Validation Therapy and Two (Mercifully) Short Poems

By C.A. Bryson

This post begins with a follow-up on last week’s Therapeutic Reasoning and Validation Therapy post.

I tried out Validation Therapy with my dad following a delusion he had about having to go to a conference. He had insight—he realized that he wasn’t thinking straight, but the fact that he did have delusion bothered and upset him. You may recall the scenario from last week (Scenario # 1: Milking the Cows), when I discussed the method for Therapeutic Reasoning. Dad was doing something similar: to him, attending a conference was something he did as part of his academic career, just like ‘milking the cows’.

And so, I did what Naomi Feil (Gerontologist, and expert in Validation Therapy), advised. I said ‘Dad, I hear you. I hear that you’re upset. Tell me more.’ And I listened. And within half an hour, the matter was forgotten.

Something else I use with dad that works—poetry. Recall that Ms. Feil advised caregivers to use music to soothe and calm their loved ones. Well with dad, poetry is like music to his ears. (There’ll be more on music therapy in a subsequent post, stay tuned.) And so, I bought him his favourite Lewis Carroll book ‘Through the Looking Glass’, in which the famous poem ‘The Walrus and the Carpenter’ goes something like this:

‘The time has come’, the Walrus said,

‘To talk of many things,:

Of shoes—and ships—and sealing wax—

Of cabbages—and kings—

And why the sea is boiling hot—

And whether pigs have wings.’

(p.168)

And while dad often can’t remember what day it is, he can recite the above poem by heart, as well as Hamlet’s famous ‘To be or not to be’ speech from William Shakespeare. It is in the moments when we share his childhood memories of summers up at Lake Simcoe that I savour the most and forget about his medication and doctor visit worries.  At night I think: ‘Good God, what will I do after he’s gone?’ and all that anticipatory grief washes over me in the silence, and then I feel grateful for the swooshing sound of the dishwasher and the drone of ceaseless traffic outside.

And now the poem. I composed this based on an Oprah ad I saw:

What You Need is Now

‘Create the life you want’, Oprah said

All well and good

As long as you realize

Getting what you want—

May not necessarily be

What you need.

And where you are at

Right now

Is probably just fine.

It’s like looking at a rose:

It’s beautiful but…

Watch out for those pesky thorns!!

The life I want?

Let me see…

Venice

Lobster

Cheesecake without calories.

The life I have?

A 90-year-old

His ‘Depends’ duty

A life nourished by screens

And mac and cheese

Doesn’t sound half bad to me.

Next week’s post is on Nostalgia: what is it and what does it mean to the caregiver and his/her loved one? How can we nurture it? What are the benefits?

Stay tuned… Thanks for coming along on my journey.

CAB 2022

Person-Centred Care: Dementia 101

By C.A. Bryson

May 24, 2022 was the Annual Alzheimer’s Walk for Memories, the world’s largest fundraiser for Alzheimer care, support and research. The walk was held in 600 communities nation-wide.

Some stats:

  • 1 in 5 Canadians have experienced caring for someone living with dementia
  • The annual cost of dementia to the Canadian economy and healthcare system is over 10.4$ Billion
  • Over 500,000 Canadians currently live with dementia
  • (Alzheimer Society of Canada website)

See the following website for free, educational videos on dementia:

https://alzheimer.ca/bc/en/help-support/programs-services/webinars/recorded-videos

What is Person-Centred Care?

According to Jill Gafner Livingston (Certified Dementia Practioner and Caregiver), it is:

  • Responding with dignity
  • Putting the person first, not the characteristic
  • Knowing your loved one: their life story, routines, and entering into their logic
  • Begin with basic needs: toileting, temperature, hunger and thirst
  • Taking time to figure out what your loved one wants.

Just what is Therapeutic Reasoning?

(Dementia Solutions is a private dementia consulting service. I learned about Therapeutic Reasoning on the Dementia Solutions website above)

Therapeutic Reasoning is when you…

  • Just agree with your loved one—apologize to them, say something nice to them, show them you care about their concern, tell them you will look into it
  • Employ an effective strategy used in dementia care that provides “reasoning” that is logical to the person and helps to reason and calm
  • Reasoning that is logical to the person with dementia (but not necessarily logical in reality), which creates a calm, reassuring feeling. As a result, it is beneficial both to the person with dementia and to the caregiver.

Examples of Therapeutic Reasoning in Action

Example 1: ‘Milking the Cows’

  • A person in mid-stage Alzheimer’s may firmly believe they need to ‘go home and milk the cows.’ The caregiver may state facts such as: “You don’t have the farm anymore, you sold it 15 years ago”, which can upset the person with dementia, or even lead to additional challenging behaviors. Instead, using Therapeutic Reasoning, you can say: “Milk the cows…well…lucky us! They’ve already been milked today! Isn’t that great news. How about a cup of coffee to celebrate? Treat’s on me.”
  • Use approach wisely. Ongoing practice will help you.

