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You Ain’t Cool Unless You Pee Your Pants

Written by Sarah Brown, BS, RN, LNHA
Executive Director, Empira

“You ain’t cool unless you pee your pants!” – Billy Madison

Some of you may remember this classic line from the 1995 comedy movie, Billy Madison. Adam Sandler plays the role of an adult, Billy Madison, who has to complete all of grade school over starting with Kindergarten. While on a school field trip in 3rd grade, Billy notices his classmate had an “accident”. Sensing his classmate’s embarrassment, Billy pretends to pee his pants too to save the boy from embarrassment. Because the rest of the class looks up to Billy as an older cool kid they accept his claims and the boy is saved from embarrassment. Part of this scene includes a cut to an elderly woman who says, “If peeing your pants is cool… consider me Miles Davis.” Fun Fact (Miles Davis was influential Jazz musician with a record titled Birth of the Cool in 1957.)

Although incontinence is common, it is not a normal part of aging.

With stereotypes like the one in the movie and daily exposure to the widespread prevalence of incontinence observed in care centers, it is very easy to normalize and expect incontinence with aging. In the United States, incontinence is common for older adults and according to the National Association for Contienence (NAFC), incontinence is second, only to falls, as the reason for nursing home placement.

Incontinence affects on average 70% of residents in the Empira consortium. We have learned through the Empira Falls Prevention & Reduction program that incontinence is a common contributing cause of falls and toileting schedules also have a major influence on several other nursing home care plan areas including sleep, nutrition, hydration, skin integrity and mobility.

One thing the movie portrayed accurately is the social impact of incontinence. Through conversations with residents Empira became increasing aware of the impact it has on quality of life in our care centers. We have learned that resident don’t feel like Miles Davis, the king of cool. Residents have shared the following statements about what it is like. As you read the comments you will see they feel more like the embarrassed school mate:

  • “Because I have so many accidents I prefer not to go to my social engagements.”
  • “I buy two of every outfit because I got tired of explaining to my friends why I changed clothes.”
  • “I am limited in my ability to venture too far from bathrooms for fear of accident and embarrassment.”
  • “Going to the bathroom becomes all consuming and takes over my whole day’s schedule.”
  • “I was surprised how quickly incontinence products were suggested and it was presented as my only option.”
  • “I was living at home until I began to have incontinence issues. It was the reason I had to move to a nursing home”
  • “I don’t attend family events outside of the nursing home because my bathroom needs are more trouble than it is worth.”
  • “Bathroom routines are embarrassing and distract from living life.”

I am not saying we should all start peeing our pants.

We as aging service providers need to acknowledge that we are not helping older adults feel cool or understood as Billy Madison did with his empathetic gesture. I am not saying we should all start peeing our pants but I am saying we should all start with empathy and understanding of the impact incontinence issues has on those we care for. Our current status quo of continence care in nursing homes has normalized incontinence to the point where we don’t even see it as a problem that deserves investigating. The resident comments above convey that our actions say, this is normal, there is nothing more we can do other than offer incontinence products and a 2 hour toileting schedule.

We need more thorough understanding and more options for treatment and management besides the house special standard incontinence product. I want to encourage us as aging service providers to keep learning and to create new standards that give incontinence the time it deserves. This will allow for discovering root causes, preventative measures and alternative options for residents.

Starting January 2020, the Empira collaborative has created and deployed a new approach to incontinence titled STREAM (Strategies Targeting Resident Elimination and Assessment Management). This program will be in 25 skilled nursing homes in metro and rural Minnesota.
STREAM was made possible by PIPP funding through the MN Department of Human Services.

STREAM was developed after listening to residents share the negative impact toileting and incontinence has on their everyday life. This program will challenge current assessment practices that do not accurately reflect the resident’s condition and replace it with technology-based assessments to improve accuracy and efficiency. STREAM funding provides each community with a Clinical Informatics Specialist (CIS) who will utilize the technology based assessments and data to strengthen resident care plans for a holistic approach to individualized care.
We believe improved understanding of the root cause will lead to better options for prevention, treatment, and management and ultimately resulting in higher quality of care.

Stay tuned to follow the STREAM journey. If you are interested in learning more about continence and emerging best practices visit

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Grandpa Paul’s Letter and Legacy; A Gift from Heaven

Written by Heather Johnson, RN
Resource Nurse, Empira

Last year, my oldest son, Nicholas Pete Johnson, graduated with a degree in Law Enforcement; a proud moment for me, my husband and our extended family and friends. Nick, from a very young age had shared his desire, to anyone that would listen, that he wanted to be a police officer. He accomplished this goal at the young age of 19. Unbeknownst to me, my mother not only came to observe and take in this moment with all of us, but she came carrying a gift in the form of a letter to hand deliver to Nicholas. It was a letter that her father (my Grandpa Paul/Nick’s great-grandfather) had penned in the days following Nick’s birth; a letter that was to be given to Nick later in life. Just a few short months after he’d written the letter, Grandpa Paul died suddenly of cardiac arrest.

