How did I come to focus on sleep OT? An interview with Verena

“When I realized that addressing sleep, specifically the sleep environment, could bring quicker and more sustainable results to my clients, I was determined to spread this practical knowledge within the German-speaking OT community and beyond.”

Photograph: Canva

During 2001 to 2009, when Verena was a practitioner at the University Hospital Balgrist treating patients with spinal cord injuries, orthopaedic and rheumatological problems, she often felt at a loss as many of her patients suffering from musculoskeletal and rheumatic pain at night could not get expected long-lasting therapeutic effect from the traditional behavioural changing approaches or by using the cervical neck pillows offered by the unit.  In some cases it was not possible to relieve the pain as the cause of the pain remained unclear.

In 2010, when she started working at the League against Rheumatism Zurich as the only occupational therapist (OT), offering advice, education and help to clients with rheumatic disorders, she found that almost all her clients had sleep problems. However, none of the health professionals they saw, including Rheumatologists, Physiotherapists and GPs, seemed to notice and address this. This constantly occurring situation caught her attention and offered her a chance to find the answer and develop services of sleep improvement.

When I visited my clients at their homes, I started assessing their bedrooms and beds and checked their spinal alignment when they were lying on the mattresses. Most of the time, the ergonomic position of their beds corresponded with the musculoskeletal pain they had.”  

During her visit, Verena found that nearly 80% or even 90% percent of beds and mattresses that she saw at her clients’ homes in Switzerland are ergonomically unbefitting, most of which are generally too hard or not adaptable. Being aware of the problem, she used her knowledge in Orthopaedics and Rheumatology to adapt the beds as a first measure with low-costs. For example, she took out slates in the shoulder area to support the sinking in of the shoulder when lying on the side and supported lumbar spinal alignment with the help of rolled-up towels under the mattresses to fit the beds in order to distribute weight more evenly and improve spinal alignment.  As a result, most clients developed more restful sleep, reported less pain and were able to take part in daily activities within weeks after making small changes to their beds. With such a significant effect on pain relief and sleep, the League against Rheumatism then decided to find funds and sponsor clients with new beds to best meet their physical needs.

With these small measures, it was really amazing to see that improvements could be achieved within such a short period of time. So, I thought ‘We really need to tell all healthcare professionals about this. It is such an easy intervention that may bring considerable impact on sleep quality and pain reduction.’ That was the beginning of my interest in Sleep OT, to change sleep surroundings and try to adapt them for the purpose of sleep improvement.”

For this reason, Verena dove into finding more answers for sleep and the sleep environment, especially in the area of beds. Since there was not much relevant literature or research in the health-related field, she self-educated the knowledge of sleep, conducted further investigations, and sought as much information as possible from vendors and specialists in the domain. By communicating with other experienced OTs that are interested in sleep, especially Prof. Cary Brown, who pioneered sleep environment assessing tools such as the CBEES, she furthered her motivation in exploring the specific area in the discipline.

Besides working with scholars in academia, she found a Swiss network that is consisted of bed specialists and sells bed systems that are adaptable. Especially, the network offers a money back guarantee if a good fit cannot be achieved.  This network was a great partner for her newly developed service called “Liegeberatung (Sleep Positioning Consultancy)”. Over the next few years, she has consulted over a hundred clients, some of which received new bed systems.

A win-win situation

“I was astonished to learn that most of the mattresses and beds sold in Switzerland (and beyond the countries border) do not meet basic ergonomic criteria to support spinal alignment. Also, we are so poorly educated on the product that all of us use for one third of our lives. How could that be?”

Always intending to spread her knowledge to OT professionals and the lay public, Verena brought her study (the efficacy of the developed service in changing sleep environment) to the ZHAW Zurich University of Applied Science OT Research & Development team. Shortly afterwards, she started her teaching career at the Institute of Occupational Therapy in 2014 as a lecturer and international coordinator and trained a new OT for the League against Rheumatism Zurich in the newly developed sleep service. Sadly the study at the League against Rheumatism Zurich could not be concluded due to unforeseen reasons. Not being discouraged, Verena handed on her knowledge in the OT Bachelors course and in the first-developed postgraduate course to qualified OTs and other health professionals.

Right before the first course took place, IKEA approached ZHAW referred by a third party. The company were looking for health professionals to conduct a series of sleep workshops mainly for their ‘IKEA Family’ members and customers in the stores. ZHAW agreed to train OT students and OT practitioners as well as a few Physiotherapists to become the workshop leaders. “I am convinced that we are well-suited as a profession to educate about sleep”, said Verena, “we know what an important influence the environment is, and how to adapt it. We are experts in health education as well as behavioural change. As one sleep doctor once said: OTs could bridge the link between sleep science, sleep treatment and the daily life of people with sleep problems.

In 2016, Verena trained 12 professionals including OT students, OT practitioners and Physiotherapists to join her project as leaders of the workshops and successfully completed the first delivery of the sleep workshops collaborating with IKEA. Within 6 weeks, they had altogether organized 108 one-hour workshops among the 6 German-speaking IKEA shops, and this has since been repeated, totalling over 200 sleep workshops.

“It was such a great opportunity to participate in spreading knowledge on sleep in Switzerland thus giving our profession a bigger platform”,said Verena.

As this interview was taking place, Verena was engaged in another IKEA project in a more extensive way. This time, she is responsible for the training for the IKEA staff with the help of 4 OTs . Her team is currently delivering knowledge in all the nine Swiss IKEA stores which are located in all the three language areas of Switzerland. The workshops will be concluded in September and evaluated at a later stage.

Nicole Ruefenacht, one of the Swiss occupational therapists demonstrating how to assess spinal alignment in the workshop. Photograph: Rita Ziegler, ZHAW

So far, Verena had created a win-win deal for both the Swiss public and the OT community. As she commented:

“I think one of the great additional benefits of this project was that a small community in Switzerland that interested in sleep was fostered.  I realized though that including the topic of sleep in OT education with our cohort of 80 students, which will increase to an annual intake of 120. This will be the biggest chance in getting sleep into all areas of practice in Switzerland. I am also thrilled that more and more students choose to write about sleep as a part of their Bachelor Thesis.”

An advocacy to OTs

Communicating with lay people is an essential part of OT’s role. As a professional OT, they have opportunities to visit people in their homes, observe their living environment and give them professional advice to make changes. However, as Verena highlighted, the study on sleep and sleep environment still remains a rather small and new area which is not routinely addressed by most health professionals, including occupational therapists ourselves. Therefore, she advocated:

 “Starting with the sleep environment is a faster way to introduce clients and patients to the topic, as small changes can already have a big impact. The patients are more motivated with the follow-up behavioural changes which usually need a longer time to implement. I look forward to the OT community fully embracing this relevant topic in our patients’ lives and the development of more researches in this area.

Written by Yunke Xu