Example 2: A New Clock (My story as caregiver)

My father was upset because his favourite clock had stopped working. I tried putting in a new battery, but it still wouldn’t work. My father asked me to put in a different, fresh battery. Nothing doing. He asked me over and over to try a new battery. Finally, I took a new tack. I said: “Dad, I know of a watch repair store that also repairs clocks nearby. Would you like me to take your clock there tomorrow?” Carefully, I put the clock away out of sight. The matter was forgotten. I then bought a new clock and dad hardly even noticed!

Validation Therapy with Naomi Feil

What is ‘Validation Therapy’?

  • If your loved one is somehow unhappy, re-phrase what they have said as a question. Listen to them. Try music. Say: “I hear what you’re saying… Please tell me about it.” Then listen
  • You enjoy just ‘being’ with them. You step into their world

Naomi Feil is a Gerontologist that has a website at:

I highly recommend that you visit Ms. Feil’s website and spend just 5 minutes watching her introductory video, to watch her model the skills.

I hope you enjoyed this post, and that it will encourage you in your caregiving journey. Next week is poetry (which curiously, works really well with my dad). Stay tuned for upcoming posts on Wills and Advance Directives.

Thanks for joining me on my journey.

Stay well.

CAB 2022

Summary of Webinar: 6 Key Elements to Understanding Dementia

By C.A. Bryson

Photo by Kindel Media on Pexels.com

Note: This lecture was originally aimed at professional caregivers but is just as helpful for the family caregiver.

Instructor: Jill Gafner Livingston

Certified Dementia Practioner-Caregiver to her husband for 26 years. Her husband was diagnosed with lung cancer and had early onset dementia.

Webinar presented by American Society of Aging and sponsored by Right At Home, June 9, 2022.

Livingston shares, 70% of US caregivers have full-time jobs. Also, often one (professional) caregiver looks after many patients, there is only a limited number of caregivers.

Alzheimer’s is just one kind of dementia.

Other forms of dementia are:

  • Parkinson’s
  • Frontotemporal
  • Vascular dementia
  • Mixed dementia
  • Dementia with Lewy Bodies

Caregivers work with all behaviors. They don’t diagnose or prescribe medications.

Alzheimer’s is a non-reversible dementia.

5% of cases of Alzheimer’s start before age 65.

This is normal aging:

  • Slower recall
  • Difficulty concentrating
  • The capacity to learn is intact
  • New information takes longer to absorb

By age 65, you lose 10-15% of your recall.

If you lose your car keys OK, but if you don’t know what to do with your car keys, get checked.

Pseudo-dementia is a reversible condition. Ex. Drug interactions, or emotional disorders.

30% of people diagnosed with dementia also have depression. Both look alike.

Other Forms of Pseudo-Dementia:

  • Thyroid-mood fluctuations, confusion
  • Sensory loss (ie: hearing loss)
  • UTI (Urinary Tract Infection), looks like onset of dementia
  • Anesthesia-influences cognition

First Presentation of Dementia:

  • Memory loss
  • Personality changes
  • Verbal apraxia: Difficulty coordinating mouth and speech
  • Anomia: word-finding difficulties
  • Decline in grooming
  • Poor judgement (changes in logic)

Some examples: Elder is watching the show ‘Bonanza’. There is a scene of a barn on fire. The elder grabs the bucket, fills it with water and throws it at the TV. Caregiver says: “Why did you do that?” Elder says: “Because the barn was on fire.” Here is another example: Elderly mother in bathroom. Caregivers come to deliver food, ask: “Where are you, mother?” Mother says: “I’m in the bathroom.” Mother spends all day in bathroom, caregivers drop food off on table. Finally, daughter arrives, asks where is mother. Mother says: “I’m in the bathroom” Daughter asks: “Are you OK?” Mother answers: “I’m in the bathtub” Daughter asks: “Can I come in?” Mother has spent all day in bathtub. The mother fell in the bathtub that morning.

Second Presentation:

  • Poor short-term memory
  • Mood swings
  • Time confusion
  • Sleep disturbances
  • Change in eating habits
  • Socially dependent on family. Patient becomes very connected to caregiver-‘Shadowing’
  • Restlessness
  • Exhausting for caregiver, need support system in order. Caregiver can’t have a shower or even go to the bathroom, leads to caregiver burnout.

Third and Final Presentation:

  • Bowel/bladder incontinence
  • Very few words left in vocabulary
  • Constant supervision required
  • Short and long-term memory severely impaired

I hope you have found this webinar summary helpful. Next week, I will be posting about Person-Centred care, Therapeutic Reasoning and Validation Therapy. Stay tuned!

