On the Road

The Caregiver's Caregiver will on the road for the next week or so; following the course of Arnie's surgery and recovery.  The caregiving journey will be seen through the eyes of his immediate family. It will begin on the ride to the hospital, the inpatient stay, the trip back home and will continue the rest of Arnie's life.  Hope you will be a part of the journey with us.

Please add your comments and experiences as we can all learn from each other's experieinces.

It's Different for Men, Part 4

Men and women often seem to speak different languages.  Men are more likely to approach a problem in a direct and pragmatic manner and in certain situations that is exactly what is needed.  Women more frequently will assume the role of listener and comforter in similar circumstances allowing the individual to reach their own conclusions or gently guiding their path.  Each individual and situation remains unique in the avenue it takes to reach a resolution.          

Over this past weekend, my Dad had the opportunity to talk with Joey, a member of the community who had the same diagnosis he currently does, has gone through a similar surgery and is coping successfully with the lifestyle changes the surgery entailed.  They spoke privately; the conversation was not long or intense but at its conclusion my Dad felt a sense of camaraderie and relief.  Joey is a “having-been-there” caregiver.   Many times there is no better teacher than one who has walked the same path and can share their experiences honestly and constructively with others.  

This experience reminded me that I have spent many hours teaching and supporting individuals and caregivers in learning new skills.  As a nurse, I have reinforced the instructions already given to my father.  As a daughter, I have listened and reassured my father when questions and doubts have arisen.   Yet, it was Joey who spoke the language Dad needed most to hear-- the voice of one who has walked the same path, stumbled over similar obstacles and is there to reach out to another in need.

Thank you Joey.  

It's Different for Men, Part 3

John and Loretta were an elderly couple who had both been widowed for years when they married in their early seventies.   Loretta had two adult children who lived nearby but John had no children.   After a dozen years of marriage, John began to notice changes in Loretta’s mental and physical abilities; both chose to overlook these “mishaps” for as long as possible.  She was finally diagnosed with both Parkinson’s and Alzheimer’s disease; Loretta’s disabilities advanced rapidly with her speech and swallowing skills most affected. 

When I met them, she had just been discharged from a skilled nursing facility after a hospitalization for aspiration pneumonia.  Loretta could no longer take any foods or liquids by mouth and her speech was severely garbled.  A feeding tube had been placed in her stomach; she was to get around-the-clock feedings and medications through it.  As often happens after a debilitating event, the disease processes had further progressed and she now required assistance with ambulation and personal hygiene. 

We worked together to make a list of her medications, the times they would be due as well as the feeding schedule.  John would have to learn how to instill the tube feedings, care for the insertion site and troubleshoot the equipment-- yet more new tasks were to be added to his plate-- Loretta now also required  her blood sugars tested several times a day and insulin given when needed.

The next day, I returned and John had designed his “organization”.  Pill bottles were lined up on the kitchen counter, a chart was made for every activity required which encompassed almost every hour of the day and a notebook had been started to record blood sugar values, doses of insulin administered, feedings completed and medications given.  I noted that the details were regimented with no room for human variance which is so very common in the day-to day life of a caregiver. 

No one could fault his efforts but I asked a few question; “Did you get any sleep last night…did you eat breakfast…did you take your own medications?”   The answers were all negative.  The effects of this wear and tear on his health and well-being were already evident.  John’s only plan was to do whatever it would take to keep Loretta home but even he realized on that second day what an incredible task this would be.  Their family doctor was agreeable with any suggestions I made but their insurance company was not; home care was allowed only 5 visits to provide all the teaching and support John and Loretta would need.  Because of these intense limitations, John was very anxious to obtain outside assistance immediately--other family members refused to help--  fortunately two women from their church were available for several days each week. John insisted that he alone would be responsible for the feedings and medications but they could help with Loretta’s hygiene needs and housework as well as remind John to take his own medications and meals.

