Teena Cahill, a clinical psychologist in her mid-forties, had been married for only seven years when her husband, Brooks Dyer, had a cerebral hemorrhage one night. Rushed to a local New Jersey hospital, the 53-year-old former jet pilot and American Airlines captain sustained significant physical and neurologic damage. In fact, the physicians at the hospital said he would not live.

Cahill refused to accept that prognosis and transferred Dyer to the Hospital of the University of Pennsylvania in Philadelphia, where he remained alive but in critical condition. He was unresponsive for many days and experienced multiple seizures and a stroke. Despite her husband's complications, Cahill could tell there was hope. "But I also realized we had a long road to recovery ahead of us," she says.

Dyer remained in the hospital for three months. By the time Cahill brought him home, he was still confused and dealing with short-term memory loss, but he was slowly becoming more aware of his situation. For the next six months, Cahill devoted her life to caring for her husband. She stopped working full time and tended to all his medical and physical needs during his rehabilitation—an exhausting undertaking, she admits. Once he regained some mobility and was able to talk, Cahill enlisted the help of family, friends, and outside aides so she could focus on her career again.

Almost 24 years later, Cahill and Dyer are still married, and she remains his primary care partner (a term she prefers over caregiver). She cherishes that role because it allows her to spend as much time as possible with him. Cahill is grateful her husband survived and recovered to the point where he can communicate, shower, and get around with the help of a walker. "He's a great guy, and I still love him very much," she says.

For Better or Worse

About one in 10 caregivers looks after a spouse, according to a 2015 joint report by the AARP and the National Alliance for Caregiving. For some couples, like Cahill and Dyer, the marriage grows stronger. But for far too many, the marriage disintegrates when one partner becomes the caregiver, says Diana Denholm, PhD, a psychologist in West Palm Beach, FL, and author of The Caregiving Wife's Handbook (Hunter House, 2012).

Men are more likely to leave the marriage if they become a caregiver because they feel there is little they can get back from the relationship, says Dr. Denholm. In a 2009 study published in Cancer that followed more than 500 people who had either cancer or multiple sclerosis for five years, women were six times more likely to be separated or divorced after a diagnosis than men in the same situation.

Younger couples are also more likely to split, says Dr. Denholm, whose book draws on her experience as a psycho-therapist and nearly 10 years of caring for her husband, who had several illnesses, including Parkinson's disease. Like many spouses who become 24-hour caregivers overnight, Dr. Denholm felt stressed, angry, lonely, guilty, and overwhelmed. "It was a roller coaster ride," she says. "I didn't know if my husband was going to live or die, and the longer it went on, the more emotions I swung through, like anger and frustration."

Caring for someone with a serious neurologic disease is like running a marathon, says Barry Jacobs, PsyD, a clinical psychologist and family therapist in Swarthmore, PA. "Many people will say that they will do as much as they can until they can't anymore, and that's not good for anyone," says Dr. Jacobs, author of The Emotional Survival Guide for Caregivers (The Guilford Press, 2006) and the forthcoming Meditations for Caregivers: Practical, Emotional, and Spiritual Support for You and Your Family (AARP, 2016).

Becoming a caregiver to your spouse can strain even the best marriage, but there are ways to address the challenges. We asked experts and advocates, including couples in the trenches, for help navigating those challenges.

Prepare for Change

A health challenge can disrupt a relationship immediately and irrevocably, with big shifts and losses in many areas, including intimacy, responsibilities, and communication, says Cahill, who went from having what she considered a picture-perfect marriage to helping her husband navigate his way back from near death.

"Spouses need to pause and recognize that their marriage has changed completely and may never return to the way it was," says Dr. Denholm. "If the sick spouse is still able to communicate, I always recommend that couples talk about the changing relationship openly and honestly, and as soon after it starts changing as possible."

