Occupational Therapy in Sleep Assessment Tools for Mental Health: A scoping review

Abstract

Introduction: Sleep is a fundamental occupation critically linked to mental health stability and functional performance. According to the Occupational Therapy Practice Framework (OTPF-4), sleep and rest are formally recognized as core occupations essential to health, well-being, and participation, underscoring their relevance within occupational therapy practice. Despite the holistic, client-centered approach of occupational therapy (OT) in addressing sleep disturbances, the extent and nature of evidence regarding the use of sleep assessment tools in mental health practice remain unclear. This scoping review maps the existing literature to identify the tools used, their integration into interventions, and gaps in the evidence.

Methods: Following the Arksey and O’Malley framework and PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Scopus, and Web of Science for peer-reviewed literature published between 2015–2025. Included studies if they involved OT-led sleep interventions incorporating at least one validated sleep assessment tool for adolescents or adults with mental health conditions. Exclusion criteria included studies that did not use validated instruments, focused solely on pediatric populations, or lacked OT-led intervention components. Data extraction captured the type of tool, the intervention context, reported outcomes, and links to occupational therapy models.

Results: From 1,482 identified records, five studies met the inclusion criteria. The evidence, although limited and emerging, revealed a range of sleep assessment tools, most commonly the Pittsburgh Sleep Quality Index (PSQI) and sleep diaries, used in diverse interventions such as cognitive-behavioral therapy for insomnia (CBT-I) and weighted blankets. Studies reported improvements in sleep efficiency, latency, and mental health symptoms. Key findings include the utility of tools for baseline assessment, intervention personalization, and progress monitoring. However, significant gaps were identified, including a lack of OT-specific theoretical frameworks, inconsistent and underutilized assessment methods (for instance, diaries were rarely analyzed for occupational patterns), short-term follow-up, and insufficient linkage between sleep outcomes and occupational participation. Methodological weaknesses were also evident, including the limited use of OT perspectives and lack of long-term designs.

Conclusion: OT demonstrates preliminary promise in addressing sleep disturbances among individuals with mental health conditions. Yet, the evidence remains constrained by limited methodological rigor and a lack of occupation-focused assessment tools. Future research should prioritize the development and validation of OT-specific sleep assessment instruments, adopt longitudinal and mixed-method designs, and explicitly examine how sleep interventions influence participation in meaningful occupations. Such efforts are essential to strengthen OT’s distinct contribution to advancing sleep and rest as recognized domains of practice within the OTPF.