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What can a pineapple upside down cake teach us about grief?

By Kelly Klund

I am blessed with a loving, big, fun, boisterous family. The kind of family that is too loud, uses colorful language, picks on each other mercilessly and ends every visit and phone call with the word LOVE.  We shortened the more common phrase I love you. Why use three words when one will do?  My Uncle Harry started that.

Harry is responsible for a lot of things in our family like our love of agate hunting and the outrageous card games we play every holiday.  He is our patriarch (even though we have never used that word). When we are having a get together the first thing anyone asks is “What time is Harry coming?”

I grew up without a father. Harry is not just my uncle but also my father figure, friend and feels like a brother to me. He has been my go-to for all things male and he even walked me down the aisle at my wedding.

One of his favorite foods is pineapple upside down cake and I make it for him any time he asks. I don’t know if he loves it as much as I think he does, but he lets me believe that my pineapple upside down cake is the best thing ever made. Pineapple-post.png

Oh, and another thing about Harry…he is dying. Not dying in the way we are all dying, he is actively dying.  He is at the end of a courageous battle with liver cancer.  He asked that we all gather together today, to have one final time together as a family. Knowing what the answer would be, I asked him if there was anything special he wanted me to bring. We made eye contact, his voice was weak and he said, “Pineapple upside down cake”. Through tears that I was trying my hardest not to let him see, I nodded yes.

According to Christopher Hall, grief can be defined as the response to the loss in all of its totality – including its physical, emotional, cognitive, behavioral and spiritual manifestations – and as a natural and normal reaction to loss.   Loss and grief are fundamental to human life.

Historically, we have understood grief as progressive and predictable.  A widely recognized example of this model is the work done by Kübler-Ross in her text “On death and dying” which provides the framework for five stages of grief:   (1) shock /denial; (2) anger, resentment /guilt; (3) bargaining; (4) depression; and (5) acceptance.  This model suggested that inability to move through any of these stages would result in a variety of complications.

“Beyond Kübler-Ross: recent developments in our understanding of grief and bereavement” shifts away from the idea that successful grieving requires ‘letting go’, and instead moves us towards a recognition of the potentially healthy role of maintaining continued bonds with those who have passed away.

It is said that grief is the price we pay for love.  If that is true, I will happily “pay my bill”  every time I make  a Pineapple upside down cake and remember the gifts of my Uncle Harry’s infectious laugh, his generous spirit and the lessons he selflessly taught our family.

As you think about a loved one who is no longer living, instead of letting go, is there a way that you can express your grief by maintaining a bond?

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Hall C (2014) Bereavement theory: recent developments in our understanding of grief and bereavement

DOI: 10.1080/02682621.2014.902610

Beyond Kübler-Ross: recent developments in our understanding of grief and bereavement. InPsych 33(6), https://www.psychology.org.au/publications/inpsych/2011/december/hall/

Kübler-Ross, 1969

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Top Ten Sleep Disturbances – #10 Food

Top 10 Sleep Disturbances: #10

FOOD for Thought: the impact of diet on sleep.

Written by: Heather Johnson RN and Resource Nurse

Young man is sitting in bed and eating chicken

What we eat and drink can have a huge impact on more than just our waistlines. In fact, certain foods and drinks can help promote wakefulness during the day or encourage sleep at night. What might first come to mind is caffeine consumption and the benefits of drinking caffeinated beverages earlier in the day. For those who enjoy coffee, starting the day with a regular cup of coffee and switching to decaf late afternoon till bed time is a great beginning! However, we are talking about more than just that “cup of Jo.”
Foods that help promote wakefulness (Wake foods):

  • Caffeinated foods and drinks: Coffee, teas, and chocolate
  • Protein rich foods: Meats, fish, cheese, yogurt
  • Foods that are higher in sodium: Sausage, bacon
  • Vitamin C rich foods: Oranges, strawberries, kiwis, cantaloupe
  • Sugary foods; earlier in the day is better than later in the day

