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If there was one thing we want you to take away from the tools of Integrative and Lifestyle Medicine, it’s this: improving your patients’ sleep is essential in physical therapy.
Too many people assume that poor sleep is simply a fact of life or of aging, rather than something that can be fixed or changed. And this misconception is negatively impacting the health of our society.
In order to understand why sleep is essential in physical therapy, you must know that sleep problems can lead to many negative health outcomes ranging from cardiovascular disease to chronic pain. Sleep happens to be one of the six pillars of Lifestyle Medicine, which is why an entire chapter is dedicated to it in the book, Integrative and Lifestyle Medicine in Physical Therapy.
We’ve dedicated this podcast episode to sleep because the research and our personal and professional experience supports the benefits of good quality sleep on our health and well-bering.
In this podcast episode, Dr. Ginger Garner interviews Dr. Katie Siengsukon PT, PhD, a sleep expert. She wrote the chapter, “Sleep and Relaxation,” which is an essential resource if you want proven tools to screen for sleep disorders/issues and techniques to promote healthier sleep hygiene for your patients.
Dr. Siengsukon found her way into sleep research after feeling ill-equipped to help her patients with their sleep challenges, when starting as an entry-level PT. Through her research she learned how imperative sleep was for nearly every functioning system in the human body. Thus leading to researching how sleep is essential for physical therapy.
Thanks to her efforts, more and more people are waking up from a good nights sleep and sharing the benefits of quality sleep in their physical therapy practices and beyond.
Check out the podcast to listen to the full interview!
For those of you that prefer video, watch this conversation between Dr. Ginger Garner and Dr. Katie Siengsukon on why addressing sleep is essential in physical therapy.
You can check out her chapter, “Sleep and Relaxation” in the book, Integrative and Lifestyle Medicine in Physical Therapy.
Catherine (Katie) Siengsukon is an Associate Professor and Director of Research for the Department of Physical Therapy, Rehabilitation Science, and Athletic Training and is the Director of the Sleep, Health, & Wellness (SleepWell) Laboratory at the University of Kansas Medical Center. Dr. Siengsukon’s research interest involves understanding how sleep impacts health-related outcomes and recovery, particularly in individuals with neurologic injury or disease, and behavioral interventions (exercise, CBT-I) to enhance sleep. Dr. Siengsukon’s research has been supported by the National Institutes of Health, the National Multiple Sclerosis Society, and the American Heart Association. Dr. Siengsukon received her MPT from Rockhurst University in 2002 and her PhD in Rehabilitation Science from the University of Kansas Medical Center in 2008.
00:00 Dr. Ginger Garner: Hi everyone. I am here to talk about Integrative & Lifestyle Medicine in physical therapy and today we are lucky enough to be hearing from sleep expert and physical therapist, Dr. Katie Siengsukon.
And I’d like to share a little bit of information about her before we launch into this interview. So welcome.
00:26 Dr. Katie Siengsukon: Thank you. Thanks for having me.
00:28 Dr. Ginger Garner: I’m glad you’re here.
Katie is an associate professor and director of research for the Department of PT, Rehab Science and Athletic Training. And quite important for us as PT. She’s a director of the Sleep Health and Wellness, Sleep Well Lab at the University of Kansas Medical Center.
Her research interests involve and studying how sleep impacts health-related outcomes and recovery, particularly in individuals with neurologic injury or disease, as well as behavioral interventions, exercise, CBT, etc. to improve sleep.
Her research has been supported by the National Institutes of Health, the National Multiple Sclerosis Society and the American Heart Association.
Dr. Siengsukon received her M.P.T. from Rockhurst University in 2002, A PhD in rehab science from the University of Kansas Medical Center in 2008.
Welcome.
01:28 Dr. Katie Siengsukon: Thank you. Thank you for that introduction.
01:30 Dr. Ginger Garner: Yeah. First of all, I just, I’ve wanted to do this for years and now I get to do it because we’re kind of in person. It’s to like applaud the fact that you head up a sleep lab as a physical therapist.
When I first heard of you in your work, I was like, I was doing this. I was like, yes. I had to take a moment because that made me so happy.
I went to PT School in ’96 and starting out in PT School when we had no classes in the health and wellness. Nothing in health promotion. I had to go over into the School of Public Health to get anything on this topic.
02:13 Dr. Ginger Garner: So I was just, I’m just in awe. Thank you for the work that you’re doing and for your focus.
02:19 Dr. Katie Siengsukon: Well, thank you. I appreciate that.
02:21 Dr. Ginger Garner: And I’m sure that you got no push back along the way whatsoever.
02:26 Dr. Katie Siengsukon: We can talk about that journey at another time.
02:31 Dr. Ginger Garner: Well, I guess the easiest way to start off is what made you even choose PT to begin with.
02:38 Dr. Katie Siengsukon: So how I chose PT way back when it seems like a really long time ago, well, because now it is kind of a long time ago. I was actually in high school when I came across, sophomore/junior year in high school and we had a career fair as part of my high school. And I had never heard of physical therapy until a physical therapist came to our career day.
And she obviously loved her career. Loved her job, loved what she did. She was a pediatric physical therapist. And she just exuded this like love of what she did. And I was so captivated by somebody being so enthralled with it.
