Katrina: Resources and Recovery

Self Care and Sleep Post-Katrina
Leigh Anne B. Terrebonne, Ph.D.

Adjustment to life Post-Katrina, for even the most resilient, is enormously difficult. So many affected by this natural disaster have been forced into new living arrangements, displaced unwillingly to new cities, suffered tremendous financial losses, lost important possessions, or have had to change schools or jobs. Even under normal circumstances, life changes such as these can produce significant distress and even compromise one’s normal functioning. So many of those affected by Katrina are responding to multiple, simultaneous stressors under abnormal conditions that interfere with normal coping. As discussed elsewhere, emotions such as shock, sadness, anxiety, and irritability are normal responses to disaster or trauma. Health complaints among those affected are also common including GI upset, respiratory problems, headaches, and muscle tension. One of the most common complaints people report having following a natural disaster such as Katrina is difficulty with sleep.

Sleep Disturbances

Sleep problems can take many forms. Problems falling and staying asleep as well as early morning awakening are quite common. These sleep disturbances are sometimes associated with anxiety and depression, both common emotional reactions to trauma and natural disaster. Restless sleep and/or anxiety-filled dream content or nightmares are also common sleep complaints. Bruxism (teeth grinding) has also been shown to correlate with anxiety and depression.

People who have sustained periods of sleep disturbance can experience worsening of mood and even cognitive functioning. Increased irritability, greater sensitivity to pain, and concentration and memory problems are shown to correlate with sleep deprivation.

Increased arousal caused by post-Katrina worries, tension, and depression might affect one’s ability to fall asleep or to remain asleep, and may cause additional sleep disruption, particularly for those with a vulnerability to anxiety, depression, and sleep problems.

Other Factors Affecting Sleep:

Mood and sleep are affected by use of caffeine, nicotine, alcohol, and other substances having a stimulant affect. Excessive consumption of caffeine (which for some may amount to one cup of coffee per day) can interfere with falling asleep causing sleeplessness. Nicotine, a stimulant, also creates interference for some trying to fall asleep. Alcohol, while making it easier for some to fall asleep initially, interferes with the quality of sleep and often caused middle of the night wakefulness. Under stress, many people tend to rely more heavily on caffeine, cigarettes, and alcohol to cope with their emotional distress. At the same time, these substances are likely interfering with sleep quality.

Ways to Improve Sleep:
Basic sleep principles

-Attempt to establish or reestablish routines such as eating meals at regular times and following an exercise program. This is especially important now that normal routines of daily life have been disrupted. Take an hour to relax before going to bed and this means putting away the chores of the day. If you have lots to do tomorrow, write a ‘to-do’ list so that you won’t have to worry that you might forget something.

-As much as possible, try to go to bed at a consistent time and get up at the same time daily.

-If you are experiencing difficulty in getting to sleep, do not remain in bed for any extended period, struggling to get asleep. It is better to get up after 20 minutes, read or watch television (nothing too exciting or engrossing) until you begin to feel tired, and then go to bed. Even if you do not get much sleep at night, try to rise at the same time every day. This has the benefit of ‘re-setting’ your biological clock.

- Avoid taking naps during the day since any nap longer than 20 minutes has the potential to disturb later deep sleep patterns.

- In general, it is best to avoid over-the-counter sleep medications for any extended period. If your sleep problems remain after trying these behavioral remedies, seek the advice of a physician or mental health professional.

Try aerobic exercise

-Regular exercise is one of the better ways to help you fall asleep as well as to improve deep sleep.

-Exercise is also known to have significant anti-anxiety and anti-depressive effects and aids in increasing your resilience to stress.

- Keep in mind that exercising too close to bedtime may have the undesirable effect of physiological arousal, which interferes with sleep.

Watch your drug and alcohol intake

-Try to decrease your use of caffeine, alcohol, and nicotine.

-Ideally, avoid any use of these substances in the two-hour period before bedtime.

Practice relaxation

-Consider adding relaxation time into your daily routine, particularly before bedtime.

- For some, taking a hot bath before bed (not a shower though, which tends to stimulate those with sleep problems) facilitates sleep.

- Deep, slow breathing and progressive muscle relaxation are both useful ways to practice relaxing, a state that is highly compatible with sleep.

Remember to take care of yourself

- As a general rule, we are more prone to forgetting self care when our basic routines are disrupted and when we face intense periods of stress. In times like these, we sometimes need to be reminded to take better care of ourselves.

-Nurturing oneself with sleep, good nutrition, and exercise goes along way towards bettering your mental and physical health.

When to Seek Help

Consider seeing a physician or mental health professional

- If you’ve experienced sustained (more than a few weeks) sleep problems that don’t improve using the above methods.

-If you suspect your sleep disturbance is caused by a medical problem (e.g., sleep apnea).

- If you’ve been experiencing heightened feelings of anxiety, lack of safety, sadness, or other distressing feelings that don’t respond to self-help efforts.

-If you think you may be relying too heavily on over-the-counter sleep medications, alcohol, or other substances.

Other Useful Links:

A compendium of sleep resources can be found at:
http://www.sleepnet.com/links.htm

Harvard Health Publications on Sleep: http://www.health.harvard.edu/Publication_Catalog_Subjects/Sleep.htm

American Psychological Association’s Information on Natural Disasters and Terrorism:
http://www.apahelpcenter.org/articles/topic.php?id=4

Updated on December 2, 2005