Grief and Sleep: Lonely Days, Sleepless Nights Pt 1
This subject is particularly close to my heart – I spent a number of years as a bereavement counsellor and have lost a number of people very close to me over the years and more recently, the loss of my husband to cancer.
I thought I would take the opportunity to look at a subject which is rarely discussed until absolutely necessary and – despite the pomp and circumstance of ritual – leaves people unable to articulate their feelings (even if that just means crying).?That energy must go somewhere if not expressed – and will end up not only preying on our minds and stealing sleep but will haunt and even harm our bodies as well.
What Is Grief?
Most people experience five distinct?stages of grief: disbelief, bargaining, anger, depression, and acceptance. These stages don’t necessarily appear in a linear pattern, and it’s common to experience these stages in?different waves of intensity?throughout the grieving process. The intensity of the grief gradually lessens with time, and by around six months, a majority of people are able to accept the loss and integrate it into their lives. .
How Grief Affects Sleep
Sleep, or lack of it, is a common complaint of grief. People who have more grief symptoms are more likely to take longer to fall asleep, wake up for periods of time after falling asleep, and spend a significant portion of their time in bed awake rather than asleep.
People who are bereaved are also more likely to suffer from?middle insomnia, or difficulty going back to sleep after waking up in the middle of the night. Thoughts of their loved one keep them from falling asleep in the first place. Then, once they do fall asleep, they have trouble sleeping through the night due to dreaming about the deceased.
Sleep and Grief: A Bidirectional Relationship
While poor sleep quality is not a diagnostic tool to identify complicated grief, it may increase one’s risk of developing it. A growing number of studies show that sleep disturbance often accompanies grief, and that the sleep and grief share a bidirectional relationship.
As many as 91% of individuals with complicated grief report sleep problems. Forty-six percent say they have trouble sleeping, specifically due to their grief, at least three times per week.
At the same time, those who have sleep complaints during bereavement — including short sleep, trouble falling asleep, and waking up during the night — are more likely to develop complicated grief. In other words, grief not only disrupts sleep, but poor sleep can make the grieving process harder.
Grief is Real: You Just Can’t “Get Over It”
The loss of a loved one changes your life forever. Despite what many well-intentioned folks might advise, there is no “getting over it” or “moving on.”
Part of the problem is that grief isn’t very well understood; what very few people talk about is that the gnawing feelings of grief are rooted in fear.
For example:
Sound familiar?
Relearning to Live Life on New Terms
When you lose someone, you have to relearn your entire life. You have to relearn new ways of taking care of yourself, and sleeping is one of those things.?Grief is not in your mind; it is in your body as well – it must be remembered that whatever one cell of the body “knows” all the cells know – and grief is no different.
?Effects of Grief on the Brain
While many people associate grief with a loss or death, that’s not always the case. People can also grieve when adjusting to any sort of new normal. “Maybe you’re becoming an empty nester, or you’re newly retired; the emotions you experience look similar to grief – and underneath that grief are neurological changes that take place in the brain.” According to?Jannel Phillips, Ph.D., a neuropsychologist at Henry Ford Health System.
The infographic below gives an idea of the areas of the brain impacted by grief:
Dr Phillips goes on to say that when grieving, there can be a disruption in hormones that results in specific symptoms, such as disturbed sleep, loss of appetite, fatigue and anxiety.
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Mental health and sleep?are closely connected, and the painful toll of losing a loved one, home or job can wreak havoc on both.
Complicated Grief: No “Getting Over It”
However, for 10% to?15% of people who experience a bereavement, the intensity of grief does not lessen. These individuals continue to experience intense symptoms of grief, even after six months have passed. This is known as complicated grief, prolonged grief disorder, or traumatic grief and is receiving more recognition from doctors and clinicians.?Symptoms include the following:
Complicated grief is distinct from mental health disorders like?depression?
and?anxiety, although it can often coexist with depression and?post-traumatic stress disorder (PTSD).
A person’s risk of developing complicated grief?doubles?when they’ve experienced the loss of a close loved one, such as a child or spouse. Women, older adults, individuals with a lower income, and those who have lost someone to cancer, are also at an increased risk of experiencing complicated grief.
Grief:?Feeling it in the Body
Grieving does not just present itself with mental and emotional symptoms and, while nightmares, loss of interest, and other emotional effects are often seen when bereaved, there are many?physical symptoms?that are likely to occur, which people may miss because they don’t associate the body reacting to what is happening in the mind.
I’ve been guilty of that myself – as a therapist I should have remembered that high levels of stress due to mourning can cause inflammatory markers to go up – explaining my own joint pains of late, as I manage the of grief caring for and then losing my husband.
Many people experience aches and pains or a general feeling of being tired and having decreased energy, which could be a consequence of sleeping less, in general. Dry mouth, difficulty breathing, and pain or tightness in the chest may also occur. Eating habits may change and some discover a sensitivity to noises.
Clumsiness increases too – making the chance of work or home injuries much greater.
All of these symptoms are not only partially caused by sleep deprivation, they also make getting to sleep even harder. It’s a vicious cycle that leads to the most common effect of grief on sleep: insomnia.
The University of Massachusetts at Dartmouth also identified physical manifestations of grief such as:
Complicated Grief Syndrome: The Pain Goes On
Grief is typically believed to subside within the first 6 months of trauma – but that is just a guide; everyone grieves in their own time. However, people who show signs of grieving past the usual 6-month mark may be considered to be experiencing?Complicated Grief?and might need professional help to ease symptoms.
“Prolonged Grief Disorder” or “Traumatic Grief” may also be used to describe Complicated Grief Syndrome.
Some experts believe Complicated Grief is closer in nature to Post Traumatic Stress Disorder than depression; the syndrome has only recently been accepted as an elevated level of bereavement. However, statistics say Complicated Grief disorder affects somewhere between 7 and 20 percent of those coping with a loss.
There are a variety of tell-tale signs that doctors think could point to a higher risk of experiencing Complicated Bereavement. People who depend on the presence of a loved one for a?positive mental or emotional reward?become attached to this feeling, causing them to be unable to move forward with this symbolic “reward.” Likewise, people who have?historically had a difficult time?dealing with other losses in their life may require extra help in coping with grief later on.
Not All Grief Is Created “Equal”
However, it must be remembered that every single person will experience grief differently and a lot depends on the relationship with the person lost. There’s no one right way to grieve but understanding the unique circumstances of the loss may help indicate a healing path that makes the most sense for the individual.
I found this to be very true as a bereavement counsellor – each person’s response to grief is unique to their situation – and required individual solutions best suited to their temperament and needs.?I often had to do homework to find the key that would help my clients unlock their grief – looking at cultural values, religious beliefs, other relationships, etc.
In part two of this series, we will take a look at the impact of the manner of death and what reactions they elicit, as well as suggested ways to cope with loss.
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