And I knew I wanted to do something in the medical field. I loved anatomy.
I love learning about how the body worked. I just wasn’t quite sure what career path I would take. And I guess that I didn’t even know if physical therapy was an option. I didn’t know any physical therapist. No one in my family was a physical therapist. And so it really was a great opportunity to learn about this whole entire career that I never even knew existed.
But once I learned about what it was and what it involved, I was set. I went to undergrad knowing that I wanted to go into physical therapy. I actually chose the university I did because they had a program where you could start undergrad. And then also transition into the master’s level program. And so I was once I made it in my mind that was the path that I ended up taking.
04:08 Dr. Ginger Garner: Wow, that’s fantastic. The beginning of your story was actually identical to mine. I haven’t heard somebody, I haven’t heard somebody with the same story.
Yeah. Except it was a classmate because we were presenting on careers and a classmate presented on PT. Same thing. I didn’t know that existed. Yeah. Like fun. It sounds like an active career. I thought I was going to go to law school.
04:34 Dr. Katie Siengsukon: Yeah, very different from law school for sure.
04:37 Dr. Ginger Garner: Yeah. Yeah. Yeah. And I went to law symposium and I was like sitting all day every day. I can’t do it. So, wow. You know, that makes me want to note when my high schoolers, I have two teenagers in high school, when is their career day?
04:57 Dr. Katie Siengsukon: Right. And I know, I have a middle schooler. Um, and same thing, they have a career day and I think, wow, I need to make sure that I’m there so that I can share about physical therapy and what it is because I think we, we need to be promoting ourselves to, um, you know, very, very early and very young. And I think those career fairs definitely have some value.
05:16 Dr. Ginger Garner: They sure do. They really do. I wish we had more exposure to that and that our kids had more exposure to that. Well, you know, as a PT, what’s one of the most valuable things that you think. I mean, it can be is what you enjoy the most or what you think is the most valuable piece of what you do. But what would that be?
05:37 Dr. Katie Siengsukon: Wow. So what I’ve value most about physical therapy. I think I value just the variety of clients that we can work with. And I don’t think I really had even appreciated that when I started a PT program. But I think just the, you know, the breadth of people and the impact that we could have on their lives. I think also that opportunity that we have to really connect with our clients and not saying that other healthcare providers don’t have that opportunity.
But I think because we oftentimes work with our clients over multiple sessions, you know, we really develop this bond and we really get to know them.Which, and I think also allows us to really address and help guide them in their journey of health. You know, in a way that a lot of other healthcare providers don’t have the opportunity to do so.
06:28 Dr. Ginger Garner: Yeah, I feel the same. I think we have a unique opportunity because we get to spend so much time with them.
I think that’s this, the next question I’m thinking about my head because I’m super curious as, as a PT who’s, I practice yoga and Pilates and mindful movement and then getting into lifestyle medicine and all that journey. I’m intrigued to know what made you choose sleep in physical therapy. How did that journey happen? How did that transition happen?
07:05 Dr. Katie Siengsukon: So when I, after I graduated from, entry level physical therapy program, that was in 2002, I practiced full time as a clinician in an outpatient practice. And so it was a very general outpatient practice. We saw patients with all sorts of different diagnoses from orthopedic to neurologic. And what resonated with me was in what I felt ill-equipped to help my clients navigate was their sleep challenges.
I felt like a lot of patients were reporting that they were having difficulty sleeping, you know, because of X, Y and Z. It could be because of the injury that they’ve come to see me or the condition that they have or the, you know, the onset of a neurologic condition. You know, whatever it was across the board, so many of them were reporting having sleep challenges.
And that was something that I had not learned anything about in physical therapy school.
And, you know, I would talk to them about positioning and that was about the only thing I felt comfortable talking to them about. But I think that’s really what peaked my interest is, gosh, this is an important factor for most of my clients, if not all of them. And it’s something that I don’t know much about.
And so that’s really what peaked my interest, but then when I decided to go back to do my PhD, and I knew I wanted to stay in Kansas City. I’ve family in town and just for various reasons, wanted to stay in the area.
And Laura Boyd was on faculty at KU Medical Center. And she was studying factors that influence motor skill learning in people who had had a stroke. And so things like amount of practice, type of practice, timing of practice, you know, those sorts of things where we think about motor learning. And so this was now 2004, and that was when several people were starting to study the impact of sleep on learning. Both learning declarative information, but also learning motor skills.
But nobody had looked at will this sleep impact learning of motor skill and people who had a neurologic injury? So long story short, that’s what I ended up doing my dissertation project on, which, you know, obviously it was a very narrow focus as part is the relevance of sleep, you know, because it was specific to how it’s sleep impacting motor learning.
But it well, one it taught me how to be a good researcher and the research method and all that. But it also really opened my eyes to the importance of sleep for basically every function of our body. Yes, it’s important for learning new skills, it’s important for memory consolidation.
