By Benjamin T. Ladd | The Miriam Hospital
Cindy, a case manager at a cardiopulmonary rehabilitation center, feels overwhelmed by a myriad of responsibilities in her life: on top of worrying about her patients, she takes care of her mother, is helping her son get ready for college and can’t find the time to make necessary repairs around the house. These challenges are made more stressful by the financial strain they place on her. To make matters worse, anxiety regarding these issues keeps her up at night, making it even more difficult to focus on obligations to family and patients during the day because she feels tired and worn down. It seems Cindy just doesn’t have the energy for all the challenges she faces every day. Her situation highlights opportunities to develop skills and learn strategies that can be used to manage anxiety, to sleep better at night and to live a more productive and peaceful life.
People experiencing anxiety sleep significantly less and experience less time in the REM stage of sleep compared to individuals with lower anxiety levels. Poor sleep quality can result in increased anxiety, creating a feedback loop in which sleep and anxiety both become progressively worse. Furthermore, low sleep quality is related to numerous adverse health behaviors like poor dietary choices, smoking and decreased exercise. These behaviors are especially detrimental for those who have experienced a significant cardiac or pulmonary event. As many as 50% of older adults have a sleep disorder; given the array of health consequences that result from poor sleep quality, case managers may find it useful to address their patients’ sleeping habits as a means of improving overall health. Increased levels of anxiety account for many sleep difficulties in older adults, and anxiety is a modifiable target for improving the sleep and physical health of cardiopulmonary patients.
Learning tools to manage anxiety can make it easier to fall asleep at night and, in turn, benefit cardiopulmonary health. The following strategies can be used to manage nighttime anxiety and increase the odds of a better night’s sleep; they can benefit case managers and cardiopulmonary rehabilitation patients alike.
Modify the sleep environment to optimize sleep quality. Sunlight in the bedroom reduces quality of sleep. Blackout curtains can fix this issue. The optimal temperature for sleep is on the cooler side, between 60 and 67 degrees Fahrenheit. Consider turning down the thermostat a few notches before bed each night.
Meditate before bedtime to improve sleep quality and reduce daytime impairment. One study indicated that individuals who engaged in a nighttime mindfulness intervention exhibited significant improvements in insomnia symptoms, anxiety, stress, depression and daytime fatigue interference and severity. These improvements were significantly greater than the benefits experienced by those in a sleep hygiene education intervention. The next time you find yourself having trouble falling asleep, it may be useful to try one of many guided meditations for sleep that are available on the internet.
Maintain a regular sleep schedule. Plan to be in bed at the same time each night and set the alarm for the same time each morning. Having a consistent wake-up time, even on weekends, is one of the most important keys to achieving a regular sleep rhythm.
Get back up if you don’t drop off right away. If you find yourself lying awake in bed for more than 20 minutes, get out of bed and engage in a boring or relaxing activity that does not involve your technological devices. Do not return to bed until you feel an irresistible urge to sleep. Do your best to not obsess over falling asleep; lying awake in bed wishing for sleep can be a frustrating experience that only makes it more difficult to drift into a peaceful slumber. On the other hand, if you notice that you fall asleep the second your head hits the pillow, that may be a sign that you need to get into bed a little earlier and get more sleep. It’s all about finding that sleep sweet spot!
If none of these strategies work for you or one of your patients, consult with a behavioral sleep medicine psychologist, a health psychologist, a board-certified sleep medicine doctor or your primary care physician. A psychologist or behavioral therapist is more likely to offer behavioral treatments for sleep, which most patients find work very well. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based approach that can be highly effective for individuals who are unable to resolve their sleep-related issues on their own. Evidence-based workbooks are also a great option that can work well such as this option or this one. Make sleep more peaceful and less of a mental tug-of-war by trying out one of these strategies tonight!
Ben Ladd is a research assistant at the Weight Control and Diabetes Research Center – part of The Miriam Hospital in Providence, Rhode Island.