Foods that help promote sleep (Sleep foods):

  • Whole grain foods: Popcorn, oatmeal, whole-grain crackers with a nut butter (Complex Carbohydrates)
  • Nuts: a great source of heat healthy fats. Almonds and walnuts (both contain melatonin)
  • Lean proteins: Lean meats and cheese (specifically cottage cheese)
  • Eggs: Great source of tryptophan
  • Sleepy time teas: Chamomile and ginger containing teas
  • Warm milk: Due to the tryptophan and melatonin it can improve sleep and there is a psychological link (comfort) often associated from childhood
  • Fruits: tart cherry juice and whole tart cherries, bananas, pineapple, grapes, and dried fruit all contain melatonin

In the United States, we often start our day with diets rich in simple carbohydrates and eat most of our protein later in the day. This is completely opposite of what we should be doing to help support our internal clocks. Start your day with protein-rich and foods, those rich in Vitamin-C, and any caffeinated foods. Reserve the carbs, those serotonin and tryptophan rich foods, for later in the day and evening. Per that National Sleep Foundation, an ideal bed time snack is foods that contain carbohydrates and a protein (2018). When eating carbohydrates, our brain produces serotonin; a chemical that will cause our bodies to calm and promote a pleasant mood. In turn, this allows for tryptophan to be more readily available to brain. Tryptophan in the brain then causes grogginess. Think now of how tempting a nap sounds following that Thanksgiving dinner!
What we eat, and when we eat it, is important. How much we eat in one sitting is as important. Another reason you may feel so tired after that tasty holiday meal, is the over-consumption of foods. The body now has to reroute more of its blood supply to the digestive system to help move the food through the system, making less blood and nutrients available to brain. To prevent this brain-drain, eat smaller portions of food more frequently throughout the day, still targeting the evening hours for those sleep-promoting foods.

Sleep and wakefulness are affected by diet.

You are not only what you eat, but when you eat, and how much you eat.

That is FOOD for Thought.

Resources:
Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study. The Center for Health Design Research Coalition. Harvard Medical School, 2010. Retrieved from: https://www.healthdesign.org/sites/default/files/Validating%%20Acustic%20Guidelines%20for%20HC%20Facilities_Sound%20Sleep%20Study.pdf
National Sleep Foundation: What is sleep hygiene? Retrieved from: https https://sleepfoundation.org on Feb. 15, 2019.

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Top Ten Sleep Disturbances – #9 Activity/Inactivity

Regular physical activity#9 Activity/Inactivity

Heather Johnson RN and Resource Nurse

Have you made the connection yet between how improving your exercise and physical movement during the day can positively, and significantly, improve your ability to sleep well at night? Some may think that is a no-brainer connection, however, it is worth exploring how that connection works.

  • Being more physically active, requires energy. Expending energy helps a person feel more tired and ready to fall asleep at the end of their day. In fact, our bodies produce a hormone called Adenosine, and this hormone acts as a neurotransmitter as it continues to build up during the day when a body is more and more physically active. Ultimately, it is the buildup of this hormone that will “drive” our bodies to sleep at night.
  • Physical activity during waking day time hours increases our time spent in the deep sleep phase at night. This deep stage is where the majority of our physical healing takes place and where our immunity is built and restored.
  • Regular physical activity and exercise can also help in our body’s ability to reduce stress levels. Stress is often a common cause of sleep issues when it comes to falling asleep, resulting in restlessness and bouts of wakefulness during the night.

The National Sleep Foundation offers that as little as 10 minutes of aerobic exercise, such as walking or riding a cycling, can dramatically improve your sleep quality, especially when it is done on a routine basis. Research indicates and supports that early morning and afternoon exercise helps to reset the sleep wake cycle by raising body temperature slightly and then allowing it to drop later in the day. Exercise promotes increased sleep efficiency and duration regardless of the mode and intensity of the activity, especially in the middle-aged and elderly adults and those suffering from disease.

What can we do?

