Dealing with Sleep Disruption Caused by Anxiety
Anxiety is a prevalent mental health issue among the elderly population residing in nursing homes. Around 40 million Americans face anxiety at some point in their lives. Anxiety, along with its underlying triggers, can significantly disrupt sleep patterns, making it difficult to fall asleep and stay asleep. This can create a vicious cycle where anxiety hinders sleep, and sleep deprivation, in turn, exacerbates anxiety.
It is crucial for elderly individuals in nursing homes to seek help from therapists when anxiety starts affecting their ability to maintain their daily routines, especially their sleep. Quality sleep plays a vital role in maintaining both physical and mental health. Picture your body constantly stuck in a state of fight or flight while you’re attempting to sleep, hindering your body’s recovery and your ability to function during the day.
Sleep deprivation can also compromise your immune system. Even a short period of sleep loss can lead to a significant increase in anxiety and its debilitating effects. It can be important to distinguish between insomnia (general persistent problems falling and staying asleep) from mental health diagnoses effecting sleep. The goal is always to treat the source of the issue.
Strategies to Address Anxiety-Induced Sleep Issues Independently
There are some simple techniques that can be attempted to alleviate anxiety and improve sleep quality before seeking therapeutic interventions. Breathing exercises and a technique called “triangle breathing” can help regulate your heart rate manually, assisting in calming you down in the moment. Triangle breathing involves inhaling for three seconds, holding your breath for three seconds, and exhaling for another three seconds. This straightforward method can help bring your mind and body back to a calm state. Anxiety comes from thoughts, so it takes a ‘neck down’ intervention to try and fight or distract from those thoughts.
Incorporating meditation, yoga, or physical exercise into your routine can also be effective in calming both your mind and body. Physical activity offers various benefits, such as lowering blood pressure, managing weight, reducing the risk of physical illnesses, fostering social interaction, and promoting healthier coping mechanisms. Moreover, in today’s era of constant digital connectivity, putting your phone away and setting it to silent mode can eliminate distractions that might trigger anxiety when attempting to sleep.
How Therapists Can Assist in Treating Anxiety-Related Sleep Problems
Collaborating with a therapist experienced in anxiety therapy can provide valuable support in minimizing its daily impact and restoring a healthy sleep pattern. Anxiety therapists typically employ cognitive-behavioral therapy (CBT) and guided therapy to help you regain optimal sleep quality.
CBT is the most used therapy intervention for addressing anxiety. It aims to identify and rectify negative thoughts and beliefs that contribute to anxiety. CBT can improve sleep by creating awareness of behaviors that disrupt it, such as maintaining a consistent bedtime routine, reserving the bed solely for sleep, eliminating stimulants that hinder sleep, and removing distractions and light sources from the bedroom.
Another effective anxiety therapy intervention is guided therapy, which uses mental imagery, memories, and stories to evoke positive and calming feelings. Guided therapy can assist in calming your mind, preventing it from wandering and triggering anxiety. An example of this technique is imagining yourself engaging in a mundane activity like painting a room with a soothing color. This keeps your mind focused on the task at hand, reducing anxiety triggers. Learning to connect your mind and body helps diminish anxiety’s grip on your overall well-being.
If anxiety is interfering with your ability to sleep or carry out daily functions, it’s advisable to reach out to a therapist. While anxiety is common and often experienced in specific situations, persistent and life-altering anxiety doesn’t need to be a burden you carry in your daily life. There are numerous highly effective therapy interventions available to help you regain the quality of life you deserve.
Taking Sleep Problems and Anxiety Further
Working in collaboration with a therapist and a medication prescribing professional can be an option if therapy alone does not significantly reduce the symptoms. Top quality providers will attempt supplements like melatonin, magnesium, and lavender before attempting medication that provides sedation effects. Many nursing home facilities have their own Nurse Practitioners who prescribe medications. Otherwise, there are telehealth options for prescribers. The collaboration of prescribers and facility staff is important to monitor and track any changes or side effects that could signal a need to change or stop prescriptions.
