Our family’s unique Thanksgiving tradition has little to do with food or football. It has everything to do with our values, beliefs, and goals.

After we finish our turkey, and after the dishes are cleared, we talk about how we want to die.

“No pumpkin pie until you tell me how you want to die!”

I know it may sound morbid and it’s often uncomfortable.  But it’s necessary. Thanksgiving is actually the perfect time to have conversations like these. It’s a holiday that almost everyone celebrates, and it brings the family together from far and wide.

My mom started this family tradition in 1992. She wanted to explain why she picked some of her children and not others as her health care proxies – the person who’ll make your health care decisions if you’re unable to do so.  She talked about factors we should consider when deciding what to do if she was incapable of making her own decisions.

My mom was brilliant in her approach to discussing a difficult topic during an uplifting holiday gathering. I hope her tips help you have similar conversations this Thanksgiving.

4 Tips for Discussing a Difficult Topic

1. Begin by discussing what matters most to you. My mom didn’t start with a cold list of whether she wanted a certain procedure like a breathing tube. She began by discussing what made her life worth living. To her, it was being a “Babci” (grandmother in Polish) for her grandchildren.

She loved being a grandmother. She wanted to be present and able to interact with them. If that wasn’t possible, she wouldn’t want certain life-saving procedures.

2. Discuss your values. As a Catholic, she wanted ordinary – and not extraordinary – measures to save her life. She wanted a natural death. If her heart stopped beating, for example, she wasn’t in favor of resuscitation.

3. Come from a place of love. Serving as a health care agent is a huge responsibility, and it’s not for everyone. You’re grieving for your loved one, yet need to be clearheaded and practical when deciding what this person would want at the end of their life. Often, you’ll have to manage potential conflict among family members. It requires a delicate balance of involving everyone in the discussion while ensuring the final decision is based on what matters most to your loved one. Each of us only dies once.

My mom knew that two of my four sisters would be too emotional to handle this responsibility. At the dinner table that Thanksgiving, my mom told those sisters that, “I didn’t pick you because I love you too much to put you through something you can’t handle. It’s a hard job and I don’t want to put that kind of responsibility on you. I love you too much to do that.”

I was named my mom’s health care agent, and my other two sisters were named as backups. My mom explained to my sisters that my role was to stand in her shoes when making decisions and to keep the whole family in the loop and involved in the entire process. She wanted to ensure that any decisions would be based on her values, beliefs, and goals for care.

Here’s one more tip that helped my family navigate these difficult conversations over the years:

4. Talk about stories in the news. We’d reference news stories and discuss what we’d do in these scenarios.

I remember discussing the case of Christopher Reeve, the Superman actor who became a quadriplegic after falling from a horse and breaking his neck in a riding accident. My son said he’d be OK living as a quadriplegic as long as he was able to think and interact with others. My daughter, however, wasn’t so sure since Reeve benefited by having a lot of money to help make his life functional!

Resources to Help Guide Conversations

As you’ve realized by now, these are difficult conversations. (To help, there are a variety of resources and tools available at CompassionAndSupport.org)

One of the resources is a document that lists what to keep in mind when choosing a proxy.  The person, for example, must be willing to talk to you NOW about your wishes. If the person is uncomfortable talking about it now, then he or she won’t be able to do so when you need it the most.

During our Thanksgiving talks, we also take the extra step to review our individual Advance Care Planning documents to make sure they reflect our current feelings. We have blank forms on hand in case new documents need to be completed and witnessed.

For individuals with serious or advancing chronic illness, there’s also a document called Medical Orders for Life Sustaining Treatment (MOLST), and an electronic version called eMOLST. MOLST is recommended for those who want to further define their wishes for medical interventions, including resuscitation. The MOLST form is legally approved and has to be followed by all health care professionals including emergency medical services (EMS) personnel across New York State.

Regarding that first Thanksgiving talk, I still have a funny photo of my sister’s husband. He had a hand to his head and a “what are these people talking about!” look on his face!

But it turns out these annual Thanksgiving conversations were invaluable as he suffered through his own terminal disease years later. He was seriously ill, undergoing aggressive treatments, not very mobile and living in a nursing home. He recalled these Thanksgiving talks, and how he discussed the importance of living his life to the fullest in the end. Additionally, he wanted to spend time with his son. That’s how he decided to leave the nursing home and switch to treatments that were less aggressive. Making these choices helped him enjoy what he had left of his life.

I encourage your family to adopt our Thanksgiving tradition.  Save your family possible heartache and turmoil in the future by discussing and documenting each family member’s thoughts and views on a difficult, but necessary topic.

Lack of sleep isn’t just an inconvenience, it’s a public health problem. If you have trouble falling asleep at night or staying awake during the day, you’re not alone. According to the Centers for Disease Control and Prevention, approximately one in four American adults has a sleep or wakefulness disorder.

Was it the wine I drank with dinner? I didn’t think I napped that long. Is it because I didn’t run today? I never followed up on that project. What’s that noise? I need chapstick. WHY CAN’T I SLEEP?  

