Descanso e Sono na Terapia Ocupacional: a ocupação que prepara todas as outras

[00:00:13][music] [music] [music] Hello, hello, Teusada. I hope you are doing very well. I'm feeling great and super excited to start today's content. This content promises to be completely different and outside the box, as you've already seen. I wanted to start this class with a very simple question, but one that I think is very uncomfortable. In the last occupational therapy assessment you conducted, you asked how your patient was sleeping and wondered what you did with that information afterward.

[00:01:24]I ask this because we, occupational therapists, occupational therapy students, have a somewhat strange relationship with sleep. We know theoretically that it's an occupation. He 's there, by name and surname, within our occupational therapy practice structure, EPTO4, in its current, right, Portuguese translation.

[00:01:51]Rest and sleep are areas of occupation, not activities of daily living. Rest and sleep are not leisure; rest and sleep are work. It is a category of its own with theoretical weight equivalent to care or social participation.

[00:02:11]Tell me if you've ever considered rest and sleep as an occupational therapy practice. If you've ever worried about, wait a minute, folks, I've gotten myself into a mess.

[00:02:25]If you've already considered evaluating it as an occupation, let me know in the chat. If this is your first time watching this live stream, please type " first time" in the chat. If you're already a regular, don't miss our bi-weekly live stream here on YouTube. We have quality technical content; just type "regular" in the chat. And if you already know the school and, even more than that, you've already subscribed to the school, leave a really nice testimonial about your experience on our platform here in the chat, answer the question. Is it worth subscribing to Edu school or not? That's what I want to know from you before we get into the actual content, which I've already given you as a preamble, I've already told you what our topic will be today, I've prepared a sensational lesson, all based on scientific evidence for you. I would like to strongly urge you to like this live stream, to enjoy this live stream. It's very important for our work because it shows Instagram and YouTube that this content is relevant. If you're here for the first time and aren't yet subscribed to the channel, please subscribe – it's very important to us. Today, folks, there won't even be time to breathe. I have a lot of content to share with you.

[00:04:03]So, to avoid distractions, I'm going to ask you to please put this live stream on the television, okay? Why? Because your experience will be much better and because it also reduces the urge you have to keep going in and out of YouTube. Combined?

[00:04:22]So, for those who arrived here for the first time, there were many people, Igor arrived here for the first time, and there were many people. So, before we begin, I want to introduce myself. I am Naiana Santos, an occupational therapist for 19 years, working exclusively with occupational therapy in psychiatry and mental health, and I am the creator of what is the first, the largest, and certainly the best continuing education platform for occupational therapists in Brazil.

[00:04:55]At the end of this lesson, I'm going to show you what Edu is like on the inside. I'll show you platforms, supplementary materials, and how we distribute this content. But I want you to know that our platform already has over 3,200 active students. I'm on Instagram. If you don't already follow me, you can follow me, Naiana R Santos, and also follow the school in Tocantins.

[00:05:23]Within our ecosystem, we have two postgraduate programs.

[00:05:27]Occupational therapy, uh, focusing on occupations, on neurodivergences, focusing on the occupations of children and adolescents, and we also have occupational therapy in mental health focusing on the occupations of adults and the elderly, right? So, those are the two postgraduate programs we offer. To pursue postgraduate studies at Eduó, you must have a degree in occupational therapy. Even if you hold a degree in another field, you are not eligible as an occupational therapy student. So, if you're a qualified professional watching me here today, get in touch with our support team, and we'll give you all the information you need to pursue postgraduate studies using this original methodology focused on occupations. I 'm here every two weeks on YouTube talking about occupational therapy and the career paths of occupational therapists. Very well then. Very well then. Anything else, any other warnings, Igor, that I forgot?

[00:06:35]No no. So let's get straight to the content.

[00:06:38]Let's get straight to the certificate, shall we?

[00:06:40]Oh yes. There are a lot of people in the chat asking about certificates. Guys, repeat after me. The bi-weekly live stream doesn't match the schedule. Certificate. The bi-weekly live stream does not confer a certificate.

[00:06:57]Today's live stream is bi-weekly; it doesn't offer a certificate, but it provides a lot of knowledge. And I promise you that at the end of the class I 'll ask you about that. It was worth staying here with me for this hour, and then you'll answer me with all the sincerity of your heart. I wanted to start this class, uh, you know, since I already started with this uncomfortable question the last time you asked about your patient's rest and sleep. But I still think that in clinical practice, sleep is usually treated as a background issue. like that piece of information that we record in the medical history and rarely develop as a focus of intervention.

[00:07:47]This isn't just my impression, nor is it rhetorical exaggeration to grab your attention in the first few minutes of my video. This is documented in the literature. I'm sharing with you a scientific article that will be available to Eduará subscribers, recorded on the Edu Roil school platform. In 2018, they reaffirmed this in 2022 and wrote that, despite insomnia being a growing public health problem, there are still few examples of intervention and research in occupational therapy in this area. So, this class, everyone, has a very specific objective. I want to show you three things. First, what does EPTO actually say about sleep, because most of us know the category name but not the conceptual architecture behind it. And before I move on to the second point I want to address in this lesson, I want to show you what EPTO is. Because there are many people who don't know about it, and I know that there are many people who don't know about it. So, the EPTO is this document right here. If you look closely, mine is quite old because I use it a lot; it's all scratched up. It's a document you can find for free on the internet, right?

[00:09:17]Free. Print the screen. If you don't know EPTO, please take a screenshot and type in the name shown here.

[00:09:27]Oh my God. This is the name that's on Google and will appear. It's a free document, and our lesson today is based on it. If you're a subscriber to the Occupational Therapy school, you already know that in the fundamentals of Occupational Therapy, we have a course that I taught and prepared on the structure of occupational therapy practice. It's a free document that you can download from Google, and I strongly recommend that all 800 of you who watch me live read the structure of occupational therapy practice. Right? So, the second point is that the most recent scientific evidence demonstrates the effectiveness of our actions in the field of rest and sleep. And here I'm going to present research from 2026, a very recent year. I'll list them for you.

