Changes in the occupations in daily life and sleep in individuals with ADHD by using a Chain Weighted Blanket Johanna Larsson and Maria Joensen

Supervisor: Gunilla Carlsson april 2015

Bachelor thesis. Department of Health Sciences, Occupational Therapy programme, Box 157, S-221 00 Lund

Translation Jacob Sandelin SPE AB SensiSereni

Abstract Background: People with ADHD often have sleep difficulties, and a lack of sleep can increase the diagnosis symptoms. Occupational therapists focus is to enable all to cope with their occupations in daily life. A chain weighted blanket could be an option to improve this. Prior research in this area is increased, which may be due to sleep not clearly been seen as an activity within occupational therapy. Purpose: Describe how individuals with diagnosed ADHD experience if sleep and occupations in daily life have changed, and in that case how, after using a chain weighted blanket. Design: Qualitative interview study with retrospective design. Method: To reach the aim semi-structured interviews were used. These were noted and analysed through a content analysis with a manifest approach. Results: Six people participated. Results showed that all participants felt an improved sleep. It showed that the sleep onset reduced, the sleep deepened and they woke up more rested. They also experienced a better functional ability. Conclusion: Occupational therapist should develop their knowledge about sleep and interventions that can improve it. Further research is needed.

Keywords: occupational therapy, occupational balance, chain weighted blanket and sleep problems.

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Tableofcontent

1. Introduction

2. Background

3. Purpose

4. Method

4.1 Design

4.2 Selection / study group

4.3 Data Acquisition

4.4 Ethical considerations

4.5 Procedure

4.6 Data Analysis

5. Results

5. 1 Sleep better

5.1.1 Falling asleep faster

5.1.2 Less sleep medicine

5.1.3 Positive for sleep quality

5.2 Have more energy

5.2.1 Wake up more refreshed

5.2.2 Positive for activity execution

5.2.3 Improved functional capacity

6. Discussion

6.1 Method Discussion 6.2 Results Discussion

6.3 Conclusion

References

1.Introduction

Faced with this bachelor thesis the writers came in contact with four occupational therapists in Social Psychiatry in southern Sweden. These prescribe chain weighted blankets and were interested to find out how people with Attention Deficit Hyperactivity Disorder [ADHD] experience using the chain weighted blanket. Since most of the surrounding municipalities to this city do not prescribe chain weighted blankets, the authors want to investigate whether the use of a chain weighted blanket may involve changes regarding practicing daily activities but also sleep.

2.Background

Only partially translated. But the following headlines were given.

2.1 ADHD 2.2 Occupational therapy and activity 2.3 Balance of activities 2.4 Sleep and Sleep problems when having ADHD 2.5 The chain weighted blanket

No previous studies that the authors have found and studied the examined how the chain weighted blanket as the only tool for adults with ADHD may lead to changes in daily activities and sleep. Thus, there is a knowledge gap that this study may help to fill with increased knowledge and understanding in this area.

3.Purpose

The purpose is to describe how adults diagnosed with ADHD experience if sleep and daily activities have changed, and if so how, when prescribed a chain weighted blanket.

issues: • In what way is the quality of sleep affected when using a chain weighted blanket? • re the persons experiencing any difference in their everyday activities? • Are the persons experiencing that they achieved some changes in sleep and balance between activities?

4.Method

4.1Design

This study is a qualitative interview study with a retrospective design.

4.2Selection/studygroup

The selection made was a deliberate selection (Kristensson, 2014). Therefore, inclusion and exclusion criteria were designed to identify participants. The inclusion criteria were that the participants would be enrolled in Social Psychiatry and that they would have got the chain weighted blanket prescribed during the period January 2009 to December 2013.They should not have any other prescribed cognitive aid than a chain weighted blanket. This was because the authors wanted to minimize the risk of something else had been able to influence any

changes that occurred when using the chain weighted blanket. They should have had the blankets for at least six months, to have the experience of using it.

