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OT Faculty, Alumnus Are Changing the Way Poor Sleep is Treated

Nabila Enam, OTD, and Christopher Yang, DrOT USP ’14 ’16 (OTD), are treating disordered sleep using highly effective, holistic approaches based in mindfulness. Enam and Yang are sharing their evidence-based success with providers and clients in an effort to make this treatment more readily available, particularly for patients with traumatic brain injury.

patient trying to sleep in hospital

Written by: Emmalee Eckstein

Published: June 29, 2023

Total reading time: 4 minutes

We’ve all experienced the occasional sleepless night caused by anxiety or excitement — sometimes, tossing and turning is a natural part of being human. But individuals who consistently experience sleep disruptions may be suffering from more significant issues like excessive stress, major problems with their circadian rhythms or traumatic brain injury (TBI).

Healthcare professionals have a variety of ways to treat disordered sleep, the majority of which are pharmacological, but recently, occupational therapists (OTs) like Nabila Enam, OTD, clinical assistant professor of occupational therapy, and Christopher Yang USP ’14 ’16 (OTD), have begun getting more involved in treating disordered sleep, and their holistic methods have been highly effective.

“A lot of OTs don’t incorporate sleep into their treatment plans,” says Enam. “It’s new in our profession — sleep wasn’t considered an activity within our scope until as recently as 2008, even though it has an incredible impact on an individual’s overall recovery process.”

A lot of OTs don’t incorporate sleep into their treatment plans . . . even though it has an incredible impact on an individual’s overall recovery process.

Nabila Enam, OTD, clinical assistant professor of occupational therapy

Enam and Yang have set out to change that. They regularly deliver presentations to professional groups and client populations about their research and successes in treating sleep issues.

Yang, a travel therapist who is currently on contract at Hilo Medical Center in Hawaii, has been working with the TBI population in a hospital setting for years. Once he identified his patients were having incredible difficulty with recuperative sleep in the hospital setting, Yang began providing them with mindfulness-based sleep kits.

“Something is always beeping, lights are always on – you never know what time of day it is. That can make it hard for someone without a TBI to fall asleep,” explains Yang. “So add into that some damage to your hypothalamus, which controls your sleep, or a lack of melatonin production – it could be impossible to get any kind of quality rest.”

Yang discovered Namasté Care, which was originally developed by Joyce Simard in 2003 as a program for individuals with advanced dementia in residential facilities. The two basic principles of the program are creating a calm environment and providing all activities and interactions with an unhurried, loving touch.

Yang’s neurology patients were commonly experiencing the same symptoms as any dementia or Alzheimer’s patient would – spastic motion, behavioral outbursts, nerve pain. He immediately began identifying familiar language and approaches being used in Namasté Care, like activities of daily living (or ADLs for OTs), meaningful tasks (or meaningful occupations for OTs). So Yang set out to incorporate Namasté Care into his patients’ treatment plans by creating a mindfulness sleep kit.

“I go through a checklist with the patients and their caregivers identifying what works for them – it can be as simple as a calming fragrance, a weighted blanket, white noise machines,” says Yang. “We want the patient to be actively involved in creating the environment.”

We want the patient to be actively involved in creating the [sleep] environment.

Christopher Yang DrOT USP ’14 ’16 (OTD), travel OT

Enam has been using mindfulness as an OT for the entirety of her career.

Before teaching at Saint Joseph’s, Enam worked as a full-time clinician in long-term care supporting the adult TBI population with community re-entry. She is also a certified yoga instructor.

“People with TBI often need a supervised environment since their physical and cognitive abilities can be so compromised,” recalls Enam. “And as these clients were aging, their symptoms — like issues with balance, rigidity and spasticity — were getting worse and worse. Traditional OT approaches weren’t working.”

Enam tapped into her yoga training and found her clients making real progress. She modified movements using chairs and blocks for support and the yoga practice resulted in a significant improvement in her clients’ balance and relaxation.

In her current role, she’s done research focused on student stress and SEPTA shift workers that asks participants to actively engage in mindfulness work to improve sleep and decrease anxiety.

Next, Enam wants to expand her reach out into the neighborhood of West Philadelphia, working with TBI survivors who are struggling with sleep in their own homes using Yang’s sleep kit.

The pair plan to continue talking to the OT and TBI communities about using mindfulness as treatment through lectures and seminars.

“This is an evidence-based treatment option,” says Yang. “It’s working, patients are finding success and comfort in these methods.”

Enam agrees. “More than anything, we want clients and patients to know where they can find this kind of treatment; we want providers to know they can implement this kind of treatment. It is effective and holistic — it is exactly the kind of tool we should be implementing as OTs in the field.”

Learn more about Saint Joseph’s Occupational Therapy program.