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Fighting Caregiver Fatigue

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.