 

John’s approach to Loretta’s caregiving needs is a very common one; most men who provide care for a loved one are recognized for their organizational skills, their attention to detail, their “get-er-done” approach to these responsibilities.  These are all admirable traits for any caregiver but no more so than the hands-on, nurturing skills women are more likely to bring to caregiving situations.   

Men are also more willing to recognize that they need help and will seek additional support; their reasons may vary but common ones include embarrassment with providing the intimate care often required, other family commitments and financial responsibilities.  Women much more frequently have a difficult time admitting their need for additional help; they are intent on doing everything themselves that their loved one requires as they sense they should be able to handle all tasks.  Regardless of gender; the risk of fatigue, emotional and physical stress and social isolation are factors that can occur and are often avoidable in the caregiving experience.     

It's Different for Men, Part 2

One day several years ago, I stopped in after work to help with the caregiving responsibilities as my mother was recuperating from a total knee replacement.  When I entered the usually organized and immaculate kitchen, I was surprised to find a half dozen post-it notes attached to each cabinet door.  The notes read; “pills, cups, soup bowls, napkins…”  I quickly and quietly pulled my father aside and asked him what was going on, his reply was humorous but not surprising; “Your mother told me she would not tell me where another thing was in this kitchen, I would just have to find it for myself.”   Knowing both my parents, it was easy to understand that my father had asked repeatedly where the same item was and my mother frustrated with the new limitations she was experiencing had reached the end of her patience.

My dad had also been forbidden from washing any of her clothing, he begged me daily to please wash the items as my mother would not be happy to see the soiled clothes in the basement.  I reassured him that this was one concern he did not have to worry about as Mom could not yet maneuver the cellar steps and she would not be happy if I washed a load for just one or two items.   

By the end of the second week, the constant togetherness had become a great source of irritability, especially for my mother.  Prior to the surgery, they were used enjoying different activities individually and as a couple.  Dad was now afraid to leave her alone and she was not used to perpetual companionship.  On Friday, I arrived and relieved Dad from his caregiving duties in time for the local high school football game.  His car was not even out of the driveway before my mother asked 2 things of me-- to go and get her an apple dumpling from the local ice cream shoppe and to not rush back-- she really wanted and needed some time alone.

While these experiences are humorous in the re-telling, similar events occur in many households across the nation.  Older couples, especially those whose lives began in the depression-era and bloomed into marriage and families in the post-World War II years, learned to act in certain predetermined roles and in the homes of many elderly residents these roles remain intact.  Men worked outside the home, repaired the cars and mowed the grass while women carried the responsibilities of housework and child-rearing.  Even when both worked outside the home as my parents did, the woman was twice as likely to provide the care inside the house. 

This division of labor functions well for many couples until illness or injury affects their usual routines. Reversing roles and learning new tasks is often difficult and sometimes overwhelming.  The wife who never drove or the husband who never managed the household budget could face impossible obstacles.  The other spouse may express anger or depression related to the unavoidable changes in lifestyle.

Often as in the case of a planned procedure or a slow progressing illness, the changes that will need to occur can be learned at a reasonable pace, instructions can be written or additional outside assistance can be arranged.  Once mastered, the new skills should not always be relinquished to the recuperated owner of the responsibility, sharing the tasks may be possible.  On the other hand, the caregiver should not be quick to assume duties that the individual can still complete.  The benefits of the team approach in caregiving may make the obstacles feel less insurmountable.    

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It's Different for Men

Statistics tell us that there are approximately 65 million adults who care for a family member or friend in any variety of settings in this country.  In a report recently published by AARP and the National Alliance for Caregiving; more than two out of three of these caregivers are women but there are approximately 14.5 million men now assuming caregiving responsibilities.  This is a significant number and a rapidly increasing one in our society.

Men and women often have similar life experiences and challenges yet studies have demonstrated that the genders have dramatically different communication, operational and coping styles; the way they approach the role of caregiving is no exception to this diversity.  All caregivers share the fatigue, fear and isolation that caregiving can bring to the dedicated family member. 


