Sleep experts recommend a bedtime routine – practices that get you to slow down, clear your mind, and prepare you for sleep. Before I became a caregiver I didn’t think about a bedtime routine very much. It was what it was. But becoming my mother’s caregiver, my twin grandchildren’s caregiver, and my husband’s caregiver, changed my thinking. I need sleep and have a nightly routine to promote it.
You may have a routine as well. However, if you don’t have a routine, it may be wise to establish one now. Having a bedtime routine will help you sleep better and wake up in the morning refreshed, energized, and ready for the day.
Exercise during the day. Mayo Clinic, in a website article, “Lifestyle and Home Remedies,” recommends at least 20-30 minutes of physical activity per day. “Activity helps promote a good night’s sleep,” according to Mayo. Your activity may be a brisk walk, stretching exercises, or lifting weights.
Start to slow down. Though your TO DO list is long, and you have been rushing from one thing to the next, put on the brakes after dinner. Accept the fact that you didn’t get everything done. Continue with tasks that don’t require much thought, such as folding laundry.
Nix the television. Television programs, especially the news, can stick in your mind. Because my husband’s legs are paralyzed, watching television is one of his main activities. He is especially interested in the history of World War II, upsetting images to say the least. I asked him not to watch war programs after dinner and he complied with my request.
Reduce background noise. Peppy music may keep you going during the day, but it isn’t the best match for a good night’s sleep. If you still want to listen to music, choose something that is soothing. You may listen to classical music, for example, or hymns.
Turn off the computer. Like television, computer work can stick in your mind and keep you awake. I try to turn off the computer, but sometimes this is hard to do because of incoming emails from my publisher. So I leave the computer on and do other small jobs or read. Just before bed I check my incoming messages once more.
Take a warm bath. According to sleep experts, a warm bath can relax you and make you drowsy. Since I am not a bath person I don’t follow this tip. However, if a bath relaxes you, it may be just the thing you need.
Slow your mind. This is one of those things that is easy to say and hard to You can clear your mind with meditation, reading poetry, prayer, or a soothing book. Don’t start a murder mystery.
Adjust the thermostat. A cooler room promotes sleep, so turn down the heat or set the air conditioner at a cooler, comfortable temperature. Keep your loved one’s medications in mind. If your loved one takes medicine that makes her or him cold, adjust the thermostat accordingly.
Prepare your room. Close the curtains, shades, or blinds. Subtle background noise, rain sounds, or a running fan, may help drown out other noise, according to Mayo Clinic. The bedroom isn’t the place for a television, the clinic notes, and you should “avoid TV, computers, video games, smart phones or other screens just before bed.”
Your loved one needs a routine and so do you. Establishing a bedtime routine is a trial and error process. Delete the tips that don’t work for you, and focus on the ones that do. Getting a good night’s sleep changes your outlook on life. Busy caregiving days are easier when you are well-rested.
As a full time-caregiver, you may find that once it’s finally time for you to call it a day, you’re asleep before your head hits the pillow. If that’s the case, you don’t need to read any further.
But if, like many, you find that on some nights, even though you’re exhausted, your mind keeps going and won’t let you fall asleep, you’re not alone. When your day is filled with caring for someone and your focus is on a constant stream of demands and tasks to be done, there may not be time left for worrying or dwelling on upsetting thoughts. But when you’re finally alone in a quiet, dark room, those thoughts may finally have a chance to emerge, and linger.
Here a few ideas that may help keep anxiety and worrisome thoughts from robbing you of some hard-earned rest:
If you can manage it, a quick warm shower or bath can be calming, both physically and mentally.
It raises your body temperature and the natural fall back to your normal temp when you get out signals your body to sleep. Plus, water is symbolically cleansing, allowing you to close your eyes and imagine your worry washing or floating away and disappearing down the drain.
Try one-minute journaling.
