Effect of Relaxation and Meditation to the Sleeping Patterns of the Caregiver and the Person with Dementia - Term Paper Example

Running Head: EFFECT OF RELAXATION AND MEDITATION EFFECT OF RELAXATION AND MEDITATION TO THE SLEEPING PATTERNS OF THE CAREGIVER AND THE PERSON WITH DEMENTIA Does relaxation and meditation help improve sleeping patterns for the caregiver and the person with dementia I. Background Dementia is a gradual loss of memory. It is an effect when the parts of the brain that involves learning, memory, decision-making, and language are affected by any of various infections or diseases.(1) Normally, there is loss of mental ability and affects the complex motor skills of a person when the brain nerve cells died or is permanently damaged. Dementia was from a Latin word de and mentis which means apart, away and mind. It was used as a word related to mental disorder in the year 1874 by Henry Maudsley. As a person gets older, he/she will most likely to develop dementia. Sometime after the age of 65, about 1 in 20 people develop dementia and about 1 in 5 people over the age of 80 have dementia. (2) Although dementia is associated with old age, this is not related to the normal signs of ageing or the usual forgetfulness of an old person. The most common causes of dementia are Alzheimer's disease, vascular dementia, Dementia with lewy bodies and sometimes HIV dementia. Moreover, it can also be caused by vitamin deficiencies from poor nutrition, reaction to medicine and thyroid dysfunctions. Typically, a person with dementia develops an attitudinal change. They tend to be regularly confused and disoriented with their thoughts and surroundings. More often than not, the patient will be forgetful, have a problem with speech and language and has a lack of judgement causing slight accidents. Consequently, patients become neglectful of their personal hygiene and nutrition. After being diagnosed with dementia, patients naturally suffer an emotional impact. The most common reason for this is denial and shame. Irritability, anxiety, forgetfulness and lack of direction are commonly observed behaviour of patients. They suffer from depression and involuntary bodily function symptoms such as withdrawal, anorexia and insomnia. A disorganized sleeping pattern is a common dilemma in dementia. Problems of distinguishing between day and night will change sleeping patterns of the patient. For some, they may be asleep during the morning hours and wide awake for the rest of the evening when everybody else is asleep. Other patients have lesser activities during the day and needs little rest, causing them to wake up in late evenings. There is also a tendency of falling asleep too early and waking up too early. Sleeping problems may also be caused by the effect of sedatives given to the patient. Environment, whether it is an abrupt change of surroundings or room temperature will also cause sleeplessness for a person with dementia. For the problems with sleeping patterns, it is best to identify the causes of sleeplessness, to be able to solve the problem easier. Since dementia is a progressive disease, it often results to patients needing 24/7 supervision. For families having one of their members afflicted with dementia, it becomes highly stressful and downright painful as the dementia worsens. That is why; families often opt to hire caregivers who are well trained in the field of occupational therapy if they can afford the services' fees. For professional caregivers, it involves a lot of hard work and patience to take care of demented patients. Patients could be in a mood swing, in a disillusioned or confused state, simply wandering of, or having hallucinations. Caring for demented patient is physically and emotionally stressful for the caregivers. The emotional impact of caring for a loved one with Alzheimer's disease or dementia is the hardest part for many caregivers, especially those who experienced fear of stigma and/or denial before the diagnosis. (3) Sometimes, the emotional attachment of a person with a loved one suffering from dementia is the main reason why diagnosis is delayed up to 6 years. The change of behaviour is commonly an issue of a family caring for a demented patient. When hiring for a caregiver, he/she will be scrutinized so that family members will know that the caregiver cares for the patient just like they do. For a family member caring for a loved one with dementia, the job is emotionally strenuous and would need a lot of support from friends and family members. It is often said that the caregivers are silent victims of dementia. Due to agitation, a demented patient will have tantrums when somebody is caring for them and will distress the caregiver who has no other intentions but to care and give understanding to their patient. To reduce these depressing incidents and avoid further emotional damage, sleeping and meditation have therapeutic effects if done regularly. It is always best for the caregivers to take good care of themselves so that they can effectively care for others. II. Aims The aim of this study is to improve the understanding of the effect of relaxation and meditation to the sleep pattern of a person with dementia and the caregiver. III. Specific Aims 3.1 To identify the causes of sleeplessness of a dementia patient. 3.2 To identify the causes of sleeplessness of a caregiver of a dementia patient. 3.3 To evaluate the effectivity of relaxation and meditation to improve sleep patterns of a dementia patient. 3.4 To evaluate the effectivity of relaxation and meditation to improve sleep patterns of a caregiver of a dementia patient. IV. Review of Literature Why is sleeplessness or change of sleep pattern common to a person with dementia Amyloid beta protein, which is found in Alzheimer brains, causes disrupted sleep-wake cycles when injected into normal animals.