And so, it’s important for immune function and cardiovascular disease and, you know, all of these other health benefits that again just really opened my eyes to that breadth of the importance of sleep. And I thought gosh, why is this not something that physical therapists are learning about. And so that really then again, I think it jump started my research careers as far as sleep, but then it also jumped started my interest in getting this information out to physical therapists just as far as like our role in helping to identify sleep issues, you know, refer as needed, but also help to guide our clients in sleep health promotion techniques, you know, within our scope of practice.
And so that’s really my passion is just getting that information out to physical therapists.
So you like, yes, this is what then our scope of practice is within our wheelhouse. And I think maybe most importantly is that this impacts our patients recovery and impacts their well being, it impacts their health. It could prevent or delay chronic conditions. I mean, this is so it’s not just a like, yeah, we should do it. It’s that we really need to be doing it and it’s what’s best for our patient.
10:39 Dr. Ginger Garner: Yeah, it’s a must. Okay, so I’m going to take just a moment to plug, Katie’s chapter and the book which is an absolutely lovely chapter on sleep and the relaxation that must occur with it in order for it to happen.
I think I have a curious question because I remember when I first started to talk to patients early on about integrative techniques. It could have been mindfulness or a yoga based or pilates based movement. I’m thinking back to two decades ago of some of the challenges that were there.
Some people might call it push back. Some people might say, oh, what does sleep have to do with, you know, my back pain, what is. So what are some of the ways that you’ve encountered those challenges and how have you overcome those?
11:35 Dr. Katie Siengsukon: So I mean, I think that there definitely has been push back and I think any time you’re talking about, you know, expanding practice or expanding thoughts on scope or practice. And when I think there’s going to be a little bit of, you know, healthy dialogue push back, if you will. But I definitely did struggle in that regard.
I mean, and I think too is just, you know, a new faculty, a new researcher being fairly junior, you know, I think that came with it too is like, well, you don’t have a ton of experience and you don’t come with this, you know, really robust sleep background, you know, as far as training in sleep.
Which I have gone on to become board certified behavioral sleep medicine. So I hope that kind of squelches, you know, that little bit that push back.
I think I had to look at this as like a long, long game, right? Like I could I could be trying to get out and put people at CSM or just having conversations with various people on podcasts and you know, talking about the importance of sleep.
But I think being able to tie it and this I really had this like, aha moment. I had published that paper, the perspective paper in 2017 about, you know, the PT role in sleep health. But what, but I think a lot of people don’t know, is that paper actually got rejected.
When I initially submitted it and I can’t remember it was maybe 2014, 2015. But yeah, it was, and it was one of those, where I like had revised it and I revised it multiple times and it kept getting asked for more and more revisions, but then ultimately got rejected.
And I was, I mean, devastated to say the least, but so I tabled it for a while, you know, kind of licked my wounds for a little bit. But, but I had to, I had to take a step back and think about how to best frame it. And it was actually, it’s better now and I can say that now, you know, in hindsight, of course.
I think the paper is better now. The recommendations I was able to write into that paper, I think are better because I framed it in the context of health and well-being.
And so I think that’s where PT’s are kind of, of course, that makes sense. Like rather than just, you know, the importance of sleep. If we can frame it in the context of sleep as one of the main pillars of health and wellness, you know, along with exercise and nutrition and stress management and, you know, all those good things. I think a lot more people are kind of like, yeah, that does make a lot of sense on why we need to consider sleep as well as these other pillars of health and well being.
I think, too, I also needed our profession to kind of move to the point where they were more open to prevention and health promotion and wellness. You know, I think it just needed to be like enough critical massive people that are kind of like, ah, yes, our profession really does need to focus in those areas and then of, you know, then of course, sleep is an important piece of health and well-being as well as prevention.
So I think it was just a matter of, you know, just kind of biding my time a little bit, making sure I framed it in appropriate way that made sense. But I think now that people get it and I think our profession had to take a move to the point where we were focusing on the holistic person. You know, we kind of had a shift from this really medicalized model to really thinking about more psychological informed patient care, which, again, I think people are buying into that and recognizing the importance of sleep as well.
So, so again, I think it was just a matter of a little bit of movement as far as our profession. And, and then, and I think what’s also been helpful is kind of finding other physical therapists who really get it as well. And I think, again, kind of creating a coalition of people who are interested in prevention and health promotion and wellness.
And, and that’s been incredibly helpful, you know, to kind of find that tribe of people because it’s more than just my voice continuing to be like, yes, sleep is important. And now we have kind of a whole group of people that are saying like sleep is important as well as these other health behaviors because that’s important for health and well-being and ultimately recovery of our patient.
15:43 Dr. Ginger Garner: Yeah, it makes me wonder if in this, in our particular text here, we have, we have a tribe of 40 people, 40 physical therapists who are experts in this area, riding on it. I wonder how many times sleep is mentioned through all of the chapters. And, I’m curious because I know every chapter probably mentions at least once if not a dozen times and then we have a whole chapter dedicated to it.
So, I’m wondering if in direct clinical care, because I know this question comes up to me all the time teaching other PT’s, OT’s and mental health providers how to use integrated and lifestyle medicine in their practice. I get this common question. Well, what if you’re patient or your client is then pushing back?
And then how do we approach that? So, I, I’m going to relay that question to you because I know you’ve probably gotten that quite a bit. I mean you run the sleep lab now. I’m sure you have all kinds of stories.