Five Advocacy Tips For Living In Skilled Nursing Facilities
Adjusting to a new environment can be difficult. Adjusting to an environment that is typically seen as a higher level of care from an independent life can be even more challenging. As older adults are requiring more dependence in self-care, it is important to be mindful of how individuals and families can advocate for needed care. There can be many factors that can affect how care is delivered in skilled nursing facilities. As a telehealth therapist who works more often with rural facilities, I have compiled a list of the top five tips for addressing advocacy concerns.
- Know your rights: Familiarize yourself with the rights you have as a nursing home resident, such as the right to privacy, to be treated with respect, and to make decisions about your care. This means that staff should be knocking on doors before they enter private rooms. If you are in a meeting (like a therapy session) where you expect privacy, there should be some type of sign on the door making notice of a private conversation taking place. If there is a care plan meeting, sufficient notice of the meeting needs to be given to residents and their guardians/power of attorneys as well as any parties they wish to invite. Skilled nursing facilities are most often privately owned businesses although they still have to adhere to state and federal regulations. There are state ombudsmen who will inform on rights as well as county aging and disability resource centers (ADRC) that can assist with knowing rights.
- Speak up: If you have concerns about your care, don’t be afraid to speak up and let your caregivers and nursing home staff know. You have the right to have your concerns addressed and to have your needs met. As a therapist, I encourage my patients to speak up, often their voices are the last bit of control they have in their lives. One needs to understand the difference between addressing concerns with CNA’s, LPN’s or aides versus nurses and administrators. If the issue is smaller, then the aides may be able to assist in correcting things quickly. If there are larger concerns, nurses and administrators may be a better option to listen and respond.
- Keep a record: Keep a journal or log of any issues or concerns you have, including dates, times, and the names of any staff involved. This can be helpful if you need to report a problem or issue to the nursing home administration or to a regulatory agency. What I will say instead of writing things down (people often cannot write due to sight and arthritis or neuropathy) is to keep track of how often a concern is verbalized and to whom it was verbalized. Often, a concern will be lost at the doorway when the staff move on to addressing the immediate needs of another resident. As a therapist, I have found that staff will often listen and respond in a way that keeps the resident calm in the moment and then there is no further action taken. These situations are more difficult when residents have isolated contact with family members or if they require corporate guardians (non-family guardians/POA). In Wisconsin, a guardian is only required to be in communication every three to six months (sooner if needed) and to see individuals once per year face to face.
- Use the nursing home’s grievance process: If you have a problem or concern that cannot be resolved through casual conversation, use the nursing home’s grievance process to report the issue. The grievance process is probably the most effective way to get issues resolved or to get some accountability and action. Issues or complaints related to direct interactions with staff are usually handled through the grievance process. The facility’s social worker (who sometimes isn’t even a social worker) can assist in explaining the grievance process.
- Be assertive and keep family or friends informed. It is important to be firm and clear about your needs and concerns, but it is also important to be respectful of the staff and caregivers who are working to meet your needs. Staff have a lot to deal with during their shifts and a lot of different personalities to connect with when assisting residents with their personal needs. Keep your family informed about your care and any concerns. They can be a valuable source of support and can help you advocate. Know where to go for help: If you feel that your rights are being violated or that you are not receiving the care you need, don’t be afraid to seek help from facility management teams, ombudsmen, facility social workers, and county human service departments.
Five Therapy Goals for Treating Dementia and Agitation
Dementia can present in many ways; it is often considered an umbrella term for diagnoses that create a loss of memory or thinking abilities that cause interferences with managing daily life. Dementia can be associated with the following diagnoses: Alzheimer’s, Vascular, Lewy Body, Frontotemporal, mixed dementia, and other contributing factors.
