Beating Hospital Insomnia
Last updated: February 2023
It is often said that hospitals are where you go to be treated, but home is where you get well. And that idea comes from the fact that sleep does not come easy while in the hospital. From constant sounds and lights, midnight vital sign checks, and the dreaded 4:00 AM blood draws - good sleep just doesn't seem to happen.
While I was inpatient my sleep was so poor and off schedule, we often joked the best time to sleep was noon because that was the only time I was left alone for more than ten minutes.
And that is indeed how I functioned! Out of necessity, the majority of my sleep came between noon and three each day and I would just accept being kept awake all night.
The effects of sleep deprivation
By the time I got home and it was time to really work on my radical cystectomy recovery I discovered I was dangerously sleep deprived with my entire sleep rhythm thrown off. I could not sleep at night and was exhausted all day.
The sleep deprivation made me weak and hindered my ability to get up and walk as I needed to for recovery. It also made me a truly horrible person to be around. I was angry, confused, and downright mean at times.
Through palliative care, we attempted sleep aides, but the medication did not sit right with me and instead made me anxious and gave me nightmares. We experimented with different dosages and medications, but obviously, that was not the correct route for me. So we decided to try a more practical approach.
It's time for some shut-eye
It was time to develop a solid sleep routine. The idea was a standard routine to prepare for bed each night and my body would adjust to and re-learn a correct sleep pattern. But what does a sleep routine look like?
Everyone will have a different way to tell their body it's time for shut-eye, but this is what I worked on with my palliative care team to break my post-hospital insomnia.
The first step is to choose a time to start winding down and do your absolute best to stick to the same time every single day. And surprisingly, it is much earlier than you think. Giving yourself a solid 3 to 4-hour routine gives your mind and body time to settle after a long day.
My routine starts at 6:00 PM, this is typically when my house has dinner. I make a point to try and have dinner around the same time each night - always leaving exceptions for special nights out. On a typical night, sitting down for dinner is my shift from workday to winding down for bed.
The next vital step having a hot shower or bath each night, even if you always have a morning wash. Treat yourself like a toddler, bath time is part of the bedtime routine.
Why does this work so well for young children? After a warm bath, your core temperature will drop a few degrees, and this drop signals to your body that it is time for sleep. This is why a good hot shower can be so relaxing after a long day.
I try to take my shower just before getting into bed so that I can make use of the natural sleep signal and not have it interrupted by last-minute chores or tasks in my day.
Electronics go bye-bye-bye
Once in bed, the electronics go away. For me, I struggle with drifting off if the TV is on, and scrolling on my phone can easily steal hours if I let it. I even draw the line at reading digital books.
It has been proven that the blue light on electronics tells our brains to be awake. So all of it has to go. Often times I'll just lay in bed snuggling my dog and chatting with my husband for a while until sleep catches up to me.
When push comes to shove
Initially, this routine did help me fall asleep but I still struggled with waking up regularly at 4:00 AM, like I would for blood draws. It was frustrating to wake up so early and be wide awake.
The great advice my palliative team gave me was to do one of two things. If I woke up but felt tired and as if I could possibly go to sleep, I should get up, wash my face with warm water, change pajamas and get back into bed. If I felt very awake and like I wouldn't be able to go back to sleep I should just go ahead and get up and start my day, but the rule was no naps during the day.
For option one, something about the pseudo "bath time" and the act of putting on pajamas really did help me fall back asleep. For option two, getting up and starting my day, but not napping ensured I was properly tired by the end of my day. Daytime naps can easily throw off sleep rhythm if it's something you are working on.
Beating hospital insomnia
It took a solid two weeks of follow-through, but eventually, I found myself back on a more appropriate sleep schedule and feeling much more rested. That is when I finally noticed an improvement in my recovery as well.
Over two years later I still follow my same sleep routine, but I also still suffer from clusters or individual nights where sleep evades me. This unfortunately can be a permanent side effect of spending so much time in the hospital. I follow my team's advice and make sure I do not nap after nights when sleep has been a struggle, and 90 percent of the time it ends up being a one-night thing.
What do you include in your bedtime routine? Tell us about your experience in the comments below, or share your story with the community.
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