[00:10:30]Thirdly, and perhaps most importantly in this lesson, this is where the gaps lie. Because recognizing a gap is not a weakness in our profession, it's a sign of scientific maturity. And I 'll conclude with a clinical case set in our reality, within the Brazilian public health system (SUS), so that we can leave here with a management strategy. Some people are asking me to show it again, right? I'll show it here just one more time. The name is right here, it's highlighted. It's a document you can easily find. To reiterate, bi-weekly live streams do not confer a certificate. A lot of people are still asking, please help me out in the chat, okay? Okay, so how do we find sleep on EPTO4?

[00:11:23]He's going there to bring a conceptual architecture. Focus on the lesson, because I promised you there was a lot of content. If you get distracted, if you get distracted, the class will fly by and you'll have missed that structure that I'm sure no one ever showed you before. EPTO, folks, he defines rest and sleep as [clearing throat] restorative activities, pay attention here, that sustain, look how important healthy and active engagement in other occupations is.

[00:12:00]In other words, sleep is not an end in itself within our professional logic; it is a condition of possibility for everything else. If the sleep of our patients, children, adolescents, adults, or elderly people we care for is compromised, the theoretical expectation is that there will be a decline in performance in other occupational areas, such as work, self-care, and social participation. And that, incidentally, is one of the most consistent findings in recent literature. So, reviews of the material I produced over the last 3 years, in order to build this lesson, point to strong and recurring associations between poor sleep and impaired attention, memory, executive functions, emotional regulation, and daytime performance.

[00:13:10]Who here has never had insomnia? And you don't exactly know that's what I 'm talking about, do you? Therefore, problems with rest and sleep have direct repercussions on one's occupations. But what few people know, and I think this is the first point I want you to take away from this lesson, is that the EPTO, this document I presented to you, does not treat sleep as a single block. Look what he does.

[00:13:42]He divides this area of ​​occupation into two distinct components: preparation for sleep and participation in sleep.

[00:13:54]And right now, I want to ask you to breathe. I'm also going to take a breath because I'm a little nervous. That's a lot of people, almost 1000.

[00:14:01]Speak very loudly.

[00:14:02]I'm speaking very loudly because I'm anxious and nervous, right? here. Lots of people.

[00:14:07]Thank you so much, everyone. I'm so flattered by this live audience. I promise not to disappoint you.

[00:14:19]So, breathe. I breathed too. I'm going to take a sip of water. I suggest you take it too, because I want to tell you something.

[00:14:29]Who here has attended one of my classes?

[00:14:31]Raise your hand.

[00:14:33]Who here has attended one of my classes?

[00:14:36]Raise your hand. My students know, a good class is one where you leave feeling what?

[00:14:45]Annoyed.

[00:14:48]I want you to leave this class today feeling uncomfortable.

[00:14:55]annoyed.

[00:14:57]I want you to leave this class today with a clear understanding that there's still a lot you need to study. Why? Because it's discomfort that gets us out of our comfort zone.

[00:15:08]So I'm going to speak, I'm going to speak quickly.

[00:15:10]I have a lot to say here to you all. It will bother you. It will bother you. It will give the impression that you don't know anything. That's right. Calm down, breathe.

[00:15:24]Then you write down your main questions and later you search on Edu. Then you will search the scientific article databases. If you 're an Eduardo subscriber, is that a deal?

[00:15:43]So, when EPTO talks about preparing for sleep, it's referring to everything that precedes and enables sleep. So, the conceptual structure within EPTO, folks, is what he's explaining; I'm just organizing the reasoning here for you. He describes four elements within the sleep preparation component. The first element is engaging in routines that prepare the body and mind for comfortable rest.

[00:16:17]So, we're talking about things like personal hygiene before bed, reading a book, listening to music, and bedtime rituals. Some people like to meditate, other people like to pray.

[00:16:36]The second element that the PTO itself provides as sleep preparation is determining the desired sleep schedule and duration, as well as the necessary wake-up time. So, how many hours of sleep do you need? 7 o'clock, 8 o'clock? People like me who need a little more sleep, 9 hours, organize yourself so that you can go to bed at the time that suits you and get your sleep hours.

[00:17:06]The third element is establishing sleep patterns that support growth and health. These patterns, and this is important for you to understand, are determined both culturally and personally. There is no single, correct sleep pattern.

[00:17:29]The fourth element that EPTO brings us is preparing the physical environment for sleep: making the bed, ensuring an adequate temperature, turning on a small fan or air conditioning (if you live in cold climates), covering yourself well, and having access to a heater if you have access to one.

[00:17:47]Lock up the house, our own house, set up sleep support equipment, turn off lights, unplug electronics.

[00:17:59]EPTO, he talks about preparation for sleep, which is what we just saw, but he also talks about participation in sleep, which in turn is what happens during the act of sleeping itself. Here the structure describes three elements. He talks about the structure of occupational therapy practice; he says it's necessary to take care of personal needs for sleep, such as ceasing activities to ensure the onset of sleep, napping, and dreaming, right? These are aspects of participating in sleep, such as maintaining an uninterrupted sleep state, attending to nighttime hygiene and hydration needs, including negotiating the needs of others in a social setting, for example, for those who provide nighttime care to someone like a baby, a child, an elderly person, a person with a disability, or also monitoring the comfort and safety of the person sleeping. Why, folks, am I insisting so much on this division? Because, as you will see in the next section, this distinction between preparation and participation is not just an exercise in taxonomy, division, or nomenclature.

[00:19:21]She is the lens through which the most recent research has mapped where occupational therapy is truly effective and where it's only effective on paper. And that's when we get into the scientific evidence, right? And now I want to talk to you all, I know that there are many occupational therapy students in this live stream, including people who have just started college. And it's important, everyone, that you know that the practice of occupational therapy is based on scientific evidence. It is necessary for you to ground your tools and professional reasoning in literature. It's necessary for you to know what the literature from the last 5 or 10 years has to say about that specific experience you're accessing.