  • Determine what activities and physical movement are of interest to you or your loved one. If you are a person who enjoys walking, by all means, walk and when possible do this outside and expose yourself to the outdoors and sunlight. Do what you enjoy!
  • Create opportunities for purposeful movement throughout the day. Even 5-minute increments of exercise, scattered throughout the day, are beneficial.
  • Incorporate movement with something fun! Example: Playing your favorite music while you fold laundry, wash dished, or clean.
  • Create a routine to ensure that activity and movement happens.
    Find a Buddy or two to move with you.
  • Know your physical limitations and the limitations of your loved one. Find opportunities and be creative.

Not only does physical movement and exercise have a positive impact on our sleep, physical movement promotes a sense of well-being, self-worth, improves mood, reduces the risk of several diseases, promotes stronger bone and muscle health, lowers the risk of falls, and provides an opportunity to socialize.
Regular physical activity and exercise can help you to fall asleep faster, get better sleep, deepen your sleep, and improve your over-all sense of well-being! It’s a good thing.

References:

Dolezol, B.A., Neufeld, E.V., Cooper, C.B. Interrelationship between sleep and exercise: a systematic review. (2017). Adv Prev Med. 2017; 1364387. doi: 10.1155/2017/1364387.
Mayo Clinic: Exercise: 7 benefits of regular exercise. (2018). Retrieved on Feb. 17, 2018 from: https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise/art-20048389

National Sleep Foundation: The Science of Sleep & Your Lifestyle: How exercise impacts sleep quality. (2018). Retrieved on Feb 17, 2018 from: https://www.sleepfoundation.org/articles/how-exercise-impacts-sleepquality

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Top Ten Sleep Disturbances – #8 Positioning

#8 Positioning

Heather Johnson, RN, Resource NurseSleep like a baby

Most of us have a favorite sleeping position, and this typically the first position that we lay in when we first go to bed for the night. This is the same position that you have probably enjoyed for a number of years. Now, imagine not sleeping in your regular bed and being unable to physically assist yourself into that favorite position? Imagine not being able to articulate to someone how they can assist you into that comfortable position? How well would you sleep? Or, better yet, would you be able to sleep?
According to Rachel Salas, M.D. and Associate Professor of Neurology at Johns Hopkins Medicine, sleep position is less important for a young and healthy person. But, as we age, the older we become, and with the addition of medical issues, sleeping positions can have positive or negative effects on our sleep and on our health.
Positioning suggestions from Sleep.org:

  • If you have back or neck pain, sleeping on you back may not be the answer. If you have soreness in your back and neck, consider experimenting with different sleep positions and pillows to find what works best for you. Some people find sleeping on their back with a pillow supporting their legs helps to ease low back pain. Sleeping on your back makes it easy for your spine, neck, and head to maintain a neutral position, as there is no extra pressure on these areas.
  • If you suffer from snoring or sleep apnea, position yourself on your side (side-lying) or sleeping on your stomach to help your airway to stay open which may reduce snoring and mild apnea.
  • If you experience reflux and heartburn, sleeping on your right side can, in fact, make your symptoms worse. Try sleeping on your left side to prevent symptoms.
  • Consult your medical provider for suggestions.

Bed Of Nails Isolated

Additionally, if your loved one is unable to communicate their desired sleep position, take note as to what their most comfortable sleep position is or had been. And, assist in communicating this to their care team in helping your loved one receive restorative and comfortable sleep.
When it comes to your bed and bed placement and environment:

  • Replace old mattresses and pillows; check on the manufacturer’s recommendations for longevity. The firmness for both pillows and mattresses is a matter of preference, but do find those that are supportive, minimize pressure on prominent body parts, and that provide the means to keep your spine and neck in alignment.
  • Extra pillows, properly placed for body support, can be helpful.
  • Clean and comfortable sheets matter. Washing sheets and vacuuming the dander and dust from a mattress can help impede allergic reactions that often contribute to impaired sleep.
  • Close your blinds or drapes to prevent street lights or moonlight from disrupting your sleep.
  • Position your bed so that you are not facing distractions (blinking lights from a computer or alarm clock, a desk that is piled high with task that need to be completed, or light shining under your bedroom door) that may prevent you from falling asleep.