16:51 Dr. Katie Siengsukon: Yeah, I mean, the good thing is that when people come to us, to our lab, it’s because they know they have sleep issues and they want to do something about it. So, I have gotten past that.
17:03 Dr. Ginger Garner: Yeah, absolutely.
17:04 Dr. Katie Siengsukon: I mean, I’m frequently working with people who are like all in, or more likely, have had a sleep issue for five years, 10 years, however many years, and are desperate to sleep better.
You know, I think another benefit of the sleep piece, you know, is that everyone has likely had an experience where they haven’t slept well, you know. And then they know that even one night of poor sleep, you maybe don’t feel great the next day. Like your brain’s not working as well. Or you are just still really tired, maybe you’re like, oh, and then I’ll have another cup of coffee.
Whereas I wonder with, you know, not wanting to eat, you know, a well-balanced diet, not wanting to exercise. I don’t think you see that immediate negative consequence quite as much as you do with not sleeping well.
And on the flip side, having people do experiments where they are like, okay, let’s do a week where you’re trying this to enhance your sleep. You know, oftentimes we can get people sleeping better fairly quickly. So again, they see that positive benefit, again, relatively quickly, where I don’t know that there’s always that such an immediate, an immediate, obvious benefit for other health or lifestyle behaviors.
So, so getting people to buy in as far as, you know, wanting to address their sleep, again, it’s not oftentimes very difficult or, and if they do, you know, they’re often willing to like be like, sure, I’ll try this for a week and then like, wow, my sleep is so much better. Why didn’t I do this, you know, five years ago?
18:38 Dr. Ginger Garner: Yeah, that’s a really good point. So that’s a good way to sell the benefits of sleep, the obvious benefits of sleep. And I think another important point that you brought out made me remember when we’re talking about, let’s just say smoking cessation or avoiding, you know, environmental pollutants that would impact systemic health, no just musculoskeletal health, is getting the person to share with you why they think improved sleep would help them.
Or getting them to share, you know, getting them to share a story of how when they, it could be sleep, it could be another topic. But since we’re talking about sleep, if they didn’t sleep, well, how did they feel, how does it personally impact them? And they’re their own motivator, you know, to create that change. So, yeah, it’s a powerful take home message for, I know there’s there’s a PT listening who is trying to talk about sleep with their patients and they’re getting that, well, why is that important?
19:42 Dr. Katie Siengsukon: Right.
19:43 Dr. Ginger Garner: I think that if you ask the patient or the individual, the person why it’s important to them, then they’ll come up with their own answers.
19:52 Dr. Katie Siengsukon: Right. Right. Well, and I did because I, we know the benefits of sleep, you know, we think like, yes, you just tell people to go do these things and they’re going to do it. And so I ended up doing training in health coaching and so I went to my certification in health coaching and I found that so incredibly helpful.
Because I think to your point of assessing how important is this behavior change the individual, how motivated are they? I mean, I think that really impacts how you approach it with that particular person.
The words you use, the strategies that use the motivational techniques that you use. I mean, to me that is because that was not something, again, I learned in my physical therapy program. Although I think more and more programs nowadays are including more training on coaching and motivational interviewing and those various communication techniques. But that was hugely helpful for me as far as I think helping clients change behavior as well.
20:51 Dr. Ginger Garner: Yeah, that’s another, that’s another important point because we know that talking about sleep is within our scope. And I so appreciated when they finally did publish your paper that I was super excited about that. And I, and I do site your work frequently when I’m teaching. So thank you again for that.
But what I was going to mention there, is people often ask about that scope. And yes, it’s in our professional scope. But then I often invite their bus to take it a step further and say, okay, if it’s in our professional scope, yes, is it in your personal scope? Maybe not. And then that’s when, you know, the flag goes up and you go, okay, well let me vet what’s out there in terms of continuing education. Because if, you know, I was born as a PT in 1998, right? So, as I think anything prior to that, we got nothing.
21:52 Dr. Katien Siengsukon: Right.
21:53 Dr. Ginger Garner: We effectively got nothing on that. And now thank goodness there are programs increasing, increasingly that are including these topics and including the text, which is wonderful. So I think we have to encourage new PT’s to ask that question. They know it’s in their professional scope, but if it’s not in your personal scope, then seek out that continuing education that you feel like will make you well rounded.
22:20 Dr. Katie Siengsukon: Right. Absolutely.
22:25 Dr. Ginger Garner: Yeah. So sleep is for those listening and don’t know. Sleep is one of the solid pillars, the solid six pillars of lifestyle medicine. So it is part of that integrative lifestyle approach that kind of naturally pulled you in. But did you pick kind of an integrative lifestyle approach first? Or do you think that sleep called out to you first? And then that became integrative and lifestyle medicine?
22:54 Dr. Katie Siengsukon: For sure, sleep called out to me first. I mean, I definitely saw that as a new clinician and recognizing that I didn’t have sufficient background or training or even just, you know, what do I do and to help people sleep better? Or who I refer them to even. And that’s so that clinical piece I knew was missing as far as my training.
