about when it comes to stress management, but they can be as powerful for managing as dealing with the emotional content of our brains.
What advise would you give to someone who is struggling with sleep problems or fatigue.
Helen :: So I think I think a lot of our discussion today has probably been for people who have just have a sleep problem. But if what we are suggesting is not working. And normally I say to people, you know, if you’ve put into practice, all of these sleep principles we’ve covered for a few weeks, even up to a month. And you’re not seeing significant improvements might not be completely perfectly if you’re not seeing significant change, then you would want to investigate further. Because you may have now what we call a sleep disorder.
So there’s a difference between sleep problems and disorders. And there are a number of sleep disorders that people can have and might not even know they have. I think obstructive sleep apnea is a good example, someone often doesn’t know that during the night they actually stopping breathing and then disrupting their sleep.
So what I would say to someone is, if you’ve tried to usual, consistently, over about a month. And you still feeling un-refreshed In the morning, still struggling with fatigue, then go to your GP. You might have another condition that’s playing into this, it could be a psychological condition, you might have post traumatic stress disorder, anxiety, depression, might be an actual sleep disorder.
Start with your GP, your GP can decide whether you need more specialized investigation through something like a sleep laboratory, where they actually monitor you overnight. But even with all of that, your first interventions should preferably not be medication. Once you have tried what you can, the GP might be your next port of call and might open up further more specific investigations for you.
I think we’ve covered covered some really broad aspects of it is a huge topic. I think we’ve hopefully given some practical pointers for people. I would just reinforce again to people that make rest a part of your healthy lifestyle. Don’t just focus on nutrition, don’t just focus on physical activity, focus on your sleep, and focus on including rest. Whether it’s every day, whether it’s on your weekends, bring it into your life because because no amount of business and no amount of pushing on and on is going to serve you well. Rest needs to be part of a healthy lifestyle.
Contact Information for Helen Roome
WhatsApp :: 083 556 8871
Email :: firstname.lastname@example.org
Website :: https://helenroome.co.za/