While habits can be difficult to change, if one chooses to alter their routine sleeping position. The National Sleep Foundation suggests to break this habit; one can try to sleep on the opposite side of the bed (2017).
The choice you make on your sleep position and posture can have a potential impact on your back and neck, fatigue, sleep apnea, muscle cramping, impaired circulation, headaches, heartburn, stomach problems, and even premature wrinkles. Choose your position wisely, and, when caring for others, make their choice for sleep position a priority.

Resources:
National Sleep Foundation: What is sleep hygiene? Retrieved from: https https://sleepfoundation.org on January 2 , 2019.
Sleep.org. : Which sleep position is best? Retrieved from www.Sleep.org/articles/best-sleep-postion on January 2, 2019.

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Top Ten Sleep Disturbances – #7 Pain

 Donna distesa a letto con dolore alla schiena

#7 Pain
A Serious Intruder on Restorative Sleep
Heather Johnson, RN, Resource Nurse

A recent poll of the American public, found that 21% of Americans experience chronic pain and 36% had had acute pain in the past week. Combine those totals, and it equates to 57%, leaving only 43% of Americans who report being pain free. Pain ranks as number seven in the Top Ten Sleep Disturbances.

People with pain often report feeling less control over their sleep. They report being worried about lack of sleep and its effects on their health. Worry leads to stress. Stress and poor health, often go hand-in-hand and can often be linked to fragmented sleep. Fragmented sleep translates to interrupted sleep which prevents a person from receiving 7-9 hours. Seven to nine hours of uninterrupted sleep is necessary for restorative sleep. Restorative sleep is needed for physical and emotional healing. Sleep loss is known to contribute to feelings of depression and fatigue, which in turn can increase a person’s pain perception. Research indicates that if a person experiences poor sleep due to pain one night, they are more likely to experience pain the next night, and the next night, and so on. We know that pain can be a serious intruder on restorative sleep.

Pain, depression, and fatigue are interrelated. Further, pain often is linked to insomnia, and, when both of these problems coexist, the perfect recipe for additional problems has been created. Additionally, evidence suggests that sleep loss increases reports of pain, when you don’t sleep well you have a heightened sensitivity to pain. This vicious cycle of poor sleep due to pain affects multiple areas of a person’s day to day life.

What can a person do?

  • Determine the source of the pain. Is it physical pain? Is it emotional pain? Get to the root of the problem, identify the root cause. Once you’ve identified the source, address the source with the right solution or intervention.
  • Seek direction from your medical provider.
  • Exercising or stretching of sore muscles by stimulating blood flow and easing pain
  • Evaluate your positioning in bed; your pillow, mattress, and environment.
  • Retrain you brain to think of something positive as you head to bed for the night.
  • Research non-pharmacological interventions such as, relaxation techniques (focus on your breathing), guided imagery, aroma therapy, heat/cold, and massage.
    If it’s physical pain, consider a longer acting pain reliever, one that will last throughout the night.

Don’t let pain rob you from a good night of sleep!

References:
Cosio, D., Lin, E; PPM: Practical Pain Management. Disturbed Sleep: Causes and Treatments. 2018. https://www.google.com/amp/s. Accessed November 20, 2018.
National Sleep Foundation. Recommended Sleep. 2015. https://sleepfoundation.org/how-sleep-works/how-much-sleep-dowe-really-need. Accessed November 20, 2018.
Onen, SH., Alloui, A., Gross, A., Eschallier, A., Dubray, C. 2001. The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects. J Sleep Res. 10, 35-42. doi:10.1046/j.1365-2869.2001.00240.x

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Top Ten Sleep Disturbances – #6 Incontinence

Adult man in a toilet at home

#6 Incontience

Heather Johnson, RN and Resource Nurse

Did you know that more than 1/3 of adults awaken during the course of the night to go to the bathroom at least twice? This is identified as Nocturia; the need to awaken during the night to urinate, and leads to fragmented sleep and opens the door to additional related complications.