Putting something, almost anything, down on paper each night in a notebook kept bedside has been shown to help put one’s mind at ease, without taking up too much rare and precious downtime. If a worry keeps bouncing around in your thoughts, write it down in a sentence or two to get in on the paper and out of your head. Alternatively, many folks this helpful: write one, just one, specific thing from the day which you are grateful for. It can be as big as the support of a loving friend or as small as the comfort of a well-brewed cup of tea. You don’t have to come up with the thing you’re MOST grateful for, as long as it’s A thing. It needn’t be profound, and it’s ok to have some repeats over time, as long as you’re specific in whatever it is you’re grateful for that day.
Switch out the TV or computer for a book, recorded book or podcast.
Screens may seem like a good distraction, yet most of us have become so used to watching them while doing something else that our minds can have a way of drifting to the same unhappy thoughts we were hoping to avoid. Reading creates more distraction by requiring more of our attention, and listening to a calm but engaging voice recording as can be found with many recorded books or podcasts of radio programs like This American Life (a personal favorite) has the benefit of allowing us to have the nurturing experience of closing our eyes and maybe even falling asleep while someone tells us a story. If you’re using a digital recording you can often set a timer so that it shuts off on its own after 30 minutes or at the end of one episode, and you can always skip back the next night to wherever you drifted off the night before.
Follow some form of set routine before bed, even if it’s very short.
Doing the same sequence of activity each night helps train your brain to fall asleep more easily. For example the tips above would combine to make a nice routine: take a quick shower; get in bed for one-minute journaling; fluff your pillow, turn on a podcast and turn off the light. Or pick any simple routine that works for you.
Caregiving takes lots of energy. You need restful sleep in order to have this energy. That’s a given. But circumstances and worries may keep you from sleeping. Even if you go to bed early, you may toss and turn, keep looking your bedside clock, and worry if sleep will come. Instead of being your friend, sleep may be your enemy. I found this out the hard way.
A year ago my husband’s aorta dissected. Our house was only blocks away from the hospital, and I was able to get him to the Emergency Department in time. Just in time, for my husband was bleeding to death. Surgeons operated on him three times in a desperate attempt to save his life. The first two operations were a temporary “fix” and he continued to bleed internally.
The third operation saved his life, but my husband had a spinal stroke during the 13-hour operation, and it paralyzed his legs. After being hospitalized for eight months he was dismissed to my care. I am grateful for my caregiving experience. My mother had stroke-induced dementia and I was her family caregiver for nine years. In 2007 my twin grandchildren lost their mother and father in separate car crashes, and the court appointed us as their guardians. Suddenly we were GRGs – grandparents raising grandkids.
Now I was my husband’s caregiver and I needed sleep. While sleep problems are common, they are a problem I don’t need. The source of my sleep problem was easy to identify – my husband’s incontinence. Every morning I get up at 3 a.m. help him with self-catheterization. Sometimes the procedure goes quickly, and other times I may be up for 45 minutes to an hour. Once I am fully awake it is hard to get back to sleep.
So I have my little tricks. Often I visualize a blank television screen and try to empty my mind. Reversing my thoughts is another trick. I think about the good things I have done in a day, such as making a delicious dinner, catching up on laundry, paying bills, and enjoying television with my husband. When I do this, I am taking a chance because switching thoughts takes mental effort, and this effort can keep me awake.
At 4:30 a.m. one morning I gave up and got up. You may have had similar experiences. Sleep is essential to quality caregiving and these suggestions from a Mayo Clinic website article, Sleep Tips: 7 Steps to Better Sleep, may help you. I have edited the tips and added some personal comments.
Have a sleep schedule. I try to go to bed at the same every night, between 9:30 and 10:00 p.m. Lately I’ve been striving for the earlier time to get enough sleep.
Watch what you eat. No spicy dinners for me. Though I like spicy food, I avoid eating it for dinner. Mayo Clinic says you should not go to bed “either hungry or stuffed.”
