Dreadful Dreaming: Nightmare and Sleep Tips for Cardiac Patients

As any good doctor will warn you, nightmares are one of the most common side effects of open heart surgery. Anxiety over an upcoming operation, the fear that another might soon follow, bad memories surrounding the first — with so many possibilities, it would be a bit surprising if you didn’t have a disturbing dream or two. But with all the stress of reality, who needs the extra burden of stressful slumber as well?

Photo (c) Kim Berkley 2015

Don’t fear the reaper!

Before my AVR surgery, proper sleep — and thus, dreaming — became a rare luxury. My symptoms always got worse at night. The more tired I got, the worse I felt, and the harder it became to get any rest. It became a vicious cycle. Once I was in the hospital recovering from the operation, however, I dreamed vividly.

The weirdest dream I had involved a local cafe which had recently closed. In the dream, my friends and I were a much less effective version of the Scooby gang investigating the murder which had caused the cafe to close (in real life, it closed for financial reasons). Somehow solving the mystery involved flying away from a pack of black dogs on the back of a giant golden Sphinx statue.

Another less surreal — but more upsetting — recurring dream I had in the hospital involved an orange kitten. Every dream involved a slight variation on the same plot: me finding a small orange tabby who needed saving in some way or another. Once he was stuck in the road during traffic. Another time he was sick. Yet another dream involved him being kidnapped (catnapped?). Every single time, I failed at the last moment. I even had that dream more than once on the same night.

I didn’t have many nightmares once I got off the heavy pain medication — and strangely, none of the ones I have had since then involved surgery. Instead, I have had several disquieting dreams about the time I fainted from dehydration just after my discharge from the hospital. While dehydration itself doesn’t sound all that scary, the collapsing part definitely was.

I also had a dream once that I was racing to escape from a dark subway being invaded by Cloverfield-type aliens (or possibly the things from They), and that somehow my surgeon was going to save the day. It was pretty cool, actually.

Though many psychologists believe nightmares are the mind’s way of clearing out the negative stuff and working through problems, such facts are small comfort when you’re waking up in the middle of the night with a pounding heart and a severe case of the shivers. And of course, there’s no real cure for nightmares, either. If there ever is, I’d like to be the first to know.

Barring that, however, I do have a few tips for fellow dreamers looking for a little solace from the storms raging in their subconscious minds. Note that most of the following advice is also good for just getting more (and better) sleep in general, even if all your dreams are of rainbows and butterflies.

Strive for Quality and (Well-Timed) Quantity

Rest is never so important as when your body is recovering from a severe illness, injury, or surgery. It’s important not to push yourself beyond your limits. If you’re tired, rest. Say yes to cat naps as needed, but avoid midday sleepathons. Instead, if you’re super-tired, aim for an early (but still reasonable) bedtime. Pushing yourself to stay up later than necessary when you’re exhausted can actually make it harder to fall asleep when you finally do go to bed — and there’s nothing worse than feeling totally wiped out and utterly wide-awake. Sleep deprivation can easily turn into a vicious cycle — you lose sleep, it gets harder to sleep, so you lose more sleep, and all the while you’re more and more likely to have nightmares, because guess what? Sleep deprivation can increase the incidence of bad dreams — making it even more difficult to get some quality shut-eye. Don’t fall into that trap.

Strive for Balance

Balance rest with light activity — walking is by far one of the best exercises in this case. Getting back into the groove (or into it for the first time if you’ve been slacking in the past) takes time, but it’s worth it once you begin to get your energy back. You never quite appreciate the gift of easy mobility as much as you do once it’s taken away from you, even for a relatively short period of time. Learn your lesson and don’t take it for granted — take advantage of it. Walk. Swim. Dance. Whatever floats your boat.

A balanced diet helps too — the healthier you are, the better your quality of sleep. Avoid consuming caffeine and refined sugar at night, and try not to eat less than an hour before bed. If you’re too hungry to skip the late-night snack, opt for something like whole grains, fruits, or nuts.

The Medication Situation

If you’ve been prescribed any pain medications, try to take them half an hour before bed. Not only will they likely help you sleep, you also might be able to avoid some of the side effects of such medications as well. When I was discharged, I was given a prescription for oxycodone. It’s effective enough as pain medications go (for me it worked much better than the morphine), but it made me extremely nauseous to the point where I began to have real difficulty eating and keeping it down. At first, I took it in the afternoon. When I switched to only taking it as-needed at night, I was finally able to enjoy real food again. (And I slept like a log.)

Similarly, if you take any pills for your heart rate or blood pressure — for instance, I currently take metoprolol to keep my pulse steady and in a safe range — it’s best to take these at night, too. Just don’t leave them till right before bed. Leave an hour or so of buffer room between the pills and bedtime. Why? Some of these medications — mine included — require (or at least strongly recommend) that you take them with either a full glass of water or some food. No one likes waking up in the middle of the night for a bathroom break if they can help it.