[00:20:19]The school of theology, in fact, is a major shortcut to this need, this obligation. Why?

[00:20:27]Imagine if you were going to attend a course on play. Within the platform, we have a course called "Playing with the Handmaid Intervention." Professor Isis Daniela, who taught the " Play" course, conducted a literature review to present the course to you. So, in her course, you will become acquainted with this literature. Imagine you want to study mental health. To create a mental health course and upload it to the platform, I conducted a literature review and then included it there.

[00:21:01]So you won't need to search, it will already be organized there according to your needs in your clinical practice. Well then, since we're talking about evidence from the literature, in 2026, a publication recently came out in the international journal of occupational therapy. It's a systematic review with a very specific objective, which was to classify all occupational therapy interventions for sleep, already published, according to these two EPTO categories: sleep preparation and sleep participation.

[00:21:42]More than 7,500 studies were tracked across four databases. After the entire screening process, look at this, folks, only 10 studies met the inclusion criteria. 10, guys. That in itself is a very important piece of information. The amount of rigorous research on occupational therapy intervention for sleep is still very small. But the most relevant finding of this study was not the study number, but the distribution pattern between the two categories. The review found that the overwhelming majority of interventions focus on sleep preparation. In other words, occupational therapists are at work. Please note that I am referring to intervention in occupation, a practice based on occupation.

[00:22:49]Pay attention now. If you traveled, come back with me. Occupational therapists, according to a systematic review published in 2026, found that these people, we are working with routines, education on sleep hygiene, environmental modification and personal reflection. And we are doing very little work on participation in sleep. Of the three participation components I mentioned above, only one—that is, taking care of your personal needs, such as quitting smoking, controlling caffeine intake, and avoiding daytime naps— appeared in four out of the 10 programs. The other two components, maintaining uninterrupted sleep and meeting nighttime needs, were virtually absent from all studies. There is a plausible explanation for this, and the authors themselves discuss it. Why? Pay attention. Are you all paying attention, folks? This class is dense. This class is tough. Pay attention.

[00:24:05]The authors of the 2026 study themselves discuss this. Maintaining sleep and managing nighttime awakenings are phenomena that are currently studied primarily by sleep medicine and geriatric nursing, often associated with physiological decline and chronic clinical conditions.

[00:24:33]In other words, we occupational therapists are systematically working at the gateway to sleep, that is, we are working on what comes before and leaving practically untouched everything that happens during the night. And the authors are clear in saying that this reinforces the need for a multidisciplinary approach to deal with the real complexity of sleep. And I don't know if everyone here in this live stream knows me, knows my story, and is already familiar with the famous administrator. The administrator is Igor, he's right here next to me. I'll show it to you.

[00:25:21]Here he is. He is the strategist of the school of toó. He's in charge of everything. Duda and I obey, and so does Cris. Anyway. And Igor, for some reason in life, is my husband, right, handsome? Uh-huh.

[00:25:36]Very well then. Igor has a big problem with sleep distribution, right, Igor?

[00:25:42]Now that I know.

[00:25:43]Wow, beautiful. He's saying he knows now. He has a big problem. He wakes up frequently at night to go to the bathroom. And truth.

[00:25:51]And then this week he woke up all excited saying that he only woke up once and that he didn't get up to go to the bathroom, he went back to sleep. In other words, he developed interoceptive strategies to resist the urge to go to the bathroom and fall asleep. I used to do that.

[00:26:11]Breathe.

[00:26:12]It was breathing. He's saying he did CPR.

[00:26:15]And then he managed to sleep through the whole night. And he woke up very happy about that, telling me to sleep through the night. Do you believe it? Something that shows how different people are. Something that happens to me every night. It's difficult when I wake up at night. So, folks, just to give one example from everyday life, and I know you have many examples. I know that you guys out there, and there are many people here who suffer from initial or terminal insomnia, also have difficulty participating in the sleep process. Mothers of young children, you know, who don't sleep through the night. Uh, Igor Lopes is asking if the technique was taught by a therapist, speech therapist, or another professional. on Dr. Baracate's Instagram.

[00:27:04]He saw it on Dr. Baracate's Instagram; he's a doctor he really likes. He saw it on Instagram and it worked. Oh, information, psychoeducation, it's a tool, right? And Dr. Baracate is a public figure who provides a lot of relevant information. Okay, so remember I told you that the researchers of the 2026 systematic review found only 10 articles. Some of these articles deserve highlighting because they illustrate well what a well-designed occupational therapy intervention can achieve. So, it's R, which I started this class with, and citing 2022, they published a quasi-experimental study in Hong Kong with people from the community with insomnia, structured from the Person, Environment, Occupation, Performance model. PEOP is a model in occupational therapy that isn't very well known here in the West, but if you read Japanese or Chinese literature, you'll find this model a lot: person, environment, occupation, performance, PEOP.

[00:28:22]So, in that program they were working on three fronts. How interesting!

[00:28:27]They worked on raising awareness about the factors of sleep hygiene. They worked on the front of promoting an environment conducive to sleep. They were working on restructuring participation in election-related activities with a focus on work-life balance. The results, compared to a control group, showed a significant improvement in sleep efficiency, insomnia severity, and occupational balance, with gains maintained across the segment. This article caught my attention because it discusses intervention strategies related to sleep participation. Oh, I'll repeat it because it's very interesting. Awareness of sleep hygiene factors. This relates to psychoeducation.

[00:29:22]Another intervention: promoting an environment conducive to sleep. Therefore, it is possible for the occupational therapist to visit the client's home, observe their sleep environment, their bedroom, their space, their bed, and make adjustments to make that environment more comfortable.