Watch what you drink. If I feel like coffee after dinner, I make coffee that is ¼ caffeinated. Avoiding alcoholic beverages is a wise decision because alcohol can wake you up later.
Create a ritual. Full-service hotels turn down bedding, and I do too. Right after dinner I turn back the bed covers and get out my pajamas, a time-saving tactic.
Buy comfortable bedding. For some reason, I feel cozy and snug the minute I get under my quilt. I also have comfortable pillows.
Though sleep experts have differing opinions about naps, taking a nap in the afternoon is the only way I can make up for the sleep I have lost. But I am careful to sleep for only an hour. I hope you get the sleep you need and have sweet dreams. If you have more suggestions for getting a good night’s sleep, please share them with other caregivers in the comments.
I’ve read some wonderful, well written, articulate articles on The Caregiver Space. Textbook perfect! Some of them, in my opinion, worthy of an award. In the perfect world of a caregiver, or at least a sane world, following many of the guidelines I’ve been reading, life would be much better for the caregiver. And yes, all or most of what I’ve read, I believe, would truly be in the best interest of the patient and caregiver. But what if you reside in the “insane” world of a caregiver, where reasoning, rationalizing, thinking on your feet with little or no sleep is required on a daily basis? Remember, these articles are written as general guidelines, and are to help those that in many cases can be helped.
Food for thought. I was a caregiver for my wife Annie, who was fighting a particularly nasty blood cancer. Each night before I gave her nighttime medications to her, I checked her ostomy pouch for any leakage. Any signs of leakage meant I had to change her bag. On one particular night I noticed a trace amount of yellow staining around the seal. I immediately knew there was a leak, and the bag had to come of immediately. The yellow staining is indicative of stomach acid. Not good! Acid will fry the skin in very short order. Before I took the bag off, I always made sure to cover any exposed skin area so there would be no germ transfer from feces. Once the skin was covered I’d remove the bag. On this particular night she was experiencing diarrhea. So the body waste was shooting out about 6 inches or more. That was around midnight. I know this because my daughter Melissa called me to check on her momma before she went to bed.
The problem with Annie was, she had an Ileostomy which tend to always be putting out waste or drainage. And when there is waste or drainage, there can be no bag placement as the seal will not stick. This was my worst nightmare when changing her bag–when will the drainage stop? So while Annie slept peacefully in her hospital bed, I set beside her in her wheelchair waiting for the drainage to stop. About half way through the night I saw what I thought was the perfect opportunity to put the pouch on–I needed a four minute window. So I immediately started heating the rubber seal that goes around the stoma (the end of the small intestine where the body waste comes out) with a hairdryer. Once heated it could be molded to fit over the stoma, sticking to the skin, and the bag would then be placed over the stoma too and stick to the seal But fate was not on my side and the body waste started coming out again. That event was replicated a few more times. At 7:30 A.M., Melissa phoned me on her way to work to check on her momma again. I told her I couldn’t talk at the moment as I was just finishing up putting the pouch on. She was a bit shocked, but such was the chaotic life of this caregiver. So there was rarely such a thing as a sleep schedule for me, but when there was, it was 2 A.M. to 6 A.M.
My Sleep Solution
The morning of this event I could not just get up after changing the bag and say, “Annie, I’m going to go get some sleep honey.” Not even a chance! It was time to start her day. But I had a plan–sleep when she sleeps. I knew she’d have a two hour nap or so in the afternoon, and I could nap, too. So what I did when she fell asleep, was pull her wheelchair up beside her bed, put her hand in mine, then lay my head down on the bed and nap. By holding her hand, if she moved I’d feel it and wake up.