CAB 2022

Sleep Demystified

by C.A. Bryson

The following material is translated (by me) from:

‘Troubles de Sommeil : Sous le Radar’ by Martin LaSalle

Les Diplomés Number 441 (Spring 2022)

50% of Canadians suffer from sleep disorders

25-30% from occasional insomnia

10-15% from chronic insomnia

30% from sleep apnea

Researchers hypothesize that such lifestyle factors as atypical work schedules (experienced by 35% of Canadians) such as night work for example, coupled with anxiety and stress, might exacerbate sleep disorders. One must also bear in mind socio-economic factors and the social determinants of health, which means that certain groups are more at risk of sleep disorders and lack of sleep. Other factors such as light pollution, noise pollution, lack of proper ventilation, as well as excessive heat or cold can also contribute.

10 Myths About Sleep Revealed:

  1. One hour’s less sleep at night is insignificant.

False.

Even one hour less sleep can have deleterious effects on the body and cognition.

  • Alcohol helps you sleep.

False.

While alcohol may help initiate sleep, it can interfere with sleep rhythms.

  • A good night’s sleep enhances performance on tests.

True!

A good night’s sleep will enhance your performance on tests while pulling an ‘all-nighter’ does not. It appears that lack of sleep effects memory, specifically the area of the brain known as the hippocampus (the seat of memory).

  • Melatonin helps you sleep.

True and False.

Melatonin is not a sleeping pill. It helps the organism realize that it is dark, and usually only effects sleep if it is accompanied by proper sleep hygiene: regular bedtimes and wake-up hours, an effective sleep environment and relaxation before bed.

  • Sleep before midnight is better.

False.

Sleep quality is determined by phases of sleep and does not depend on the time at which you fall asleep.

  • You can make up for lack of sleep on the weekend.

False.

While extra sleep on the weekend may make up for lack of sleep the two nights prior, it will not make up for lack of sleep earlier in the week (Monday to Wednesday).

  • Screens detract from a good night’s sleep.

True!

Blue light emitted from screens inhibits the natural secretion of Melatonin.

  • One shouldn’t eat before bed.

True and False.

While a heavy meal or greasy or spicy food may inhibit sleep, a small snack before bed will do no harm.

  • A catnap is good for your health.

True!

Provided naps are no longer than 20 minutes long the overall effect will be beneficial, whilst longer naps will have negative repercussions on your sleep.

  1. Physical activity enhances sleep.

True!

Physical activity promotes relaxation which in turn enhances sleep.

More on sleep:

While lack of sleep has been correlated with the onset of Alzheimer’s disease, those with sleep apnea who use CPAP (Continuous positive airway pressure) machines gain at least 10 more Alzheimer’s free years on those who don’t use them.

Individuals who experience frequent nightmares may benefit from Imagery Rehearsal Therapy, a visualization technique in which people imagine their transformation day after day.

Free Resource:

Sleep on It! Canada

Canadian public health campaign on sleep (COVID-19, Sleep Disorders, Podcasts-in ‘Tools and Resources’)

I hope you have found this post helpful in your nightly quest for sleep. Stay tuned for resources to help you manage a loved one with dementia.

CAB

Planes, Trains and Automobiles: A Look At Seniors and Transportation

By C.A. Bryson

Recently, I wrote a letter to my local MP concerning the provision of bus stop shelters in the City of North Vancouver. I have observed, in my travels around the city, senior transit riders standing for upwards of half an hour at bus stops unable to sit down and rest. Furthermore, lack of bus shelters at some stops means no shelter from inclement weather.

This is simply not acceptable. About a year ago I found myself perusing online and read the following articles on seniors and transportation. These were truly fascinating and cutting-edge visions for enhanced transportation options for seniors.

The WHO (World Health Organization), created a Global Network of Age-Friendly Cities and Communities for older residents. They covered such issues as:

  • Health
  • Communication
  • Housing
  • Employment
  • Outdoor Spaces
  • Public Buildings and Transportation

Did you know that by 2030, seniors aged 65 and over will number 9.5 million and will make up 23% of Canadians?

Safe, affordable and accessible transportation for seniors must be prioritized. While the existence of ride-hailing services (taxis, Uber, Lyft) has been around for several years in Vancouver, we still have a long way to go. Uppermost in the minds of adult children of seniors is the issue of senior driving.

1st Article:

‘How Self-Driving Cars can Empower a Growing Population of Older Adults’ by Robert Moser,

American Society of Aging, 2021

https://generations.asaging.org/how-self-driving-cars-can-empower-older-adults

Of self-driving cars, experts say:

“For those who may lose the ability or confidence to drive, self-driving vehicles can help them to maintain a vibrant social life, allowing them to pick up grandkids from school or head out to dinner with friends without having to drive.”