The first in a series

Happy Father's Day

I want to thank the four most important men in my life-- my maternal grandfather, George, my father, Arnold and my uncles, John and Frank-- for teaching me the three most important things in life; the love of God, family and the strength of gentleness.

I wish you all a Blessed and Happy Father's Day.

On the Other Side of the Bed

Over the last few days, I have had the opportunity to assume the role of family caregiver and during this time there have been numerous interactions with professional caregivers.  Observing their actions and listening to their words has reinforced the impact their approach can have on both the individual and the caregiver in stressful situations.  All caregivers make an impression on those in their care and should integrate certain actions into their role:  

• First and foremost, caregivers should always introduce themselves and their role to the individuals in their care.  A sincere smile and direct eye contact are very important in acknowledging the importance of both the individual and the caregiver in the current situation.  When at all possible, reach out and shake their hand, touch their forearm or pat their shoulder; touch can be comforting and confidence building.  They deserve your full attention.

• Explain what is about to occur or what has occurred, how long the procedure may last, what the expectations are and what concerns or problems are present.  Prepare them if there will be pain or discomfort.  Discuss these topics at the level of their understanding; repeat the information and instructions several times if need be.

• Take time to listen to their concerns and answer their questions.  If the answer is not known, admit it and obtain the answer when at all possible.  What is routine for the professional caregiver may be a new and frightening experience to the individual and their caregiver. 

• Offer sincere reassurances when appropriate; “It is almost done”, or “You are doing a great job” especially if any of the senses are compromised or pain is involved to decrease fear and anxiety.  

• Make sure they know what the next step in their care will be; a follow-up appointment, a phone call and the approximate time frame they will have to wait to obtain results.  Waiting can be incredibly anxiety producing.

This same advice is valid for any caregiver in any role they assume for an individual in need.  Standing or lying on the other side of the “healthcare bed” is not only a unique experience; it is a great learning tool.

The Language of Touch

Recently, the benefits of human touch have made headlines in seemingly unrelated nightly news reports …but are the stories really that different?   They both demonstrate the struggle of a hard fought battle and the powerful shield touch provides.  

During a recent national basketball championship game, the camera caught one player reaching out to touch his teammate’s back during a critical moment--that simple touch was a vote of support and confidence.  It had a calming and successful effect on the other player’s performance.  Science supports this too; several social psychologists from the University of California-Berkeley recently analyzed hundreds of hours of professional basketball films and concluded that the teams that touch the most win the most. 

The other story focused on the incredible improvement in Rep. Gabrielle Giffords condition since the gunshot wound she suffered to her brain in January.  Much credit is given to the physical contact she received from family and friends at her bedside.  Again and again we were shown the simple grasp of hands that she and her husband shared as she lay unresponsive.  Did this gentle human contact contribute to her quick recovery?  Touch can forge a bond of trust in its simple silence.

Caregivers--family and professionals--practice the healing effects of touch each and every day as they provide care to another whether they are meeting physical or emotional needs.  The delicate touch to a hand, a gentle pat on the back, and a tender hug are all seemingly small physical gestures with powerful rewards for both individuals involved.  Caregivers often need to learn to accept the same sense of comfort, peace and pleasure touch can bring into their lives.

Finding the Answers

Reggie and his wife Gina are a delightful couple in their early 70’s; active with their family and community, working part-time jobs and facing a variety of health care problems together.  One Saturday afternoon while sitting at home, Gina suffered a stroke that has left her paralyzed from the waist down with no ability to control her bladder or bowels.  She has been hospitalized over a month now and her anticipated discharge to their home is to occur in about two weeks.  After several conversations, Reggie is finally  more realistic of all that homecoming will entail but it has taken many crises to reach that point.