While Nocturia occurs at any age, for those over the age of 60, it becomes much more common, especially for those with a diagnosis of diabetes, hypertension, and/or heart disease. Also contributing to this night-time urgency are: urinary tract infections (UTI), small bladder, kidney disease, enlarged prostate gland, prostate or bladder cancer, neurological disorders, stress, anxiety, fear, psychological issues, sleep apnea, an imbalance of antidiuretic hormone (ADH) or pelvic prolapse in women. Medications are also known to increase nighttime incontinence. Side-effects from hypnotics, insomnia medications and psychiatric medications can also increase your risk of incontinence.

Some people may fail to make it to the bathroom in a timely manner and so live with incontinence. Approximately one to two adults in every 100 live with adult nocturnal enuresis, where they are incontinent of urine while sleeping. If you are among this population, you are not alone.

Identifying the cause of the nighttime incontinence should include a consultation with your medical provider. This may help to direct the treatment if there is a solution, and offer direction to help manage the incontinence.

Toilet paper, capsules and alarm clock on black background

Strategies to help you with nighttime incontinence from the National Association for Continence and Mayo Clinic include the following:

  • Limit your fluid intake later in the day, with dinner, and prior to bed.
  • Reduce your intake of caffeine and alcohol (both are known bladder irritants, especially if consumed later in the day).
  • Avoid acid foods (known bladder irritant).
  • Elevate your lower legs later in the afternoon. This will assist in stimulating the flow of fluid to your kidneys and eventually the ability for your body to rid itself of the fluids.
  • Void the bladder before bedtime, even if you do not feel the need to void.
  • Wear absorbent briefs during the night; ensure proper fitting and absorbency to match the needs.
  • Quit smoking(known bladder irritant).
  • Eat more fiber to help prevent constipation.
  • Maintain a health weight.
  • Practice pelvic floor exercises.

Again, consider the listed strategies, consult with your medical provider to determine the cause(s), and a proper assessment can lead to treatment options to solve the problem or offer ways to manage the condition. Take these steps to minimize sleep disturbances and to increase your access to restorative sleep.

Resources:
National Association for Continence (NAFC), Incontinence causes and about adult bedwetting: Retrieved from: nafc.org on October, 26, 2018.
Mayo Clinic, Urinary incontinence: Retrieved from: mayoclinic.org on October 28, 2018.

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Top Ten Sleep Disturbances – #5 Medications

#5 Medications

Heather Johnson, RN, Resource Nurse

Can Medications Interfere With Restorative Sleep?

The answer is simply, “YES! “ A host of medications can contribute to insomnia (Sleep Foundation, 2018).  Conversely, a number of medications can cause and contribute to day-time drowsiness and napping.  Recall from the last blog that napping can interfere with restorative sleep.   Couple that with some standard medication administration times and practices in long-term care and we have a recipe for anything BUT restorative sleep.

 The Sleep Foundation highlights the following medication list that can affect sleep:

  • Anti-arrhythmic medications
  • Beta blockers
  • Clonidine
  • Corticosteroids
  • Diuretics
  • Cough, cold, and flu medications that contain alcohol
  • Headache and pain medications that contain caffeine
  • Nicotine replacement products (patches, lozenges, gum)
  • Sedating Antihistamines
  • SSRI’s
  • Medications to treat ADD and ADHD
  • Theophylline used to treat asthma
  • Thyroid hormone replacements
  • Herbal replacements

These medications can disrupt restorative sleep and your normal circadian rhythm.  Don’t lose sleep over the side-effects.