Reassess Your Roles

Gender roles and responsibilities in the marriage may also change. The husband might need to start cooking for his wife as she recovers from surgery, for example, or the wife might have to mow the lawn or shovel the driveway if her husband is diagnosed with a disabling or degenerative illness.

Review the list of household responsibilities and determine how to divvy them up based on the changed circumstances, including deciding whether to hire someone to handle a task you or your spouse once managed.

"Both spouses need to come to terms with the change, accept it, and get help if the change is too much to handle," advises Dr. Denholm.

Resist Taking on Everything

Many caregivers throw themselves into their new role so wholeheartedly that they neglect their own care or forget to consider how their spouse might be able to contribute. Sacrificing your own life won't make your spouse healthy again, says Dr. Denholm. And ignoring how your spouse can participate, in whatever small way, could breed helplessness or resentment.

Dr. Denholm worked very hard to step back and allow her husband to contribute, but even she was not perfect. "I probably should have let him roll out the trash container to the curb more often," she admits.

Ted Vahan, 55, of Huntersville, NC, encourages his 59-year old wife, Elba, to help as much as she can. After a diagnosis of breast cancer, Elba had a heart attack and a cerebral hemorrhage. She can no longer walk and suffers from short-term memory loss. She also has trouble coordinating her movements. "When she is in a cooperative mood, she tries to feed herself and put on her clothes, but that's not all the time," says Ted.

Cindy Isaacs of Huntsville, AL, gets some help from her husband, Rick, who was diagnosed with amyotrophic lateral sclerosis (ALS) less than three years ago. Married for 38 years and now in their early sixties with two adult children, Cindy and Rick have made adjustments since his illness. She takes care of him, and although he has limited use of his arms and hands and can't cook anymore, he still likes to shop with her. "He suggests new ideas and understands when I need to eat out or bring take-out home," says Cindy.

Avoid Isolation

Spouses who become caregivers may feel isolated from family, friends, and colleagues, which may discourage them from talking about their situation. "If you keep a lot of information private, people will have no idea how bad it might be behind closed doors," says Dr. Denholm. She recommends talking about your challenges with people you trust so the anger doesn't build up and erupt.

Or join an online or in-person support group. The Well Spouse Association, an organization dedicated to spousal caregivers, provides a list of telephone support groups on its website. Connecting with caregivers in the same situation offered much-needed emotional support for Vahan, who attended the association's annual conference, where he was surprised to meet so many people. "One of the best things about going to the meeting is knowing I'm not alone," he says.

Talking to a therapist is also effective for sharing your difficulties and getting help managing your emotions, says Dr. Denholm. Opening up to your spouse's doctor or neurologist may also yield helpful strategies, says Maisha Robinson, MD, a neurologist at the Mayo Clinic in Jacksonville, FL. "The neurologist may have ideas about specific treatments or therapies that may improve mobility, mood, or other symptoms that may enhance the overall quality of life for the one needing care, which in turn could also improve quality of life for the caregiver," she says.

Cahill, who writes and lectures extensively about caregiving, understands the value of talking to others. She's involved with the Interfaith Network of Care, a local New Jersey support group that encourages faith-based organizations to volunteer a few hours a week to give in-home caregivers a break. Since Cahill already has an extensive team of helpers, she doesn't use their services, but she recommends that other spousal caregivers seek out similar resources. "These partnership opportunities are all around us if we start to think about the world as one of opportunity instead of isolation," she says.

Cultivate Healthy Communication

Being able to talk to your spouse candidly is important for every marriage, but it's especially crucial for couples in which one person is taking care of the other. Partners may need to have delicate or difficult conversations about everything from toileting to the changing nature of their intimacy.

