When I don't get enough sleep some nights, it definitely affects my ability to provide quality care for my wife, Carol, the next day. I find myself dozing off on occasion when I am reading or just sitting with her. Sometimes, our routine gets disrupted, and I know that it affects her as well. Carol has late-stage Alzheimer's disease and is, therefore, quiet and inactive most of the time. However, that doesn’t mean she should be neglected by me.
Thank God that Carol is a good sleeper at night so she doesn’t keep me awake. However, when she has a "not-so-good" day, when I feel the stress of 24/7 caregiving, when I don't feel well, when I have a lot on my mind, or when I get to bed past my normal bedtime -- when these and other factors occur, I definitely do not get all the sleep that I need. And it of course affects my ability to provide quality care for Carol the next day.
Most nights, I do not have a problem getting to sleep -- but when I do, I feel "sleep-challenged" the next day. Do you have this problem as well?
I wrote about getting enough sleep and the stress relief that it provides in Are You Getting Enough Sleep?
. 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 caregiving challenges of the next day. In that column, I discussed the sleep cycle and ways to improve your sleep habits. In this column, we will explore various proven strategies to overcome sleep challenges that you and I may encounter as caregivers.
Research is increasingly showing that most people need an average of seven to eight hours of sleep every night for optimal health -- maybe more for caregivers. Yet many do not get enough sleep. Although television ads are quick to tell people that a little pill can solve their sleep problems, any pill may not necessarily be the best solution for various reasons.
According to Michael Twery, PhD, acting director of the National Center on Sleep Disorders Research (www.nhlbi.nih.gov/sleep
), the best way to overcome sleep challenges is to practice good sleep hygiene, such as instituting a calming nightly routine and steering clear of caffeine and alcohol during the hours before you retire. If sleep problems continue, he recommends that you consult a physician. When sleep eludes you, Dr. Twery recommends the following strategies. Please keep in mind that these strategies are generic and apply to everyone, not only spousal caregivers.
Feel the rhythm. You have a preprogrammed biological clock that is designed to make you sleepy at night. Don't fight this natural process, advises Dr. Twery. Listen to your body and go to bed and wake up when your body tells you, generally at the same hour each day, even on weekends.
Create a routine and stick to it. To encourage your body's natural sleep rhythms, do the same thing before you go to bed every night, such as listening to soft music (no rock), reading a novel (no papers from the office) or eating a light snack (such as natural peanut butter on whole-wheat crackers or other combinations of slow-burning, or low-glycemic index carbohydrates combined with a healthful fat). This stabilizes both serum glucose and cortisol and provides a calming effect on the body. Over time, you'll come to identify these routines with sleep, and performing them will make you feel sleepy.
Gentle exercise can help but aggressive exercise won't.
Some people choose the soothing, rhythmic movements of yoga or tai chi to wind down as bedtime approaches. These quiet the body, explains Dr. Twery. But no intense workouts, he warns. These will have the opposite effect. As reinforcement, check out this story
on research just published on our website.
Take a hot bath. A bath will calm you from the day's rigors, and the drop in body temperature when you get out of the tub may help you feel sleepy, says Dr. Twery. Follow this with sleep in a comfortably cool bedroom.
Create a welcoming sleep environment. Make sure your bedroom is quiet, dark and not too warm or too cool. Eliminate possible disturbances such as computers, TVs, bright or blinking lights, noise and an uncomfortable bed or bedding. When ambient sounds are annoying and uncontrollable, some people find it beneficial to mask them with the white noise generated by an air conditioner, fan or white noise machine.
Watch what you eat and drink in the evening. Avoid caffeinated products (coffee, tea, soft drinks, chocolate), alcohol, sugary snacks and heavy meals for three to five hours before bedtime. Like caffeine, nicotine is a stimulant, so you also should refrain from smoking.
Take the "Scarlett O'Hara approach" to your worries. Think about them tomorrow. Stress is not a good bedtime companion, and obsessing over your troubles won't make them go away -- it will just keep you awake all night. In addition to the calming techniques mentioned above (hot baths, relaxing music, yoga, etc.), meditating a few minutes before bedtime can help you set your worries aside and put you in a calmer and sleepier frame of mind. If you have something that is stuck in your head, jot it down on a piece of paper kept on your night stand. Once you have "put the thought" somewhere safe, your mind will be free to let it go until morning.
Catnapping is cool. Conventional wisdom has it that napping during the day will disturb your sleep later that night. However, there is little concrete research to back this theory, and Dr. Twery points out that your biological clock actually makes you sleepy twice a day -- once at night and once between 1 p.m. and 3 p.m. Unless they interfere with nighttime sleep, short catnaps of 20 to 30 minutes before 3 p.m. are fine. (Note: If daytime sleepiness is a chronic problem, see your physician. It may be a sign of an underlying sleep disorder.)
Let the sunshine in. Try to get outside in the sunlight for 15 to 30 minutes a day. This helps control your biological clock and the pineal gland's production of melatonin, the so-called "hormone of darkness" that regulates your sleep cycles. When all is well, melatonin levels rise during the night and decline at dawn, explains Dr. Twery. Failing to get enough sunshine during the day can throw this process off kilter and result in irregular sleep patterns. Personally, I try to give Carol 3 milligrams of melatonin in juice or ice cream about an hour before bedtime to help her to sleep. It really works for her -- and for me since if she gets a good night's sleep, I typically will, as well.
Consider sleep aids. For example, face masks and nasal pillows (devices used for continuous positive airway pressure, or CPAP), earplugs and humidifiers can be helpful. Some people have favorite teas made from a combination of the following according to individual needs -- hops, wild lettuce root, skullcap, Jamaican dogwood, valerian, with a pinch of Thorn apple leaf for flavor. It is best to work with a naturopathic physician to determine which is best for you.
Use sleeping pills only on a temporary basis and when absolutely needed. In quest of elusive sleep, many people are quick to turn to over-the-counter sleeping pills or heavily hyped prescription drugs such as zolpidem tartrate (Ambien) or eszopicione (Lunesta). While your doctor may recommend these to cope with a self-limiting situation such as jet lag, shift work or short-term stress, they are not a long-term solution. The more dependent you become on drugs, the less able you will be to sleep soundly and evenly on your own. Moreover, sleeping pills have unwanted side effects such as daytime sleepiness and fuzzy thinking and, as we've all heard lately, sleep eating (when someone takes a sleeping pill, gets up in the middle of the night, binges on food, and remembers nothing about it the next day).
See a physician. Chronic sleep difficulties can be a sign of more serious underlying problems such as sleep apnea or depression. Be sure to see your doctor for proper diagnosis and treatment. Solutions exist and there's nothing better for your spousal caregiver health and wellness than getting a good night's sleep.
Using the strategies suggested in this column, as well as those posted in Are You Getting Enough Sleep?
, you should be able to overcome any sleep-challenged problems that may occur in your life as a spousal caregiver. I have personally applied several of these strategies with success. Have you?
WORDS TO CARE BY…
"Oh, sleep! It is a gentle thing. Beloved from pole to pole."
Samuel Taylor Coleridge (1772-1834)