One-third of Americans sleep less than 7 hours per night and more than half of adults have reported sleep problems (Irish et al., 2015; Luyster et al., 2012). Although poor sleep may result in impaired motivation, emotion, and cognitive function, chronic sleep deprivation has more serious side effects, including risk for cardiovascular disease, cancer, and diabetes (Irish et al.). Additionally, sleep disturbances can increase an individual's risk for falls and accidents, and can contribute negatively to quality of life and functional ability (Siengsukon et al., 2017). Physical therapists (PTs) can be active interdisciplinary team members to screen for poor sleep health and promote optimal behaviors to thwart sleep-related sequelae. However, a survey by Siengsukon et al. (2015) suggests knowledge gaps among PTs in relation to sleep quality assessments and intervention tools aimed at promoting healthy sleep behaviors. The authors assert that all PTs should consider incorporating the following into routine practice: 1) assessing overall sleep health and screening for sleep disorder risk, 2) referring to other practitioners for additional assessment when necessary, 3) providing sleep hygiene education, 4) providing an appropriate exercise program, 5) considering proper positions that promote sleep quality, and 6) addressing bed mobility issues.

Assessment of Sleep Health

A recent publication from the American Physical Therapy Associations (APTA) Home Health Section titled "Sleep Management in the Home" (Siengsukon & Miller, 2018) is a valuable resource for home healthcare providers. The document that includes a sleep decision tree, a description of medications that impact sleep health, and specific interventions applicable to the practice of PTs toward promoting sleep health is available at https://www.homehealthsection.org/store/ViewProduct.aspx?id=11049369&hhSearchTer

Screening questions are an integral part of the sleep screening and assessment process. The following questions could be helpful to determine further intervention needs (Siengsukon et al., 2017):

1. How many hours of sleep do you typically get?

2. Do you feel well rested when you wake up?

3. How would you rate your overall sleep quality? Would you say your overall sleep quality is very good, fairly good, fairly bad, or very bad?

Interventions to Promote Positive Sleep Hygiene

Many sleep hygiene modifications are attainable through relatively inexpensive environmental modifications (e.g., purchasing light-blocking curtains) and directed education (e.g., stimulus control and comfortable sleep positions). PTs can provide individualized sleep hygiene education based on a patient's home setting and medical conditions, learning preference, and access to resources and technology. In addition to patient-focused education, instruction to family members and caregivers should be considered.

The following are specific suggestions PTs can incorporate into skilled interventions and educations to promote positive sleep hygiene behaviors (Siengsukon et al., 2017):

1. Sleep and wake up at the same time every day.

2. Use bed for sleep and sexual activity only.

3. Leave the bedroom if unable to fall asleep after 20 minutes and then return when sleepy. Relaxation techniques are an alternative for individuals with safety concerns related to getting in and out of bed or other limitations to mobility.

4. Develop a relaxing sleep routine, such as taking a warm shower or bath, reading a book or performing a wordsearch puzzle, meditation, or stretches from a therapist-prescribed home exercise program.

5. Although an exercise program can improve sleep at night, it should be avoided 2 to 3 hours prior to bedtime.

6. Avoid caffeine, nicotine, and alcohol as they may impair an individual's regular sleep cycle.

7. Reduce internal and external lighting and noise.

8. Regulate the temperature of the room.

9. Avoid unprescribed or over-the-counter sleeping pills.

10. Avoid electronic use while in bed.

11. Avoid eating large meals or foods that can cause an upset stomach 2 to 3 hours prior to bedtime.

Consideration for the holistic patient experience and patient preferences should be incorporated into sleep hygiene education and interventions. For example, an individual may be willing to switch to a decaffeinated coffee with dinner, but not give the coffee up altogether. Another example may include an individual with physical limitations that led them to regularly sleep in a recliner chair that could in turn negate education related to sleeping in a bed. In these circumstances, motivational interviewing or health coaching can be fruitful techniques to bring about positive behavior change aimed toward the unique needs and goals of each individual. Routine sleep health screening and promoting positive sleep hygiene techniques can be useful to PTs to identify and mediate potential sleep-related conditions.

Wearable Ultrasound Patch Tracks Blood Pressure

The pressure of blood flowing through arteries and other blood vessels can harm organs when it remains too high for too long. High blood pressure, or hypertension, can lead to heart attack, stroke, kidney disease, and other health problems. But this common disease usually doesn't cause warning symptoms, so many people don't know they have it.

A blood pressure test is the only way to detect hypertension. The usual method is with a blood pressure cuff on the arm. A research team led by Dr. Sheng Xu at the University of California, San Diego, set out to develop a thin, wearable blood pressure sensor using ultrasound transducers. The team engineered a stretchable, flexible device that can be worn as a skin patch. It has an array of ultrasound transducers so the one that's in the best position over an artery can be selected. A layer of silicone beneath the patch eliminates the need for the gel used with conventional ultrasound probes. The work was supported in part by the National Institute of Biomedical Imaging and Bioengineering. Results were published in Nature Biomedical Engineering.

The patch could produce waveforms for vessels as deep as 4 centimeters below the skin surface. The researchers compared the skin patch to a pen-like tonometer for measuring blood pressure on the neck, wrist, arm, and foot of a healthy 22-year-old man. When the man moved or twisted, the readings were more stable with the skin patch than with the tonometer. The team found better precision and accuracy with the patch as well. The precision and accuracy of the skin patch hasn't yet been compared to the invasive catheterization method of measuring blood pressure. For the next phase of development, the team would like to engineer a way to make the skin patch wireless.

REFERENCES