The exclusion criteria for participation in the study was that participants did not get to have an active housing support from the municipality during the survey. A housing is a support that is given to people with mental disabilities and which purpose is to contribute to strengthen their ability to cope with everyday life in their home or in the community (Isaksson, 2013). If the participants in this study had had an active housing, this could have influenced any changes the participants experienced when using their chain weighted blanket. Before the survey started 18 persons who met the criteria for participation were asked to participate, eight people thanked then yes. However, during the data collection period there were two persons that were not possible to get hold of. So finally, the six people participated, five women and one man aged 21-49 years. The median age of participants was 29.5 years. Three of the participants were using sleep medication before prescription of the chain weighted blanket. Three of the participants were living together, and three of them were living alone. The chain weighted blankets had been prescribed between January 2011 and October 2013. The median time for how long the participants had had their blankets was 26 months.

Because of the prevailing secrecy in psychiatry, the authors could not receive any of the background data on those who chose not to participate.

4.3DataAcquisition

Data collection in this study was done through semi-structured interviews and the content of the questions were formulated to capture the participants' experiences (Patel & Davidson, 1994). The authors chose not to record interviews, but only take hand written notes. This because the recording may cause some concern and the authors wanted to minimize the risk of further loss of participants. An interview guide was designed to help the authors to keep the focus on the phenomenon that they wanted to study (Kristensson, 2014). The interview guide consisted of eleven questions and included participants' perception of the chain weighted blanket, balance in their activities, and sleep (Appendix 1). The interviews took between 10-15 minutes to complete. The questions were asked in a certain sequence and if necessary supplementary questions within those prepared.

Before the interviews took place, the authors conducted test interviews, partly to try the interview guide, partly because the writers would get the opportunity to practice as an interviewer (Dalen, 2007). These test interview was first performed at the authors' relatives and then at each other.

4.4Ethicalconsiderations

In a qualitative study, which means that researchers investigate people's perceptions and experiences, it was important for them to be aware of the ethical dilemmas that may arise (Malterud, 2014). According to Codex (2013), the study's participants give their explicit consent to participate, for information about the study, such as the purpose, method, estimated time of interview and handling of the material. Before the interviews were conducted the participants were informed about this, as well as the voluntary nature of participation and the opportunity to pull out at any time without justification and that any

health care should not be affected (Codex, 2013). They were also informed that the interviews were made individually by the two authors but the analysis would be carried out by both of them. Two participants gave written consent. Four participants gave verbal consent as they chose to perform a telephone interview. When the interviews included personal issues, it was important to show respect and feeling of security by assuring the participants that there was no risk of identification (Malterud, 2014). The authors discussed ways to implement data collection and came to the conclusion that only take notes. Using sound recording can be valuable, but can also be a cause of complications that can affect the value of the results (Yin, 2013). The authors believe that this study is justified and they had thought through before any discomfort that this study may cause the participants (Kristensson, 2014). Thus, they concluded that the study benefits outweighed the possible discomfort that could occur and therefore considered that the effort required of the participants were not unreasonable considering the benefits this study can contribute. The authors separated the analysed texts from the personal information of the participants and this material was kept locked up. Upon successful completion of study, all the material will be destroyed.

4.5Procedure

The data collection began with that the authors contacted the head of the business where the four occupational therapists that the writers had come into contact with worked to get a written consent (Appendix 2). After this the occupational therapists helped the authors to find the participants that met the criteria for the study. The persons were informed about the study and asked about participation by their respective occupational therapist. If they wanted to participate, they gave their consent to the authors to contact them. The contact between the participants and the authors were then done over the phone where participants were given more information about the purpose of the study, the voluntary nature of participation, that whenever they wanted they could choose to terminate their participation without giving any reasons why. After agreement was given the data collection (Appendix 3) started. All data collection was done in two weeks. The first contact with the selected persons were made through SMS, which was the wish from them. At this contact point, they were asked if they had any possible requests for where the interview should take place. Four of the interviews were conducted one by one of the authors over the telephone and two of them were made personally by the authors in the Social Psychiatry's premises, according to the participants' wishes. The authors felt that it was important to take into account the participants wishes to the interview environment so that it was relaxed for those who would be interviewed. This is to minimize any distractions. The total interview material covers approximately four pages computer-written text. When the data collection was completed, the authors sent out e-mail or letter to all participants where they thanked for their participation and once again informed of the study's voluntary (Appendix 4). During the interviews, the authors received the participants email address or home address, and a consent to contact them.