[00:29:41]Restructuring participation in ballot box activities with a focus on occupational balance. And here he's talking about strategies for adjusting routines within mental health courses. There are several, uh, several pieces of content about this, okay? If you're already an Edu subscriber, look for the mental health courses there. I'll show you at the end of the live stream. Another important study focusing on the elderly population is the systematic review published in the American Journal of Occupational Therapy in 2018 by authors Smallfield and Molitor. They analyzed three level one evidence studies. The highest level within the methodological hierarchy, you know what I mean? And they found strong, unmoderated evidence, folks, strong evidence for cognitive behavioral strategies within the scope of occupational therapy, that is, strategies. And pay attention here once again that I am talking about intervention, strategies such as relaxation, strategies such as education, sleep hygiene. Look, psychoeducation is showing up here again.

[00:31:01]problem solving, physical exercise. And this program can be delivered both individually and in groups. This remains one of the strongest bodies of evidence our profession has regarding sleep, and it specifically concerns the elderly population.

[00:31:22]I also want to bring up a study that isn't about effectiveness, but about intervention design, because I find it methodologically very instructive. TNE and colleagues in 2022 published an expert opinion study using the DELF methodology, surveying 56 clinical and academic experts in three rounds about what would be the ideal format for an occupational therapy intervention for sleep in people with schizophrenia spectrum disorder.

[00:31:59]The central finding was not a specific technique, but the widespread emphasis on the need for personalized intervention; that is, it calls for person-based practice, subject-centered intervention, and the challenge of keeping this intervention simple, brief, and feasible within the routine of the service.

[00:32:29]This sends a very direct message to us, to you, who work within the SUS (Brazilian Public Health System). I, for example, am a worker in the Brazilian public healthcare system (SUS).

[00:32:40]Sophisticated paper-based interventions don't fit into the routine of a service that survives in real-world clinical settings. I'll repeat it because it's important. Highly sophisticated paper-based interventions don't fit into the routine of a service that doesn't survive in real-world clinical practice.

[00:33:01]And now we arrive at a double gap, that is, the gap between participation and assessment tools. I already addressed the first gap in the previous section.

[00:33:17]Occupational therapy plays a strong role in preparing for sleep and has almost no involvement in sleep itself. But there is an equally important gap, and it's not in what we do, but in how we measure what we do. Then, in 2025, Zainund and colleagues conducted a scoping review specifically on sleep assessment instruments used by occupational therapists in mental health. And the finding is uncomfortable, but it's necessary to listen to.

[00:33:56]Of the five studies that met the inclusion criteria, most used a known, validated instrument—which has even been translated into Portuguese—the Pittsburgh Sleep Quality Index, right?

[00:34:13]Another tool that is also used is sleep diaries. These are generic tools borrowed from sleep medicine that were not developed through an occupational therapy logic.

[00:34:28]They measure sleep latency, efficiency, and they also measure the number of awakenings. They do not measure whether the improved sleep translated into improved morning care routines or increased work productivity. That's a problem, isn't it? And the authors of this review themselves are explicit. To date, there is no validated sleep assessment instrument specifically for occupational therapy that directly measures the functional impact of sleep on daily activities. This limits comparability. That 's true, because each survey uses different combinations.

[00:35:11]And at this point, I need to make a note of scientific rigor with you all, because I promised that this class would be thorough with the literature, and I think you've already realized that it is, so that you can see that yes, there is literature available for us to discuss occupations. If you follow me here on YouTube, you've already seen that we're doing a series, one of which is the live content, a series about the occupations. We've already talked about ADLs (Activities of Daily Living), I brought a lot of literature. We've already talked about IADLs, and I brought a lot of literature. I've already discussed health management, also based on literature, and now we're talking about rest and sleep.

[00:36:01]Recent literature mentions an instrument developed called the Sleep and Occupational Impact Scale. In other words, I'm not going to speak English here and embarrass myself in front of 100 people because I don't know how to speak English.

[00:36:19]I located the bibliographic reference for this scale, but I did not have access to the full text of the original article to reliably verify the specific psychometric data that sometimes circulate in association with it. So I'm going to tell you that this scale exists, okay?

[00:36:38]I saw the article, but I couldn't access it. And I'm telling you this so you know that in the article they describe the performance numbers for this scale, but I haven't been able to see how it actually works yet. I'm just giving you the idea. It is also worth noting that Zainund's review points to other structural limitations. The research segment rarely exceeds 3 months.

[00:37:13]Despite the initial positive gains, population diversity is very low, with most studies focused on Western contexts and lacking cost-effectiveness analysis, which makes it difficult to convince health managers about the cost-benefit ratio of our intervention, right? So, everything's fine up to this point, right? Is everyone following me? All very well?

[00:37:45]If you have any questions, just write them down and Igor will note them down for me, and then I can change it. Right?

[00:37:55]Given this scenario, I want to propose an approach that is not new to those who already attend my classes, which is critical appropriation.

[00:38:06]We don't reject international evidence because it's solid and convergent, right? They help us, they give us a real theoretical foundation to justify our work in sleep management within the multidisciplinary team.

[00:38:24]But we're not going to adopt the criticism either, because this evidence has a specific target. The articles I cited to you were produced mostly in Hong Kong, the United States, Argentina, the United Kingdom, and Iran, in contexts very different from our SUS (Brazilian Unified Health System), with very different populations that are not ours. And what does that mean in practice? This means that we can and should use the principles that emerge from this literature. The PEOP model that I mentioned to you, Falk's emphasis on personalization and simplicity of interventions, Smallfield's strong evidence for low-cost cognitive behavioral techniques—but we need to translate these principles into our concrete reality, in the CAPS (Psychosocial Care Center), in the outpatient clinic, in the healthcare setting. mental health, where consultation times are short, the number of cases that occupational therapists handle is very high, and material resources are limited. It also means that we need to stop importing assessment tools without questioning whether they capture what is central to our profession. The impact of sleep on a person's occupational life is not solely due to the physiological architecture of sleep itself. And right now, before we get into the fictional clinical case, based on real facts, that I've constructed here to exemplify this robust theory I've presented to you, I want to know if you've ever seen a lesson on rest and sleep, all translated into scientific articles, outlining the structure of occupational therapy practice, describing the role of sleep and preparation for sleep. Wow, lots of people are praising it, that's great, thank you very much. And I always remember, if the quality is this good here in the free version, imagine what it would be like in the paid version within the Occupational Therapist School platform, having access not only to my brain and the classes I produce, but also to hundreds of occupational therapists, their knowledge, and the literature reviews they've done. This was my dream, and today I see it realized.