In a quiet moment following the graduation ceremony and subsequent traditional hubbub, with tears in her eyes, a big hug (something my grandpa was famous for) and with extreme pride for having kept this letter preserved for close to 19 years, my mother presented the letter to my son. In his letter, addressed directly to Nicholas Pete, my grandfather shared information about his lineage, how extremely proud he is to have been able to meet and hold his great-grandson, and his specific hopes to see him graduate from college one day. Grandpa wrote about my strengths, and those of my mother, and how proud he was to be part of our lives. He wrote about his hopes for Nicholas as he grows and becomes a man and how he will one day take his place in this world and will do amazing things. True to Grandpa’s prediction of Nick’s responsible and respectful character, Nick, without reservation, silently and solemnly took in every word from Grandpa Paul. Needless to say, my heart was full and my eyes were more than misty as I witnessed this moment.

You see, in my eyes as a child, and then into adulthood, my grandfather was larger than life; not only in his tall and somewhat massive stature, but in his presence and how he lived life. His nickname to those that knew him well was the “Grizz.” He identified me as his “Little Blond Girl”, a nickname that I proudly wore. We had this connection, he and I. When he spoke at my wedding, he revealed that it was my words, as a child that convinced him to quit smoking after many years: “Grandpa, I want you to see me graduate, to be at my wedding, and to know my babies. Smoking is bad for you and I want you to stop.” It was with his encouragement and support, and being welcomed to temporarily live with him and Grandma, that I was able to have attended and graduated from college for nursing. He taught me to be brave, to work harder than those around me, to display integrity, and to always lead by example.

Grandpa Paul, Valedictorian of his class and the only son in his farm family, denied himself a full-ride scholarship for college to stay on the farm during the war. My grandfather was a husband, father to six, farmer, lumber yard manager, pilot, gardener, caregiver to his parents, avid reader, and also a very prolific and poignant writer. As a child, and as his houseguest during my college years, I can recall watching and hearing him plug away at a typewriter (never a computer) with his eye glasses on the tip of his nose and cup of coffee close by. Grandpa wrote personal and professional letters, letters to the editor, and a newsletter column that he called “The Old Filosopher” that served also as his personal journal. He was known for his ability to formulate and pen speeches that were informative and motivating. He often could be found speaking in front of large and small groups; a duty that he seriously enjoyed as the mayor of Clarks Grove, MN, the Minnesota State Elks President, and the unquestionable family spokesman. No matter the number of people in front of him, I, with others, learned to listen to the power of his messages.

While searching for advice from my grandfather, and, as I was trying to figure out my life’s plan as a young adult, I recall him telling me “Look, the best advice I can give you is this kiddo… when you are needing to make a very important decision in life and are questioning your path, go to the cemetery. Go there and look around you, it is there that you can truly see the opportunity that you have in front of you, seize that opportunity.” It was here that he admitted that he wished he would have said, “I loved you” more often.

Nick was too young to remember meeting Grandpa Paul. He has seen photos and heard stories. On his college graduation day, Nick personally experienced the power of Grandpa’s legacy, his wisdom, and the power of his words.

Grandpa closed his letter to Nicholas Pete with:

“I couldn’t be prouder that “Petey Johnson” will carry on and make his community proud of him in the future years- I just know it will happen and always know that no matter what, you will always carry your great grandfather’s love with you!”


Your Great Grandfather Paul E. Hanson (The Grizz)

Through his own words that surfaced at a pivotal point in Nick’s life, my Grandpa Paul was able to share his deep love of family and offer words of advice directly to my son, his great-grandson, through this letter. Since receiving the letter, we have shared this writing with family members and friends as a priceless gift to all that knew my grandfather and for those that may have wished they had. There are healing words contained in his writing, words of hope, and words of optimism, of a strong work ethic, and sharing of family traits and experiences. But most of all, words of pure love from a grandfather to his great- grandson. What better legacy can there be? Words are healing and stories are best told by those that have the wisdom and experience to draw from.


Grandpa’s Little Blond Girl

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The Risk is Worth the Reward

Written by Sarah Brown, BS, RN, LNHA
Executive Director, Empira

Have you ever wondered why some conversations are harder than others? Like when people get nervous for a marriage proposal…even when they know the person is going to say yes. Or, on the other hand, people get nervous to break up with someone. These conversations are difficult because they are important to us and we think:

  • What will the other person think or say?
  • What if they get emotional?
  • What if I offend them?
  • What if I get emotional?
  • What if they think less of me?
  • What if I get don’t get the answer I hoped for?