Backdrop to this event: Annie was at home, but her condition was serious to critical. Two weeks prior to this event while in the hospital she had surgery and 18 inches of her intestines were removed, creating the ostomy. She now had a feeding tube as well, with no mobility. She weighed seventy-nine pounds and was essentially dying. As her loving caregiver husband, I had the Power of Attorney to choose life over death, or as some would say, death over life. I chose life and fought off two aggressive attempts to put her on hospice and took her home. However, the hospice company honored a request by me, and made sure I had all the equipment I needed to care for her at home when we got there. I brought her home on a cold February night after 51 days in the hospital, and by doing so we ended up making our “Last Summer,” the “Best Summer Of Our Lives,” as we made a box full of new memories that I still cling to today.
It’s not officially winter yet, but the days in North America are already getting shorter.
There are many of us who don’t meet the diagnostic criteria for seasonal affective disorder (SAD), but who still feel sluggish and irritable when the days are short. I find it helpful to do a little DIY SAD therapy. I’m certainly not the only one who’s tempted to curl up with a cup of tea and a book until Spring rolls around. Here’s what I do each winter to make it a little bit easier to get out of bed each morning and be productive during the day.
Let the sunshine in
It’s a little unnerving to look out the window and see someone right across the courtyard; privacy film solves that problem without blocking the light.
We’re starting with the obvious, but don’t jump ship yet.
Do your best to get 15 minutes in the sun each day. Can you sit by a sunny window? It’s worth it to rearrange the furniture to maximize sunlight if you can.
I took the idea of artificial sunrise pretty literal and set up a model of the solar system with the sun on a timer.
I have a really hard time waking up in the morning without sunlight. They sell nifty little alarm clocks that simulate the sunrise, but I do just fine setting a lantern on a timer. A word of caution – some timers will make a little clicking sound, so get a digital one if you’re sensitive to noise. It’s cheap, easy to set up, and makes a huge difference in my mornings.
People swear by SAD therapy lamps, but they cost hundreds of dollars.
Friends swear by their professional SAD lamps, but I wasn’t ready to spend $400 on a light therapy box. Instead, I replaced my light bulbs with brighter daylight bulbs. These CREE daylight bulbs do an amazing job of making my apartment feel sunny. If the $10 per bulb price tag seems a little steep, you can get these fluorescent daylight bulbs at a more reasonable price.
Add some greenery
This plant is doing just fine without any natural light.
Plants cheer up a room and improve air quality. Plants are great at helping to balance the amount of moisture in the air and filter out harmful chemicals that are found in many homes. Luckily, there are plants out there that are hardy enough to survive almost anything. The standard plants you find at most chain stores are a safe bet.
Pothos are my favorite easy plant – you can snip off a branch from a friend’s plant, pop it into any container of water, and it’ll survive for months without any attention. They do just fine even without natural light.
Spruce things up
The winter months keep us inside much of the time, so it’s important to make sure our space is as comfortable as possible.
Most of us are never going to have a clutter-free home. When my apartment is full of clutter it really stresses me out – and poses a tripping hazard. I have myself trained to put things away when I’m done with them. I also have designated ‘clutter zones’ to keep it in check. There’s one spot on my desk for things that are in process, a basket next to the door for things I need to bring out or put away, and space to empty my pockets on my bedside table.
It’s easy to end up with duplicates of things, so I like to switch paintings, rugs, and knickknacks around when the days get shorter. This is a great time to take a look at what you have in the basement or back of the closet that can brighten up your decor. There’s no need to buy new things when you can simply re-arrange what you have.
These DIY tips are helpful for people who feel sluggish when winter hits, but aren’t adequate help for people who could be diagnosed with SAD. If you’re experiencing serious depression or SAD is interfering with your life, it’s time to see a doctor. Serious problems call for professional treatment.
It’s evening, and after a long day you finally have a little bit of time before bed to answer those emails, watch a short program, or buy that book on Amazon you’ve been meaning to order. Or maybe you need to stay up just to get work done. When you’re finished, you get into bed, exhausted, and… spend an hour staring at the ceiling.
You were so tired, are so tired, yet sleep eludes you, the caregiver, at the moment when you need it most. Unfortunately, you may be experiencing the blue light blues.
