Last week the clocks went forward – something which most people greet with a combination of irritation (losing an hour’s kip), bewilderment (why do we do this?) and delight (hurrah, the nights are lighter).
But for Dad it was just rather confusing, having to be woken up ‘in the middle of the night’ as he saw it, so we’ve been introducing him to British Summertime gradually.
If there’s anything that Dad really hates it’s the process of waking up in the morning, regardless of the time, but especially when it’s still dark.
I remember he was often late for work when we lived in Kent – in a house with a huge willow tree in the front garden. Dad would blame the cavorting squirrels for his tardiness – they were very entertaining - but I wonder if, even then, he just hadn’t had enough sleep.
Nowadays he is tired most of the time and will sometimes have what we call a ‘dead’ day; staying in bed and sleeping like a teenager. Completely out for the count and with no interest in having anything to eat or drink. It can be rather worrying to watch. But just as we're thinking of calling the doctor because he's on the verge of being comatose, he’ll wake up refreshed and wonder why he’s so hungry!
It turns out that there’s a very good explanation for this perpetual tiredness. Crazy as it sounds, Dad probably has chronic sleep deprivation.
Sleep expert Professor Colin Espie explains that most older adults struggle to get a proper night’s sleep, and that the elderly suffer disproportionately from sleep deprivation.
The amount of sleep we need varies from person to person, and is different at different stages in life. The trick is to figure out how much sleep you need and then be sure to get it. There’s no point in setting your alarm clock by the national average of 8 hours. Some people need more sleep and others less. And it’s the deep, restorative REM sleep that we need most of all, not the light superficial stuff.
The professor says that sleep/wake needs are not taken into account nearly enough when planning care services for older adults. ‘Good sleep and good wakefulness are every bit as central to a person’s wellbeing as food and hydration’.
Important though sleep is, that’s not a reason to reach for the prescription pad.
‘Where dementia is concerned sleeping pills and other major tranquillisers are part of the problem not the solution’, says the professor. ‘Older non-demented people with insomnia respond best to cognitive behavioural therapy (CBT) not sleeping pills. In fact sleeping pills are generally contraindicated in old adults. In the UK we still hugely over medicate the population’.
Dad is not on sleeping pills, so that’s not relevant to him. But what may be affecting him adversely is his ‘circadian amplitude’.
This is the ability to differentiate between the light and dark cycles, and in people with dementia if the ‘amplitude’ drops they are less well able to make that distinction. The result is that sleepiness infiltrates the day and wakefulness infiltrates the night. Older people - and especially those with advanced dementia - should be out in daylight as much as possible to counteract this deficiency and maximise the positive effects of light on synchronising the biological clock.
Dad hasn’t been out of the house since November. It was a risk back then because it was starting to get cold, and something I wouldn’t think of doing now while we’re in the grip of these biting Arctic winds.
But as soon as it’s a bit warmer I’ll get Dad into the back garden for some fresh air and sunshine in the hope it might help him to sleep better at night and be awake more during the day.
I never know what kind of night Dad has had – the baby monitor by his bed only alerts me if he makes a noise, not if he’s lying awake, unable to get to sleep, or only sleeping lightly. So when Dad’s having one of his ‘dead’ days, he may well need to recharge his batteries after a poor night’s sleep. But I wouldn't want it to become a habit. It won’t help anyone if Dad turns into a night owl – awake all night and asleep all day.
And carers need to get a good night’s sleep too!
I’ve just done the Professor’s Great British Sleep Survey and discovered that my sleep score is already a rather poor 5.6 out of ten. The website has given me some helpful tips on how to achieve better quality sleep but of course I’ve realised that one of the reasons I may be feeling tired is that I am sleeping too lightly myself. Maybe I’ll try turning off the baby monitor at weekends and see if I can grab more of that deep sleep by not having to keep half an ear out for Dad all the time.
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