Top tips for a better night’s sleep
By Dr Gemima Fitzgerald, Clinical Psychologist
Getting a good night’s sleep is good for all of us, but especially for family carers of people with dementia. We know that good sleeping patterns are essential for our physical and mental wellbeing. As carers, we feel stressed when we believe we don’t have the resources to cope with whatever demands are being placed on us, and lack of sleep really depletes our resources.
But despite how important it is for us to sleep, we’re not very good at it. The 2016 Great British Sleep Survey found that 63.1% of people feel they don’t get enough sleep. Poor sleepers are seven times more likely to feel hopeless and five times more likely to feel alone. Therefore, as family carers, our need for good quality sleep is a vital component for reducing stress and increasing our resilience.
So, how about you? Do you struggle to get off to sleep? Or often have a restless night, leaving you tired and irritable the next day? If so, you’re definitely not alone. Our sleep tends to be affected by four things: our environment, our routine (or lack of it), our behaviour, and our thoughts/emotions. Here are my top tips for a better night’s sleep:
Keep your bedroom free from clutter, try to have as dimly lit a room as possible (use a nightlight if that’s helpful), replace your mattress every eight years, have your phone on silent and keep the room temperature as cool as possible.
Our bodies naturally produce a chemical in our brains called melatonin, which helps us to get to sleep. When we are in a good routine of going to bed at the same time every night, our bodies learn to produce melatonin at that time. Try to go to bed at about the same time every night. Have a night time routine that starts to calm you down, e.g. take a warm bath, and/or practice deep breathing before bed.
Exercise or walk every day. Increasing exposure to natural light during the day increases melatonin production, so a daytime walk outside can really help sleep. Cut down on caffeine after 2pm. Avoid alcohol just before bedtime to give your body time to metabolise it. Don’t consume fizzy drinks or high sugar foods for three hours before bed, ideally. Banish all LCD screens at night (laptops, tablets, smartphones, TV), although it may be a good idea to try using relaxation apps/cds.
Low mood and anxiety are often characterised by being awake, and unable to get back to sleep, between the hours of 3am-5am. Thoughts that can keep us awake are: worries about the recent past, current problems and anxieties about the future.
On top of these worries and anxieties, when we are aware that we’re not sleeping, that can make us anxious that we should be asleep and our stress levels rise, making it even harder to get to sleep. I’ve definitely experienced that horrible vicious cycle myself!
One approach that has really helped me with sleep is Acceptance and Commitment Therapy (ACT). ACT teaches people that trying to resist worry is unhelpful and instead we should just accept that this is the way things are right now and to stop fighting. I find it helpful to keep a notebook and pen by my bed so I write down any things I remember to do, or worries that I need to address the next day. Then I tell myself that I will deal with it tomorrow.
An ACT approach also suggests that if you’re struggling to sleep just comfort yourself with the knowledge that your body is resting while it’s lying in bed. So, don’t panic. You may not be asleep, but you are giving your body a well-earned rest. And that’s ok.
It is known that we tend to have poorer sleep as we get older; for example, many peri-menopausal and menopausal women find it really difficult to sleep at night. Also, conditions such as sleep apnoea, chronic pain and restless legs can interrupt sleep. If there are physical health problems that are affecting your sleep it is definitely worth seeking advice from your GP. However, whatever the issue, helping our bodies to get into ‘sleep mode’ with the tips I’ve suggested is something that is worth trying and may well benefit you.
I hope this has been a helpful read. As a carer of a person with dementia you may be under a great deal of strain and looking after yourself, which includes getting enough sleep, is vital. I am now going to practice what I preach and try to buy a new mattress – it’s definitely been well over eight years since I bought mine!
Challenges of sleep in dementia
By Lorraine Haining, Specialist practitioner and Nurse
Sleep difficulties can affect some people with dementia, and we are not yet clear as to why this occurs for some and not for others. It is thought it may be related to the dementia affecting the person’s internal biological clock which helps us to define the time of day, therefore the person starts to feel sleepy at the wrong time of day. The type of dementia you have can affect your sleep, such as Lewy Body Dementia, or Parkinson’s Disease Dementia which can cause the person to be sleepy during the day with very disturbed nights.
Being active during the night time hours can be a common occurrence for a person with dementia. Research shows that it may affect up to 25% of people with mild to moderate dementia and 50% of people with severe dementia.
The problems associated with disturbed sleep adds to the level of vulnerability and risks for the person including injury, leaving the home in the middle of the night and the impact on the sleep patterns of carers often leaving them fatigued and exhausted Carers report disturbed sleep to be one of the most difficult and distressing things to deal with. Identifying and treating sleep issues is an important part of dementia care as this can alleviate stress for the person and carer, and could potentially slow cognitive decline
Sleeping too much
People with dementia, especially those in the later stages, can often spend a lot of time sleeping both during the day and night and this can sometimes be worry carers, friends and family. Excessive sleep is often due to the disease progressing and as the damage to a person’s brain becomes more extensive, they gradually become weaker and frailer over time.
- Changes to our internal clock
- Inactivity/cat napping
- Poor lighting
- Medication – Side effects, inappropriate dosage or timing of medication
- Changes to metabolism
- Misinterpreting cues in the environment – visitors leaving and the person thinking they need to go with them
- Other underlying health related problems -infections, pain, or sleep apnoea
- Continence Issues
- Increased confusion
- Disorientation for time, place and person
- Restlessness, pacing, need to go somewhere
- Mood Swings/low mood
- Resistant to care
- Physical/verbal aggression
- Change in body language and facial expression
Things that might help – environmental
Daytime & Early Evening:
- When dark, close curtains to reduce reflections and possibly cover mirrors or glass doors to prevent misinterpretation of reflection
- Good lighting to see clearly and prevent shadows
- Check if too hot/cold
- Reduce noise/ distractions – radio, TV or choose calming soothing
- Ask people not to visit after a certain time of day
- Avoid stimulants- tea, coffee alcohol
Bedtime – Set the scene:
- fold down covers, draw curtains, lay out night attire
- provide a milky drink
- Blackout curtains prevent breakthrough light
- Fit night lights/floor and door sensors
- Maintain regular routines
Things that might help – physical/psychological/medical
- Keep active during the day – walking, dancing, tai chi
- Get outside for exposure to sunlight
- Arrange a medication review
- It may be Symptoms of depression- see GP for advice
- Avoid late dinners ensure person is not still hungry
- Drink small amounts often to stay hydrated, reduce after 6pm
- Be aware of your own stress, it can transfer!
- If there is a sudden change or rapid fluctuation in person’s behaviour See GP to assess any underlying medical cause – UTI, pain
- Ask for a continence assessment to ensure using the correct pad at night