On Senior Drivers:

  • For the medically at-risk driver (a person, regardless of age, who has a medical condition that may affect driving performance), driving cessation has serious consequences, such as isolation. What is needed is an action plan for maintaining community mobility.
  • Driving is a complex skill
  • Driving IADL (Instrumental Activities for Daily Living), therefore driving is a basic skill
  • Driving performance may show the first evidence for dementia
  • We will all outlive our driving ability by 6-10 years. Individuals with mild cognitive impairment may continue to drive, but an expert must make that determination. It is helpful to seek out a driver rehabilitation specialist who is also an OT (Occupational Therapist)
  • IADL may be determined by the OT

2nd Article: ‘Plugging Transportation Gaps: Microtransit Can Fill In Where Public Transit and Ride-Hailing Fail’ by Aparna Paladugu and Gabriel McCaig, American Society on Aging (2021)

https://generations.asaging.org/microtransit-can-fill-transportation-gaps

To report an individual who may be unfit to drive:

Contact Driver Fitness Unit: 250-952-6888

Or write to Road Safety BC

https://www2.gov.bc.ca/content/transportation/driving-and-cycling/roadsafetybc/medical-fitness/report

On-Demand Public Transit: What is It?

  • On-Demand Public Transit is a mix of fixed route bus service and Uber or Lyft Ride-Hailing
  • On-Demand Public Transit also known as Microtransit
  • Users request shared shuttle bus via an app that picks them up in minutes
  • Vehicles are routed to final destination, picking up other travellers along the way who are heading in the same direction
  • This kind of transit can be a lifeline
  • Freedom for the price of a bus ticket

Already Launched:

Newton, Mass (USA) and West Sacramento, California

  • Newton has a phone line with operators trained in older-adult sensitivity
  • They are wheelchair accessible
  • In Wilson, North Carolina qualifying older adults have special discounted pricing
  • An example of para-transit is HandiDart
  • On-Demand Public Transit is more sustainable than para-transit
  • These measures help older adults age in place and remain independent

How To Ride a Lime Bike (based on YouTube video):

  • Easy to follow 1-minute video on YouTube (Google ‘How to Ride a Lime Bike’)
  • To use Lime, you must download the app
  • Open the app, find your nearest ride
  • On your Smart Phone, unlock your bike by scanning the QR code or entering the 6-digit ID
  • Unlock cable
  • Put your foot on the ground and kick off to start ride
  • At end, lock cable and take photo of bike

Please note that NSCR’s Better At Home program offers transportation to seniors free of charge, for things like doctor’s appointments (also picking up prescriptions)

Call Nicola Harris at: 604-982-3313

Next week I talk about this year’s Alzheimer’s Walk and some resources for those caring for individuals with dementia.

Pictured Above: My grandfather’s car.

CAB 2022

Preventing Senior Scams: Some Basic Advice from One Who’s Been There

By C.A. Bryson

Note to Readers: I’ve reached the point in my caregiving where bullet points are necessary. (‘The time has come…’ so to speak). My sincere apologies if this detracts from the overall reading experience.

Some Memories of Scams:

  • In the 2010s my parents were hit with the Microsoft Scam. Do you remember that one? Someone phones from some random country and says your computer’s been infected by a virus and you must pay to clear the virus. We had to get their hard drive reformatted for that one.
  • The other scam was when my parents tried to renew their passports online. Somehow, they got onto a bogus website and were charged and had their information stolen. Watch out for that one. Check carefully that the passport website is, in fact, genuine.

Other Scams (Senior Safety 2021):

  • Grandparent scams: Someone reaches out to grandparents claiming to be a grandchild or family member in trouble/need of financial assistance. Basically, they just take it from there.
  • Extortion: Money obtained from person, entity or institution through coercion.
  • Seniors are being targeted by fraudsters impersonating real government officials
  • Phishing: Scam emails or texts that trick you into handing over your personal and banking details.
  • Other: You get an email asking you to help to transfer a large amount of money overseas. I think a lot of people have been hit by that one.
  • Roofer Scams: A Questionable roofing company says they checked your parent’s roof and says it must be repaired. But they don’t do any actual work, and then charge you anyway. After all, how could they check? (Now of course, we have Airdrop on our phones. Our roofer used that function, when he did our roof last winter.)

Advice from the Royal Bank of Canada (RBC):

https://www.rbc.com/cyber-security/index.html

  • Never use public WiFi to access your online banking as unscrupulous people can steal your banking info
  • If you get an offer that sounds “too good to be true” by email or social media offering you a job or a lucrative business venture, do not give out your ID details or any financial info
  • Create strong passwords—long, alpha-numeric combinations with symbols, and non-consecutive numbers. Do not use your birthday, spouse’s name or any family name, and do not use the same password for multiple accounts.

How to Block Calls on TELUS:

  • How to block nuisance calls on your parent’s phone (I found this out from a Caregiver Support Group participant). Use the call control feature. It blocks system-generated phone calls (robot calls). The caller must press ‘9’ or won’t get through. Call TELUS customer service to set it up. (604-310-2255)

Warnings from Amazon:

(Email: May 11, 2022)

  • Do not give out account information over the phone or give info to scammers who may use calls, texts, or emails to impersonate Amazon customer service.

