How to deal with some common disruptions and sleep better

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We tend to think of sleep as personal, a process confined to our bodies. But sleep occurs in a social context, even for people who live alone.

We share time zones; work standardized hours that incline most of us to sleep at similar times; abide by noise ordinances at night; limit light, sound and rolling over to accommodate bed partners; and suffer with all-night snowplows and early garbage trucks. Even our private ruminations as we lie in bed with insomnia are often about other people.

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As a sleep psychologist, I treat individuals. But the irony is that often their problems are inflamed by other people. Even within the milieu of a cooperative household, one person’s sleep can occur at the expense of another person’s sleep. Examples include snoring and caring for an infant throughout the night.

Emotions may run high on all sides and complicate interventions. But we can make choices that might benefit everyone’s sleep.

Here are a few of the most common interpersonal scenarios I encounter, and some suggestions that have helped my patients and may help you. Don’t hesitate to seek individualized health care as needed.

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Family members in distress

Elderly parents or their caregivers call at odd hours in crisis. College-aged children text or call in tears late at night. Partners bring up serious concerns at bedtime.

The unpredictability and urgency of these requests can make it hard to relax, and the effects can reverberate for hours.

We might prefer to be available 24/7, but we don’t always have the choice. Struggles can persist for years, and it makes sense to consider alternatives such as:

- Establishing boundaries with family members about hours you are available, and speaking with caretakers about situations under which you should and should not be contacted.

- If you have siblings or a partner, creating a rotating on-call schedule with them.

- Scheduling check-ins earlier in the evening.

- Securing more services for the person in distress.

Thoughtfully convey and abide by your limits. This can help you not to fear and resent others’ needs, and perhaps help them to understand the importance of limits.

Also try to examine whether you tolerate too much because you feel excessively responsible and guilty.

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A partner who has sleep apnea

It’s not easy to sleep next to someone with untreated apnea. The cessations in breathing can be worrisome, and the snoring disruptive.

But not everyone with significant apnea accepts treatment. Some feel fine, question the validity of their overnight diagnostic test in the sleep lab, don’t feel too concerned about future cardiovascular risks, and are wary of using a positive airway pressure (PAP) machine (which is one of several possible interventions; I wrote about a CPAP adaptation regimen here). Yet it can be detrimental to loved ones to refuse treatment.

On the other hand, I am struck by how often partners do not speak up about their own suffering. They ironically seek help for their own sleep. It is only through talking that I learn that they sleep well when the individual with apnea is away or in the other room.

Speaking up would be self-respecting and could encourage the apnea sufferer to commit to seeking help. But there can be complex power dynamics at play. If speaking up feels too fraught, consider consulting with a therapist.

To help until treatment can be established, you could try sound mitigation. Sleeping apart is sometimes preferred.

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Noisy neighbors

My patients have dealt with it all - from oblivious upstairs neighbors dragging chairs across the floor at 3 a.m. to intentional harassment with slammed doors to all-night motorcycles and drug deals. They’ve endured indifferent landlords and retaliation for polite requests. You may have your own such experiences.

If a neighbor is insensitive but not abusive, and the noise is far from a nightly occurrence, what we invariably work on (besides all-important sound blocking) is preoccupation. My patients lie awake anticipating disruption even when none is forthcoming.

Assuming no real danger, try to reframe your task as allaying preoccupation. Then it becomes mostly a matter of where else to put your mind and of soothing self-talk.

You can also work to cultivate feelings of safety through reminders that you are safe; use of mantras for a few minutes each day and when you are anxious; noting your own anxiety (vs. focusing on what you are anxious about); and cognitive techniques for diminishing catastrophic thinking about sleep or the neighbors among other methods.

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A partner with ADHD

People with attentional issues are overrepresented in any sleep practice because of challenges with getting to bed and falling asleep. When I see a sleep patient with attention-deficit/hyperactivity disorder, we discuss multiple strategies to work around those challenges.

But if you live with someone with ADHD and associated sleep trouble, you may have experienced disruption to your own sleep and household routines. Their moving about at night and inconsistent or delayed schedule may interfere with your falling or staying asleep. In addition, you may lie awake with worry about them and with frustration and worry about your sleep. If they are not awake to help with morning tasks or are depleted and forgetful, you may feel the stress of overwork and resentment.

In my experience, many partners provide helpful structure and reminders, but they sometimes adopt a parental, exasperated tone toward the individual with ADHD. They may misconstrue their loved ones’ challenges as willful obstinacy or signs of not caring.

It can help to take control of one’s own sleep rather than relentlessly attempting to induce the other person to change.

Consider whether you can destigmatize ADHD and adopt the attitude of a supportive equal. Both partners should respect ill feelings that may have built up over time and figure out an equitable division of household tasks that plays to each person’s strengths and rhythms. Flexibility helps. Sincere effort and recognition of all that both partners do can go a long way.

While the onus is generally on the person with ADHD to accommodate others’ schedules, both members of a couple need their sleep. Agree to rules about sensory intrusions. Separate bedding or bedrooms and sound mitigation might help with mismatched bedtimes. The person with ADHD should know that professional sleep help is available. If inequities persist, consider other ways to get relief.

We inhabit an interdependent sleep ecosystem, where our choices affect others and theirs affect us. Thoughtful action can bring relief.

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Lisa Strauss, PhD, is a clinical psychologist in private practice in the Boston area. She specializes in sleep disorders.

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