[00:41:10]It was about having a little corner of your own. A doctorate, it's our little corner, a protected corner that's just for us, occupational therapists and occupational therapy students. So we can exchange our stickers. There you can leave comments, we have a community there, we have an exclusive WhatsApp group where we post all the information, new courses, monthly courses, there's a new course every month. The school of to is not stagnant water. On the contrary, tomorrow that lesson will be edited and available on the platform along with scientific articles for those who want to learn more about rest and sleep. So, if you're in doubt, don't doubt anymore, come join us and become part of the Teó school community. Finally, I'll explain a bit about the platform, show you the ecosystem, show you the supplementary materials, talk about pricing, all that stuff, okay? Because before, I prepared a clinical case, which is Marisa's case, a fictional clinical case, but as I've already told you, it's based on real events. So, uh, why? Because it's based on elements of practice, right?

[00:42:31]I have 19 years of experience in mental health practice. I'll call her Marisa.

[00:42:37]Marisa is 43 years old and is a user of a CAPS 2 (Psychosocial Care Center) with a diagnosis of bipolar affective disorder, under treatment for 2 years. She comes to you, the occupational therapist, referred because the team noticed that in the last two months she has been arriving late to therapy sessions, reporting drowsiness. intense ballot box. And the daughter, who is the primary caregiver, says that Marisa goes to sleep at 4 or 5 in the morning and wakes up at noon. Oh, he's switching day for night, as we say. If we applied traditional reasoning, this information would probably be recorded as anamnesis data, and the focus of the intervention would go directly to activities of daily living, to inclusion in workshops. But given how we've built things up to this point, we're going to do things differently. We're going to treat sleep as a direct target of structured occupational therapy intervention, not as a passing comment, not as something her daughter said. So, the first step is to evaluate the instruments with critical awareness. Yes, you can use the Pittsburgh Sleep Quality Index because it is validated, free, and widely recognized by multidisciplinary teams. And then you might ask: "Naiana, do you use this instrument?" No, I, Naana, don't use it.

[00:44:13]I know of one; there's even a book here that's solely about mental health assessments.

[00:44:19]This instrument is available, but I don't use it, right? Why? Because we don't just rely on the validated scale, we supplement it with a simple sleep diary. So, what I use is a paper diary filled out by Marisa herself or her daughter, recording bedtime, times of attempts to fall asleep, number of awakenings, and time of waking up. And most importantly, we complement that with a focused occupational interview. What did Marisa stop doing or start doing with difficulty because of this sleep pattern? This is something no generic sleep scale will tell you. Ready. That's exactly the gap Zainund is describing. The second step is the sleep preparation intervention, using what is already well established in the literature, adapted to the context of limited resources, inspired by the PEOP model, which I've already mentioned to you, and the cognitive-behavioral strategy.

[00:45:32]You work on three fronts without any financial cost, right? The first line of intervention with Marisa and her daughter is psychoeducation about sleep hygiene, using simple language, with the whole family present, because the daughter is central to this case. Secondly, we are going to restructure the ballot box procedure.

[00:45:57]If Marisa is waking up at noon, the immediate occupational therapy goal is not to force an ideal sleep schedule from day to night, but to negotiate with her a gradual anticipation of the wake-up time anchored in a meaningful activity first thing in the morning.

[00:46:18][snoring] It could be coming to the CAPS itself, it could be a breakfast shared with her daughter. This is routine occupational restructuring, not a doctor's prescribed schedule.

[00:46:30]Right?

[00:46:35]Thirdly, we will work on modifying the sleep environment using what already exists at home, that is, advising on closing curtains, using a dark cloth on the bedroom window, removing cell phones from reach of the bed at night, and if the family has a heavier blanket or cover available, testing its use as a low-cost sensory measure.

[00:47:03]My oldest son, Henrique, has a very difficult time falling asleep, going to bed early. And then, while rummaging through my things here at home, he found a really heavy comforter, asked to sleep with it, and that was it. This really helps him to settle down, to relax, so he can fall asleep, right? In the third step, folks, in this intervention with Marisa, I want to bring you back to the discussion about participation in sleep, because it is precisely at this point that most of the interventions documented in the literature for Marisa report that she wakes up in the middle of the night and keeps ruminating on thoughts about family conflicts. This indicates impaired sleep participation. She's having trouble maintaining uninterrupted sleep. Within the scope of occupational therapy, you won't be doing psychotherapy on the content of thought, because that's not within our technical expertise. But you can work on a simple behavioral strategy, building a sleep recovery plan together with Marisa, something like a brief breathing technique or neutral sensory focus for nighttime awakenings, and negotiate with the CAPS team for a coordinated referral, if necessary, for the specific clinical management of these awakenings.

[00:48:36]So, Igor mentioned here that he managed to sleep through the night this week using a breathing strategy. As for me, I don't know if everyone knows, I think not, because not everyone here knows me, follows me, I had breast cancer last year and part of my treatment is taking medication that greatly reduces my estrogen and progesterone levels. And because of that, I entered perimenopause, you know, preparing for menopause. Well, I started having sleep problems that I'd never had before. One strategy I adopted during my day was prayer. So, when I woke up at night, I'd be stuck with these thoughts, just bad things, you know? When you wake up in the middle of the night, it's just bad things that keep churning in your head. Breathing exercises don't work for me, but prayer does. So I start to pray. Prayer, Our Father, Hail Mary, Guardian Angel, whatever comes to my mind, I pray it like a mantra and then I can relax and fall asleep. Therefore, you need to gather your client's occupational profile and work with them to develop these strategies. I found mine, Igor found his. I've seen other people here saying it's relaxing.

