Have you ever felt like you did not sleep well or are always tired? There are many reasons you may not feel rested when you wake or fall asleep during the day. Below are some common issues. You may have a reason for not sleeping well that is not in this blog. If you feel you are not sleeping well, be sure to consult your healthcare professional. Sleep is essential, so getting a good night’s sleep is important.

The process of sleep allows the body to rest and rebuild itself. You can think of sleep as turning off your computer in some ways. When off, the computer is working to clean and reorganize itself. In an unrelated way, your body is like that as well. Your body is resting and repairing itself.

Sleep occurs in four stages. Generally, individuals need four to six cycles of sleep stages to feel rested.

Stage 1 is nonrapid eye movement (NREM), which is light sleep lasting five to ten minutes. Your brain and body slow down.

Stage 2 is an NREM stage, also a light sleep but lasting as long as 25 minutes. Your muscles relax, your body temperature drops slightly, heart rate, breathing, and brainwaves slow—sleep spindles form, which allows your memories to be stored in your brain.

Stage 3 is an NREM deep sleep lasting 20 to 40 minutes. Your body regrows tissues, strengthens your immune system, and builds bones and muscles.

Stage 4 is rapid eye movement sleep (REM) which lasts about 10 minutes, although it does get longer with each sleep cycle. In this stage, your brain activity is as busy as while you are awake. Your muscles are completely relaxed, except your eyes which move rapidly. Breathing is faster, heart rate and blood pressure increases.

According to the CDC, this is the amount of sleep needed by age:

Age Hours of sleep needed

0-3 months 14-17

4-12 months 12-16

1-2 years 11-14

3-5 years 10-13

6-12 years 9-12

13-18 years 8-10

19-64 years 7-9

65+ years 7-8

Lack of sleep can lead to medical issues. It has been related to depression, anxiousness, obesity, heart issues, high blood pressure, lowered immunity, and diabetes.

Some common symptoms of lack of sleep include slowness in thinking, forgetfulness, concentration issues, loss of motivation, temper flares, yawning, drowsiness, falling asleep during the day or just feeling tired all the time.

With neurological disease or injury, you may have difficulty sleeping due to worry or anxiety about your situation. You may be unable to ‘turn off’ the day and relax, have restless legs, tone (spasms), or pain that keeps you awake. This may also include disordered breathing, which is a constellation of breathing issues including sleep apnea and is prevalent in individuals with neurological issues and leads to sleep issues. Silent autonomic dysreflexia (AD) can occur, which elevates your blood pressure without symptoms. If this leads to interruptions in sleep is still being investigated. Also, personal care that needs to be performed at night leads to interrupted sleep. These activities can include turning, catheterizing, and extreme sweating, among others.

Getting a good night’s sleep involves your healthcare professional and your own actions. If you feel you are not well-rested, talk with your healthcare provider. Someone who sees you sleep, or a caregiver may tell you about issues they have noticed. After all, you are sleeping, so you might not know if something is happening in your sleep, like episodes of stopping breathing or restless legs. You may need treatment for a medical condition that will allow you to sleep better. Treatment may be needed for tone (spasticity), silent AD, anxiety, pressure injury, or other medical issues that keep you from natural sleep.

Ask your healthcare professional about altering your catheterization schedule that will allow for blocks of four to six hours for a bit longer sleep. You may be able to lay flat for an hour with your legs higher than your heart before sleeping time, catheterize to take off dependent leg edema collected through the day, and then sleep for four to six hours before waking to catheterize again. There may be some equipment that will allow pressure dispersion automatically, as in a pressure altering mattress or bed overlay. You will still need to turn but perhaps not as frequently. Your healthcare professional will be able to help you with medical concerns and avoid complications as you adjust to finding the right combination for a good sleep.

If worry or anxiety is an issue, ask for a consultation with a mental health professional. Adjusting to changes in life and lifestyle after neurological issues is an ongoing process. Being able to discuss your issues in a nonjudgmental setting can be extremely helpful.

Medication for sleep including prescriptions, over-the-counter, supplements, and recreational should always be discussed with your healthcare professional. Anything taken in by mouth, inhaled, or any other delivery method can interfere with your regular medication or become toxic in certain medical conditions.

Medication Alert!

The over-the-counter medication, melatonin, is very popular for sleep issues but can be extremely dangerous for individuals with neurological issues. It has significant side effects which can be amplified for individuals with neurological issues. These include side effects of headache, dizziness, nausea, drowsiness when you do not want to be drowsy, confusion, abdominal cramps, depression, tremor, anxiety, and extremely low blood pressure, among other issues. It can affect anticoagulant medication (blood thinners), anticonvulsants, contraceptives, diabetic medication, and immunosuppressants. Always check with your healthcare professional or pharmacist to see if any over-the-counter medication will affect your health condition or current medications. This is critical. Be sure that melatonin is right for you as an individual before taking it.

You can also take action to help yourself sleep. Below are some suggestions.

Set a routine for bedtime. Go to bed at approximately the same time every night and wake at about the same time every morning. Have a bedtime routine. These will provide signals to your body that it is time to sleep. The body needs sleep to rest and repair every day. Shortchanging sleep during the week does not catch up over the weekend.

Use relaxation techniques such as deep breathing or thinking about pleasant events. If you have stressors, write them down, so you do not need to think about them at night. Practice meditation.

Turn off devices. This includes TV, phone, and anything with a screen. Avoid the temptation to turn them on if you wake in the night. Screens stimulate your brain to stay ‘wired’ when you want your brain to relax.

Avoid nicotine, caffeine, alcohol, and sugary drinks before bed. Caffeine is a stimulant to your brain. Alcohol may make you sleepy for a while but then causes your brain to wake up, so it is even more difficult to go back to sleep. Sugary drinks can stimulate your body as well as require you to wake up to catheterize.

Try a lighter meal in the evening. A heavy meal can lead to indigestion or gastric reflux. These conditions can lead to sleeplessness.

Put activity into your everyday plan. This may be something physical you do or something physical that someone does to your body, like stretching or range of motion.

Avoid daytime naps, if possible. If you do need a nap, set the alarm for 10-15 minutes.

It may take some time to sort out sleep issues. But it can be accomplished.

Pediatric Consideration

Children require more sleep than adults as their brains and bodies grow and develop so quickly. They also go through phases where they may not sleep well because of separation from their parent(s). This can be developmental or from life issues. Everyone who has raised children knows they sometimes call out in the night for mommy or daddy.

Separating developmental processes from health issues can take a bit of effort. A child may call for you because their splint irritates them or is uncomfortable. It takes some parental knowledge to be able to discern developmental issues with physical causes, especially if the child does not have the vocabulary for expressing themselves. You know your child best and will be able to isolate the issue. Be sure to offer your thoughts to your child’s healthcare professional.

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the "how-to" on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.

And if you want more Nurse Linda, sign up for her monthly webinars here. Don’t worry, we archive her answers so you can refer back and sift through her advice. Consider it Nurse Linda on-demand!

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