Reggie and I have spoken weekly since the event occurred.  Initially, he was devastated but very certain that Gina would be coming home and everyone in the family would help care for her.  His focus was on having a ramp built so she could get in and out of the home.  Reggie wasn’t yet able to hear my cautions concerning all he would need in order to bring Gina home and to provide the care she would need.  I encouraged him to speak with the discharge planner at the facility.  His reassuring reply was; “my daughter talks with those people”.  When I expressed concerns over his well-being he would laughingly say; “I take care of myself just fine, I rest when I am visiting with Gina at the hospital.” 

On the next call, Reggie was hopeful that Gina would walk again after rehab as the focus would be on getting her legs stronger instead of the extenuating problems they were experiencing in stabilizing her other health care issues. Gina had developed several infections during her stay and Reggie’s mood was bleak but his focus was becoming more realistic; “…how can I ask our kids and grandkids to give up their time to help in their mother’s care… but how can I do it alone?”  He would still need to work outside the home to meet their expenses.  I listened and offered emotional support but my concerns were that once Gina came home, he would be carrying the very heavy workload of providing care alone with only intermittent home care services.  Reggie was still not ready to really hear what was being said and he continued to allow his daughter alone to meet with the discharge planner.

Then, Reggie became ill from the stress, fatigue and lack of self care of his own health care needs.  Reggie had tried so hard to stay strong for everyone else and to not concede to the normal fears and realizations the situation brought into their lives.  He was hospitalized for several days.  Unfortunately, it took this crisis for him to realize he needed to be honest with his wife and children about his ability to care for Gina in their home.  Finally, he was going to ask for a family meeting to discuss the realities of the situation.  He would then meet with the discharge planner and his family.  I tried to gently broach the subject that the best place for Gina at this time may not be their home. He seemed more receptive to this possibility now.  

In Reggie and Gina’s situation, family was there and willing to help but the game plan was not well developed.  In crucial times like these, an experienced discharge planner can be invaluable in identifying the actual care that will be needed, informing those involved of the community resources available and recognizing obvious and sometimes not so obvious stumbling blocks that family cannot always see.  Getting the primary caregiver and other family members who will be involved after discharge together with the planner as soon as possible after the individual is hospitalized is vital and can save countless hours of anxiety and misinformation.   

 

In Reggie and Gina’s situation, family was there and willing to help but the game plan was not well developed.  In crucial times like these, an experienced discharge planner can be invaluable in identifying the actual care that will be needed, informing those involved of the community resources available and recognizing obvious aetimes not so obvious stumbling blocks that family cannot always see.  Getting the primary caregiver and other family members who will be involved post discharge together with the planner as soon as possible after the individual is hospitalized is vital and can save countless hours of anxiety and misinformation.   

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Heat Wave

Most summer health problems produce only discomfort or embarrassment for the individual affected; heat rashes, sun burns and heat cramps are the most common ones.  Learning about these irritating problems is important to guarantee a more comfortable summer and to differentiate from more serious summertime conditions.

• Heat rash is a skin irritation caused by excessive sweating during hot, humid weather.  It appears as a red cluster of pimples or small blisters and usually occurs in the creases of the body; elbows, under breasts, groin region and behind the knees.  The best treatment is staying in a cool environment, keeping the affected area dry, and if using a dusting of powder it is important to apply to dry skin and to remove completely by washing the area, rinsing well and patting completely dry at least once a day.

• Sunburn is caused by overexposure to the sun.  The affected skin becomes red, painful and abnormally warm.  Blisters may develop as the degree of burn worsens.  It can be prevented by using a SPF 15 or greater sunscreen before going outdoors and reapplying it throughout the day, covering exposed skin with lightweight clothing and hats and avoiding sun exposure during the hottest time of the day usually from noon until 4pm. The best treatment includes avoiding repeated exposure, applying cold compresses and moisturizing lotions to affected areas.  Do not use salve, butter or ointment.  Do not break blisters.