[00:50:00]I've seen other people here who do it in other ways. Right? The fourth step is reassessment and follow-up, which involves reapplying the sleep diary in 4 weeks along with the quick measure of self-reported occupational participation.

[00:50:17]So, for example, you could ask Marisa how many days last week she managed to arrive on time for the workshop, right? This simple, original piece of data is a handcrafted approximation of what would be expected from a specific occupational sleep instrument, uh, if it were made in a standardized way, right? So I want to wrap up today's live stream, and start the final stretch of our class here. Everyone's thinking, " Oh, it went by too fast, it's almost over."

[00:50:54]But don't be sad because this Sunday we're going to start our Acelera Teo program. And I'll talk about him in a moment.

[00:51:04]Let me close this. In conclusion, occupational therapy now has real and growing evidence to justify its role in clearing the throat during sleep. This is published literature, as I mentioned before, it's systematized with studies that have a strong level of evidence in certain populations, but this evidence has a specific format; it's robust in preparing for sleep. Its role in sleep is still in its early stages and it lacks assessment tools. It's a research frontier, a practice that's still open, right? And I honestly think this is a very nice invitation for those who are starting out in the profession now, and an invitation for further study for those who are already trained occupational therapists and feel they need sharper tools for this demand that is increasingly appearing within our services, right, everyone? So, there are people here talking about their strategies, you know, for improving sleep participation. It was very fast.

[00:52:20]What a shame. Oh, Lopes is saying that also sounds, massages, warm baths.

[00:52:26]That's right, folks, you need to find your own way and work with the client to develop strategies. I saw it here in the chat quickly, right? He 's right here, people are asking about specific cases. So, Naana, uh, nonverbal earth child, how do I do it, Naana? Hey, elderly person with dementia, what do I do, folks? Everything in occupational therapy. And if you don't know that, there's no shame in it. You'll find out now. Everything in occupational therapy begins with an assessment.

[00:53:09]So, why doesn't a nonverbal child with autism sleep at night? Is it a biochemical issue, and does she need to take medication that requires a prescription from a neurologist or psychiatrist? That 's because she has issues; she has sensory processing disorder.

[00:53:31]Therefore, she needs to undergo a sensory integration therapy assessment with an occupational therapist to identify these dysregulations and provide sensory accommodations, because she has a fear and it's an emotional issue. So, folks, an evaluation is necessary for any clinical case. What I know is, there's a science for everything. If you have a nonverbal, 9-year-old child with autism who does n't sleep at night, you have somewhere to go for help. I know it's not easy, that it's a privilege for the few. Psychiatrists are lacking in the network, neurologists are lacking in the network, occupational therapy, I won't even mention it. That's why we have so many people studying occupational therapy today, but there's no way I can give answers to specific cases in a one-hour live stream. What I know is that the literature is available for you to study and understand, within the context of the occupational profile and occupational performance analysis of that person, why they are not engaging and participating in their occupation, rest, and sleep. Did you understand? So, folks, look, within the platform, we even have an introductory course—which is anything but introductory, it's wonderful—on sensory integration. And the girls are going to talk about these issues, they're going to talk about these things, I'm not from that field, you know, so I might say something wrong here. So, they're going to talk about sensory accommodations, they're going to talk about strategies, Talite and Vitória, who were the occupational therapists.

[00:55:18]what they did. Well, before we conclude our meeting today, answer your questions, and show you the platform, I want to discuss a topic with you all. I've been a graduate for 19 years, folks. I've been living this entire time and paying my bills exclusively through my work as an occupational therapist. I realized along my journey that I wouldn't become a reference in my field, which is psychiatry, and understanding professional identity is another part of my work. Through the course, I realized that to fully grasp the scope of occupational therapy, I needed to invest in knowledge acquisition, training, reading, and exchanging ideas with other occupational therapists. Outside the box, with self-reflection, with mistakes, with successes, with hours of practical experience, with listening, with exposure, and that this investment would be forever.

[00:56:25]I became aware, I realized that knowledge doesn't take up space, that it was my responsibility to stand out from the crowd by doing a little more than everyone else does. and keep doing it.

[00:56:43]Today I went to the doctor and on the way back I was thinking, I don't think there's any occupational therapist who produces more paid and free content than me, because we have two postgraduate degrees, we have the Occupational Therapy school platform, with new courses every month, and I'm here doing live streams for you guys every 15 years.

[00:57:12]For me, there's no one else who creates this much content. I've stood out from the crowd, and I don't have to be tactful or ashamed to say so. Why?

[00:57:24]Because life gradually gets better. It's a process. You'll listen here, learn a new tool there, hear from those who think differently from you over there, and read a lot.

[00:57:38]You're going to practice, practice, practice.

[00:57:41]Reflect on the practice and you will repeat this flow. I am often asked if it is difficult to be an occupational therapist. And my answer is always yes. It's difficult being an occupational therapist. Bearing the responsibility of dealing with people's lives, with occupational roles, with entire histories, demands clinical reasoning, complete presence, sensitive listening, and the courage to uphold choices amidst fragile health systems and endless demands. It often seems too heavy, but it is precisely within that weight that the possibility of growth lies.

[00:58:34]Those who find ways to continue learning acquire what they need to transform difficulty into strength.

[00:58:45]The school, Edué Ela, was born from this understanding. It 's not a course, sorry, it's not a course. It's not a course you're going to take, it's not a mentor you're going to have, it 's not just one idea you're going to have, it's a process.

[00:59:03]It is by being available, patient, and focusing on the long term that I will be able to help. Theories and students of tools to also achieve their dream there, right? I realized that true recognition doesn't come from letterhead, but from solid practice, applied science, and professional identity. And we here at the school in Tocantins want to be a bridge for you. We have a slogan, and our slogan is: "I win in the long run." We don't believe that it's in one class, one thought, or one report that you're going to change and flip the switch, as people like to say. It's a process, and we want to be a bridge for you.