Finally, here’s a useful phone number for CAFC (Canadian Anti-Fraud Centre): 1-888-495-8501

Hope you’ve found the above helpful. If you know of a scam that’s not mentioned, why not leave a comment to help our readers stay safe.

Next week’s post is on the issue of transportation, always a concern for seniors who no longer drive. Personally, I’ve dealt with this issue for years with some success. So, stay tuned…

Soon is the Alzheimer’s Walk coming up, I’ll be writing about that also. The issue has personal meaning for me, which I will write about too.

Staying Calm in a Hectic World

By C.A. Bryson

In the last few weeks, I wrote about sleep—sleep disorders, and what to do about it. This week, I’m writing about relaxation, because I think it’s important in this post-COVID period. We’re all a bit shaken, frankly, and we need to work on our own recovery, slow as it may be. In this post you will read some recommendations for how to stay calm that you can try at your leisure. If you like this post, leave a comment, and I’ll post more like it. Otherwise, the next few weeks will be devoted to Will preparation, Advance Care Planning, and Representation Agreements, as I think we need to prepare ourselves for our futures as we face the inevitable, difficult though it is to face.

What follows, first of all, is a relaxation exercise called ‘Release the Day’, to be done just before bed. You can try it tonight if you like. It’s very simple—you just have to follow the steps.

Paul McKenna, ‘I Can Make You Sleep’, Sterling, 2009, ‘Release the Day’ (p.128)

Read the exercise through carefully before you do it:

  1. In your mind, visualize what you were doing just before you went to bed.
  2. Visualize what you were doing just before that—who was with you, what was happening.
  3. Go back through the day, one event at a time, in full colour and remembering all you heard and said.
  4. For each event your will have a memory that is compressed—it won’t take as long to remember as it took to do it. But there will be a sequence and all the key emotions will come back to you.
  5. Go back through each event until you end up when you woke up this morning.
  6. Now you know what happened, what you felt, and what you expected and your mind can put them all together.

I include the next exercise because I know some caregiving folks can get awfully strong feelings at times, and this exercise helps you deal with them in a way that’s positive and supportive. I particularly find this exercise helpful during my anxious moments, and I wonder if you will too.

Paul McKenna ‘I Can Make You Sleep’, Sterling, 2009, ‘Letting the Feeling Unfold’ (p. 117)

Read this exercise through carefully before you do it.

  1. Let yourself feel the emotion. Don’t reset to it, or act on it or resist it or reject it. Just let yourself experience it.
  2. Now notice if there is any tension in your body related to that feeling and try to examine it.  Whereabouts in your body do you feel it? What is it like? Try to describe it to yourself.
  3. Next ask yourself, “Why do I feel like this?”
  4. Whatever the answer, next ask yourself, “Why does this matter to me?”
  5. Again, whatever the answer, ask again, “Why does that answer matter to me?”
  6. Keep asking this over and over again, until the answer is something positive that you want or care about. This is the positive value that your emotions are telling you about. You will know that you have arrived at the right place when:
  • It is a positive feeling—something you wish for, not something you reject.
  • It is personal—it is about your values, not about what anyone else thinks, does, or feels.
  • The original feeling is noticeably reduced or changed.
  • Pay attention to this positive, personal feeling and you will know that your original feeling has been transformed into something positive and motivating.

Lastly, I include my personal Top 5 Favourite Calming Activities, based on an article I read in Prevention magazine (Issue 2022: Dealing with Depression: Feel Happy Calm and Connected in Our Changing World (pp. 37-45), ‘Easy Ways to Take Care of Yourself’):

This is a follow-up (of sorts) on a previous post I wrote on Fun Things to Do. These are inexpensive, easy-to-do activities that are calming and feel good at a time when we all need to chill out because we’ve been through so much in the last few years of the COVID-19 pandemic. I’ll be writing more about the issue of the pandemic and its impact on our mental health in an upcoming Grapevine article, but in the meantime, here’s something to whet your appetite.

My Personal Top 5 Calming Activities:

  1. Knitting (or crocheting). A large British study did research that found the repetitive action of clicking needles can be meditative and calming. Further, a Canadian study that looked at women with anxiety who also had eating disorders found that knitting made most of them less preoccupied and anxious.
  2. Give yourself a massage: if there is no one else willing or able to work out the tension in your muscles, you can do it yourself. Some good spots you can reach yourself are the muscles of your shoulders, the hinge of your jaw, and pressure points on your hands.
  3. Do Progressive Muscle Relaxation (PMR): Research has found that PMR helps reduce anxiety and calm breathing. Lie down and relax; then tighten, hold, and release each muscle in your body one at a time, beginning with your toes and moving to the crown of your head. Do it slowly and methodically, and don’t forget the muscles of your face. It only takes a few minutes from start to finish and it can help you sleep.
  4. Donate your time: ‘Volunteering gives people purpose, which raises their self-esteem and lowers loneliness.’ According to research, people with social anxiety who lent a hand felt less anxious about social situations than those who didn’t. According to Canada Helps, donations to charity were down 10% during COVID. If you don’t have time to lend a helping hand, consider making a small donation to your favourite charity. For example, on May 29 is the Alzheimer’s Society of BC Alzheimer Walk.
  5. Watch Nostalgic TV: Nurture your Inner Child and watch re-runs of Mr. Bean (hilarious!) or Seinfeld or The Simpsons. Even Fantasy Island (remember that show from the ‘70s?) is making a come-back these days.

