We welcomed D and J who haven’t been before. D said that he enjoys talking with people. He also told us he was looking for solutions. D had a stroke in the right side of his brain. This has given him left-sided weakness and perceptual difficulties which will be greater in the left half of space.
J and D said that he sometimes doesn’t recognise her because he does not recognise faces. So, when he sees J, he identifies her by what she is wearing. If he doesn’t recognise her, then she’s a stranger. The stroke has knocked his confidence. He relies on J to be there. So, from his point of view he has sometimes told the stranger (ie, J in reality) to get J (ie herself!). This is obviously confusing for J who described one occasion when she tried to tell him that she was there next to him, but he was agitated, so she had to leave him for a moment to search for herself! We discussed how J might reassure him that she is there more speedily and effectively. For example, we wondered if acknowledging and appreciating his upset in the first instance might help. We wondered if a reassuring touch might work. If neither of these help, we agreed that it would be best to experiment to find out what corrects his misrecognition and reassures quickest.
He also sees things that aren’t really there. We looked at how that might happen. First, visual perceptual processes work by taking guesses about what’s in front of us. Our guesses are usually pretty accurate, but we regularly make errors. For example, it turns out that we often don’t see things that are there (eg, we hunt for our keys only to find that they were right in front of us all the time). We sometimes see things that are not there (eg, we are fooled by visual illusions such as a staircase that only goes upwards or downwards even though we know that must be impossible – see the figure below).
Also, in poor lighting conditions, we might misinterpret the shapes that we see as an object that “disappears” when we realise what is actually in front of us. Well, there’s a good chance D makes a lot more visual misinterpretation errors than he did before his stroke. These misinterpretations may well be what he labels as “visual hallucinations”.
The second possible explanation for D seeing things that are not there is that he has a broken sleep pattern. Of course, everyone sees all kinds of things when they dream though many forget what they were or even that they had dreamt. Most people have seen things that are not there as they have fallen asleep or woken up. Their eyes were usually closed, but occasionally we can see things with open eyes as we drift off to sleep (indeed, a few people sleep with their eyes open – which can unsettle partners initially!). D drops off to sleep during the day, so his sleep at night is broken and he often dozes in light sleep. D might well be seeing things that aren’t there because he’s drifting in or out of sleep. In fact, both of the foregoing explanations might be true – drifting in and out of sleep might combine with a tendency to misinterpret what he sees – so, most of his hallucinations might occur when he’s drowsy.
D’s disturbed sleep pattern creates other challenges. For example, he often wakes up and finds that J is not there (they sleep separately because he prefers to sleep downstairs on a lounger). This frightens him, and he calls her on the phone from downstairs. The most likely explanation for D’s disrupted sleep pattern is that he is inactive and bored throughout the day, so he often falls asleep during the day. We only need so much sleep per day, so if we sleep during the day, we only need a few hours of sleep at night. We discussed how D could find out how much sleep he needs every 24 hours by recording how long he has slept in a sleep diary. If he does that every day for a fortnight, the average amount he needs per day will be clear. The next step is to shift all of that sleep into the night if possible. I described a procedure that can do that. However, it requires that D’s day becomes more active and structured. If he’s not doing things then he won’t be able to stop himself from dropping off.
L said that she has a regular sleep pattern. However, she finds that she sleeps for 7 hours at night. She also sleeps for 2 hours in the middle of the day. So, she needs to sleep for 9 out of 24 hours. She distributes her sleep so that her midday sleep refreshes her for the afternoon. This system can only work if she sticks to a fairly regular pattern – her sleep must be linked with the rise and fall of arousal that we experience throughout the day (eg people tend to be sleepier after lunch). Being active when she is awake is essential to maintaining that pattern. We tend to sleep when we are inactive and bored – doing something meaningful keeps our minds active and awake.
R talked about the importance of being active in his life. However, he said that he sometimes gets stuck in repetitive action sequences or ruts. He said that he sometimes reflects on possibilities without enacting any of them. We talked a little about the reasons for that but didn’t spend much time on considering solutions. Maybe we’ll do that next time?
The next meeting will be at 1.15pm on Monday 10th September 2018 in Llewellyn Hall, Swansea Road, SA4 9AQ (Take the Gorseinon exit from Junction 47 of the M4, turn first left at the next roundabout, and Llewellyn Hall is almost on the immediate left, next to the church).