/ May-June 2007 / Fighting Caregiver Fatigue
By Kristine Dwyer, Staff Writer
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 3 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
Caregiver fatigue cannot be understated.
According to Webster’s dictionary, fatigue means “physical or mental
exhaustion; weariness.” Sleep is absolutely necessary to live;
however, it is often low on the priority list 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 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
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.
Recognize that fatigue is present and that
it is negatively affecting daily life.
Seek solutions to alleviate fatigue and
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 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
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