Calvin’s day begins before 5
A.M. He knows another exhausting day lies ahead. He
allows himself only enough time to have a cup of
coffee and read the paper before lying back down by
his wife’s side until 6 A.M. when the daily routine
begins again; toileting, showering, dressing,
wheelchair transfers, laundry, meal preparation,
housekeeping, correspondence, paperwork, yard work,
personal care. Soon its time for a doctor
appointment; more wheelchair transfers, a trip to
the pharmacy, grocery shopping, and then, finally, a
return home to continue the care routine. No time to
rest during the day. Bedtime planning takes an hour
so he begins by 9 P.M. Calvin is physically and
emotionally exhausted by 10 P.M. and falls asleep
quickly. But he is awakened and out of bed at least
three times during the night, tending to his wife’s
needs, taking her to the toilet, or changing wet
sheets. He attempts to return to bed and finds he
cannot fall asleep. His mind is active, he feels
anxious and has relentless thoughts that swirl in
his mind. Daybreak seems to come too quickly and the
schedule begins once again. Caregiving consumes 24
hours of the day and sleep deprivation and fatigue
are the common denominators.
Caregiver fatigue cannot be
understated. According to Webster’s dictionary,
fatigue means “physical or mental exhaustion;
weariness.” Spouses, adult children and family
members alike are susceptible to caregiver fatigue
whether they are providing care twenty-four hours a
day or caregiving from a distance. The sandwich
generation faces particular challenges as they
attempt to provide care to elderly parents while
juggling the demands of young families and fulltime
careers. Whether caregivers are losing actual sleep
or simply wearing down from the constant worry and
obligations, help is needed before feelings of
resentment and guilt set in or the caregivers’
health is compromised.
Sleep is absolutely
necessary to live; however, it is often a low
priority in the whole caregiver scenario. As an
adult, our bodies need six to nine hours of sleep
and after age 65, we need six to eight hours per
night. The American Association of Retired Persons
(AARP) likens the need for caregivers to take care
of themselves to performing regular maintenance on a
car. Without regular attention, even the finest cars
and caregivers will soon deteriorate. Rest must be a
priority. The brain’s frontal lobe especially relies
on sleep to effectively function. Without adequate
rest, the brain’s ability to access memory, control
speech and resolve problems, is greatly hampered.
Family caregivers truly are
at risk of physical and emotional problems of their
own while they are providing care to a loved one.
Fatigue contributes to an increased vulnerability to
illness and it is prevalent in nearly all
caregivers, yet unseen by most. The results of
fatigue creep in over time, robbing the energy and
focus of a caregiver. They often become so immersed
in their role that they are unable to see their own
health decline ‘right before their eyes’. According
to one home care director, by the time many care
providers realize they have become caregivers, they
are already suffering from the symptoms of caregiver
fatigue and are headed for burnout!
Lack of sleep can affect
emotional as well as physical health. It can produce
anxiety, anger, irritability, affect concentration
and task performance, impair judgment to the point
of danger (driving, using machinery and
administering medications), and impact job
performance. Sleep deprivation can lead to mental
distress, memory loss, and depression. One male
caregiver reported that the emotional fatigue was
greater for him than the physical exhaustion. He
explained that his wife’s behaviors (for example,
false accusations, memory loss, hallucinations, and
repetitive statements) often lead to daily arguments
and disrupted routines that drained his emotions. He
finally learned, over time, that he had to train
himself to ‘pick his battles’ in order to avoid
arguing as well as ignore some of his wife’s
peculiar responses and redirect their daily
conversations.
The physical consequences of
sleep deprivation can include changes in appetite
(weight gain or loss), frequent infections,
addictions to alcohol or prescription drugs,
problems with focusing, droopy eyelids and increased
sensitivity to pain. In addition, lack of sleep can
interfere with the body’s ability to regulate
insulin production and the metabolism of sugar,
putting caregivers at a higher risk of developing
diabetes.