I almost always get a full eight hours each night, so having days when I’m running on six hours isn’t ideal, especially since I become a groggy, grumpy, downright miserable human being if I’m not well-rested. Luckily this doesn’t happen often.

But for those who are clocking four or six hours on the regular—WAKE UP!—you need more sleep! Take it from the researchers who found that participants getting four hours of sleep a night for two weeks functioned like a person who hadn’t slept for 48 hours. And those who got six hours every night over a period of two weeks performed like those who had been awake for 24 hours.

The Science Behind the Sleep Study

Forty-eight people joined a study conducted by researchers from the University of Pennsylvania School of Medicine and Harvard Medical School. The point of the study was “to inform the debate over whether human sleep can be chronically reduced without consequences.” Essentially, do humans really need eight hours of sleep?

Researchers split test subjects into four groups—those who slept eight hours, six hours, or four hours every night for two weeks, and those who stayed awake for three days straight. Each person was measured on sleepiness and how well their brain worked. Here are a few examples of the kinds of testing participants underwent:

• For reaction time, subjects were measured on how quickly they could respond to a visual stimulus. Curious about the test? Get your reaction time here. Apparently my alertness may be suboptimal and I should consider medical evaluation—hmm, interesting.

• They were also measured on their memory and had to match numbers to shapes (something like this), as well as complete 50 addition and subtraction equations that build upon each other (check out this animation).

• To measure sleepiness, subjects were asked to rate how sleepy they felt using a scale from 1 to 7. For example, at 9 a.m., I was a “1” or “Feeling active, vital, alert or wide awake.” Then at 3 p.m. I was a “4” or “Somewhat foggy, let down.” Then at 11 p.m. I was a “6” or “Sleepy, woozy, fighting sleep; prefer to lie down.”

As you can imagine, the well-rested group that got eight hours a night for two weeks did significantly better than any of the other three test groups which had their sleep restricted. But the surprise lies in how the group sleeping four or six hours per night thought they were functioning.

Which brings me back to why you need more sleep if you’re only getting four or six hours each night. According to the study, not only did participants function as poorly as people who had been awake for 48 or 24 hours straight, but participants were more tired than they thought they were.

In other words, not enough sleep can be just as dangerous as having no sleep at all.

Dr. Matthew Bartels, a chief medical officer at Excellus BlueCross BlueShield, who was not involved with the study, agrees with the study’s findings. “Sleep is absolutely essential for mental alertness and better physical health,” he stated. “I think most people can relate that when you get a good night’s sleep, you feel better and are more alert.”

Get Out of Sleep Debt

There’s no easier way to get all of the positive benefits of sleep—stress relief, restored energy, improved mood, the ability to think clearly or fight off infection—for such little effort. If you’ve been skimping, not only are you more tired than you think you are, but according to the National Heart, Lung and Blood Institute, you’re putting your body at risk for having heart disease, high blood pressure and other medical conditions that develop over the long run.

The good news is that if you haven’t been getting the recommended seven to nine hours of sleep, you can pay it back to yourself slowly and over time. To get out of “sleep debt,” common methods include going to bed earlier or taking short naps to compensate, but weekend catch-up is not advised.

 Going to bed earlier doesn’t necessarily mean moving your bedtime back two hours. Try going to bed 15 minutes earlier each weeknight. If your typical bedtime is 11 p.m., go to bed at 10:45 p.m. on Monday, 10:30 p.m. on Tuesday, 10:15 p.m. on Wednesday—and so on. Come Saturday morning, you will have made up almost three hours of sleep.

I know new parents are probably tired of people telling them this, but if at all possible, try to sleep when your baby does (even if that means going to bed at 8:30 p.m.!). I realize that this is much easier said than done!

And if you’re pro-nap like me, limit daytime napping to less than one hour. “It’s certainly OK to take naps from time to time,” says Bartels. “But the long-term solution is to get the proper number of hours of sleep at nighttime so you aren’t disrupting your sleep cycle.”

Good Sleep Hygiene

If you have trouble falling and staying asleep, you may need to consider making sleep hygiene a habit. Everyone can benefit from it.

For example, the Sleep Foundation suggests avoiding bright lights (including cellphone and TV screens) 30 to 60 minutes before bed. Other recommendations include:

• Going to bed and waking up at the same time every day, including weekends
• Doing a relaxing activity, such as reading before bed
• Exercising at a time that works for you
• Creating a Zen bedroom by dimming the lights, turning the thermostat down and having plenty of cozy blankets
• Make one of 11 easy snacks to help you sleep better

If all else fails, Bartels suggests talking to your doctor. “If a patient is having trouble falling and staying asleep, I question the cause,” he said. “Is there another condition that could be causing the sleepless nights?”

So what’s the difference between four hours, six hours and eight hours of sleep? Besides the obvious time and cognitive effects, Bartels says the quality is just as important as the quantity. “There are phases of sleep needed to ‘reset your clock,’” he said. “When you get the optimal hours, your body has time to move through the sleep stages and benefit from the regenerative effects of sleep.”