But then absolutely I think how I’ve helped physical therapists see the value in sleep is really like you said, then tying it to that lifestyle medicine piece. Tying it to that holistic person and if we’re going to help that entire person, you, you can’t not talk about sleep along with those other pillars of optimal health. So I definitely was first, you know, I think teased by sleep, but certainly see how it now fits in with a more, you know, lifestyle medicine approach.
And I think though, too, you know, the more I’ve learned about how sleep impacts nutrition or how, you know, our meal regularity impacts our sleep. How our stress impacts our sleep or sleep impacts stress, you know. So all of those components are also so inter-related as well. And so it’d be really remiss if I was just sitting here talking about sleep, but not recognizing how it fits within the context of all of those other pillars and that relationship between sleep and all those pillars as well.
24:21 Dr. Ginger Garner: Yeah, absolutely. It’s very synergistic, you know, interdependent relationship. So you have to be busy with the research you’re doing and running the sleep lab, you’ve got to be crazy busy. So just a little bit.
24:38 Dr. Katie Siengsukon: Just a tad.
24:40 Dr. Ginger Garner: So I’m wondering, well, (A) from one, you know, female clinician to another, like, how do you, how do you do all that? But I’m also wondering what your typical day looks like? What is the, what is the, what are the patients that you see that come in? What are the most typical problems that they have and how often and what do your referrals look like?
So kind of take us through a day in the life, if you will.
25:08 Dr. Katie Siengsukon: Sure. So I, I’m full-time academia. So I teach, I do research, I do service as part of my job. I also have four kids between the ages of eight and 14. So they also keep me very busy as well. And so it’s funny that you ask because I was just part of a talk at CSM about your research path. And so I kind of gave me a chance to kind of reflect on my research path and then give about, you know, a five to ten minute little piece about how I got to where I am and maybe some lessons learned.
And really, my, you know, my main lessons learned are, is I’m, I’m intentional with my time, you know, and so as I think COVID has kind of messed up this work life balance a little bit or, you know, the, the barriers or the boundaries between work and life because we now can work. Everywhere and anywhere at all times, so that’s been a little more muddied, but but I am very intentional.
Like if I’m at home with my kids and we’re doing something that I’m with them and what I’m at work. I am in work. Not to say that I don’t have to work at home on the evenings and weekends, but I do, but again, I’m very intentional with that, with I have this particular project. It’s going to take two hours to do and I carve out that time and then I’m done.
But I think though on the flip side, you know, having having kids, having a family, I’m having family in town. I think it also gives me, you know, kind of a sense of purpose as far as I’m, I’m more than a clinician, I’m more than a researcher, I’m more than an educator. As, as all of us are, you know, we’re very nuanced people with various roles and I think that helps give me a little bit more balance in my life.
But my, my typical day gosh, I’m, I’m, I’m not a triathlete, so I apologize if I offended anybody, but I kind of see my day is kind of being like, you know, I have three different events. I have my morning event where I’m getting the kids up that I’m getting out the door and then I come into work and then I have my, my work event. I have my evening is the way I cap it off and we’re running around to various kids activities and sometimes putting them to bed and doing a little bit more work.
But my, my typical day at work, what I love about what I do is the variety. I get to do research, which I find so gratifying. I love to write grants. I love to write manuscripts. I see the value and, you know, getting the funding to do the work, but then also publishing the work to disseminate it.
I love that I get to teach in our physical therapy program. We also have a PhD programs. I mentor PhD students as well. I love that I get to work on various service opportunities. But as far as the people that we see, the clients that I work with as far as sleep challenges, it’s all related to our research projects.
And so it really kind of varies on whatever research project we have going on. So like right now, we have a big clinical trial that’s funded by NIH. We’re doing Cognitive Behavioral Therapy for insomnia in older adults to see if it enhances cognitive function and reduces beta amyloid accumulation. So I am supervising. I have an interventionist to provide the CBTI [cognitive behavioral therapy intervention], but I provide oversight on that intervention.
And then we’re in the works to, because I’ve realized like, yes, CBTI is effective to treat insomnia, but man we’re missing a whole lot of people that maybe don’t have a diagnosed sleep disorder, but likely have poor sleep health.
So I’m very interested in kind of expanding those interventions beyond just treating insomnia, but really to more of a sleep health enhancement intervention. So I’m hopeful that, you know, we’ll get some funding for that and we’ll develop that program. Because I think that will also be really relevant for physical therapists because that is one pushback that I get, is great Katie that you do CBTI, but I don’t want to go out and be trained in CBTI.
And I don’t suggest all PT’s do that, but I think we certainly could be helping to promote enhanced sleep health. And so I think if we had a more structured program on how to do that, I would hope that that would be more easily integrated into PT practice.
29:31 Dr. Ginger Garner: Yeah, I think that’s a really important distinction in your research work and I’m really glad you’re making that leap from people with diagnosed sleep disorders who we would naturally know need that intervention to the millions of us out there in the world who have disordered sleep without a diagnosis and then here we are with a range of I’m in pelvic health, I also see orthopedic. So it could be pelvic organ prolapse, where they are getting up three or four times a night to go to the bathroom, et cetera.