Couples who ignore problems and avoid conversations may be harboring a lot of anger and resentment, which can push them apart, says Dr. Denholm. She suggests a few strategies to ensure that each exchange is productive and less charged with emotion and anger. First, avoid unloading your frustrations and anger on your spouse, she says. Then, set aside a specific time to discuss a thorny topic and have a clear idea beforehand of what you want to discuss. Write down what you want to say ahead of time. And when asking to set a date for the discussion, be sure not to get pulled into a conversation about the topic. "This will be a big temptation, and your spouse will likely have questions, but having the discussion at this point will be less effective," she says. "When it's time to have the actual conversation, be sure to frame it using 'I' statements, and avoid using 'why' statements." For example, instead of saying, "Why don't you hold my hand anymore?" try expressing it as, "I feel closer to you when we hold hands."

For Cahill, using "I" statements is more productive. "When I ask the 'why' questions, especially when I'm annoyed, I will get less of what I'm already not getting," she says. "When I focus on the 'I,' it helps us connect better."

Learn to speak your partner's language, says Dr. Denholm. In general, men respond better when asked for their thoughts rather than their feelings. For example, instead of asking, "How do you feel about your prognosis?" when your partner has been told he has six months to live, ask, "How do you think we should plan your final days?" Using this language can make tough discussions easier, she says.

Be Open to Intimacy

Some spouses may want to maintain the same level of intimacy as they had before their partner's health changed, says Cahill. For other couples, the sexual part of their relationship may be over, or they may need to put it on hold until the sick spouse gets better. Either way, it's important to talk about sex and intimacy so that each partner understands the other's needs, and to manage each other's expectations.

Ted and Elba Vahan's intimate relations changed completely after Elba's health worsened. "Our sex life is the least of our worries, but I still like to kiss her, and that's something we have talked about," says Ted, who has cared for Elba for nine years. "Unfortunately, because of her short-term memory loss, she forgets what we talked about a few minutes later. We still kiss, although she sometimes turns her head away and laughs."

Touch really matters, many couples acknowledge. "We touch a lot," says Cahill. "My husband reaches out to me, and I need that connection with him. Sometimes I need to remind him, and sometimes he needs to remind me, but we find ways to connect through touch."

Guard Against Depression 

Sadness is a normal reaction to watching your spouse's health decline or your relationship change. So is mourning the loss of happier days. Caregiving has its ups and downs, and occasionally feeling blue or a sense of loss is to be expected—but if emptiness and despair take hold, you may be experiencing depression.

Some telltale signs of depression include a change in eating habits or sleep patterns, feeling tired, a loss of interest in people or activities, agitation, anger, and thoughts of death or suicide, according to the Family Caregiver Alliance. "These are signals to take some action, whether it's talking to your doctor, a friend, or seeking professional help from a therapist or counselor," says Dr. Denholm.

Ask for Help

Caring for someone takes both a psychological and a physical toll, according to a 2012 study in the Journal of the American Medical Association. Citing anecdotal evidence that many caregivers die before their sick spouses because they have neglected their health, Dr. Jacobs emphasizes how important it is to ask for help to ease the burden of caregiving. "From the beginning, it's vital to determine what resources are available from family, friends, and the community," he says.

Cahill relies on a network of family and friends for support. For example, her husband goes to breakfast every morning with retired friends from the community. "They have a great time, and I have about 90 minutes to catch my breath and do what I need to do," she says. Once a year, a friend of her husband's comes and stays with him while she travels to a speaking engagement or for fun.

Caregivers shouldn't overestimate their ability to care for their spouses, whether that involves bathing or lifting them into bed or a wheelchair, says Dr. Denholm. These activities could be strenuous and unsafe for both the caregiver and the sick spouse. "My husband was over six feet tall, and it was difficult moving him around. I finally hired a home health aide to help with bathing," she says.

Carve Out "Me" Time

Asking for help is important, but so is scheduling personal time. Cahill tells her husband that sometimes he just has to leave her alone for a few hours. "He can be very dependent on me, but I tell him that I need blocks of uninterrupted time."

Cindy Isaacs has also learned to recognize her limits. "I know that if I do not step back and take a break I will fall apart emotionally and physically," she says. After a break, she feels rejuvenated, and that, she says, makes her a better caregiver.