Waking Up to New Practice Areas: Sleep Apnea and OT
Ashley Opp Hofmann
“Sleep affects every aspect of a person’s life,” says Cindi Petito, OTR/L, occupational therapist and owner of Seating Solutions in Orange Park, Florida. For those with sleep apnea, using a physician-prescribed continuous positive airway pressure (CPAP) machine is key to getting restful, restorative sleep. Seeing all sorts of possibilities for occupational therapy practitioners to integrate addressing sleep apnea into their practice, Petito is leading the way in showing how occupational therapy can benefit persons individuals with this condition.
Understanding Sleep Apnea
Sleep apnea is a condition in which an individual pauses his or her breathing while sleeping. These pauses can last anywhere from several seconds to minutes and typically occur between 5 and 30 times per hour. Usually, a blocked or collapsed airway obstructs oxygen, leading to either very shallow or paused breathing. Many persons with sleep apnea use a CPAP machine in which a mask fits over the nose and mouth and blows air into the throat, preventing airways from narrowing or getting blocked.
Petito entered the sleep apnea arena almost by accident. As a wheelchair specialist, she works closely with durable medical equipment (DME) providers, including those who provide sleep apnea equipment, such as CPAP machines and masks. “One day I ventured in and started looking at the equipment, just out of curiosity,” she says. The face mask in particular caught her interest. “It looked a face splint to me, and it’s the most important piece as far as being compliant with the equipment because clients have to wear this apparatus on their face when they sleep at night,” Petito explains. “If it’s not fitted properly, then the clients don’t get a good night’s sleep. They actually lose sleep.”
She looked into sleep apnea further, researching its causes and effects. “I realized the impact sleep apnea makes on individuals’ physiological conditions. It affects their daily lives and skills, and how they operate throughout the day, whether they’re at work, home, or school,” Petito says. Because sleep, or lack thereof, affects daily life so directly, “the whole scope of sleep apnea and its effects and complications fit right into the realm of occupational therapy.”
Incorporating Occupational Therapy
Recognizing sleep apnea as an entirely new, potential area of occupational therapy, Petito decided to volunteer 1 day per week for a CPAP equipment provider, sitting in on the initial equipment set-up appointment and the follow-up. Petito uses her occupational therapy skills to ensure that clients know how to correctly wear the mask and that it fits comfortably. Then she interviews clients about their apnea before and after using the CPAP machine, and gives them information about this condition. “They don’t seem to get education about their sleep apnea from a sleep lab or their physicians, so they come in without fully understanding how it affects their lives,” she says.
Petito has noticed that clients with more severe apnea often have little problem adjusting to the CPAP machine, and those with milder apnea tend to need at least 6 to 8 weeks to get used to wearing it at night. Those who use the machine report they “have more energy and feel like they can stay awake through their work day. They’re at less risk of falling asleep at the wheel,” Petito says. “I also get a lot of positive responses from spouses and significant others who were previously affected by the snoring and restlessness at night.”
“Occupational therapy practitioners can integrate [sleep apnea] into their practice,” says Petito. In the revised version of The Occupational Therapy Practice Framework: Domain and Process, “rest and sleep” has been moved from being an activity of daily living to being an area of occupation, in recognition of the vital role it plays in supporting healthy engagement in all areas of occupation. “If we have diabetic clients or clients with obesity, we are already providing education and training to them on how to adjust and live with their disease. If they are also a sleep apnea client, I think we could easily incorporate this aspect of treatment into our current practice,” says Petito.
Working with Stakeholders
Clients with sleep apnea aren’t the only ones who could benefit from occupational therapy practitioners addressing the occupational area of sleep. Manufacturers, such as Resmed and Respirionics, have expressed interest to Petito in working with occupational therapy practitioner to improve clients’ compliance with their products. “They have a vested interest in making sure clients use their products. Very often, when clients are not compliant, they’re either not comfortable with the machine, they’re not tolerating the pressures, or the masks fits uncomfortably,” Petito explains. “If somebody doesn’t follow up with that client, then they usually stick the machine in the closet and their condition worsens.”
According to Petito, “Manufacturers think using occupational therapists is great because we will follow that client and look at every aspect of his or life in a holistic manner and improve compliance.” Petito also points out that manufacturers know that occupational therapy practitioners work in diverse and multiple health care settings, unlike respiratory therapists, who typically work for either a sleep lab or a hospital.
Although sleep apnea is a brand new area for occupational therapy, it’s also a natural one because sleep affects every occupation in which someone might engage. “Occupational therapy practitioners can really help these clients with sleep apnea adjust to and understand their condition,” Petito says, “which definitely promotes occupational therapy.”