• Heat cramps are muscle pains or spasms- usually in the abdomen, arms or legs-- and often occur with strenuous activity because of the loss of salt that occurs from excessive sweating.  The best treatment includes stopping the activity, getting into a cool place, drinking juice or a sport beverage and resting.  If the cramps last longer than one hour, medical attention should be sought.

Even short periods of high temperatures and severe humidity can cause health emergencies that may be life-threatening.   It is important to stay informed during extreme heat conditions for health and safety updates, to take precautions to protect yourself and your loved ones and to be prepared to administer first aid treatment.

• Heat Exhaustion is a heat-related illness that can develop after several days of exposure to high temperatures and inadequate replacement of fluids thus causing excessive loss of water and salt from sweating that can result in dehydration.

• Signs of heat exhaustion include: heavy sweating, paleness, muscle cramps, tiredness, weakness, dizziness, headache, nausea, vomiting and fainting.

• The best treatment includes drinking cool, nonalcoholic drinks, resting in an air conditioned environment and taking a cool shower or bath.  If the individual cannot keep liquids down, they will need to be evaluated by a physician.

• Heat Stroke is a life-threatening condition that occurs when the body can no longer regulate its own temperature; the body’s temperature will rise rapidly, the sweating mechanism the body relies on to keep its temperature in balance fails and the body cannot cool itself down.  Individuals who are bedridden and don't have access to water and are not in an air-conditioned area are at a very high-risk of developing heat stroke. This condition can lead to brain damage, organ failure and even death if not treated quickly.  

• Signs of heat stoke include: fever above 103 degrees orally, red, hot dry skin, rapid strong pulse, throbbing headache, dizziness, nausea, confusion, seizures and loss of consciousness.

• The best treatment includes calling for assistance immediately, moving the individual to a shady or air conditioned area and begin to cool their bodies down rapidly this can be accomplished by applying cool compresses to neck, groin, armpits regions, spraying them with cool water from the garden hose, wrapping them in a cool wet sheet, or assisting if able into a cool bath or shower.   Do not give the individual fluids to drink. Do not give aspirin, acetaminophen or ibuprofen to lower fevers.  Do not give salt tablets.

Nearly half the country is currently experiencing a heat wave; already seven heat-related deaths have been reported and there is a very realistic possibility of more yet to occur.  We need to be aware of those that may be most at risk and how we can best protect them from heat- related illnesses.  The seriousness of these risks is heightened if the individual is a child, elderly, pregnant, obese or injured.  Some medications--high blood pressure and water pills especially-- may intensify the threat.  Healthy, athletic individuals can also be affected if the warning signs are ignored.  As the dog days of summer come early delivering hot temperatures and high humidity, the goal is to keep everyone cool and comfortable.

Beat the Heat

Summer is upon us with all its heat and humidity, at times reaching extreme levels.  Many individuals especially infants, small children, the elderly, and those with chronic medical conditions or are prescribed certain medications suffer heat-related deaths and illnesses because their bodies can not compensate to extreme heat. 

Here are some simple tips that can prevent this from occurring: 

• Stay informed.  Listen to your local news and weather channels during extreme heat conditions for health and safety announcements and follow their advice.  This is also important for those suffering from breathing problems or allergies, ozone or allergen warnings are frequently issued during the summer months.

• Get cool and stay cool.  Air-conditioning is the number one protective measure against heat-related illnesses and death.  During times of extreme heat, if your home is not air-conditioned spend time in locations with air-conditioning-- shopping malls, public libraries, movie theatres or heat-relief public shelters in your area--during the hottest times of the day.  Electric fans can help to provide comfort but once the temperature soars above 90, fans alone will not prevent heat-related illnesses.  Cool showers or cool sponge baths are another way to cool off.  Avoid using the oven during the mid day can also help to decrease the temperature in your home.  Keep meals light and cool too.