The problem is that those illuminated screens we all tend to look at on computers, TVs, tablets and smartphones emit more light on the blue end of the light spectrum than does natural light, or most of the other types of lighting in our homes. And research shows that, while all types of light inhibit the secretion of melatonin, a hormone which helps us fall asleep, exposure to blue light has a particularly strong effect. Without melatonin flowing through our system, our brain decides that it’s the middle of the day and time to stay awake, even when our body and mind are very much in need of rest.
This is the reason why you may have heard, from me or countless other sources, that it’s a good idea to avoid screens during the two hours before bedtime. This is true for you and for anyone for whom you’re caregiving.
But what if that’s simply not possible, given your schedule or responsibilities?
Firstly, do try to limit your exposure as much as you can during those evening hours, especially during the time right before bed.
If you really can’t avoid screens, especially if you need to use something with an illuminated screen such as a video monitor in your role as caregiver, try using glasses or goggles specifically designed to block blue light. True blue-blocking glasses can be pricey, around 80 dollars, but you might consider that a worthwhile investment in exchange for some much-needed sleep. A less expensive alternative are orange tinted glasses, which also reduce blue light but affect other colors as well, so they may not be a great choice for watching a movie. On the other hand, they could do the trick if you’re mainly writing texts, emails (or, just as an example, writing an article for a website at 9:00 pm).
Avoid unnecessary light sources, such as the LED displays gracing nearly all room electronics (humidifiers, for example) by removing the display out of your direct line of site, or covering them with a piece of tape or paper. Every little bit counts, especially if you find your eyes open in the middle of the night.
If you need to use night lights for safety purposes or in order to provide care during the night, try using red nightlights. Red light has the least melatonin-suppressing effect.
Not all blue light is bad. Looking at illuminated screens during the day (as well as getting plenty of exposure to natural light in general) can actually help increase energy and alertness during the day and may make it easier to fall asleep later. Of course that’s assuming the blue light doesn’t stick around during the night.
Check out f.lux, a free computer app which adjusts the lighting on your computer and other devices based on the time of day, so that the screen emits more blue light earlier in the day, then shifts to more orange and red in the evening.
As often happens, new technology has been created to help correct a problem caused by another technology (screens and, originally, electric power itself). Take advantage of anti-blue-light gadgetry as much as you can and, when possible, try to just power down and give your mind and brain a break.
For caregivers, late nights and early mornings can be common and sleep is often a precious commodity.
Likewise, the burdens you face may leave you staring at the ceiling when you actually do get a chance to turn in. It’s not surprising, therefore, that many caregivers experience sleep difficulties and naturally look for different ways to reclaim the rest they so dearly need. Sadly, some common strategies we turn to when chasing sleep can do more harm than good. Avoiding these common traps can help prevent chronic insomnia and other more serious problems.
[title text=”Here are the top 5 mistakes you’re likely to make when trying to avoid a sleepless night:”]
1. Drinking alcohol.
After a long, difficult day it can feel relaxing to unwind with a glass or two of wine. Likewise, people who start having trouble falling asleep at night you may find that a nightcap helps them nod off more quickly and easily. However, while alcohol may help you fall asleep initially, it actually disrupts sleep during the second half of the night, leaving you feeling more tired and less rested in the morning.
2. Taking over-the-counter sleep aids.
The most popular drugstore medications like Nyquil, Unisom, and pain relievers with “PM” on the end of their name are all sedating antihistamines. Like alcohol, many of them will interfere with your sleep in the early morning hours. Likewise, using either alcohol or sedating antihistamines long-term can lead to tolerance, meaning that their ability to help you fall asleep diminishes over time. As a result they can actually make even falling asleep more difficult in the long run.
3. Falling asleep in front of the TV.
There’s no doubt that watching television can help distract us from the worries of the day, and some find it has a calming effect. But the blue light generated by televisions, computers, smartphones and any other type of lighted screen has been shown to negatively affect sleep. If you’re having trouble getting the rest you need, try shutting off all screen devices a full 60 minutes before bedtime, and read a book (or non-lighted reading device) or listen to some relaxing music instead.