Talk therapy is used to ease the progression and agitation. Creating therapy goals for a patient with dementia requires careful consideration of the patient’s individual needs and abilities. As a telehealth therapist that works with patients in skilled nursing homes, dementia can be a challenging diagnosis for individuals, family members, and facility staff.
Here are five therapy goals that may be appropriate for a patient with dementia:
- Improve communication skills: Dementia can often cause changes in communication abilities. Therapy goals might include improving the patient’s ability to express their needs and wants, as well as improving their understanding of spoken and written language.
- Promote independence: Despite the challenges of dementia, it’s important to promote as much independence as possible. Therapy goals might include helping the patient learn new skills or strategies to help them manage their daily activities more independently.
- Enhance memory and cognitive skills: Dementia can cause changes in memory and cognitive skills. Therapy goals might include helping the patient use strategies to improve their memory and cognitive skills, such as using memory aids or practicing memory exercises.
- Manage behavioral challenges: Dementia can sometimes cause behavioral challenges, such as agitation, aggression, or wandering. Therapy goals might include identifying and addressing the underlying causes of these behaviors, as well as developing strategies to manage them effectively.
- Improve quality of life: Ultimately, the goal of therapy for a patient with dementia is to improve their quality of life. Therapy goals might include finding ways to help the patient feel more engaged, fulfilled, and satisfied with their life.
It’s important to keep in mind that therapy goals for a patient with dementia should be realistic, achievable, and tailored to the individual’s needs and abilities. It may also be helpful to involve the patient’s family and care team in the goal-setting process. Involving medical professionals who manage medication is also an important aspect of managing agitation and progression of symptoms.
Working closely with nurse practitioners who provide medication management, I have seen some conversations when they collaborate amongst themselves. Beyond drug classifications and possible common uses, medication knowledge is beyond me especially when it comes to CMS requirements. Remember that there is no handbook for dementia with agitation which makes it one of the hardest types of patients to treat.
The Red List: Developing a Spotlight on Policies and Initiatives Affecting People
Previously, I created a separate website specifically for my therapy clients. That website was called, “The Rebellion Clause.” Now, The Rebellion Clause redirects to this website.
The idea of the Red List grew out of the idea of policy changes affecting the livelihoods of the people they were supposed to protect. Before my start in the world of social work, I wrote about gaps in the community related to crisis intervention services and how agencies dealt with children who had higher level behavioral health needs. I turned my photography website into an advocacy website and was eventually able to land a job addressing those themes and topics in direct practice every day. I went from a made up job title to Clinical Director in a few years.
Now I find myself at the top of the social work field, essentially doing private practice telehealth therapy for the various populations. I conduct telehealth therapy with patients in four states. I’ve gotten the itch to continue my written advocacy work after working with clients in skilled nursing facilities.
There is no doubt that COVID had a massive impact on social service delivery and staffing changes. It almost seems like we’re back in the 1970’s after de-institutionalization began and we’re finding ways to either keep people in new forms of institutional care or fighting against the current to get people back to the level of independence they had before the pandemic.
After watching ‘The Black List’ on Netflix, I had the idea of creating a ‘Red List’ for agencies and policies that keep individuals stuck in new forms of institutional care. I also want to focus on state and federal initiatives that are not effectual in their goals. A lot of taxpayer dollars are wasted on awareness campaigns. Awareness campaigns only reach the people who are already aware of the issues. I hope to give a platform for real people negatively effected by policies and initiatives or do not go far enough to be fiscally beneficial.
10 Skills for Adjusting to Living in Skilled Nursing Facilities
Transitioning to a skilled nursing facility due to medical needs can be challenging for many people. With or without the threat of COVID, skilled nursing facilities are a closed door environment. Here are ten ways to cope with this difficult transition from a therapist’s perspective:
1. Acknowledge the feelings: It’s essential to acknowledge and express the emotions that come with adjusting to a new environment with less privacy, independence, and community interaction. Feelings of sadness, frustration, and fear are normal and expected.