Choose Your Entertainment Wisely

I’m a fan of many a good horror flick and campfire tale, but when I first got home from the hospital, the last thing I wanted to see was blood and guts and grisly, grimy death. It was months before I watched so much as a psychological thriller again. (More on that in a later post.) But even if you’ve got a penchant for gore and a stronger stomach than I, if you’re having nightmare issues, it might be time to reassess your choices when it comes to your Netflix queue.

Photo (c) Kim Berkley 2015

Welcome to my nightmare?

I’m not saying you should never watch a scary movie ever again — but if ghosts and demons and serial killers covered in blood are part of your regular entertainment fare, maybe it’s time to shake things up a bit and space the scares out a little more. Even if your nightmares don’t seem to have any direct connection to what you’ve been watching or reading lately, dreams seem to be very much connected to what we subconsciously absorb throughout the day. It only makes sense that subjecting yourself to too much horrific imagery could affect your dreaming in a negative way. Just because you’re not actively scared by scary movies doesn’t mean your mind can’t turn the imagery from them into something that does scare you once your eyes are closed.

Again, timing matters. Try not to start or end your day with a case of the heebie-jeebies — cushion the creepy stuff with more positive sensory input, like watching your favorite comedian’s latest stand-up routine or reading that classic (non-horror genre) novel you’ve been meaning to read for about six years now. It’s about time, isn’t it?

Invest in White Noise

No, I don’t mean that one Michael Keaton movie with the weird ending. If your heartbeat is bothering you at night — whether you’re pre-surgery and it’s pounding with anxiety or, like me, you’ve got a mechanical valve tick-tock-ticking in your ear at all hours of the day and night — there’s nothing quite like steady background noise to drown it out and speed you off to Slumberland. If you’re looking for music, I highly recommend new age, instrumental acoustic folk, something along those lines — something both instrumental and soothing, rather than exhilarating. Songs with lyrics are more likely to grab your attention, and a bit of caution is necessary when choosing soundtracks or classical music — both have a nasty habit of surprising you with a sudden crescendo, unless you keep one particular track on repeat all night.

Also a good choice: a fan. Anything with a steady hum will do, but fans have the extra benefit of keeping your bedroom cool. (Science says our optimal sleep temperature falls somewhere around 65 degrees Fahrenheit, or 18 degrees Celsius.)

Zen Your Den

I’ve written before about seeking out a zen attitude to combat daytime anxieties about mortality. Surprise, surprise — chilling out is good medicine for night-borne fears as well. In addition to the usual advice regarding stress management — trying yoga, meditating, focusing on positive thoughts, sharing your feelings, etc. — there’s also the environmental factor. That is, the state of your sleep environment. As I just mentioned a moment ago, temperature is a factor in sleep quality, but there’s so much more to it than that.

Did you know clutter can stress you out? Similarly, bright lights and colors and certain scents can trick your mind into thinking it’s rise-and-shine time rather than bedtime. Keep away from the blue lights of everyday electronics — computers, tablets, etc. — for at least half an hour before bed. Grab some potpourri or some linen spray, or buy some scented candles or an oil warmer and burn them in the evening (just be sure to put them out before falling asleep!). If your bedroom could use a little redecorating or even just reorganizing, set aside some time for it and, in the words of Shia Lebouf, “just do it!” Good dreams come more easily and more often when you’re in a setting which makes you feel safe, comfortable, and calm.

And, of course, don’t forget to clean. It’s hard to settle down when you’re sneezing up a month’s worth of dust and/or pet dandruff. Your vacuum is your friend. Spend some time with it now and then.

Ask for Help

If you find rest remains stubbornly elusive despite your best efforts, don’t be afraid to speak with your doctor about it. He or she may be able to advise you on a number of solutions, including prescribing medications or referring you to a psychologist or psychiatrist. It’s not a sign of weakness to ask for help — nor is it a sign of strength to refuse it. We are all only human; everybody needs help sometimes.

It’s also important to talk to your doctor if your nightmares are accompanied by other, potentially more serious, symptoms. Sleep deprivation can wreak serious havoc with both your mental and physical well-being, and is especially hard on your heart. If you wake in a cold sweat, remember that it’s not uncommon for recent cardiac surgery patients to experience night sweats for several weeks following an operation.

However, if you find you are running a fever, call your doctor — or, if the symptoms are obviously serious (fever over 104° Fahrenheit/40° Celsius, severe chest pain, etc.), go straight to the emergency room. Enduring a potentially unnecessary trip to the ER is better than trying to tough it out, only to realize too late that you’ve made a mistake. Better safe than sorry!

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2 thoughts on “Dreadful Dreaming: Nightmare and Sleep Tips for Cardiac Patients

    • Hi Rachel, thanks for your comment! I’m so glad you found this post helpful.

      Yeah, I was a bit surprised myself, though for me I think I had more nightmares before surgery than after (just because I was so scared of the surgery itself). I’ve always had a thing about bad dreams and nightmares (I just generally seem to have them more often than most), but even in spite of that, I rarely have any that directly deal with my heart, surgery, etc. I think it’s probably at least partly due to the fact that the farther out from surgery you are, the more used to your new situation you are and the more comfortable you are in your own skin.

      Good luck with your dreams (and I mean that in every sense)! :)

      Like

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