4. Exercising in the evening.
You have my deepest apologies if caregiver responsibilities leave no time for any exercise, period. Exercise is a wonderful tool for improving mood and can even help you sleep better, as long as it’s done at the right time. If you can make time for it, try to get moving in the morning or at least 3 hours before bedtime.
5. Going to bed too early OR too late.
For a caregiver sometimes late nights are unavoidable, but burning the midnight oil to do things that could be left for tomorrow may backfire because it causes your body to release cortisol, which can make your brain have difficulty falling asleep even when your body is exhausted. On the other hand, some caregivers may be tempted to crash extra early when given the chance, especially if their loved one is asleep. This can also backfire by causing you to wake in the very early morning, setting off a process in which your body gets out of synch with its natural sleep rhythms. Understanding that you may not always get to choose your bedtime, the more often you can get to bed no less than seven and no more than nine hours before you’re going to need to get up, the better.
Now that you know what not to do, what options do you have when sleep eludes you?
Aside from the sleep boosts of exercising earlier in the day, reading a relaxing book in the later hours instead of watching TV, and doing your best to get to bed at a reasonable time, try creating a regular bedtime routine. It needn’t be long, and could include things like a quick bath or shower, applying an aromatherapy body lotion, or reading from a book of meditations. Whatever you choose, making it a nightly ritual will help condition your body and mind to settle down for the night.
Sasha Carr Ph.D is a licensed psychologist and certified child and family sleep coach dedicated to helping people of all ages have healthier sleep. She is a co-author of The Caregiver’s Essential Handbook, which provides practical advice for elderly caregivers. For more information about Dr. Carr, please visit her website at offtodreamland.com
It’s our pleasure to introduce Sasha Carr, Ph.D. as a new monthly contributor to The Caregiver Space’s Lifestyle Section!
Sasha Carr, contributor to the ABCs of ZZZs for Caregivers
Sasha is a licensed psychologist and certified child and family sleep coach. Her new monthly column entitled “The ABCs of ZZZs for Caregivers” will focus on deeper sleep practices and how you can integrate them into your own life. For caregivers with a loved one in the house, all too often we sleep with one ear open. Others just don’t know how to fully turn off their brains at the end of the day so sleepless nights turn into foggy mornings.
We’re here to change all that. It’ll take time, but you deserve it.
Sasha brings a wealth of knowledge consulting with families, groups, and organizations all over the United States through her sleep consultation company, Off to Dreamland. She is a faculty member at the Family Sleep Institute and resident sleep expert for Women of Wellness of CT, a professional health and wellness network dedicated to caring for women and families.
The caregiver community holds a special importance for her, which is why she’s generously offered to donate her time to addressing the real sleep needs of caregivers. She worked directly with a population of caregivers at Rutgers University’s Health and Aging project. Dr. Carr is also the co-author of The Caregiver’s Essential Handbook, a book addressing the critical ins and outs of everything from navigating the medical system to finances, emotional health tips and more.
In the upcoming months you can look forward to addressing topics like:
Sleep Mistakes Revealed: The top 5 things you may be using to try to sleep that do more harm than good
Stop Staring at the Ceiling: How to quiet a worried mind and give it the rest it needs
Avoid the Blue Light Blues: Using electronics mindfully so that everyone in the house can sleep better
If you have specific questions or a topic that you would like Dr. Carr to write a column about, please let us know. From our site to your bed, we’re committed to getting you there, any way we can.
Stay tuned for The ABCs of ZZZs for Caregivers!
Sasha Carr Ph.D is a licensed psychologist and certified child and family sleep coach dedicated to helping people of all ages have healthier sleep. She is a co-author of The Caregiver’s Essential Handbook, which provides practical advice for caregivers of the elderly. For more information about Dr. Carr, please visit her website at offtodreamland.com