As we age, our bodies undergo numerous changes, and one often overlooked aspect is the disruption of the natural cycles that regulate our sleep-wake patterns (circadian rhythms). For residents in care homes, this disruption can be particularly challenging, impacting their overall health and wellbeing.
Poor sleep can negatively affect mood, cognition and overall health, it is therefore, crucial to address these issues in care home settings.
Care homes must accommodate residents with diverse backgrounds, each bringing their own unique circadian rhythm challenges.
Interestingly, a resident's previous occupation can play a significant role in how their circadian rhythm is affected in later life.
Certain occupations, especially those involving irregular hours or night shifts, can lead to long-term alterations in circadian rhythms.
Many care home residents experience sleep fragmentation, waking up multiple times during the night. This can be exacerbated by previous shift work or high-stress occupations. This can cause severe confusion for residents living with dementia, as they may then (in their half-sleepy state) proceed to prepare for their working shift on autopilot.
Nurses, factory workers, and security personnel, for instance, often work non-traditional hours. The disruption of sleeping during the day and being awake at night can lead to a condition known as shift work sleep disorder (SWSD). Even after retirement, these individuals may struggle to adjust to regular sleep patterns.
Occupations with high stress levels, such as emergency responders, military personnel, and corporate executives, can lead to chronic stress and anxiety. This can lead to high levels of stress hormones like cortisol which can disrupt sleep patterns, making it difficult for these individuals to establish a stable circadian rhythm.
Residents who have previously travelled often with their work, (pilots, flight attendants, and business travellers) will have experienced jet lag regularly through frequently crossing time zones. This constant resetting of their internal clocks may result in a long-term circadian rhythm disruption, affecting sleep quality and consistency.
Farmers, construction workers, postmen, milkmen and athletes will often have experienced schedules dictated by natural light and physical activity. Their circadian rhythms may be more in tune with natural day-night cycles, potentially leading to better sleep patterns. However, retiring and moving to a less active, indoor lifestyle can disrupt these well-established rhythms.
Residents with disrupted circadian rhythms often struggle with excessive daytime sleepiness, leading to napping and further disturbing nighttime sleep.
My HOPES approach to care home activities planning covers each part of the jigsaw needed to create person-centred activities.
H stands for HISTORIES, O stands for OCCUPATIONS, P stands for PREFERENCES,
E stands for EXPERIENCES and S stands for STRENGTHS.
Learning about a resident's previous occupations can guide the creation of personalised daily schedules that align more closely with their natural rhythms.
Encouraging regular physical activity during the day can promote better sleep at night. Activities should be tailored to the resident’s abilities and previous lifestyle. Exposure to natural light during the day and minimising artificial light at night can help too.
Try to keep to consistent daily routines to help reinforce regular sleep-wake cycles. This includes scheduled meal times, activities, and bedtime routines.
Relaxation techniques, and social activities aimed at reducing stress levels can help improve sleep quality.
By recognising the long-term impacts of different types of work, activity coordinators can implement strategies to help residents achieve better sleep and overall health, ultimately enhancing their quality of life.
As we strive to create more personalised and responsive care environments, addressing the unique circadian needs of each resident will become increasingly more important.
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