(4) Due to mental dysfunction, the patient's biological clock is affected. Because of this, they cease to distinguish the difference of night and day. Some may be restless during the night because of lesser activities during the day. The side effects of medications and diuretics also cause sleepless nights for the patient. Pain can be a cause of change of a patients sleep patterns. Cramps, stomach pain, arthritis, pain in urinating due to urinary track infections are several reasons why sleeping patterns of a patient is affected. More often, since dementia started to show up at the old age of 65, sleeping patterns are changed because older people needs less sleep. So, how does a change of sleep pattern of a demented person affect his or her caregiver The help of an understanding caregiver can bring joy and meaning to the lives of patients. But a caregiver, after a long day of caring for the patient will be tired and as a person, the body needs complete rest. Nevertheless, when the demented person started wandering during the night, especially when everybody else is asleep, there could be a possible danger of accidents and the likes that will be harmful and risky for the patient. It is however, the caregiver's responsibility to look after the demented person. So when the patient wakes up in the wee hours of the night, the caregiver should also rise to look after the patient. These activities will lead to exhaustion of the caregiver. This kind of lifestyle will equally be dangerous to the caregiver. As a silent victim of dementia, caregiver's memory will decline and fatigue will lead to depression. The caregiver will experience a poorer quality life because of depression and emotional tension and there will be a tendency of early needing professional or institutional care. What is relaxation and what is its relevance Relaxation is the act of unwinding, loosening tight and tensed muscles, refreshing the body and mind and savouring a state of quiet, peace and comfortable feeling. There are many variations of relaxation. These are the Muscle relaxation (Jacobsonian exercises), The Turtle Technique, and Visual imagery (picturing tranquil scenes). (5) Studies show that relaxation, when followed correctly can reduce anxiety almost immediately. When a person is relaxed, he/she can feel calm, happy and energetic. Relaxation gives a 'break' from things and lowers activity within the limbic system of the brain, the emotional centre. (6) What is meditation and what is its relevance Meditation is a boundless, tranquil communication with your inner self. It is a re-acquaintance of a person's inner character, its calmness, quietness, awareness, joy and harmony of a person which is hidden or covered by problems and anxieties. Meditation is known to have powerful benefits such as reducing the cholesterol level, and high blood pressures. Infact, Dr. Peter Nixon, a celebrated cardiologist, as well as Mayer Friedman, one of the most renowned names in cardiology, both endorse the positive impact of meditation of heart disease - its prevention and reversal. (7) V. Point of Discussion An Occupational Therapist's job is to figure out which areas are suffering and how they can assist that person in performing these activities in a more functional, successful and independent way. (8) Occupational therapy is a study of combining work, caring for ones self, fun, play, adaptation of tasks and the environment to improve the value of life by increasing development and prevent disability. The relevance of occupational therapy in studying improvement of sleeping patterns for the caregiver and the person with dementia through relaxation and meditation, is to provide caregivers the information of how caring for ones self through relaxing and meditating regularly, can help caregivers overcome depression and stress. By improving these patterns, the caregiver can give full value to life as well as work effectively to take good care of somebody else's life. There is a saying that goes, "If a caregiver doesn't know how to care for her self, how will she know how to care for others" THE PATIENT Some people relax with sport, exercise, listening to music, watching TV, reading a book, etc. However, some people find it helpful to follow specific relaxation exercises. (9) Lack of activities during the day causes sleepless nights for a demented person. So instead of just lying around and doing nothing, it will be helpful for the patient to do relaxation through exercise such as jogging around the village or park, walking or peddling. The power of touch should not be under estimated. Massage is a touch therapy which gives general relaxation to a patient. Trials of massage therapy for relaxation and reduction of agitation, wandering, and disruptive behaviours showed mixed results with three of six trials demonstrating positive effects. (10) By tenderly talking to the patient and by touching and massaging, the demented person will feel that he/she is being cared for and will reduce the feeling of anxiety, agitation, distress and confusion. Meditation and yoga is proven to be a cleansing process which has the power to effectively diminish various disorders. It promotes balance and fall prevention as well as improving various mood situations. It is a slow form of activity that keeps a person in-touch with the inner self and gets control of ones breathing thus enhancing relaxation. However, due to the lack of concentration and in a state of confusion, meditation is not proven to be effective for a person who suffers dementia. Noisy surroundings can also contribute to a demented patient's state of confusion so by ensuring quietness, the patient can now relax. THE CAREGIVER The emotional burdens of a caregiver sometimes permit them to forget how to laugh and smile. Change of sleeping patterns may cause physical and mental exhaustion. Caregiver and other family members should also realize that relaxation and meditation have extra ordinary benefits in human lives. When