Graduation Year


Document Type


Degree Type

Open Access Capstone

Degree Name

Doctor of Occupational Therapy (OTD)


Occupational Therapy


Sleep is the most important restorative occupation, and pre-sleep routines, which precede sleep, have not been explored in normal adult sleepers. Routines are an important construct in occupational therapy, but it is not well-researched.

The purpose of this project is to add to the body of knowledge regarding pre-sleep routines through description by normal sleepers. This research can inform occupational therapists in regard to the usual patterns and dynamics of pre-sleep routines. Open systems theory, a grounded theory approach, and graphic and interview methods were used in this qualitative study.

Participants were 16 adults, between the ages of 23 and 60, who were considered good sleepers, based on scores from the Pittsburgh Sleep Quality Index. People drew pictures of their pre-sleep routines and were interviewed later. Drawn activities were categorized and compared with transcribed interview data.

Participants varied in how they described pre-sleep routines in terms of time and activities. Similarities were also found. This group of adult normal sleepers described pre-sleep routines as occurring in specific locations, under certain sensory and environmental circumstances, without much thought, usually in a solitary fashion, in a predictable sequence, and on a regular basis in the same way most days. People described activities that were essential to include every day and those that were not. Participants report that they do specific activities before bedtime in order to ensure that sleep is not disturbed and to prepare for the next day. Drawings were found to be a useful method to collect data on routines.

Faculty Mentor

Doris Pierce

Department Affiliation

Occupational Science and Occupational Therapy

Committee Member

MaryEllen Thompson

Department Affiliation

Occupational Science and Occupational Therapy


This is the first known study using drawings and interviews to investigate the construct of bedtime routines from the perspective of adult normal sleepers. Special thanks to the 16 study participants and two pilot study participants who were willing to share about their pre-sleep routines.

IRB Approval Number (if applicable)