I hope you enjoyed this post. Stay tuned for more post-COVID-19 survival tips. And enjoy your day. Next week’s post is on scams, specifically, how to prevent getting scammed.

(Note on the Image: My dad celebrated his 90th birthday this week, and this was one of the birthday cards he got. It was a big milestone for my dad, or indeed, in anyone’s life. Would that I could be even half as fit and healthy as he is when (if) I get to 90!)

Sleep, Part 2 – How to Get a Good Night’s Sleep: Release the Day

By C.A. Bryson 2022

In Part 1 of ‘Sleep’, I introduced the concept of disordered sleep. In Part 2, we treat the problem. Part 2 is the Rx.

But first of all: Just why is sleep so important? Sleep is important because it serves to integrate new memories with existing knowledge and restore brain chemistry to good balance. Caregivers with poor sleep:

‘Have reported greater burden, increased depression, and poorer cognitive function. Caregivers with poor sleep are also more likely to place persons with dementia into residential care communities.’

‘In Search of Quality Sleep’ by Glenna Glasgow Brewster (March 31, 2022)

https://generations.asaging.org/search-quality-sleep

I’m all for doing whatever you can (that’s legal, and doesn’t harm your body or anyone else), to get a night’s rest. Personally, I’ve tried CBT-i (CBT for Insomnia), and Yoga Nidra, and have met with some success. The number one thing I learned from CBT-i was not to worry if I couldn’t get to sleep. But it seems to me the secret is in the title to this post: and that is, release the day. Truly and completely.

Paul McKinna, author of ‘I Can Make You Sleep’ (Sterling, 2009, p. 107), has this to say about ‘What to do when your head is filled with thoughts’:

‘Quite often our lives get filled up with relatively unimportant things and it is difficult to find enough time for ourselves. The only time you get to think things over is right at the very end of the day when you have some time to yourself, in bed, in the dark and quiet, so the unconscious seizes the moment just before you get to sleep to get you to think about what really matters to you. This is actually a very good thing—it is just not the most convenient time to do it.’

Notes from ‘How to Unwind’ by Akanksha Singh (Real Simple magazine, 2022, pp. 84-87):

  • The basic idea is, at bedtime, switch from ‘doing’ mode to ‘being’ mode. Do the things you love to do and stop thinking you have to be “productive”
  • No doom-scrolling!
  • Screen time before bed is ok, IF and only if, you get enough daylight time outside to help your brain see the difference between night and day and keep your circadian rhythms on track. Note: what are circadian rhythms? Google says: ‘physical, mental, and behavioural changes that follow a 24-hour cycle. These processes respond primarily to light and dark.’ Also, by screen time, I mean light-hearted screen time: reading texts from friends, playing a game of online solitaire, that sort of thing.
  • A hot shower or bath before bed helps you fall asleep faster. Sometimes baths are recommended over showers—an hour and a half before bed is optimal.
  • Soothing mellow music and soft, warm lighting help.
  • Writing down everything that’s on your mind is an effective way of releasing anger, fear and shame.
  • Try progressive muscle relaxation: tense and relax your muscles, starting at your forehead, and working down to your toes.
  • Try mindfulness meditation. Insight Timer is a free app. Headspace is also good but it is by subscription.
  • Try Yoga Nidra. You can find a free meditation at the following website: (Note: you have to subscribe but it’s free.)

https://www.doyogawithme.com

  • Try CBT-i (Cognitive Behavioral Therapy for Insomnia). There are online courses you can take.

One More Thing For You To Try…

Sleep-Inducing Foods. (From: ‘Feed Your Sleep’, Real Simple magazine, 2022, pp. 48-50)

Here are 5 of the Foods they recommend:

  1. Yogurt: Keeps your gut healthy. A well-balanced gut influences serotonin levels, which in turn facilitate sleep.
  2. Cereal: In particular, oatmeal made from whole or steel-cut oats, contains a neurotransmitter called GABA, which has a relaxing effect.
  3. Bananas: These contain magnesium and potassium, both of which are sleep-promoting nutrients.
  4. Cherries: Especially tart cherries, which are a good source of sleep-inducing melatonin. Drink 8 ounces tart cherry juice in the morning and again at night, and you may increase your sleep by an hour, studies show. (My caregiver coach will vouch for this.)
  5. Nuts: Particularly cashews, almonds, and walnuts. These are sources of tryptophan (long known to be associated with sleep), they are also high in fibre, and high-fibre foods (like nuts) are in general beneficial for sleep.

