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Posted: March 23, 2006

Spousal Caregiving

Are You Getting Enough Sleep?

Bill Andrew

Have you had trouble sleeping at night because of the stress caused by the never-ending daily caregiving of your loved one? Have you ever thought that perhaps getting a good night's sleep would reduce your stress? Do you know ways to improve your sleep habits and help you to feel rejuvenated each day without risking your health -- and the health of your loved one? Hopefully, this column will help you address these questions, get a good night's sleep, and reduce the stress in your life.
The March 17-19 issue of USA WEEKEND featured an article by Dr. Tedd Mitchell in the HealthSmart segment entitled Sleep Soundly, and I wanted to share his clinical insights with you. Dr. Mitchell's suggestions may help you get a good night's sleep while also dealing with the daily stress you can incur as a caregiver. 
When most people talk about "stress," they are usually talking about the negative emotional effects that occur. But stress can present itself in many other ways such as high blood pressure, headaches, sexual problems, intestinal problems (ulcers), and other typical stress-induced manifestations.  For many, stress means having difficulty getting a good night's sleep -- something that we spousal caregivers desperately need. 
In fact, insomnia is one of the most common conditions associated with stress, and this means a person just does not sleep as well as nature intended. Most of us have insomnia from time to time -- as a spousal caregiver, this might be a quite frequent situation for you. It is a common problem for many people whether the difficulty is getting to sleep or remaining asleep for a full eight hours. According to the National Sleep Foundation's 2001 poll, some 7 of 10 Americans reported frequent sleep problems -- although most were not diagnosed as a sleep disorder.
Sleep is nature's way for your body to "recharge its batteries" each night. It allows your system to recover from all of that day's activities and stress while preparing you for the challenges of the next day. While most people think of sleep as a very inactive state during which the body is resting and doing nothing, the opposite is actually the case. 
In fact, as you sleep, your brain is busy all night and goes through five cycles -- called stages -- progressing from very light sleep to very deep sleep. The first four stages start from very light sleep to very deep sleep -- often called non-REM sleep. The fifth stage is called REM sleep -- that is, "rapid eye movement" sleep during which dreaming typically occurs. You start sleeping very lightly (Stage #1) and systematically progress through the four stages of non-REM sleep moving from Stage #1 to Stage #4 (see chart below). 
You then enter the REM phase of sleep (Stage #5) which can last for several minutes or up to an hour. REM sleep gets longer with each subsequent cycle. A person may go through up to five sleep cycles in a typical night which recur in sequence with the first one usually lasting about 100 minutes.
The Sleep Cycle
  • Stage #1. This is the lightest form of sleep and a person can be awakened very easily.
  • Stage #2. In this stage, body temperature tends to decrease and light sleep occurs.
  • Stage #3 and Stage #4. This is deep sleep -- also known as slow-wave or delta sleep -- which is characterized by rhythmic breathing. Stage #4 is much more intense than Stage #3.
  • Stage #5. This is REM (rapid eye movement) sleep during which intense dreaming occurs from heightened brain activity and rapid eye movement does occur. This is a lighter sleep than that of Stages #3 and #4 primarily because your brain is very active during this Stage.
We all have different ways of unwinding after a stressful day of caregiving, sometimes relaxing with a drink or two. While alcohol may, indeed, relax you initially, don't count on it to help you to sleep through the night. Research has shown that alcohol disrupts the normal sleep pattern and can lead to diminished energy and increased fatigue the next day, especially if taken just before bedtime. According to the National Institutes of Health, drinking alcohol within an hour of bedtime can disrupt the second half of the sleep period. During this disruptive period, you may wake up and have difficulty falling back to sleep. As a result, your body does not get the rest and rejuvenation that it needs -- and your stress stays with you.
Many spousal caregivers find that insomnia significantly upsets their lives and makes it much more difficult to provide the type of care that their spouse needs and requires. Getting at least eight hours of solid sleep each night is imperative for spousal caregivers. Do not make the mistake of resorting to unhealthy behaviors -- such as alcohol -- to try to combat this problem. Instead, see if some tactics suggested below will improve your sleep habits without compromising you overall health.

How to Improve Your Sleep Habits
  • Do not drink alcohol for several hours before bedtime.
  • Do not drink caffeinated beverages for several hours before bedtime.
  • Do not eat for several hours before bedtime.
  • Get your exercise during the day -- not just before bedtime.
  • Try to go to bed at the same time every night.
  • Avoid taking long naps during the day.
  • Finish up any work-related or caregiving-related tasks early in the evening so you don't take your stress to bed with you.
  • Make sure your bedroom is dark, quiet, and cool making it conducive for a good night's sleep. 
  • Do not take your pets to bed with you
  • Do not allow yourself to toss and turn if you have trouble falling asleep or if you are awakened during the night. Get out of bed and go to a relaxing area (not in bed) and read until you become sleepy. Then head back to bed.
While your caregiving responsibilities may not allow you to follow many of these suggestions, try to apply as many as you can.
Dr. Mitchell's suggestions for getting enough sleep are time-tested from someone who knows. He is the medical director of the wellness program at the renowned Cooper Clinic in Dallas, Texas, and a contributing editor for USA Weekend magazine. I referenced some of his previous work in a previous column Do You Want to Become a Better Spousal Caregiver?.
How many of his suggestions have you personally used? I can honestly say that those most applicable have been part of my spousal caregiving routine for many years. Actually, when I go to bed about 10 p.m. most nights, after several hours of relaxing reading, I fall asleep almost immediately and do not wake up until six the next morning. Of course, it goes without saying that if my wife, Carol, needs me during the night, I am right there for her. However, I am fortunate in that she sleeps most of the night, despite her late-stage Alzheimer's disease.
If you have any experiences or suggestions about getting a good night's sleep, and would like to share them with other readers, drop me a line at
"Sleep is the golden chain that ties our health and bodies together."
Thomas Dekker (1572-1632)

Bill Andrew identifies himself as a former “nutritionally-empowered Alzheimer’s caregiver” who attributes the slow-down in progression of Alzheimer’s disease in his wife, Carol – and the growth of his own personal emotional, mental, physical, and spiritual capability and strength to provide quality 24/7 care for her in their own home – to the targeted nutritional supplements they both took on a daily basis. Carol went to her Heavenly reward on June 9, 2008 – Bill continues on to advocate for family caregivers. Contact Bill with your caregiving questions and comments via email at

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