Caregiving for a Patient With Insomnia

There are many types of sleep disorders, including insomnia, sleep apnea, narcolepsy, parasomnias, and others.¹ Lack of sleep and sustained interruption in sleep habits can lead to chronic health problems and negatively impact your patient’s quality of life.  Knowing what to look for, understanding the differences in a chronic sleep disorder and simply the inability to sleep because of stress or bad news, and knowing how to treat or help your patients improve their sleep habits are all things a CNA or HHA should know.

The Definition of Insomnia

Insomnia is very common, with 30 to 40 percent of all adults reporting some symptoms of insomnia each year.² According to experts, insomnia is a condition where a person has difficulty falling asleep or staying asleep once they climb into bed.  Those who suffer from insomnia can feel uncomfortable about their sleep habits, and usually have one or more of the following symptoms:

• Low energy
• Fatigue
• Mood difficulties
• Decreased productivity
• Problems concentrating

Your patient(s) may want to talk to you about any sleep problems they may be having. Or, you may notice a difference in mood or energy and ask if sleep is an issue.  If they admit that they have not been able to sleep, or if they complain about waking up multiple times during the night, you may want to document your conversation and notify the nurse in charge or a family member so that the patient’s sleep issues do not become chronic; affecting their health.

What Are the Causes of Insomnia?

Insomnia may be caused by medical conditions, psychiatric conditions, poor sleeping habits, the use of certain substances, and biological factors.

Medical Causes of Insomnia

There are many different medical problems that can lead to the development of insomnia.³, including:

• Low back pain
• Chronic pain at any location
• Neurological problems such as Parkinson’s disease
• Asthma
• Arthritis
• Endocrine problems like hyperthyroidism
• Gastrointestinal reflux disease (GERD)
• Allergies

If your patient complains about an inability to fall asleep regularly, you should mention this to the nurse on duty, or a family member. It would also be smart to just ask your patient if her or she knows of any reason why they can’t sleep.  Maybe they are worried about a health issue, or money.  In some instances, there are simple tools your patient can use to improve sleep without medications that you can recommend. Suggest they wind down before sleep, not eat a big meal before sleep, decrease the light in the bedroom, limit distractions, or getting rid of the television in the bedroom.

Your patient’s shouldn’t have to accept bad sleep as a way of life.

What Can I Do If My Patient Has Insomnia and Gets Depressed

Sleep difficulties may be a symptom of depression; the risk of severe insomnia is considerably higher in those who are suffering from major depressive disorder.  Studies show that insomnia can worsen or trigger the onset of depression.  There are a number of things you as a CNA or HHA can do to help if you suspect a patient is depressed, including:

• Become the patient’s advocate to family and friends
• Talk with the patient’s family and friends and encourage them to visit often. Mention if the resident is experiencing any signs of depression, and how they can help reduce anxiety and feelings of hopelessness in their family member
• Take the patient for a walk on a regular basis
• Make sure they are maintaining a regular eating schedule
• Help involve them in opportunities to interact with other’s in the facility or out of their home, such as playing cards, watching movies, joining a knitting club, etc.
• Encourage them to keep in contact with friends
• Make sure they are taking their prescription medications
• Help family to understand that patients suffering with depression can not simply “snap out of it” but need compassion and understanding as they cope with depression brought on by the effects of aging, physical limitations, living away from family, or health problems
• Further educate yourself about depression and the care of depressed patients

What Are the Typical Symptoms of Insomnia I Should Know About?

Almost every person understands what it feels like to be awake, wishing for sleep, and staring at the ceiling.  This can occur when a person becomes jet lagged or when they are overwhelmed and anxious about the circumstances in their lives.  But, what is the difference between a temporary sleep problem and a serious sleep problem that requires treatment?

According to experts, those with insomnia tend to have at least one of these symptoms⁴:

• Difficulty in personal relationships, such as with caregivers, friends, and family
• Difficulty functioning at work or at school
• Behavioral problems, such as feeling aggressive or impulsive
• Having a mood disturbance, such as depression or irritability
• Having cognitive problems, such as problems concentrating
• Feeling tired or having low energy
• Having non-restorative sleep, in which they wake up tired
• Difficulty staying asleep at night
• Problems falling asleep at night

Regardless of the cause of your patient’s sleep disorder; if insomnia becomes a regular problem, you should encourage them to talk to their doctor and their family about some type of treatment. You may also want to think about whether or to what degree the insomnia is affecting your patient’s daily life.  If your patient has low energy and feels tired during the day and it interferes with their productivity and with their enjoyment of hobbies, family or friends, it usually means they need help to deal with this problem. Sometimes, just talking about their insomnia can help.

How Can I Get My Patients To Talk About Their Insomnia?

You patient may think that sleep problems are just a normal part of life.  It is, however, important to help your patients, and your patient’s family take any sleep problems as seriously as they do other aspects of their medical health. Be an advocate for your patient by encouraging them to talk about their sleep habits, and ask questions, like:

• What time do you go to bed, wake up in the morning, and do you nap in the daytime?
• Do you have problems falling asleep, staying asleep, or do you wake up too early? How many times a week do you have trouble sleeping?
• Do you lie awake feeling anxious at night? Do you know why your anxious?
• What do you do when you can’t sleep? Do you read, get out of bed, or watch television?  Is there anything you have previously done that has helped you sleep better?
• How long have you had problems sleeping? Is it a new issue or one you’ve had off and on all your life?
• What is your sleep environment like? Is the bed comfortable? Is the room dark enough at night?
• What can I do to help?

How Can I Care for My Patients with Sleep Disorders?

• If reading has helped in the past, suggest they find a good book to read before turning out the light at night
• Alcohol is a stimulant, so advise them not to drink alcohol before bedtime
• If they are upset at something that has occurred during the day or by something they witnessed on TV, teach them deep-breathing techniques that can calm and relax them
• Warm milk is said to help relax a person prior to sleeping
• A soothing conversation with a family member can help sometimes
• A short walk (don’t overdo it) down a hallway, or outside can often help
• Soft music can help some people relax prior to bed time
• Sometimes going to bed at the same time each night, and waking up at the same time each morning can help a patent begin a routine of sound sleep
• Advice patients who nap during the day, yet find themselves unable to go to sleep at night, to forego their nap and see if it helps
• There are also different sleep aids for patients who can’t sleep. Talk to the head nurse, patient’s family or doctor prior to suggesting a sleep aid.

The best thing you can do to help a patient with a sleep disorder is to encourage them to have good sleep habits so they get into the habit of sleeping at the same time and awakening at the same time.  But understand that sleep is as vital to your patients as eating and breathing.  Lack of sleep, no matter what the reason, can lead to both physical and mental problems.  Lack of sleep can affect a patient’s emotional state (moodiness, fatigue, and depression), put the patient at risk of developing chronic illness (hypertension, heart disease, and stroke), and lower the bodies defenses to infection and sickness.  Listening is sometimes the best medicine for people with a sleeping disorder.  This is especially true if you’ve built a relationship of trust and reassurance.

References

1. 32 Solutions for When You Can’t Sleep; Greatist.com; Laura Newcomer, 2014
2. What causes insomnia? https://sleepfoundation.org/insomnia/content/what-causes-insomnia.
3. Insomnia; National Sleep Foundation (NSF), 2016
4. Symptoms; National Sleep Foundation (NSF), 2016