4.6DataAnalysis

As analysis method, the authors used a manifest content analysis. The focus of this method is to describe the changes by finding similarities and differences in text content (Lundman & Granheim, 2012). The approach has been inductive then experiences will have been analyzed without pre-prepared templates, model or theory (Lundman & Granheim, 2012). In the first step of the analysis the authors studied separately all interviews. The purpose of this was that both of them would get an overall picture of what the lyrics were about (Kristensson, 2014). Each of the writers wrote after the perusal down their thoughts about what they read and then met and discussed the overall impression they had received through the texts. The next step in the analysis process was that the authors jointly identified the meaningful units of the interviews, ie the parts of the texts that relate to the purpose of the study. The parts that the authors could not relate to their purpose was taken away. When the meaningful units were identified the authors began to encode them. A code is a description of a sentence unit that gives a brief content description. This process is called condensation, which means that the text is shortened and becomes more manageable, but the core content is preserved (Lundman & Granheim, 2012). Even as the writers had relatively little text to work with, they felt that it was possible to condense the material collected. The authors began the condensation by encoding two interviews separately, the interviews that were coded was the same for both. Then they met and discussed and compared their encodings. Only after this process, the authors could divide up the interviews so they got two each of the remaining interviews which they then coded separately. When the condensation was conducted the authors read through all the codes that have been written down to look for similarities and differences in these. The codes, which they considered to be related they summarized in one category. This resulted in the beginning to a number of categories. The authors then examined these together to identify for common ground to bring down the number and create main categories. When this was done was read codes, categories and texts again through, this was done separately by the authors that they could get an overview of the study's overall picture (Kristensson, 2014). Examples from the interviews have been picked out by the authors to enhance the content. Participants are referred to the result as a participant A to F to clarify where he interview were taken from.

5.Results

The results are presented in two main categories: Sleep better and Have more energy.

5.1Sleepbetter

Subcategories: Falling asleep faster Less sleep medicine Positive for sleep quality

All participants in the study experienced sleep problems of varied nature before they started using a chain weighted blanket. These difficulties could for example mean that sleep was messy, worried and contained too few or too many hours.

5.1.1 Falling asleep faster

All participants reported that they felt that the time it took them to fall asleep was reduced. Factors to feel more relaxed was a recurring response, that the use of the chain weighted blanket prevented them to "roll over" as before, contributed them to calm down. The sleep onset time was shortened was something they all expressed. A participant told me that before the use of the chain weighted blanket could take between two to three hours to fall asleep. The weight of the chain weighted blanket was important. Participant F said that the weight gave security which helped him now fall asleep after a few minutes.

"Before the chain weighted blanket I could lie awake until the early morning hours but now I usually fall asleep within half an hour." (C).

5.1.2 Less sleep medicine

Participants A, B and C had previously been using sleep medication, all of these indicate that the use of The chain weighted blanket affected their need for medication to be able to fall asleep.

Participant A had taken sleep medication for virtually his entire life, but after starting to use the chain weighted blanket now only take it if necessary.

Participants B claimed to sleep well with only the chain weighted blanket but that the combination of the chain weighted blanket and sleep medicine improved sleep further.

Participants C took no sleep medication at all, but managed solely with the chain weighted blanket.

5.1.3 Positive for sleep quality

All participants felt that the chain weighted blanket has had positive effects on their sleep that led to a better, deeper sleep as it had been less worried with fewer awakenings. Participants A, B, C, E and F stated that the use of the chain weighted blanket made them sleep more hours per night than before. Several of the participants expressed that the circadian rhythm had changed to “normal”. Participant A stated, for example, that he never been a morning person, but feel that the use of the chain weighted blanket has made the circadian rhythms become more normal. Participants B stated that before the chain weighted blanket there was barely any sleep for two to three days but then could sleep 24 hours on end to make up for lost sleep.

"Before I woke up several times a night and had great difficulty getting back to sleep again" (B).

