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Assessing Sleep: An Interprofessional Approach

Sleep is a critical, yet often underassessed, health metric across all domains of functioning. Importantly, individuals with substance use disorders are at increased risk of sleep disturbance, which may contribute to continued substance use difficulties. In response to this relation between sleep and substance use, Dr. Peggy Swarbrick at the Rutgers Center of Alcohol and Substance Use Studies, and associates Jennifer Gardner (Rutgers School of Health Professions), and Robert Kitzinger (Kean University) have combined their expertise in the fields of occupational therapy and social work to highlight the importance of sleep for recovery. In their experience, these authors note, many individuals with substance use disorders report significant sleep disturbances, which can result in impairments across physiological, emotional, and behavioral domains. The relation between sleep disturbance and substance use disorders is bidirectional, as disruptions to circadian rhythms and substance use are reciprocally reinforcing. Further, aspects of substance use (i.e., withdrawal, stimulation) further disrupt regular sleep-wake cycles. Regulating sleep may be especially important in early stages of substance use recovery, according to surveys of adults in treatment.

Despite the relationship between sleep and substance use, assessment of sleep often is not a primary focus of early substance use treatment planning. Gardner, Swarbrick, and Kitzinger outline strategies for sleep assessment using an interprofessional approach. They suggest that occupational therapists are well-suited to assess sleep disturbances, given their expertise in understanding both sleep preparation (i.e., routines to prepare for comfortable sleep) and sleep participation (i.e., completing personal needs for restful sleep). Factors to consider for a complete sleep assessment include quantity, quality, latency onset, and perceptions. One assessment that specifically captures sleep needs among individuals with substance use concerns is the Substance Use Sleep Scale (SUSS). This self-report tool includes 23 items assessing sleep problems, including nine items addressing sleep problems related directly to substance use such as consuming alcohol in order to sleep. Other available assessments for social work and behavioral health professionals are available, with each measuring different facets of sleep disturbance, difficulties, and sleep hygiene habits. However, the SUSS is the only currently available assessment that specifically captures the role of substance use in sleep functioning. Gardner, Swarbrick, and Kitzinger have published  a table to help guide providers in selecting appropriate sleep assessments.

Following assessment, sleep goals should be integrated into treatment planning and interventions. Among the empirically supported interventions, strong support has been found for cognitive behavioral therapy for insomnia (CBT-I) which targets cognitions and behaviors about sleep. Additional components of CBT-I include relaxation strategies and sleep scheduling. CBT-I has demonstrated utility in improving sleep efficacy, latency, and use of medications for sleep. Importantly, there is CBT-I smartphone application that can assist individuals, with the support of their providers in setting goals and implementing their sleep plan.

Development of specific sleep hygiene goals should be done in consultation with the behavioral health, social work, or occupational therapy provider. Setting specific goals, modifying the individual’s environment to support behavior change, and discussing potential barriers to following the plan are crucial steps for effective treatment plan implementation, along with the use of interprofessional teams. Ongoing assessment of sleep and behavior tracking is essential for monitoring progress and adjusting treatment plans as needed. Gardner, Swarbrick, and Kitzinger note that sleep is a critical area of future research in understanding substance use risk and recovery. Future work would benefit from examining subjective views on sleep, understanding perspectives on rest vs. sleep, relationships between sleep and daily functioning, and the effects structuring time for individuals in recovery.

Source: Gardner, J., Swarbrick, M., & Kitzinger, R. H. (2022). Sleep is something, not nothing: an interprofessional approach to sleep assessment and treatment to support substance use recovery. Journal of Social Work Practice in the Addictions, 23(1), 39-53. doi: 10.1080/1533256X.2022.2159643