What can you do about it? Talk with your Medical Provider, Nurse Practitioner, and Pharmacist and ask if your medications could be contributing to your poor sleep.  There may be other medications, non-pharmacologic interventions, possible recommendations on changing of the time of day in which you take the medications and dosing changes that can possibly be made. Restorative sleep is foundational to our overall health and well-being.  Do seek medical advice from the experts to aid to in aligning your medication to best support you and that offers you the best opportunity for restorative sleep. 

A “perfect prescription” for a good night’s sleep just may be a change in your medication.

 

References:

Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study. The Center for Health Design Research Coalition. Harvard Medical School, 2010.  Retrieved from: https://www.healthdesign.org/sites/default/files/Validating%%20Acustic%20Guidelines%20for%20HC%20Facilities_Sound%20Sleep%20Study.pdf

National Sleep Foundation: What is sleep hygiene?  Retrieved from:  https https://sleepfoundation.org on October 3, 2018.

 

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Top Ten Sleep Disturbances – #4 Napping

Astronaut Sleeping on Moon

#4 Napping

Heather Johnson, RN, Resource Nurse

The Good, the Bad, and the Ugly of Day time Napping

Have you taken a midday nap, only to awaken feeling more un-energized than before your nap? Have you said to yourself “Self, you should have never taken (said) nap” as you are now feeling much more tired than you had prior to the nap? If so, you are not alone. Why does this happen? According to the National Sleep Foundation, our body starts to naturally feel unfocused and tired in the middle of the afternoon (typically between 1 p.m. and 3 p.m.) and results in us feeling sleepy as most people’s circadian rhythm takes a natural dip.

NEGATIVE EFFECTS OF DAYTIME NAPPING

What we do know from research and epidemiological studies, is that a nap lasting longer than 30 minutes “robs” our sleep bank at night and, in fact, leads to long-term ill-health effects, including higher morbidity and mortality, especially among the elderly. Healthy adults require 7 to 9 hours of uninterrupted sleep, preferably at night, to function optimally. People often will nap out of habit, boredom, or in an attempt to compensate for sleep-deprivation caused by a disruption of sleep, sleep fragmentation, a sleep disorder, or work schedules. Daytime naps can cause what is known as sleep inertia, where your body feels groggy and disoriented after waking up from a nap. This may happen as the result of being woken (by others or an alarm) after your body has entered a deeper stage of sleep. Daytime naps may also cause insomnia and poor sleep quality at night.

POSITIVE EFFECTS OF DAYTIME NAPPING

When done properly, the Mayo Clinic has found that daytime napping can have its benefits. Napping can offer an opportunity for relaxation, provide an opportunity for a rejuvenating “mini-vacation”, improve mood, reduce fatigue, increase alertness, assist with memory, and improve performance and reaction time. Some refer to these short-measured opportunities as a “power nap.” A recent NASA study found that military pilots and astronauts improved their performance by 34% and alertness by 100% when given the opportunity for a 26 minute nap.

26 minutes? Not 25 or 27? No, exactly 26 minutes is what NASA research found. Napping longer than the 26 minutes is when our body starts to enter into a deeper sleep stage and leaves a person feeling less energized, groggy, and at times, unpleasant to be around. This post-nap period, lasting often 10-20 minutes after awakening, can leave a person feeling disorientated and can have detrimental impacts for those who must perform after waking from a lengthy nap. Post-nap impairment (sleep inertia) can last longer for people who are sleep deprived or those who are not receiving consolidated and restorative sleep at night.

NAPPING DO’S AND DON’TS FOR HEALTHY ADULTS

• If you have to nap during the day, keep it limited to one per day, making it no longer than 30 minutes (Remember NASA says 26 minutes) 
• Take the nap in the afternoon (Preferably between the hours of 1pm and 3pm), taking a nap later than this may affect your ability to sleep later that night
• Create a restful environment that is quiet, dark and at a comfortable temperature with few distractions
• If the need for the nap is related to poor quality sleep at night, identify ways that you can have a better night’s sleep

Is there an “ugly” to daytime napping? Yes, when you don’t adhere to the recommended guidelines and research, you will likely have adverse emotional and physical health effects.
The bottom line…. When your body is getting 7-9 hours of restorative sleep at night, on a routine basis, you are putting your body in the best condition to function at its optimal level.