These people deserve you know sleep hygiene and health and intervention as well. So you know what would you say then to the therapists out there who are since that you’re looking in that direction for research. What would be some of the red flags that you would identify of not having a sleep diagnosis, but just being, having a struggling with sleep or having just disordered sleep in general.
What are some of the things that therapists can initially look? Which I think also begs to say it’s in your book chapter. But I guess, what are some of the most important things out of that book chapter? And I think that would be one of them, perhaps.
30:44 Dr. Katie Siengsukon: Right, right and because I think you have an excellent point and I think I would love for people to start to think about how everyone has a sleep health. Thinking of sleep health on a continuum where you can have like really poor sleep health, but you can also have really good sleep health and everybody falls somewhere on that continuum.
Regardless of not if you have a sleep disorder, you know, because soon sleep medicine we typically think about oh insomnia, you get treated by this with; sleep apnea, you get treated by this; with Restless Legs Syndrome you get treated by this. So I want to move beyond just this idea that you have to have a sleep disorder, but we all have this continuum of sleep health and how can we optimize sleep health for every person.
And so I think you know, I think sleep health is a newer concept. Again, because we’ve been so focused on sleep disorders that there’s a scale that Dan Buysse who is the one who created the Pittsburgh Sleep Quality Index, which a lot of people are probably familiar with. He has also created a sleep health scale called the RU-SATED Scale.
And so that’s a questionnaire that looks at, so RU-SATED stands for different words like regularity, satisfaction, alertness, timing, efficiency, and duration are the components of sleep health. And so there’s a question for each of those items on this questionnaire. The issue with it is that there’s only one study that has validated that questionnaire and so I think with any new questionnaire development there’s always you know kind of a development period right where they put it out there.
And there have to be validation and reliability studies until people are like yes, this is a great questionnaire to use so it’s really kind of at its infancy at this point. There’s also been some interest in looking at sleep health using kind of a combination of self report measures as well as actigraphy.
Because again, you can measure obviously duration with actigraphy or you can measure alertness using the Epworth Sleepiness Scale.
So there’s been some efforts again to kind of build what we call the sleep health composite using these different assessment tools and there’s been a couple of studies that have been published using this sleep health composite score. So that I think that’s the challenge is like how do we define sleep health and then really how do we assess it.
And I think that’s still kind of being grappled with you know within the clinical and research world about how to best do that. And some people use like the Pittsburgh’s Sleep Quality Index as a way to look at sleep quality and that certainly is one important piece of sleep health.
But that’s obviously a very well used tool. But I guess I also don’t want to discount the importance of screening for common sleep disorders. Because we certainly know that there’s a large number of people that have undiagnosed sleep apnea, undiagnosed periodic limits of sleep???{IM NOT SURE WHAT SHE SAYS HERE!!!} And they are having what they’re reporting is poor sleep or not restful sleep. And yet they’re not getting assessed for those sleep disorders.
And so I think we certainly still, even with our emphasis being on sleep health, I think we still need to be mindful of those sleep disorders and helping to screen for those sleep disorders because we would then refer those people for the appropriate treatment that they need because just promoting sleep health is obviously not going to keep somebody’s airway from collapsing while they’re sleeping if they have sleep apnea for example.
34:13 Dr. Ginger Garner: Right. And that’s an, one thing that you’ve said really resonated with me because I think it’s the struggle that our healthcare system lives in daily which is we can identify disorders, these diagnoses but integrative medicine, it’s history, has been really rooted and seated in identifying precursors to disease and disorder and I think that’s what we’re talking about is there’s the this this the screening inventory, which would identify problems that require referral. But this new inventory would help us identify precursors and just improve their overall sleep hygiene and wellness in a way that we really haven’t had available and like in other areas of medicine they’re missing too.
What, you know, what if we had ways to I think integrative medicine does answer that in a lot of ways and so does lifestyle medicine, is to identify root cause that could lead to heart disease, root causes that lead to metabolic syndrome, or certain types of cancer that are preventable, that type of thing.
So that when you said that I was like, oh yes, that’s the heart beat of the integrated approach is to identify precursors to disorder and disease.
35:33 Dr. Katie Siengsukon: Yeah, absolutely. And I think we know that sleep and poor sleep is a health risk factor for lots of chronic conditions. And/or could be an early indicator of possible disorders. And so I mean, I think that’s just another way to be thinking about it.
I’m really doing a disservice to my clients. If I’m not doing this assessment because we could be catching these things earlier on.
36:05 Dr. Ginger Garner: Yeah, yeah, absolutely. And the way that I, I’m in the clinic several days a week with my practice and will talk to people about, sleep is usually the first thing that I ask about in the lifestyle inventory.
36:15 Dr. Katie Siengsukon: Oh, wow, that’s awesome.
36:17 Dr. Ginger Garner: Yeah, well, and then I explain it to them this way. I say, you know, if you’re not sleeping well, it doesn’t matter how good I am as a therapist. It just doesn’t anything that I prescribe for you is going to fall absolutely flat. So let’s get this sleep thing worked out first. And then and there we’ll go from there.
That that’s a good segue to a question about the barriers that I think to integrating sleep health because, you know, as a practicing clinician, I know what most people know what they’re getting by the time they see me because I’m that’s what I do. They’re coming and see me for that particular reason.
