‘Being a Caregiver Ruined My Sleep’

Many family caregivers are likely among the one-third of Americans who don’t get enough sleep. Good worriers, they are prevented from dozing off because they’re ruminating on the next day’s impossibly busy schedule or that pile of medical bills and insurance forms awaiting them on the kitchen table. Or, like firefighters, they do fall asleep, but are primed to wake up quickly to come to the rescue by walking an unsteady care receiver to the bathroom or picking them up if they’ve fallen. One study of dementia caregivers found that they slept about 2.5 to 3.5 fewer hours per week than non-caregivers. That deficit is probably never made up. To paraphrase an old saying: There is no adequate rest for the caregiving weary.

So many of these sleep challenges are inherent to intensive caregiving. Is there anything caregivers can do to sleep better, so that they can perform their daily tasks with optimal energy and a clear head? There is a range of behavioral tactics to consider.

You’ve got rhythm

Caregivers are not designed with on/off switches that allow them to instantaneously fall asleep or wake up whenever they prefer. Sleep is regulated by the circadian rhythm, a delicate internal ballet of rising and cascading hormones adapted to a 24-hour day. To sleep better in general, caregivers would be well advised to reinforce that rhythm by practicing sleep hygiene.

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“Sleep hygiene” is an overarching term for a host of mostly commonsensical practices. For instance: Don’t drink caffeine, play video games, exercise vigorously or engage in any other overstimulating activity close to bedtime — that includes watching reel after reel on your phone. As much as possible, keep the bedroom dark, cool and quiet. Go to bed and wake up at roughly the same times every day. Limit daytime naps to 30 minutes.

Sleep hygiene also includes less obvious tips: Use your bed for sleeping (and sex) but not working or eating. Don’t use alcohol to try to initiate drowsiness; you will probably wake up several hours later and have trouble falling back asleep. If you have been lying awake for 20 minutes or more, go into another room to read or sit quietly until you feel sleepy, then return to bed and try to fall asleep again.

When these practices are used consistently, the muscles relax, breathing slows and the mind settles more readily as the body’s natural rhythm of sleeping and waking takes greater hold. If possible, care receivers should follow sleep hygiene practices too, to sleep better and be less likely to wake the caregiver.

Quieting the mind

Caregivers certainly have a lot to think about and plan for. It’s rarely helpful, however, to chew on these things in the middle of the night, when thoughts tend to circle endlessly through the mind without landing on a solution. Here are some ways of managing those thoughts:

• Over-the-counter and prescription medications are options, especially when used short-term to reset and reinforce the circadian rhythm. Those options should be discussed with a primary care physician in the context of a caregiver’s overall physical and mental health.
• There are many breathing exercises that, when used regularly, are effective for slowing heart and respiratory rates and inducing sleepiness. One of the best known is physician Andrew Weil’s 4-7-8 technique, in which you inhale through the nose for 4 seconds, hold the breath for 7 seconds and then exhale through the mouth for 8 seconds. Repeat this cycle four times. There is something about focusing on the counting and using the breath in this manner that tamps down unhelpful thoughts.
• Another technique for directing the mind away from caregiving worries is called the “body scan.” Start by focusing your attention for 20 seconds on how your feet feel, then your ankles, then knees, hips and so forth, one body part after another, until you reach the top of your head. By focusing on what you are sensing in your body right now, rather than ruminating about tomorrow’s troubles, you may become more relaxed and ready to fall asleep.
• Even before getting into bed, try to empty your mind of any thoughts that might keep you from sleeping. You can do this by writing down a to-do list or a list of worries and then putting it in a drawer or another room for the night. If you want to, you can review that list when you get up the next morning, but you don’t need to mull over its many items at 3 a.m., when you should be slumbering.

Managing interruptions

The toughest challenge to caregiver sleep is unavoidable interruptions from the care receiver or others. There are some possibilities, though limited, for managing that challenge:

• You could try to protect your sleep by asking other family members to take turns being available to the care receiver for one or two nights a week. You could also confer with the care receiver’s physicians about whether there are any medical interventions — for instance, to decrease pain or agitation — that might help the care receiver sleep through the night, thereby allowing you to sleep better too.
• You should set strict rules with other family members to not call or text after, say, 8 p.m., unless it is an emergency. Even if you aren’t ready for bed at that early hour, you need time to unwind without thinking about caregiving or any other pressing matters.

Even with these and other ideas in place, sleep will likely elude you at times. That’s just the job, and it’s a hard one. You will need to catch whatever replenishing rest you can, whenever you can, as the months and years of caregiving unfold.