In conclusion, I really do believe that, as William Shakespeare wrote in Macbeth: ‘sleep that knits up the raveled sleeve of care’ is what heals us.

What did the playwright mean? He meant, by ‘knit up’, that sleep is what soothes our daytime worries, so vital for a caregiver’s self-care and morale. So sweet dreams tonight, I hope. Next week: I introduce a sleep meditation called ‘Release the Day’.

A Note on the Images:

  1. A Sleep Sound Therapy System, gifted to me by my brother. I highly recommend it if you have sleep issues, or if, for example, late night quiet makes you feel anxious. You can relax to the sound of a crackling fireplace, a train, or ocean waves (as well as other sounds.)
  2. Mother’s Day Tea Roses (in honour of my late mother), for Mother’s Day 2022. Heads up: Father’s Day comes up next month on June 9.

CAB 2022

Ensuring Proper Sleep Part I: Introduction

By C.A. Bryson 2022

I.

Here’s a longish quote from one of my favourite sleep books: ‘I Can Make You Sleep’ by Paul McKenna (Sterling, 2009) (p. 30)

…’Pushing a child on a swing is a gentle process. All we need to do is give the child a little push at the right time, just as they are beginning to swing down again. But think of what happens if you get your timing wrong. If you leave it too late, the child is accelerating away from you and you almost have to run after them to push at all—and you have hardly any effect. Or if you try to start pushing too soon, you feel the weight of the child against you and the child comes to a sudden halt. Even the simplest swing can get out of time, and it can look quite complicated if your attempt to correct adds another twist or spin.

That is all that has happened when your sleep cycle is disrupted—the rhythm of the swing has gotten out of synch.’

‘S’ stands for ‘Senior’, but also for ‘Snore’, ‘Slumber’, ‘Snooze’, and ‘Sound’ (as in a ‘sound’ sleeper.) And yes, ‘S’ stands for ‘sleep’, ah… sleep: ever elusive, ever confounding and confabulating, ever confusing at times, sleep.

Tell me, what would you give, in terms of dollars, for that almighty Good Night’s Sleep? ‘The global market for sleep aids and technologies is estimated at 518 billion$ in 2022 and 585 billion$ in 2024.

https://statista.com/statistics/1119471/size-of-the-sleep-economy-worldwide

That’s a lot of shekels (another ‘S’!) just to catch some zzz’s!!

But sleep is serious business. Seriously. Why? Here are some sleep statistics for you (that might put you to sleep, or cause you to lose sleep, depending!)

  • Canadians aged 18 to 64 sleep around 7.12 hours on average. Around one-third of Canadians sleep less than 6 hours a night.
  • If your age is younger than 65, getting between 7-9 hours sleep is good—for seniors, 7-8 hours is the norm
  • Caregivers (that’s us!) ‘lost 2.42-3.50 hours sleep each week due to difficulty falling asleep and maintaining sleep, a significant difference relative to age-matched non-caregiver controls’

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2748661#/

‘Sleep Duration or Sleep Quality in Caregivers of Patients with Dementia’ Charles Gao, Nikita Y. Chapagain, Michel K. Scullin.

JAMA Netw Open 2019 2(8)

II.

Notes from ‘Out of Order: What You Need to Know About the Most Common Sleep Disorders, Snoring, Insomnia, Apnea and More.’ By Rick Sando ‘Real Simple’ magazine (2022) pp. 25-29.

From the Old Testament:

‘When shall I arise? But the night is long, and I am full of tossings to and fro unto the dawning of the day.’

In these notes I now cover basic information on insomnia and sleep apnea:

  • The authors recommend you see a sleep specialist if you have difficulty falling or staying asleep, as your regular doctor may not have specialized knowledge on sleep disorders
  • Note that ‘sleep deprivation’ means ‘not making or having enough time for proper rest’, rather than just being deprived of sleep per se
  • Insomnia is defined as: ‘a mood so consumed by stress that it prevents the person from falling or staying asleep and causes early awakening’
  • Matthew Walker, author of: ‘Why We Sleep: Unlocking the Power of Sleep and Dreams’, writes:’ little wonder that sleep becomes nearly impossible to initiate or maintain when the spinning cogs of our emotional minds start churning, anxiously worrying.’
  • If you can’t sleep and 20 minutes has gone by, get up and do something quiet and restful for a while and then go back to bed and try again. (More tips in Part 2 of this post.)
  • What is sleep apnea? Sleep apnea is when your airways become obstructed and your body’s oxygen supply is limited, which can result in disrupted sleep.

See:

Canadian Sleep Society

https://ccs-scs.ca

In Part 2 of this post, stay tuned for tips on:

  • How to unwind
  • Feeding your sleep
  • What is: Cbt-I and i-rest?