But I know that PT practice in large healthcare systems in rural areas in small outpatient clinics that see everything. What do you think some of the, or you hear, or know, understand, what are the barriers to integrating sleep health into those types of practices for PTs?
37:15 Dr. Katie Siengsukon: Yeah, so we actually just did a study on this because I would love to develop a toolkit for physical therapists. But I needed to first take a step back and see like well, what because I think I have it in my head what would go in this toolkit, but I wanted to make sure I was doing due diligence and understanding current practice to see what are the barriers and facilitators and then you know what people want to see in this toolkit.
37:42 Dr. Katie Siengsukon: And so it actually just got accepted for publication like last week. So that should be out soon.
Dr. Ginger Garner – Oh, wonderful! Congratulations!
37:49 Dr. Katie Siengsukon: Thank you. But the gist of this, its probably not a huge surprise, because there’s been some studies that have looked at the barriers of integrating health promotion and to PT practice. And so in some ways it kind of mirrors some of those themes.
And the huge surprise that resources is a big one, you know, and so kind of and knowledge like having that knowledge to screen for sleep issues to promote sleep health. And then not having those resources again to build your knowledge and have kind of those those readily available resources. I was surprised, I would have thought that time would be a barrier, but that was not something that that percolated to the top, which is great. But I think being mindful of how we would integrate sleep, I think, you know, over time of a number of sessions is perfectly reasonable to do it, it doesn’t have to be one, you know sit down conversation. It can certainly be integrated over multiple sessions if needed.
And so it was I think, you know, good to validate that those barriers really boil down to resources and knowledge, which we can certainly provide resources and we can certainly provide education opportunities for physical therapists to learn more about sleep.
What was fascinating though that I hadn’t expected is PT’s perceived patients having low motivation and low self efficacy as far as changing their sleep behavior. So I thought so again, I think the point of distinction though is that it’s not the patient’s low motivation or low self efficacy.
It’s their perception that the patient has it which you know, obviously we’re not assessing patients either.
So but I think that really that was interesting, but I think it also boils down to guiding physical therapists and I’ll say other health care providers as well to you know assess for motivation assess for self efficacy, making sure we’re having those conversations, but the taking on a more of a coaching approach. You know, if somebody maybe does it does have low motivation or maybe doesn’t have self efficacy, surrounding changing their sleep behavior in this case, how do we best again coach them? Motivate?
The words we use or perhaps you know we don’t touch sleep to begin with perhaps they’re more open to talking about changing their their diet or changing their physical activity level like maybe you start there instead if that’s where they identify the importance of the motivation and then build their self-efficacy with changing that behavior and then maybe revisit sleep later on. So anyway, I think I think again there’s that opportunity of like let’s let’s coach PTs to be coaches to help change our clients behaviors regardless of what health domain we’re talking about.
40:42 Dr. Ginger Garner: Well, I’m so glad that you’re doing that research and again congratulations on that acceptance so look forward to seeing that paper come out. That’s certainly going to guide what happens you know in our profession moving forward. And that I think is is a good segue into looking at opportunities for the future like what do you see as opportunities for integrating sleep health into PT practice.
41:07 Dr. Katie Siengsukon: Yeah, I mean, I think I think the big opportunity is just getting more education into entry level programs which again I think all of this is changing I mean I think I think we’re really hitting kind of this wave of people being like, oh yes sleeps important, health promotion is important. And so I see a movement for sure from more PT programs including sleep in their health promotion and wellness classes.
You know, of course we have a lot of practicing clinicians out there that would benefit I think from opportunities to education, which again there’s a lot of opportunities out there. But I think we’re seeing that movement of less push back from the PT’s themselves and then more of them being like yes I want to have this information I want to have this knowledge. I want to know how to do this because I see the benefit in doing this with our clients. And so I think, you know, the big opportunity is to be able to provide those resources and provide those education opportunities.
If we could come up with kind of an easy to disseminate sleep health promotion intervention that PT’s could be like ah, you know that’s the the three module or four module approach and I could do all those modules I want to visit or I could break up those modules over multiple visits you know but that way they would be like ah so that’s really the key pieces that I should be focusing on.
You know I think any way that we can you know make it more manageable, more straightforward, more structured, you know knowing full well that they’ll have to be some tailoring considering the individual client. But I think the more we can help guide the PT’s is like here’s here’s what’s best practice, here’s what you should be doing.
I think that can be very helpful. Again, you know, knowing full well PTs have busy schedules, we’ve got lots of clients, we’ve got lots to do. How can we make this so it’s feasible and be manageable and it ultimately doable and easy to practice?
43:03 Dr. Ginger Garner: Yeah, yeah because there’s five more pillars and integrative you know techniques and there’s so many different integrative techniques that can resonate with different patients whether it’s Tai Chi, or yoga, or whatever it is that you know really speaks to a person.
So what would you say, let’s say we have someone you know listening or in front of us that has, you know, an immediate sleep issue – what’s like the baseline thing that you start out with.? You know, with sharing with them what’s the most common you know issue that you think PTs should be addressing straight out of the gate?