Who doesn’t want that?

References:
Dhand, Sohal (2006), Current Opinion in Pulmonary Medicine. 12(6):379-382, Nov 2006. Doi: 10.1097/01.mcp.0000245703.92311.d0
Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study. The Center for Health Design Research Coalition. Harvard Medical School, 2010. Retrieved from: https://www.healthdesign.org/sites/default/files/Validating%%20Acustic%20Guidelines%20for20%HC%Facilities_Sound%20Sleep%20Study.pdf
Mayo Clinic: Healthy Lifestyle Adult Health. Napping: DO’s and don’ts for healthy adults. Retrieved from: https://mayoclinic.org on Sept 3, 2018.
National Sleep Foundation: What is sleep hygiene? Retrieved from: https https://sleepfoundation.org on Sept 3, 2018.

 

 

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Top Ten Sleep Disturbances – #3 Sleeping Environment

Sleeping on cloud.jpeg

#3 Sleeping Environment

Heather Johnson, RN, Resource Nurse

Have you ever thought about how your environment (what you are wearing, the mattress or surface you are sleeping on, the pillow and blankets that you use) can affect your sleep?

It can contribute to either a great night’s sleep, or one that falls very short and is far less restorative than you would like to think.  When it comes to creating the right environment to put our bodies into the best restorative sleep possible, there are a number of practices and suggestions that we can adopt, no matter our age.

The Sleep Health Foundation, The Better Sleep Council, and National Sleep Foundation offer great advice and suggestions.  Here are some of the following that have been found to be successful:

  • As much as possible, keep the bedroom set up and environment as familiar to the individual as possible. Muscle memory and feelings of familiarity and security are important when thinking about creating an environment that is relaxing.
  • A warm bed and a cooler room are best. The Better Sleep Council suggests that 65 degrees Fahrenheit is ideal.
  • Having a comfortable mattress and surface to sleep on is important. Check the manufacturer’s guide for life expectancy of the mattress. Check to see if it should be flipped and how often.
  • Find the right pillow for you.  Soft?  Medium? Firm?  If you are not at home, bring your own.
  • Create a relaxing environment.  Use essential oils that promote relaxation and rest such as lavender and bergamot.  Use a diffuser, or in a spray to diffuse on a pillow or blanket.
  • Provide a warm blanket that has been sprayed with a relaxing and calming oil.
  • Get rid of clutter in the bedroom. Think of your bedroom as your sanctuary; where you can escape the business of the day that is inviting and comfortable.
  • Get rid of blankets and bedding that are scratchy and uncomfortable against your skin.  If you are hanging onto the old wool blanket that your great aunt passed down, maybe use it another way instead of having it on your bed.
  • Choose a calming color for the walls. Neutral colors, muted tones, and pastels can help you to wind down at the end of the day and make any space feel calmer.
  • Think about the quality of your bedding; thread count and what appeals to you in the softness of the fabric.  Try different bedding, and remember that the functionality of the bedding should outweigh the looks and style.
  • Sleep in pajamas that are comfortable and fitting for you.
  • Always, always ensure that your path to the bathroom in unobstructed and clear, and if using a night light consider an amber colored bulb.

The sleep environment is simply the space in which you attempt to sleep. In most cases, this means your bedroom.  Make your bedroom and your bed, an inviting place to be; dress appropriately for the part.

“Sleep is an investment in the energy you need to be effective tomorrow.” ~ Tom Rath

 

References:

Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study.  The Center for Health Design Research Coalition.  Harvard Medical School, 2010.  Retrieved from:  https://www.healthdesign.org/sites/default/files/Validating%%20Acustic%20Guidelines%20for20%HC%Facilities_Sound%20Sleep%20Study.pdf

The Better Sleep Council: BedTimes Magazine 2018/04. Retrieved from www.sleepproducts.org on July 27, 2018.