Note: Upcoming Senior’s Fair at North Vancouver City Library

Tuesday, May 10, 2022 10:00-11:30 AM (Registration required)

Presenters:

  • Silver Harbour
  • NSCR-Better at Home
  • North Shore Neighbourhood House
  • Capilano Community Services

Next Week: Sleep, Part Two: Ensuring Proper Sleep: How to Sleep Well Every Night

CAB 2022

Review and Summary of ‘Complete Guide for Family Caregivers’

By C.A. Bryson 2022

In this post I review and provide a summary of the book ‘The Complete Guide for Family Caregivers’ by Caroline Tapp-McDougall (Next Chapter, Stratford, Canada, 2020). This book is available for loan at North Vancouver District Public Library (Capilano Branch.) The book is an invaluable reference guide particularly geared towards (working) Canadian caregivers, unique in the sense that it is written by a Canadian for Canadians. The author Tapp-McDougall focuses on a number of pertinent issues including: aging theory, health, mobility, memory, end-of-life issues, housing and care planning.

Firstly, the author offers a definition of the family caregiver:

‘A caregiver is a person who informally cares for and supports a family member, friend, neighbour, or individual who is frail, ill, or disabled, and who lives at home or in a facility.’ (p.15)

Here are some relevant stats that Ms. Tapp-McDougall provides:

1 in 4 Canadians are caregivers

Caregivers contribute 25$ billion in unpaid labour to the health system

Interestingly, Ms. Tapp-McDougall defines late middle-age as 45-60 years, and the elder as 60+ years.

Here are some ideal caregiver attributes:

Good attitude, energy, flexibility, gratitude and ability to communicate.

Very helpful to me was how the author defines the 4 Stages of Care. These are:

Stage 1: Active Lifestyle

Stage 2: Stable Lifestyle

Stage 3: Limited Lifestyle

Stage 4: Restricted Lifestyle

(pp.28-30)

Here is another aspect of caregiving theory that I found helpful:

  1. ‘More than 75% of what life delivers is predictable, plannable, and hence somewhat manageable…I govern myself as if there is less than a 25% chance of a sudden not-so-nice surprise at any given time.’

It is also important to consider this:

  • ‘Your elders may be scared. What lies ahead is often frighteningly difficult, a difficult, unpleasant journey that most of us would prefer to avoid if truth were known.’ (p.36)

Here are some useful caregiving tips on organization, such as:

  • Write a to-do list or active items prior to bedtime, to allow yourself to ‘let go’
  • Create an eldercare email and telephone directory of all the contacts you will need
  • Delegate—make a list of things people can do.
  • Create a shared calendar (i-phone option ‘Family Calendar’ or go to lotsahelpinghands website

In addition to all the practical aspects of caregiving, the author also offers in-depth coverage of common caregiving issues, such as:

  1. Risk:

‘Individuals (read: our parents) have the right to live at risk at least until they’re deemed to be a danger to themselves and/or others.’ (p.26)

She continues:

‘Your parents have the right to live wherever they want and do as they wish.’ (p.27)

‘Unless they are mentally incapable or causing harm to others, they can make the choice concerning their housing, legal issues, care and finances.’ (p.27)

(See also the relevant material on Senior Driving (pp. 145-48)

  • Health

Statistics regarding your health as a caregiver:

44.7% of family caregivers face deteriorating health

And: The average senior takes 11 different medications each day. (p.36)

About the topic of memory, Ms. Tapp-McDougall notes:

‘The wisdom we acquire through aging allows us to see things from a wider perspective. We have more internal data to bring into working memory for comparison before final decisions are made. Did you know that older adults have been shown to have a greater sense of understanding of these other qualities of life than younger adults? (p.159)

On Mobility:

One piece of advice is that when selecting mobility equipment is to always seek reliable mobility brands. Such as:

Invacare, Sunrise, Pride. Ask about warranties.

  • Advance Care Planning:

 CHPCA Guide:

http://www.advancecareplanning.ca

When thinking about advance care planning, the author recommends that you:

  • Record your wishes. Write them down or make a video or recording. There are also forms available in most provinces and territories. I will be covering Advance Care Planning in a subsequent post.

To conclude, the ‘Complete Guide for Family Caregivers’ is Ontario-based, and I believe the tone of the focus is largely on busy, working caregivers. Other than that, it’s a great book. Required reading for all caregivers embarking on the caregiving path (and for those further down on that path.)

For example, the relevant section on Senior Driving (p.145-48) I found highly illuminating, since we had to go through the whole process with my dad. Inevitably, most caregivers have had to face that issue with their parents, and therefore it makes sense to see what the experts have to say on the topic, and maybe get some good advice.

Caregiver Month coming up in May. Check out the Caregiver Support Program calendar for events. Upcoming in June 2022 is a workshop on Emotion-Focused Therapy. Contact Caregiver Support Program coordinator Vic Gailiunas: vic.gailiunas@nscr.ca

for more details. Next post: Sleep!! We all need it. We all want it. Ah yes, that ever-elusive sleep.

Sweet dreams everyone!

CAB, 2022