[00:59:59]Okay, now is the time to answer your questions and show you a bit about the platform, but first I want to talk about our event, our free digital congress that starts on Sunday, right? Sunday, what day is it, Igor? 26. This Sunday, the 26th, at 7:30 PM, we will begin the eighth Acelera To. What is Acelera Too? Acelera TO is a free digital congress that issues certificates to those who fulfill all the requirements. What are the rules, Naiana? So you'll need to come on Sunday to participate in the class and I'll tell you the rules, okay everyone? It's a three-day lecture series. On Sunday, I will talk about the pillars of occupational therapy practice.

[01:00:57]On Monday we will be receiving a third-year resident physician in psychiatry to talk about eating disorders in childhood, right? And on Monday, we will be joined by Lana Luise, an occupational therapist, to talk about a real clinical case study of selective eating.

[01:01:21]So, an event planned with the occupation in the center to help you in this process of winning in the long term.

[01:01:30]100% free. All you need to do is register. This event does issue a certificate. This live stream today, it's one of those we do here on YouTube every 15 days, it doesn't issue a certificate, okay everyone? So, I invite you all to participate. That's great.

[01:01:53]We go out, and at least when I finish, I miss it terribly, and you guys are on Instagram saying you miss Açaleira Te too. That's really cool.

[01:02:01]Okay, let's go. The content has no content.

[01:02:09]In the long run, I won't lose, and neither will I, you see, Jis? There's one business opportunity I won't miss, and that's for the long term. I am, I am a patient person. I have patience.

[01:02:19]Oh, my son, I have picky eating habits. I'm looking forward to this lecture. Ita Paula, this will be perfect for you, because on Monday, Micaela will be talking about what eating disorders are, it's going to be really cool.

[01:02:38]I am grateful to God for finding you.

[01:02:39]I'm a hybrid student and it's not easy without support like yours. I want to attend Tó's school. I believe it will be very good. I am convinced of that too. So, if you can, click on our link now and subscribe. Very well then. I'll answer here.

[01:02:58]Let me see if this is the right place. Everything you need to know about Eduo. So, who is Edu for? For occupational therapists and graduate students at any stage of occupational therapy. Can a student do this? Yes, undergraduate students in occupational therapy. Only they can sign. How long do I get access? One year, right? One year of access, so you can enjoy and binge-watch everything. It's not a lifetime subscription, it's an annual subscription, right? [snoring] Uh, I don't have time to watch it all, is it worth it? So I invite you to think of theo as a Netflix. You don't need to see everything.

[01:03:43]You watch what makes sense to you at that moment. Most subscribers consume a portion of the collection and are already noticing improvements.

[01:03:53]Well, if you're from a field other than occupational therapy, you can't sign up for Too, right? How does it work?

[01:04:02]You sign up, receive a login and password via email, and for one year you have access to all available courses as well as any new content added during that period.

[01:04:14]Currently, there are over 70 courses available and more than 500 recorded lessons. All of these courses issue a free certificate. You don't pay anything extra for the certificate within Edu.

[01:04:28]You pay for your subscription and have access to everything inside, right, Milena? Yes, each completed course has a certificate, right? Our certificates are not recognized by the MEC (Brazilian Ministry of Education). Why?

[01:04:46]Because non-degree courses are not required to be recognized by the Ministry of Education.

[01:04:51][snoring] What is required to be recognized by the MEC (Ministry of Education) are undergraduate and postgraduate programs, right? So, for example, our postgraduate program is recognized by the MEC (Brazilian Ministry of Education). Yes, the annual subscription costs 12 installments of R$9.90 on your credit card, and yes, it uses up your credit limit, right? And divide 100 interest payments into R$9.90. We don't work with payment slips and we don't participate in Black Friday, promotions, Consumer Day, or anything like that. Why? Because the lowest price is today.

[01:05:29]Okay, guys? So, as soon as you sign up, you'll have access to this platform, this amazing thing right here. You'll start by learning how to issue your certificate here.

[01:05:41]Next, you'll enter my favorite session, the fundamentals of root occupational therapy.

[01:05:47]Here is the course on domain and process that I told you about, EPTO, occupation analysis, activity analysis, and other content. We have the most-watched course on the platform, which is our introductory course on sensory integration. Also, on the 30th of this month, we have a live supervision session with Talite Vitória for our subscribers. The time to clear up doubts and consolidate knowledge. So if you sign up today, you'll already be participating in our free supervision, right? Igor can see there are a lot of questions here, I'll answer them when I'm finished. Uh-huh.

[01:06:25]Well, we have our own methodology, right? This is an accelerated learning program in occupational therapy, in other words, a journey of knowledge.

[01:06:35]Let's say you're an occupational therapist interested in neonatology. So here we've compiled all the neonatology lectures.

[01:06:44]Naiana, I want to study play as a human occupation; this is also something you can do here. And we have our courses. So, this month's course, which we'll be making available next Monday, we made available last month the course on cerebral palsy, and this month we'll be making available within this course the course on microcephaly and Zika virus, okay? In adolescence, VIBMP, we have training for the use of the protege, pedcat foot. Just to give you an idea, a course on pedicure is worth more than R$ 800. If you were to buy a course on cat's foot, which is a well-established assessment tool in clinical practice, you would pay more than R$ 800, which is the subscription price. So, we have all these courses here. Defraud a tipo, seletividade alimentar, protejes, praxis, intervenção cedo no bebê desgaste.

[01:07:46]And all our classes are video lessons, right? I'm going to show you a lesson here for you to watch. This one here is beautiful, look, she was Aninha, even my interviewee from last week. If you were here.

[01:07:59]She's the one who taught this course; just look at the real footage of children, it's very practical and gets straight to the point, right?

[01:08:15]So, all of our classes are video lessons with supplementary materials.

[01:08:21]So, we're going to provide you with an e-book, a mind map, and a summary for you to print, in addition to a scientific article, and what else?

[01:08:35]Oh, the slide from the class, right? Everything is available there for you to download, print, use, and so on. We have all our adult programming as well.