2. Build a support system: It’s important to build a support system of family, friends, and healthcare providers who can provide emotional support and practical help.
3. Engage in meaningful activities: Participating in meaningful activities, such as hobbies, reading, or connecting with friends and family, can help maintain a sense of purpose and fulfillment.
4. Keep a positive attitude: Maintaining a positive attitude, focusing on the good in life, and finding joy in simple things can help improve the overall well-being. Distractions are often a necessary way to stay positive. As a therapist, I always ask patients if they have comfort items in their room that help them alleviate distress or isolation.
5. Take control: Find ways to take control of the situation, such as getting involved in the care plan, participating in decision-making, and advocating for oneself. If there are guardianships or power of attorneys, having a seat at the table for one’s own care makes a huge difference.
6. Learn relaxation techniques: Practicing relaxation techniques, such as deep breathing, meditation, or mindfulness, can help reduce stress and anxiety. Access to nature, even looking out the window or sitting on a patio can have healing effects on the mind and body.
7. Stay connected: Stay connected with the outside world by utilizing technology, staying informed of current events, and reaching out to friends and family. Maintaining family connections can help residents minimize feelings of burden, worthlessness, and isolation.
8. Engage in therapy: Working with a therapist can help process the emotions and challenges that come with being in a skilled nursing facility. Telehealth is making access to medical professionals easier, even in rural America.
9. Stay physically active: Engaging in physical activity, such as stretching, walking, or chair exercises, can help maintain physical health and well-being. Facilities should have exercises activities in addition to their available physical and/or occupational therapy.
10. Find meaning and purpose: Finding meaning and purpose in one’s life, such as writing a memoir, volunteering, or advocating for others in similar situations, can help bring a sense of fulfillment and purpose to the situation.
Often times, the basic reaction for new residents is to isolate in their rooms which can be detrimental to both physical and mental health. Challenging the body with movement, challenging the brain with brain games (crosswords, trivia, reading), and seeking out personal connections help alleviate symptoms of situation-related depression, anxiety, and insomnia.
Starting Plant Seeds Indoors in Four Seasons Room |Relentless Advance
Purchasing my home in October of 2019, I had no idea what to do with the four seasons room off the back of the kitchen. It was staged with a small pullout couch and has been used as a pass through to get to the detached garage. Finally this year I figured out that I could turn it into a greenhouse rather than an extension of my backyard patio area. I am starting seeds in the four seasons room this year with Jiffy seed starting kits.
About twenty years ago, my father and I started seeds in the basement over the winter. We used saw horses and ping pong table boards. We also hung a large number of fluorescent shop lights from the ceiling. We joked about if ATF ever flew over the house and saw a large output of electricity they would think we were growing something else! The Jiffy seed starting kits I am using this year are leftovers from the twenty years ago that they have been stored in my parents’ basement.
There is just something about greenery and new plants germinating. It makes me so happy to be around plants, sunshine, and warmth. A few days ago, I was watching Garden Answer on YouTube and Laura was talking about planting several seeds from Johnny’s Selected Seeds based in Maine. The varieties that she was describing looked interesting to me for my own garden designs. I purchased four seed packets for my garden to start in the four seasons room.
With the information Laura provided in her video, I purchased ‘Sun Ball’ Craspedia and ‘Mahogany Splendor’ Hibiscus. Laura talked about how the Mahogany Splendor can be used as an alternative to Japanese Maples. Seeing as how I have purchased four Japanese maples in the last two years, I figured I would try it. Additionally, I purchased some red flower and stemmed Celosia and some multicolored Yarrow from Johnny’s. Locally I also purchased several varieties of Zinnias, Marigolds, and Alyssum.
I still have to wait for April and the low thirty degree nights so that I do not have to constantly run my heater in the four seasons room. I usually keep it at a standard 65 degrees during the winter since it is used as a pass through and my back door connecting the house from the four season room is an interior door.