There are several ways that
caregivers can take steps to fight fatigue and
improve their physical and mental health.
1. Recognize that fatigue is
present and that it is negatively affecting daily
life.
2. Seek solutions to alleviate fatigue and sleep
loss.
3. Carry out these solutions with the help of
family, friends or hired services.
One caregiver in a support
group shared that she actually used respite care in
her home to get a much-needed nap three times a
week. Another woman asked family members to stay
overnight once or twice a week to allow her a full
night of rest. An important consideration is for
caregivers to step back, set personal limits and
encourage the care receiver to perform some of their
own self-care activities. As time goes on, it can be
easy to over-help and invite greater dependence by
the care receiver. Others found, when they finally
accepted outside help, they experienced a strong
sense of relief. Most caregivers wished they had
taken the help much sooner. In some cases, when
24-hour care is no longer achievable, moving a loved
one to an assisted living facility or to a nursing
home is the best solution.
Caregivers, as well as care
receivers, need a well-balanced diet and adequate
hydration during the day to stave off fatigue and
vulnerability to illness. Try to avoid large meals,
high fat foods and the drinking of fluids before
bedtime. Taking vitamins, eating proteins, grains
and fresh produce and decreasing sugar, caffeine,
and alcohol can also promote wellness. Caffeine is a
mild stimulant and consuming it before bedtime can
affect sleep. It is also a diuretic and will result
in an increased need to urinate during the night.
Alcohol is a depressant by classification; however,
it does cause a person to sleep lighter and awaken
more frequently.
Fortunately, there are many
things that can help to decrease weariness and
promote a good night’s sleep:
- Regular exercise can
have a positive effect on improving sleeping
habits as well as decreasing stress, depression
and anxiety.
- Try to maintain a daily
routine for naps and sleep so that the body can
adjust to a rhythmic pattern.
- Listen to positive
sounds to promote relaxation before sleep. Music
or nature sounds, such as waves, can be soothing
to the soul. Avoid watching stimulating
television shows right before bed as this may
bring alarming news that unsettles our mood and
disrupts our ability to rest
- Meditation, prayer, and
deep breathing exercises are also options to use
for calming our minds and bodies so that we can
sleep. These can also be done if one awakens
during the night.
- Try drinking warm milk,
taking a relaxing bath, reading something
pleasant and perhaps journal some thoughts prior
to bedtime.
- If insomnia is
prevalent, discuss medication options with a
physician.
Caregivers must take time
for themselves and focus on their own needs (both
physical and emotional) to avoid depleting their
strength and energy. Keeping a daily log of sleeping
habits can be a “wake up call” to caregivers and a
helpful tool for the doctor to determine recommended
solutions. Record the quality of sleep as well as
the frequency. Record also the foods eaten and the
use of medication, caffeine and alcohol. Note the
activities engaged in during the day as well as the
emotions. After several weeks, trends may appear
that offer great insight into the toll of caregiving
and the decisions that need to be made to decrease
fatigue and increase energy.
After years of sleep
deprivation, fatigue can become a chronic state. The
body’s biological clocks are disrupted and symptoms
of aging seem to accelerate. One adult
daughter, who cared for her mother daily for three
years, felt she herself had aged ten years and
gained over 50 pounds. Three months after her mother
was able to move to an assisted living facility, the
daughter appeared physically transformed and
actually looked younger than before she became a
caregiver. She attributed it to finally being able
to sleep normally and to focus on her own daily care
needs now that her mother’s needs were being met by
a caring staff.
It can clearly be seen that
fatigue and sleep deprivation strongly impact the
caregiver’s ability to provide the best possible
care to their loved one. Family caregivers are at
risk and must open their eyes to their own needs and
solutions that may be available to them. Asking for
help is a sign of strength, not weakness! When
someone else takes over the caregiving
responsibilities, even for a short time, caregivers
can step back, focus on themselves, rest and get
recharged.
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