Grieving and Sleep Problems

Dear Dr. Neimeyer,

I’m in my late 60’s, and for most of my life have slept pretty well and had plenty of energy to tackle the day.  But since my wife died 14 months ago, I’ve had a real problem sleeping.  I get tired but lay awake with my mind churning, and usually watch TV until the wee hours before falling asleep exhausted, only to wake up early and unable to get back to sleep.  As a result I start the day feeling beat, and nap when I can just to get through what I need to do.  At least I am retired, because I don’t think I could keep my concentration in the kind of demanding sales career I had for many years.

In most ways I feel like I’m doing alright under the circumstances, even though I miss my wife and the life we had together.  I stay active socially and can’t say I’m really depressed.  But I just can’t seem to get my sleeping on track, and it’s really starting to affect me some days, like when I fall asleep in church or catch myself nodding off behind the wheel.  My doctor wants to give me sleeping pills, but I hate to take medicine I may not really need, and have heard that it can have bad effects in the long run.  What advice do you have for people like me?

Dave

Dear Dave,

An old professor of mine who studied sleep once called it “the gentle tyrant:  the behavior before which all other behaviors lie down.”  That is, even though it involves inactivity, it is ultimately supremely powerful–we can’t ignore its demands, and when we fail to meet them, we notice its “tyranny” in the price we pay in other domains of our lives.  Certainly the degradation of your concentration, wakefulness and energy in the context of a sleepless bereavement provides evidence for this argument.  And research also suggests that disrupted sleep greatly exacerbates stress and its serious effect on our wellness, leaving us more susceptible to diseases of all kinds, including heart problems.  So the issues you raise are serious, even if they are often overlooked in discussions of the more emotional impact of loss.

And so what might you do, beyond the short-term expedient of sleep medication, to re-set your biological clock and help ensure a more restorative nightly slumber?  Health psychologists suggest the following principles of “sleep hygiene” as essential practices to manage this crucial dimension of your day more effectively.

  1. Cut the caffeine. Faced with chronic fatigue, it is easy to fall into the habit of taking a second, third, or fourth cup of coffee or other stimulant (tea, caffeinated colas, energy drinks) to perk us up throughout the day, only to pay the price at night with “early insomnia,” in the form of laying awake for an hour or more, followed by a fitful and shallow sleep, waking fatigued, and starting the cycle all over again in the morning.  Though individual caffeine sensitivity varies with our body size, physiological make-up and history of consumption, a good rule of thumb is to limit coffee to one cup in the morning, and no more than one additional stimulating beverage in the early afternoon in order to wind down as bedtime approaches and move toward the bedroom in a less activated state.
  1. Avoid alcohol. Another “behavioral backfire” that we can suffer when struggling to sleep is attempting to induce it with a couple of stiff drinks before calling it a night.  While this might indeed help us fall asleep, it also has the unintended and often unrecognized effect of disrupting deeper levels of sleep that are most restorative, leaving us sleeping more fitfully and awakening less energized.  If this becomes a habit, of course, we can find that the “cure” becomes worse than the “disease,” in the sense that we can develop alcohol dependence and the many psychological, social and medical problems that come along with it.  Perhaps for men especially, alcohol abuse can also greatly complicate adjustment to bereavement.
  1. Set a schedule. You know yourself pretty well, I imagine, and can estimate the number of hours of sleep you need to function well, even if these tend to decrease in number across the years.  If you need 7 hours, say, make a point of going to bed at the same time each night, and getting up at the same hour each morning:  routine can be your friend, and a shifting schedule your enemy in training your body when sleep is called for.  Even if you don’t feel sleepy, head to bed at a decent hour, and set an alarm to wake yourself up at the same time each morning.  Then, if you find yourself laying awake for more than 15 minutes, get up and do something:  wash the dishes, read a magazine.  Fifteen minutes later try hitting the hay again.  Gradually more regular sleep cycles will become a rhythm, just as they likely were during your years of employment.  Research has documented that one of the secondary losses following the death of a partner is the disruption of our daily rhythms and activities, often requiring conscious efforts to re-establish them.
  1. Reserve the bedroom for rest. Though this seems obvious, the ubiquitous presence of electronics (TVs, computers, tablets and smart phones) in our lives can easily leak over to the bedroom, eroding the natural boundary between mentally activating functions and restful ones.  Less recognized is that all of these devices electronically stimulate the brain in ways that are incompatible with sleep, so that what we assume will be a way of “winding down” actually can function as a means of “gearing up.”  Instead, keep the bedroom as the sleeping chamber it was designed to be, and ease into sleep with a good old-fashioned print book or other non-electronic activity (such as gentle stretching, meditation, or journaling).  Your sleep-ready brain will thank you for it.
  1. Watch out for the nap trap. Though we seldom recognize it, daytime naps are the enemy of nighttime slumber.  Instead, consider the drowsiness of a napless afternoon as a precious resource that will help induce sounder sleep a few hours later.
  1. Get a move on. Build some exercise into your day in a way that respects, but gently challenges, your current state of fitness.  For many people a brisk evening walk of 30 minutes can discharge nervous energy and induce “healthy fatigue,” while also delaying sleep until the appointed hour.  How much is enough, and at what level of intensity, can be something to consult about with your doctor or trainer, but attempting to get 10,000 steps a day (easily measured though any of several fitness monitors) can be an appropriate fitness goal for many mature adults.  Along with eating a balanced diet a few hours before bedtime, managing your activity in this way can pay dividends in your health as well as in your adaptation to loss.

Finally, beyond sleep hygiene guidelines, be alert that sleep disorders can be both a symptom of and contributor to complicated grief.  After a few weeks of practicing the ideas outlined above you should find a significant improvement in your sleep.  If not, you might find consultation with a counselor or therapist worthwhile to check on whether there are other dimensions of your grief that warrant attention, even if these are not so clear at this point.  Ultimately sleep is just one essential part of a healthy lifestyle, and adapting to the physical absence of a loved one can challenge us in many ways, some obvious and some subtle, as we strive to rebuild a healthy life in the wake of loss.

–Dr. Neimeyer

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