Ep 6 - Rest, Relax, Sleep

You need to ensure that you rest, relax and sleep – we provide some ideas about how to fit this into your carer’s schedule, without letting your patient down.
An interview with Christine Pacey, an occupational therapist and palliative care team leader in Central Otago. 

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Transcript

 Ep 6: Rest, Relax, Sleep

Kia Ora and welcome to The Ending Life Well Podcast. This podcast series for carers focuses on advice and practical solutions for carers who have been thrown into the deep end looking after a loved family member or friend in their last days, weeks or months of life. 

 Our episode today is Rest, Relax, Sleep

 Denise
Hi, I'm Denise van Aalst, a senior palliative care nurse and educator at Otago Community Hospice, and today I'll be talking with Christine Pacey, an occupational therapist and palliative care team leader in Central Otago. Hi, Christine.

Christine
Hi, Denise. Nice to see you.

Denise
Christine, I was wanting to talk with you about sleep. It's often poor sleep, trying to get enough sleep, getting enough rest. And we've called this topic today ‘Rest, Relax, Sleep’, because sometimes it's about the resting and the relaxing isn't?

Christine
Quite often we don't give it enough value in our lives. It's such an important part of the body and how it regenerates when you sleep. I think it's important for people to know, it's not a luxury, sleep is essential, isn't it? We all need to have a good sleep.

Denise
Now, that doesn't necessarily mean though, a solid eight hours does it?

Christine
You know, a lot of people, as they get older, their sleep pattern changes. And they find maybe they need less sleep at night, and that's okay. So people usually have an idea of how much sleep they need to feel when they get up in the morning, they feel good, rather than get up in the morning and still feel tired.

Denise
So that's around that quality of sleep as well, isn't it, not just the duration of it?

Christine
You know when you look at sleep, we go into different levels of sleep. So if we only stay in the sort of first level, the very light level, then we're actually not getting enough. You know, that's when we wake up feeling tired again. But if we can manage to get into sort of that deeper level of sleep, that's, that's when we actually feel that we've had a good sleep. So for a lot of people, it's important to think about why they're not having a good sleep, because there'll be multiple reasons for it. If it's our patients they've got either a disease or they've got chronic illness or something that is affecting their body and their body's fighting really hard to fight whatever it is that's going on for them…

Christine cont… So they might be sleeping a wee bit through the day, so maybe they're not needing so much sleep at night. And that's okay, if you're okay with that. But if you're not okay with it, then you need to think about what your routine is for the day. So that might mean make sure you get up in the morning. You know, have a sort of time in the morning, where you think it's okay to get up,if you lie into lunchtime, then you aren't going to be able to sleep at night time.

Denise
So getting up at a regular time can be really helpful.

Christine
If you need a wee nanna nap after lunch, that's okay. But don't do it for longer than an hour. If you go longer than an hour, you go into deeper sleep, and it's harder to wake back up again, and that then tends to affect your sleep rhythm at night. 

Denise
And that afternoon rest can be really helpful too, Christine can't it? Because if you're really struggling through the day, and then you're dropping off in front of the telly perhaps at night, and dozing then, that's likely to impact on your sleep at night. So having a rest in the afternoon, means you'll be a bit more alert and enjoy the evening, and go to bed at a regular time.

Christine
It's all about routine, isn't it? So if you get up at a certain time in the morning, that's acceptable to you, but not too late, but also if you go to bed, at a certain time at night, as well. And it's just about trying to keep some kind of routine.

Denise
Especially when it comes to sleep

Christine
Uh huh, and routines as well before bed can help. We always try and have routine for our families, our kids so that they will go to sleep. And it's the same for ourselves as adults, you know there's no point in sitting and drinking lots of caffeine before you go to bed, for instance, you're going to be wired and you're not going to be able to, your brain's just not going to be able to switch off.

Denise
And caffeine can be hidden in a lot of things.

Christine
A lot of people like to read before bed. That's fine, sometimes that can be enough to relax you. But if you're using a tablet, you need to switch it to night mode, because the blue screen, it's a stimulant, almost to your brain. So when it gets to night time, it's better to move to the black screen with the white writing, because then your brain is more likely to relax faster, and let you go to sleep once you're finished reading, right. And some people will choose to have their shower or whatever, at night time, because that helps too. And remembering to take whatever medication you're meant to take at night.

Denise
Keeping up that regular, especially pain medication or symptom management that might disturb you at night is really quite important.

Christine
And it’s easy to forget these things. The other thing is, it's quite important that we manage through the day to get a little bit of vitamin D, get a bit of sunlight. Even if it means you're just out in the garden for a wee while if you're not able to get out and about, just some sunshine on your face, feeling that nice fresh air and just getting out four walls. Your body then has no separation if you like, from if you've been in the house all day, every day. So it's just, you know, between routine and trying to give yourself a bit of fresh air and vitamin D, can be one of these silent helpful things that you need to do.