• Drink more.  Do not wait until you are thirsty to begin to replace fluid loss.  Cool, nonalcoholic beverages are needed to increase fluid intake regardless of activity level.  A sport beverage can replace the salt and minerals lost from perspiration, alternate with a non-sodium rich beverage.  Those individuals on a low-salt diet should contact the physician before drinking a sports beverage or taking salt tablets. If you or your loved one are prescribed  fluid restrictions because of a medical condition, contact the physician for further advice. Alcohol or heavily sugared drinks actually increase the loss of body fluids.  Extremely cold beverages may cause stomach cramps.

• Dress down.  Wear as little clothing as possible and keep it lightweight, light-colored and loose fitting.

• Pace activities.  Try limiting outdoor activity to morning and evening hours.  Take frequent breaks in the shade or cool areas to allow your body to rest and recover.

• Work smart.  If you must work outdoors; wear a wide-brimmed hat, sunglasses and sunscreen of SPF 15 or higher; apply the sunscreen 30 minutes before going outdoors and reapply it according to package directions.  Begin outdoor chores at a slow tempo and increase your level of activity gradually.  Symptoms of lightheadedness, shortness of breath, palpitations, weakness and confusion are signals to stop all activity immediately.  Get into a cool area, drink something cool and allow your body to rest and recover.  

• Travel smart.  Never leave children, elderly individuals, those with disabilities and pets in parked cars for any length of time, automobiles heat up very quickly and the temperatures can rise 20 degrees in 10 minutes.  Always have fresh beverages available on your summertime journeys.

Although anyone at anytime can suffer from a heat-related illness, some are at greater risk than others.  The creation of a twice-a-day telephone or check-in buddy system with those who are more prone to heat-related problems is very crucial to the safety of loved ones and community members.  Heat-related tragedies can be prevented.  

Carry On, Survivors

My Dad is a survivor.

He was the last of 11 children born to Italian immigrant parents and as family lore has it his oldest sister and her husband were given the honor of naming him.  My father’s given name is Arnold but as he grew up his eldest brother was frequently directing him with the command of “you go”; soon he began to believe that this was his really his name. 

He matured quickly in a depression-era childhood and began to work seven days a week doing a “man’s job” at the age of 13, shortly after his father died. He had the opportunity to go to college on a football scholarship only to have that derailed after one year so he could continue to support his family; he grew stronger despite his broken dreams. 

He served in the US Army during Korea.  He worked as a firefighter for 28 years and endured the numerous physical and emotional assaults the profession brings.  He also worked countless side jobs to support his wife and children.  

He carried on through several major bouts of depression.  He had both his knees replaced on the same day and gained several inches in the process.  A week shy of a year ago, he underwent a six vessel coronary bypass.

His latest crusade is against bladder cancer.  As his daughter, I wonder “why should he have to fight such a big battle at this time of his life?”  I know better than to expect an answer to my question.  Dad has completed his prescribed chemotherapy.  Another major surgery is facing him in less than a month. He is ready to face the challenges and major life changes this surgery will bring for him at the age of 81.  

My Dad is a survivor.

My gratitude goes to all cancer survivors; your crusade from day of diagnosis is a constant source of inspiration and strength to those who know and love you.  Thank you

E. Coli: Behind the Headlines

Another health scare is dominating the headlines this week:  the severe European E. coli outbreak. The outbreak appears to be linked to contaminated vegetables, and European authorities are warning against eating raw lettuce, cucumbers, and tomatoes.  So far, 18 people have died, making this outbreak the deadliest in modern history.  Germany has been especially hard hit, with more than 1,700 people infected; more than 500 of them have severe kidney complications.

U.S. Government officials and health monitoring agencies do not believe any contaminated vegetables have reached our shores.   While that is reassuring, we should use this as an opportunity to become smarter about E. coli and the good practices that help prevent illness due to food contamination. 