The similarity in these scenarios is vulnerability and uncertainty. Our brain is wired to protect us from these feelings so we might start to rehearse over and over in our head or we might talk to a trusted and close confidant to gain the courage for the conversation. If we are unable to face the vulnerability and uncertainty, we might decide to skip the conversation all together or put it off for another day…

The longer we hold back these important conversations with our loved ones we miss opportunities for connection. We also carry the weight of things unsaid. Overtime it can cost us our peace and if we wait too long, we regret never having the conversation. However, when we do find the courage to speak up the risk is often worth the reward.

Brené Brown, a research professor at the University of Houston, found that “staying vulnerable is a risk we have to take if we want to experience connection.” Even though conversations may be difficult if we avoid them, we avoid connection. Connection is required for relationships and relationships are among the most important things in life. It is probably no surprise research overwhelming demonstrates relationships have a positive impact on the aging experience. In fact, relationships have been found to be one of the strongest determinants of health and wellness for older adults.

As an aging service professional, I have seen how facing late life can be a very vulnerable time for older adults and their loved ones. I have seen how avoidance of vulnerable conversations has led to disconnection, damaged relationships, stress, depression, anxiety, shame, regret, difficult deaths, and tarnished memories of lives well lived. I have also seen how courage to have vulnerable conversations can strengthen and enrich relationships. I have seen it heal broken relationships. I have seen it unleash an urgency for meaningful and purposeful living. I have seen how it has provided a sense of hope, peace, and acceptance.

I believe we can transform the aging experience by increasing the resources and opportunities to drive meaningful connection throughout the lifespan, all the way to end. In order to do this, we need to challenge the status quo that avoids vulnerable conversations about inevitable aging and mortality, perhaps it is where we might find our deepest connections and wisdom about what really matters.

Empira is currently working to increase opportunities for connection through vulnerable late life conversations in a grant project titled ResoLute. ResoLute proactively provides a sacred space, time, and guided resources for conversations and reflections to confront and talk about vulnerable topics related to aging and inevitable mortality such as health condition, life story, purpose, relationships, spirituality, end of life wishes, and legacy. We have titled these conversations the Work of Aging. It is called work for a reason; getting older is difficult and it takes courage to work through these conversations.

One way to help promote the courage needed to have Work of Aging conversations is to normalize them. As the older adults in your life start to bring up these kinds of topics, give them space and even encourage them to keep talking.

If you are interested in having Work of Aging conversations but still not sure how to bring up the questions check out our Connection and Reflection journal.

Check out the Empira Connection Journal and Reflection Journal

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

Written by Kelly Klund, LPN
Resource Nurse, Empira

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?


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),

Kübler-Ross, 1969

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Top Ten Sleep Disturbances – #10 Food

Written by Heather Johnson, RN
Resource Nurse, Empira

FOOD for Thought: the impact of diet on sleep.

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.

Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study. The Center for Health Design Research Coalition. Harvard Medical School, 2010. Retrieved from:
National Sleep Foundation: What is sleep hygiene? Retrieved from: https on Feb. 15, 2019.

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Top Ten Sleep Disturbances – #9 Activity/Inactivity

Written by Heather Johnson, RN
Resource Nurse, Empira

How Does Activity Affect Sleep?

Regular physical activityHave 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.


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:

National Sleep Foundation: The Science of Sleep & Your Lifestyle: How exercise impacts sleep quality. (2018). Retrieved on Feb 17, 2018 from:

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Top Ten Sleep Disturbances – #8 Positioning

Written by Heather Johnson, RN
Resource Nurse, Empira

Sleep 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

  • 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.

National Sleep Foundation: What is sleep hygiene? Retrieved from: https on January 2 , 2019. : Which sleep position is best? Retrieved from on January 2, 2019.

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Top Ten Sleep Disturbances – #7 Pain

Written by Heather Johnson, RN
Resource Nurse, Empira

A Serious Intruder on Restorative Sleep

Donna distesa a letto con dolore alla schiena

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!

Cosio, D., Lin, E; PPM: Practical Pain Management. Disturbed Sleep: Causes and Treatments. 2018. Accessed November 20, 2018.
National Sleep Foundation. Recommended Sleep. 2015. 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

Written by Heather Johnson, RN
Resource Nurse, Empira

#6 Incontience

Adult man in a toilet at home

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.

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

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Top Ten Sleep Disturbances – #5 Medications

Written by Heather Johnson, RN
Resource Nurse, Empira

Can Medications Interfere With Restorative Sleep?

Can medication 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.



Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study. The Center for Health Design Research Coalition. Harvard Medical School, 2010.  Retrieved from:

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