caregivers were asked what type of help could make their care giving a lot easier, mentioned most often are more help with day-to-day care giving activities (20%), more financial support (16%), more emotional support (15%) and more time for themselves (13%). (3) Given with reinforcement, emotional support, more time for them selves and to relax, a caregiver could enjoy a more peaceful slumber. By relaxing, the tired mind and body can now recover and go back to care giving more effectively. Meditation for caregivers is also a helpful practise to overcome stress. By getting acquainted with your inner self, a person can change his/her attitude towards life. Through meditation, a person can learn how to get hold and control of his/her self and will now be calmer in dealing with things and issues. Carers for a demented patient experiences self pity, exhaustion, lack of sleep due to the change of attitude and sleeping patterns of the patient. By meditating, a stressed caregiver can now learn how to see the beauty of things, express appreciation towards little things and get hold of his/her life again. The sleeping pattern of a patient directly affects the carer because if the patient is awake during the night, the caregiver should also be awake to accompany the patient. The caregiver should realize that a time-out for her care giving job every once and a while is beneficial for his/her health. By relaxation, meditation, observing the causes of sleeplessness and practising how to deal with the change of sleep patterns of a patient, the carer could now easily cope up with stress and will therefore know what to do to ensure that both the patient and the caregiver will have a good night sleep. The diagram below shows the causes of change of sleep patterns of a demented patient and strategies on dealing with the problem Several Causes of change of sleeping pattern How to deal with the problem Going to bed too early Keep the patient awake a little later The patient is too relaxed in the morning Keep the patient busy. Engage the demented patient on exercise to allow circulation of blood and peaceful sleep at night. Change of surroundings As much as possible, keep the patient very well acquainted and familiar with the surroundings to avoid anxiety Temperature Ensure that the temperature inside the room for sleeping is just enough. Blankets should be ready in case the temperature gets too cold. THE SPECIAL CONNECTION OF A DEMENTED PATIENT AND A CAREGIVER Caring for ones self is a sign that a person is capable of caring for others. However, the emotional tantrum of a patient is an emotional stress for caregivers. The sleepless nights of a demented patient are sleepless nights of a caregiver. The fear, stigma and denial are also the fear, stigma and denial of a caregiver. Overall 90 % of the caregivers had some degree of burden as of the patient. There was no significant difference for most of the analyzed factors but the mean Zarit Caregiver Burden Scale (ZCBS) score was higher in the spouse or adult child, compared to other relatives as the caregiver. The closer the caregiver is to the patient, the care giving emotionally gets harder and the burden is high. (11) The incapacity of a patient in controlling ones behaviour is a primary stressor for the caregiver. To promote relaxation and boost drowsiness for both the demented patient and the caregiver, it is also helpful to have warm evening baths before sleeping and music therapy. Playing of low, monotonous music and recordings of sea waves, see breeze, flowing water of the stream, chirping of birds and other sounds of nature have soothing effects to the patient and the caregiver as well as stir memories and emotions. A support group or compassionate family members is a big help for both patient and caregivers. It gives the patient and the caregivers a safe place to share feelings, gain emotional and moral support, learn practical information, and talk with people who can relate to your frustrations. (12) A substitution of work every once in a while can give caregivers time to tend for them selves, relax and meditate so as to fight depression and care for the patient more effectively. List of References 1. (2003). Types of Dementia. The Cleveland Clinic Foundation. Retrieved from http://www.cchs.net/health/health-info/docs/2300/2340.aspindex=9170 2. (2003). Demetia. Patient UK. Retrieved from: http://www.patient.co.uk/showdoc.aspdoc=23068719 3. (2006) Investigating Caregivers' Attitudes and Needs. Harris Interactive. Retrieved from http://www.harrisinteractive.com 4. Knittweis, Jim, Alzheimer's Solutions Care Giving Tips. Retrieved from http://www.caregiving-solutions.com/cartipandhin.html#sleeping 5. Required Relaxation. Retrieved from http://www.usu.edu/teachall/text/behavior/LRBIpdfs/Required.pdf#search='define%20relaxation' 6. Elliott, Roger. The Evidence for the Benefits of Relaxation. Uncommon Knowledge. Retrieved from http://www.uncommon-knowledge.co.uk/relaxation/benefits.html 7. Retrieved from: http://www.osho.nl/New-Osho-NL/Notes/Maneesha-Inter2.htm 8. What Is Occupational Therapy Anyways Why Does Everyone Keep Talking About This Retrieved from: http://www.sensory-processing-disorder.com/what-is-occupational-therapy.html 9. Relaxation Exercises. Patient UK. EMIS and Patient Information Publications 1997-2006. Retrieved from: http://www.patient.co.uk/showdoc/27000363/ 10. Complementary and Integrative Approaches to Dementia. Medscape. Retrieved from http://www.medscape.com/viewarticle/507362_2 11. Karlikaya, G. et al. Caregiver Burden In Dementia: A Study In The Turkish Population. The Internet Journal of Neurology. Retrieved from: http://www.ispub.com/ostia/index.phpxmlFilePath=journals/ijn/vol4n2/dementia.xml 12. Caring for the Alzheimer's Disease Patient. Geriatric Mental Health Foundation 2003. Retrieved from: http://www.gmhfonline.org/gmhf/consumer/factsheets/caring_alzheimer_disease.html#helping Read More