E. coli is an incredibly common bacterium; there are hundreds of strains and most of them are harmless.   Some strains live in our intestines and actually aid with digestion.  Other strains can produce toxins that can cause symptoms like diarrhea, dehydration, kidney failure and even death, especially when major organs like the kidneys are infected.

E. coli-related illnesses usually come from contaminated water sources, unwashed vegetables and undercooked meat.   Basic hygiene is the first line of defence against E. coli.  Hand-washing takes on enormous importance when we are working in dirt, using the toilet, dealing with soiled laundry, or changing an individual who has urinated or stooled.   Swimming in untreated waters is another particularly viral source of contamination. 

Should we forgo our five-a-day vegetable habit during such outbreaks?  The answer is no.  There is no reason to stop eating fresh vegetables in the United States, as officials are monitoring the situation carefully.  But at all times we should take the following precautions with raw fruits and vegetables: 

·         Purchase produce from reputable sellers.

·         Wash all fruits and vegetables; use cold water and a vegetable brush to remove obvious dirt then perform a second washing with a gentle soap.

·         Wash pre-packaged vegetables even if the label indicates they were pre-washed.

·         Remove layers of lettuce in the washing process, because dirt can hide within the layers of leaves.

·         Peel those fruits and vegetables that can be served in this manner.

·         Always cook food to appropriate temperatures and times.

If you think you may have eaten produce that has caused an illness, the most common symptoms include diarrhea, nausea, vomiting and abdominal pain.  These signs may not appear until a week after consumption.    Bear in mind that many other illnesses can cause these same symptoms, so don’t jump to bad conclusions.  Contact your doctor if you have concerns that you may have developed a food poisoning problem.  Your doctor may not prescribe antibiotics, though, because many outbreaks are now harder to treat precisely because the organisms causing the illness have become antibiotic-resistant.   

Jump-Starting Your Day

Many caregivers find it difficult to fall asleep or stay asleep at night.  This dilemma can lead to a condition called sleep inertia -- the feeling of grogginess or sluggishness we often experience immediately after waking up.   Sleep inertia can dull memory, slow reaction time, and impair decision-making abilities, as demonstrated in studies by Dr K. Wright of the University of Colorado.  These difficulties may persist for several minutes to an hour or longer after awakening.  Most caregivers wake to a non-stop day and don’t have the luxury of a gradual “wake-up” time, so they need to be especially aware that making important decisions or tackling tasks that require intense focus (such as preparing pill organizers) should be avoided until they are fully awake and alert.

Experts have some suggestions that may help you get out of bed more alert and ready to face the day:

• Stay in bed a little longer.  Allow yourself an extra 10 minutes of quiet as you wake up to allow your brain to clear.
• Let the light in.  As soon as you arise, open the window blinds, turn on the lights, or step outside into the morning sunshine when weather permits.  Light will help you to wake up and feel alert faster.
• Get moving.  Take a shower, a short walk or exercise to stimulate wakefulness.
• Engage in conversation.  Talk to someone!  The back- and-forth dialogue will pep you up and rejuvenate you for the day.
• Have a caffeinated drink.  This stimulant has the ability to block the chemical in the brain that causes drowsiness.  Coffee contains the most caffeine, but other drinks (including hot chocolate) do as well.  Within 20 minutes you should feel an improvement in memory and reaction time, according to a study in Austria.
• Eat something.  Breakfast will jump-start your brain and improve your memory.  High-fiber foods, such as oatmeal, are packed with glucose , the brain’s main fuel.
• Take a whiff.  A few drops of essential oil of peppermint on a handkerchief and take a sniff.  That will boost brain activity in the area that controls wakefulness, as established by Dr B. Raudenbush at Wheeling Jesuit University in West Virginia.

Caregivers need all the rest they can muster.  Naps may become a part of the daily routine for both the caregiver and their loved one.  Keeping your nap to less than 25 minutes will help to avoid post-nap sleep inertia and prevent the night-time sleeplessness that longer naps may produce.