That sleep has become less messy was highlighted and participants C told that there have been times when he has fallen out of bed. All participants reported that the sleep had deepened thanks to the chain weighted blanket. Participants C told that the chain weighted blanked gave him a feeling of peace and he would not want to be without it. Participants D explained that sleep has never been a problem, but feel that sleep has become deeper with chain weighted blanket.

One of the participants mentioned that hat the chain weighted blanket may become too warm during the warmer seasons. Participants E said that this was a reason why the chain weighted blanket at the moment was tucked away, but pointed out that sleep due to this had become worse and considering to bring it out again. The weight of the blanket was expressed to have an influence. Participants E had the impression that the chain weighted blanket had the best effect in the beginning of the use, but that he then got used to the weight. When testing a heavier chain weighted blanket arose nightmares and nausea, which led to a return to the original weight of the blanket.

5.2Havemoreenergy

Subcategories: Wake up more refreshed Positive for occupational performance Improved functional capacity

For most participants the awake time before using the chain weighted blanket was dominated by weakness. The participants mentioned they experienced changes regarding awakening, balance in activities and functional ability.

5.2.1 Wake up more refreshed

Difficulties with getting up in the morning was something that was highlighted by several participants. Participants B experienced great difficulty in getting up at a certain time if he had fallen asleep, but stated that it works better when using the chain weighted blanket and is now getting up at a set time. Participants D said that before the use of the chain weighted blanket it could take about an hour to get up in the morning, but that the use of the chain weighted blanket it could be made directly.

"I feel more rested even if I sleep the same number of hours as before." (D).

All participants felt that they woke up more alert and rested when they used the chain weighted blanket.

5.2.2 Positive for activity execution

Two of the participants (A and F). experienced that they have received a better balance of activities after they started to use the chain weighted blanket. According to participant A this was due to the improved sleep, which further contributed to that the participant nowadays could be as social as he wanted to be. According to participants F the improved sleep have contributed to that the sleep had become more regular which has been important to achieve balance of activities. He also said he resumed training again after a break from this. The participants (B, C, D and E) have not felt that they had improved balance of activities, but expressed that through the improved sleep now performed the same activities as before but with better quality in the performance.

5.2.3 Improved functional capacity

That the ability to function had improved was clearly expressed by four of the participants (A, C, E and F). A functional improvement they experienced was in concentration. Participant A said that after he started to use of the chain weighted blanket he does not lose focus so easily anymore. Participants B felt that strength had increased, and said that before the use of the chain weighted blanket he felt like a zombie. Nowadays the participant experienced that he manages and can cope with activities. A change in mood was also something that was highlighted by participants. Participant C felt that this was due to the stress of the morning had been reduced. Further, the participant C that the time to go up in the morning is the same time as before the chain weighted blanket began to be used, but it now takes place quietly and with a sense of having control of the situation. Also participant E highlighted changes regarding the mood and perceived to be less irritable thanks to the improved energy.

I have become calmer, nicer and more cooperative. Before, I was tired, angry and annoyed on most things. (F).

6.Discussion

This study has highlighted people with ADHD’s own views on any changes are made regarding sleep and daily activities by using the chain weighted blanket. The results showed that all participants felt that their sleep had somehow improved and that they felt more alert and rested during the day.

6.1MethodDiscussionNot translated

6.2ResultsDiscussionNot translated

6.3Conclusion

Sleep Problems arise in many of the areas where occupational therapists meet their patients. There have in previous studies been demonstrated that occupational therapists do not spend much time to sleep and its impact on everyday activities. If more occupational therapists would develop their knowledge of sleep and measures that could improve this, it can in turn lead to greater well-being of the people they encounter in their daily work. Further, the knowledge of the chain weighted blanket influence need to be spread to various professions within health and medical service that meets people with sleep problems. Today is the chain weighted blankets not prescribed in all municipalities and county councils, and this leads to an injustice for the people who are in need of this. The authors consider that the rights to this aid should not be controlled by where they live but by what their needs are. A chain weighted blanket should be as obvious to prescribe such a wheel chair. There are few studies on this area and the previous studies have focused on children, the authors hope that this study results may serve as a basis for further research.

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