Denise
What about alcohol, Christine, having a wine each night, good idea or not?

Christine
Some people aren't affected by it. I always say, if your routine was to have a glass of wine, that's okay. But if you are having difficulty, you could try a non-alcoholic one. So you could still have a wine but you could have a non-alcoholic wine, so I think it's about experimenting and see what works for each individual.

Denise
Because although people can feel sleepy with it, it is a stimulant, isn’t it? so a couple of hours later you wake up and you're wide awake.

Christine
Everybody’s different, so for some people, yes, it makes them sleepy but for other people, they can maybe fall asleep, but then like at one in the morning, they're wide awake. But usually, people are aware that it does that to them. And it depends also, when you have your evening meal, you know, if you're eating quite late in the evening, then your body's just a bit full and processing all of that and that can be hard to sleep. So again, if you're thinking about your routine, you might want your evening meal a wee bit earlier, five o'clock, six o'clock, rather than eight o’clock.  A lot of our patients don't eat much through the day. So it's just about thinking if you had a little bit of dinner at five o'clock, and you're not going to bed till nine or 10, your tummy might be empty again. So it's okay to have something light before you go to bed.

Denise
And there are some herbal teas aren’t there, that that help with sleep. They're quite easily available in supermarkets.

Christine
Yeah, there's chamomile and various other things and that's down to personal taste. So I think people just need to work out what works for them. And you could be someone who's had a really good sleep pattern most of your life, but for some reason, now you're not, so, so then they have to sit and work it out as to what they can do. So same with, you know, nicotine is a stimulant as well. So if someone's a smoker, then smoking prior to going to bed can make it more difficult to sleep. You know, I always think before you go to bed, you know that having that quiet time, that relaxation time, that wind down time, whether it is you have a nice warm bath, or a nice warm shower, or you've got something nice relaxing to read. It's not the time to have something really stimulating to watch or a book that's really, really exciting that you're not going to be able to switch off from.

Denise
This is the time to read a slightly boring book that you're happy to put it down.

 Christine
Or sometimes magazines are good at night time, because you can just read an article or a bit of the newspaper or something you can easily put down. And the thing is if you go to bed, and you lie there for a wee while, we usually say after 15 minutes, get back up again and do something boring. You might go and take a drink of water or you might go to the toilet. You might read a short article out a paper or something and then go back to bed and try again, cos sometimes just that switching mode from lying in bed thinking ‘I can't get to sleep’, if you get up and do something and then go back.

Denise
That would also apply if you were waking during the night and struggling to go back to sleep

Christine
There's nothing worse than lying there and you look at the clock turn round every hour, you're actually better just to get up, break that cycle, do something and then go back to bed. And you usually find it's easier.

Denise
I remember my mum years ago telling me she'd had a couple of nights of being awake every hour on the hour. And I asked her how she knew that. She said I'd roll over and look at the clock, and there it was, two o'clock, three o'clock, four o'clock. So I said when you go to bed tonight, mum, turn the clock around, so you can't see it. And she said, ‘What good will that do?’. And I said, because I felt she was conditioning herself to wake up, because she was expecting to and I said, ‘you’ll wake up once or twice, resist the urge don't turn the clock round and I think maybe you'll start to sleep through’, so she pooh-poohed my idea. However, she did follow it and then had to say the next day that it worked but mind you by that point, I think she was so tired, she would have slept through anyway. But it can be easy to have that conditioning can't it? So actually, as you say, not looking at the clock, can be quite a good thing to avoid.

Christine
You can also find that if you have a few nights, when you've either woken through the night or you've not been able to get over to sleep, we start to worry about it. And then we start to do it more and more. And it's almost like your subconscious makes you do it again. So it's quite good then, when you can break that cycle in some way and it's like tricking the body back into the routine it's meant to have.

Denise
Well, as you said, if you get up, and maybe go to the toilet, have a drink, and almost reset that going to bed routine don't you, so that you go back to bed and your body's like ‘oh, okay, we're going to bed, we're going to sleep’. So it is almost a little bit of a trick to just restart

Christine
The other thing you can think about is if you've been someone who have watched TV in bed, then you might need to try not watching TV in bed because the brain, it needs to decide bed is for going to sleep. So it might be you watch TV in the living room, for instance. Or you switch it off quite a while before you want to go to sleep because it's like your subconscious doesn't let you go to sleep.  The other thing I say to people is if they're lying there, and they can't get over to sleep, and their thoughts quite often that's, night time’s for people's thoughts that are in their heads, and they just, they're ruminating and they just can't get out. Have a pad, a notepad beside the bed, and just write it all down. Because sometimes it's something you say you don't want to forget, or you must remember to do that tomorrow. But if you actually write it down on the notepad, then you're okay, you kind of feel relieved because you know you're not going to forget, you can look at it in the morning and that can be enough just to let you get over to sleep.