[01:08:45]So, during the live stream I told you all, look, if you're in the early years, first, second, third, fourth semester, I've prepared a pact here for you. So, you enroll in the education program and start studying right away. Final years, mental health, stroke, elderly, hospital setting, right? We have all this content and all the courses here, as I mentioned during the live stream about the mental health courses. So, we have occupational work, we have home-based intervention for the elderly, right? Assessment of mental functions, oncology, how to structure cognitive stimulation groups, mental health, physical rehabilitation, other drugs, psychiatry, what to do when my patient doesn't want to do anything, in short, folks. And then we also have our bonus content, right? This is the content we always bring to our community.

[01:09:41]We have our theory-in- practice session, a session dedicated solely to case studies, and then we have bonuses, right?

[01:09:49]For those who want to study for public service exams, there's a clinical document kit, and for example, "Naana, I'm starting my internship and I want to print an assessment tool." You come here, you come here and print the name in the initial interview, right? A kit of therapeutic activities that you can also print. And then there's our content about life and performance, apart from recordings of all the free events we've done throughout history, since the first Aceleração. Oh, we're on the eighth episode, which means we've been doing Accelera for 4 years, and this is recorded from the very first one for you to watch.

[01:10:32]Okay, everyone? Let's go. By subscribing, I can take as many courses as I can during a year. Yes.

[01:10:42]All courses have no limit. The limit is set by your own time. Some people watch 90% of the content, others subscribe to the content, take the introductory course, and are satisfied.

[01:10:56]So it will depend a lot on your needs, right? [snoring] Uh, I'm still a student in my second semester, I'd like to study more, are there any courses you'd like to take? Yes, we have the agreements from the early years and we have the fundamental principles of the core of Occupational Therapy. Right? You can start right there, in the very first semesters. So, when you arrive, you know, in the first semester of Occupational Therapy, you're going to watch this pact here, the first-year pact, and then you're going to watch all these courses here, the fundamentals of root Occupational Therapy, all these courses here, right?

[01:11:32]This certificate is accepted at universities. We're about to celebrate our 5th anniversary.

[01:11:37]Igor, I always say it's five, we're going to be four years old.

[01:11:42]Right? We've never had any problems with any college, and today we have over 3,200 active subscribers.

[01:11:51]Over 5,000 have already passed through here.

[01:11:54]We've never had a problem. Why? Because our certificate is completely comprehensive and ready for your college to accept, okay?

[01:12:03]As supplementary coursework. There is an introductory course on sensory integration.

[01:12:09]Yes, it issues certificates. The price is 12 installments of R$9.90, totaling R$8380.

[01:12:19]The certificate is free of charge. Okay.

[01:12:25][sighing] What else?

[01:12:29]I'm from the first graduating class in Roraima that 's graduating in August. Cool. I am from Rondônia. I'm the only fellow countryman there.

[01:12:39]I am from Rondônia.

[01:12:41]Yes, beautiful. He's from the north, and so am I.

[01:12:45]Horaima, Rondônia. Ali, cousin.

[01:12:48]I am from Rondônia. Can I register for the conference? He can. It's free.

[01:12:56]Signing up. Can you take all the courses? Yes, I already answered.

[01:13:01]Can I participate? Are you on Spotify? Igor has this project to be on Spotify. You know what's missing? Schedule something for me to be on Spotify.

[01:13:10]But I'll figure something out.

[01:13:13]Okay, everyone? Our introductory S is awesome, isn't it? No, Lopes. Lopes is a girl whose name I forgot. Tell me, Lopes, what's your name? You're the one with the little picture of the frog.

[01:13:27]You're always here. I've already memorized your face. Naira is also from Roraima. Do you offer in-person immersion programs?

[01:13:36]No, we're not doing in-person immersion programs right now, but we will have an exclusive happy hour for Luana's subscribers. That's right.

[01:13:48]See, I remembered you were a girl?

[01:13:50]Oh, the interior of Paraíba. You're always here, you're very caring. A big kiss for you, Luana. Yeah, we don't have it. Now, on September 1st, the day before the North-Northeast Congress on Occupational Therapy, we're going to have a little get-together with food and drinks for those who are subscribers and members of the Occupational Therapy program. So, if you're a subscriber, you're from Recife or here, you know, near Paraíba, Natal, and you want to come to Ral, talk to us in support, okay? I'm not going to give any more information because it 's truly exclusive to subscribers.

[01:14:27]I lived there for 20 years, but where are you now, in Roraima, my beloved homeland? Oh, full of people from Roraima. It's a great introductory lesson on S da do to. I'm biased, but yes, I wrote the introductory section. I'm going to tell you a secret. Before I put the introductory part of the of the to. I don't work with children, nor with IS, okay, guys? I work with neuropsychology and psychiatry; it's a whole different field. But I went and made a very expensive introductory course. I paid R$ 2,500 for the introductory course back then, folks.

[01:15:02]Only Jesus in grace, you see? Only Jesus in grace. The introductory course on Edu within the subscription is a million times better, and it even has supervision that [clearing throat] will be available next week.

[01:15:19]Where are the saved conferences located on the platform? Down here, look. You go down, down, down, down, down, down, down. Here, you'll find all the classes I've taught on YouTube, all organized here with supplementary material and all the accelerators below.

[01:15:37]How much is what? The signature.

[01:15:39]I think so.

[01:15:40]12 installments of R$9.90.

[01:15:43]Very well, my people. So I invite you to click on the link displayed on the screen right now and subscribe immediately. No more delays. I know there are a lot of people watching me with doubts: should I do it, shouldn't I do it, is it worth it, isn't it worth it, do you have 15 days to cancel if you don't like it? Okay, everyone? If the quality is this good here in the free version, imagine the level of organization and meticulousness we deliver in the paid version. Don't waste any more time.

[01:16:19]If you can't subscribe to Teó's School today, I honor you by offering it for free here. I will be here on Sunday starting the eighth Aelera To. And I want you here with me. I'll see you until Sunday.

[01:16:34]Calm. A very strong smell. Ciao [music] [music] [music] [music] [music] [music]