The Sleep Health Foundation: Retrieved from www.sleepfoundation.org on July 26, 2018.

National Sleep Foundation: What is sleep hygiene?  Retrieved from:  https https://sleepfoundation.org on July 27, 2018.

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Top 10 Sleep Disturbances – #2 Light

Donna stanca a letto al mattino

#2 Light

“Let There Be Light”

Heather Johnson, RN, Resource Nurse

Light exposure does play a significant role as it helps this internal clock regulate our sleep and waking schedules
Have you ever wondered why light exposure plays such a significant role in setting our internal clock?
With the invention of the electric light bulb in the late 19th century, our bodies started to be exposed to more light than humans had ever been exposed to before. Because of this, our patterns of sleep are negatively impacted.
Most living creatures, including humans, have a similar internal clock, also known as the circadian rhythm. Humans, as diurnal creatures, have evolved to sleep at night and active during the day light hours. Deep within our brain there is an area called the hypothalamus which regulates the functions of our body, including sleep, energy, and hunger. Without the right amount of light exposure our bodies would have a very difficult time, at best, to regulate our sleep and wake cycles.
The natural way our circadian rhythm works is that rays of sunlight hit the cells in the retina of our eyes, the light triggers the release of the hormone serotonin (the “happy-feel good” hormone). Serotonin, which is mostly stored in our gut, is released. As the sunlight goes down in the evening and exposure to sunlight and environmental light decreases, our bodies are cued to start producing Melatonin. The hormone Melatonin “drives” our bodies for sleep at night. Since the invention of the light bulb our prolonged exposure to light late in the evening delays our body’s ability to sleep and messes up our internal clock.
In our work during the Restorative Sleep and Vitality Program (R.S.V.P) we identified that residents in long term care communities were not receiving enough white/blue light (sunlight) exposure during the day time hours and were being exposed to too much light in the evening and overnight. Exposure to overhead lighting during night-time rounding practices makes it difficult for residents to fall back to sleep as their Melatonin levels have decreased. The effects of even a brief amount of light exposure at night are long-lasting. Some studies even site that it takes our bodies up to 45 minutes for our Melatonin levels to return to the same levels they were prior to the exposure of light.
Studies show that white/blue light exposure is stimulating to our brains and more appropriate during waking hours, while exposure to red or amber colored light does not stimulate the brain as much, thus making it a better choice for late in the day and over-night. With this added knowledge, our collaborative moved away from old practices of turning on overhead lights in resident rooms during the night. Instead, if need be, staff now wear hug lights (flashlight that wraps around the neck) with amber colored lights. We use amber colored bulbs in bedside lamps that do not interfere with Melatonin production and levels. Hallway lights and lights in common areas have been outfitted with timers to have them on at 8 am and down or off at 8 pm.

Light Tips for everyone:
• Increase sunlight exposure especially early in the day (sunlight is the best light).
• Reduce white/blue light exposure in the evening and late in the day (install an app such as f.lux to block blue light on computers, change the light setting on phones to a more amber back light, shut off the television a few hours prior to bed).
• Use amber colored bulbs in lamps.
• Use an amber colored flashlights or nightlights to navigate walking at night.
• When able, take time to get outdoors or do activities within a few feet from windows.
• Use room darkening blinds in bedrooms.
• Keep the bedroom dark at night.

When light exposure is managed well during day time and night time hours, it can be used to boost performance, improve sleep, improve alertness and increase energy.

Resources:
Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study. The Center for Health Design Research Coalition. Harvard Medical School, 2010. Retrieved from: https://www.healthdesign.org/sites/default/files/Validating%%20Acustic%20Guidelines%20for20%HC%Facilities_Sound%20Sleep%20Study.pdf
Nation Sleep Foundation: What is sleep hygiene? Retrieved from: https https://sleepfoundation.org on July 10, 2018.