 Denise
I read something the other day that I thought I must try it next time I'm lying awake, because I've done that. You know, you're awake, the middle of the night thinking, busy, busy, busy. It was giving myself permission, to go to sleep, which seems silly, but I thought actually, that can also be quite a good idea, actually I've done my thinking, I'm letting that go. Now I'm allowed to go to sleep.

Christine
And you might have to use some relaxation techniques, if it's become difficult for you. And there's quite a lot of apps, podcasts, YouTube, you know, you can find something that helps you whether it's breathing, muscle relaxation. You can get some really lovely things to download that you can listen to and they're maybe short and that's just enough because you're then not thinking about your own worries and thoughts. You concentrate on something else and that's enough to get you over.

Denise
Yeah, I think that's a good idea. There are some good apps that you can put on a phone or something now that as you say, music or stories or something to listen to, that will just help distract your mind from that busyness and allow you to sleep.

Christine
And the other thing is to look at the environment, you know, to think about your bed, are your comfy in bed? Are you too hot or too cold? The optimum temperature 15 to 20 degrees in your room, you know, if you're really cold, or you're really hot, you're just, you're going to be restless. So just having a wee think about the temperature in the room and your bedding and are you comfortable. If you're not comfortable in bed, some people have lost a lot of weight and you know, our bones let us know, if we're not comfortable. Then ask your care coordinator or your occupational therapist for some help, because they can give you some toppers for the bed to make it a bit more squishy and comfortable.

Denise
Yeah, it's a really good idea because your bed does need to be comfortable, as does your pillow, if you want to sleep well.

Christine
And blocking out things that distract you. So noise if you have to, put some earplugs in. If it's too light, you need some blackout curtains on the window. If you really can't manage that, you can get these really comfortable eye masks that we use when we fly. And you can get earplugs and eye masks and things from your local pharmacies and they're not expensive, and it just might make a difference.

Denise
There's quite a few wee tips and ideas that are worth trying to help because that good night's sleep is a big factor in the energy and enjoyment of the day.

Christine
It's the trial and error, isn't it? And everybody's individuals, and there's so many different reasons for not being able to sleep or having difficulty staying asleep. So it's good for people to experiment a wee bit and see, but they need to give themselves a few nights of trying, not just one night, because sometimes you can't achieve stuff in one night. You're trying to trick your subconscious back to a routine that it's not been doing.

Denise
And if you are lying awake, try and not worry about being awake, because that's very counterproductive.

 Christine
If all else fails, and you really, really can't trick yourself round, then you can get some sleep aids. You know, there are various health food shops or you can talk to your GP if you’re needing some medication. You can get quite a lot of things that are considered healthy or normal, like it's melatonin in our bodies, that helps us sleep. And sometimes we don't have enough of it or we're not creating enough of it but you can get on-prescription melatonin, which is a natural sleep aid. You know there are things around for people. The other thing is magnesium. In New Zealand, we don't produce magnesium, so we have to have it through food sources. And sometimes if your diet’s really down, then you're not getting magnesium, and you can be uncomfortable. It's worth talking to your health professional if you're really, really struggling with sleep, and seeing if they can make any suggestions.

Denise
Because it may well be that you need a combination of things.

Christine
And sometimes you just need that extra help for a wee while to trick your body back into sleeping again. You know, you might need just a few nights of something to help you, and then that's it, that you're back in, into things again.

Denise
Yeah, that's a good point. It may just be a short-term issue. 

Christine
I mean, a lot of people don't like taking supplements. They've never taken them any times in their lives and this is the time they really don't want to but it's okay to need it occasionally.

Denise

And a good night's sleep or getting enough rest is so crucial.

Christine
I really want to touch a little bit on our carers because we've kind of concentrated on our sort of patients or people that have got something, sort of, you know, going on with their bodies that's making them harder to sleep. But for carers, they're using a lot of energy and brainpower and they’re worrying about their loved ones and there's a lot going on for them and quite often, they will have trouble sleeping, and sometimes that is just their brains just too busy. So for some of these tricks and tips that we’ve talked about, would work for them, too.

Denise
And they should also be trying them absolutely. Christine, thank you for that. There’s great ideas there for people to give a go.

Christine
You're very welcome. I hope people find it helpful. And I think that the thing is, if you're really stuck, you know, talk to one of your health professionals and get some advice and help. Don't just put up with it.

Denise
Thanks, Christine. And thank you for joining us today. 

This podcast was brought to you by Otago Community Hospice with support from Hospice New Zealand. If you found this discussion helpful, check out our other episodes of Ending Life Well, a podcast series for carers. You can also find more resources for caring for a person who's dying on our website at https://otagohospice.co.nz/education