43:44 Dr. Katie Siengsukon: Yeah, so this is somebody who actually has a sleep issue?
43:48 Dr. Ginger Garner: Yeah, they come in and it’s it this is pretty much everybody that walks through the door that I see they sit down. The sleep question is the first one on their lifestyle inventory. They fill it out in the intake form and then I ask them about it because inevitably they’ll say you know six hours what not and I want to know, are they waking up in the middle of the night can they not get to sleep initially you know what is the actual problem with sleep?
44:12 Dr. Ginger Garner: So I would say nearly everyone that walks in the door is going to have a problem with sleep. Some of it’s just because they have a six week old.
44:22 Dr. Katie Siengsukonm: Right, right.
44:23 Dr. Ginger Garner: But barring that it’s a six week old. let’s just say that you know their kids are not the reason they’re not sleeping through the night.
What are some of the low hanging fruit things that you think are helpful you know to, as a first as a first step.
44:40: Dr. Katie Siengsukon: Right, right and I think you know just like you’re doing first of all is kind of trying to understand what’s going on right like: Is it a sleep duration issue? Is it a sleep quality issue? Are they waking up to go to the bathroom frequently? Is it a stress issue? So, there’s a little bit of kind of that what I would call like a case conceptualization, right to kind of think around the you know the what’s contributing to that sleep challenge?
And again also thinking about, well could this actually be a sleep disorder? Do I do need to refer them? Does it sound like sleep apnea? Yeah refer them for further assessment and possibly treatment for that assuming it’s not a sleep disorder: you know I think of sleep health it’s kind of having four what I call buckets.
So I think about training circadian rhythm, and I think about increasing sleep drive, I think about reducing pre-sleep arousal, and I think about then everything else I call sleep hygiene. So like behaviors, environment that facilitate sleep.
So like when training circadian rhythm I’m interested in how variables there sleep schedule so I focus on having a regular wake up time exposure to light in the morning exposure to light during the day. Lack of light ideally while you’re trying to sleep, because, we want of course, the brain knows that when it’s dark that means I should be producing melatonin. So those are some kind of low hanging fruits to increase and training of circadian rhythm. For sleep drive, exercise is great for lots of reasons. We also know that exercise and physical activity increases sleep drive.
As does just being cognitively active the longer you’re awake the higher your sleep drive is too. So things like trying to avoid naps if possible, again that is very dependent on the patient. But those are some ways to increase sleep drive, both exercise, cognitive function, just being active.
Reducing pre-sleep arousal is something I spend a lot of time with, with a lot of clients so those are things like having a relaxing bedtime routine. So the brain knows that what comes next is the bed and sleep. We focus a lot on relaxation techniques. I find that a lot of people are just you know go go go all day and then it’s like oh it’s getting close to bedtime I better do my relaxation technique and well it’s really not sufficient to do it right then right for bed.
So I usually encourage people to practice relaxation throughout the day we practice mindfulness so they note kind of that that stress response that they’re having and hopefully choose to do relaxation technique at that time.
And then the other bucket again is kind of sleep hygiene which typically in of themselves is not going to be sufficient to dramatically change your sleep health, but things like you know avoiding caffeine in the afternoon and the evenings. Avoiding nicotine because that’s a stimulant. Being mindful of your water, your fluid consumption, so that you’re not having too much fluid before bedtime. You know thinking about your sleep environment. You know, comfortable bed, quiet, those sorts of things.
So those are kind of the the four buckets that I’m thinking of as as I’m talking to a client and hearing their story and their challenges with sleeping. I’m thinking about each one of those and what are possibly the factors that are contributing to those different areas of sleep health.
47:52 Dr. Ginger Garner: Thank you. I love the way that you break those down. That’s wonderful. I hope that everybody has you know picked up a copy of the book and that you’re particularly reading the sleep chapter because I totally. I believe it’s right up there with behavioral change for me you know if they aren’t able to make that shift and change it doesn’t matter how good of a therapist I am and I think you know sleep is the same if they can’t do that doesn’t matter what I can do for them as a therapist.
So I hope that something that those of you guys listening out there have picked up a couple of clinical pearls and some some nuggets of wisdom about sleep and that, that leads us all to get a really good mind’s rest tonight.
Dr. Katie Siengsukon: Amen to that.
48:39 Dr. Ginger Garner: Katie, I am going to thank you so much for sharing this time with us. I hope that therapists were no longer questioning whether sleep is important. It is how we’re going to discuss it with our patients and how we’re going to guide them in a really compassionate and empathic way towards creating the change they need for good sleep.
49:03 Dr. Katie Siengsukon: Well thank you for having me this was great, I really appreciate it.
49:06 Dr. Ginger Garner: Yeah, is there an easy way that they can find you online, look you up, etc.
49:14 Dr. Katie Siengsukon: Yeah, I’m fairly active on Twitter. I’m @KatieSleepPT that’s one way to reach me . Or also email, I’m on my email quite a bit and it’s csiengsukon@kumc.edu.
I like to talk about sleep and so feel free to reach out and I’d love to chat some more if people have questions.
49:36 Dr. Ginger Garner: Thank you so much.
49:38 Dr. Katie Siengsukon: Thank you
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