Consider grief's role in significant sleep disturbances

Patients diagnosed with complicated grief and sleep disturbance have nearly double the risk of early death.

Consider grief's role in significant sleep disturbances
Consider grief's role in significant sleep disturbances

As a physician assistant and integrative health coach, I often discuss traumatic loss and grief with patients, and as a sleep specialist, I'm familiar with the effect of grief on sleep.

As the population becomes older, it is important for health care providers to know and understand the impact of grief on patients and how to best assist patients with this stage of life.

Every person will experience grief at some point in life, whether it be the death of a loved one or the end of a relationship or job. Any of these situations can impact sleep and health.

Some patients may suffer from complicated grief, which is a prolonged grief disorder. An article from the American Journal of Psychiatry noted that complicated grief is a "unique disorder deserving of specialized treatment." Some researchers believe that complicated grief may be a form of post traumatic stress disorder rather than depression.

As the population lives longer,  couples also spend longer periods of time living with one another and losing a spouse tends to happen later in life, when social circles are smaller and families may be further apart. This leaves the surviving spouse alone and without support in many cases.

Although studies on the impact of grief on sleep have been limited, one study has shown that those who have developed difficulty sleeping and have a sleep efficiency of less than 80% have nearly double the risk early death. Many of us have heard the stories of a spouse dying shortly after their loved one -- the impact of loss may be greater than we realize.

Complicated grief is associated with a decline in global functioning, mood and sleep. Patients may have difficult falling asleep and maintaining sleep. There are often pangs of emotion, yearning for the loved one or avoidance of reminders of an individual.

Depression may need to be managed in these patients. Grief counseling and cognitive behavioral therapy can be an important tool to help patients come to terms with a shift or loss in their lives.

Sleep is vital. Encourage grieving patients to keep a consistent sleep-wake cycle, avoid naps, and exercise regularly If monitored, sleep aids can be useful in these situations, but if there is a risk of falls or other health issues, medication may not be appropriate.

Guided imagery before sleep has been helpful. Having the patient sleep where their partner used to sleep may be helpful, because it may be more comforting than thinking that the partner is no longer sleeping there beside them.

Do you have something that you use in your practice that has helped a patient suffering from grief? If so, please comment and share these techniques.

Sharon M. O'Brien, MPAS, PA-C, is a practicing clinician with an interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.

References

  1. Kowalski S et al. Res Nurse Health. 2008; 31(23-30).
  2. Prigerson, H et al. Am J Psychiatry. 1995; 152(22-30).
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