5.1 - Sleep Flashcards
Name the 5 sleep pathologies in older adults.
1) Insomnia
2) REM-sleep behaviour disorder
3) Restless leg syndrome
4) Snoring
5) Obstructive sleep apnea
What is insomnia?
- People with insomnia will experience excessive daytime sleepiness, extremely high risk for accidents and illnesses and have a significantly reduced quality of life
What are some causes, risk factors and influences of insomnia?
- In some people, insomnia can be caused by an underlying medical conditions or a medication side effect (the medication is referred to secondary insomnia)
→ in the absence of a causal factor, we call it primary insomnia; cause nothing is contributing to the insomnia, compared to when meds cause it
→ depression and anxiety are contributing factors to insomnia - Things like alcohol and coffee can increase the insomnia troubles
- Risk factors: Loss of spouse, retirement, social isolation, comorbid disease and onset of dementia, Parkinson’s disease, medication usage
What are poly pharmacies when talking about insomnia?
- Poly pharmacies are taking inappropriate prescriptions from a physician and contrary to popular beliefs, it’s more common with increased age and can also cause insomnia (bad mix of meds or prescribing smt wrong)
→ OR, you’re taking pills that the dr. isn’t prescribing
→ can have an acute effect of health
True or false: Difficulty fall or staying asleep is higher in YA.
False: It’s higher in OA
→ Affects nearly ½ of all older adults 65+
How can we manage insomnia?
For secondary insomnia:
- Target and treat the underlying condition
For primary insomnia:
- Behavior modification of sleep hygiene
- Nonpharmacological therapy (phototherapy - man made source of sunlight)
→ helps circadian rhythm, also helps with depression, sleep depression
- Medication
→ some are prone to side effects, so should only be taken a few times a week, can increase risk of falling, cause trouble in functioning
→ some of the side effects are actually a lot and may even not be productive or helpful because of them
- needs to take into account the psychological changes in sleep associated with age
What is REM-sleep behaviour disorder?
- People may display a variety of movements during REM sleep
→ Frequent cause of sleep-related injuries - can be very harmful with a partner in bed p.ex, if you’re moving around a lot, could hit them
- can even engage in certain activities like eating while asleep
- this specific disorder opens you up to other neurodegenerative conditions
What are some risk factors to REM-sleep behaviour disorder?
→ Other neurodegenerative conditions (i.e., a diagnosis of REM disorder can precede a diagnosis of Parkinson’s and AD), medications, narcolepsy, diabetes, low physical activity, head injury; there are LOTS of risk factors
How do we manage REM-sleep behaviour disorder?
- A safe and comfortable sleeping environment
→ moving any potentially dangerous objects from the room and removing any salient stimuli that would grab your attention (p.ex bright signs or loud noises) - Education on the disorder
- Removal of medication that may cause the disorder
- Treatment of any secondary causes
- Medication
What is restless legs syndrome?
- Documented neurological movement disorder
- Irresistible urge to move the limbs
→ + unpleasant tingling typically in the legs, which becomes worse in the evening which makes it very difficult to sleep in the night
→ Periodic Limb Moving Disorder is a unique motor disorder and can be considered secondary to RLS whereas with PLM, it’s more a physiological behaviour rather than an internal sensation
What are some stats about RLS and and its diagnosis?
- 10-35% of older adults have this condition
→ often misdiagnosed as periodic leg movements, but unlike periodic leg movements, the symptoms of RLS usually occur when the patient is in bed, and it can cause sleep onset insomnia
→ statistically mainly women, while periodic leg movement is equal between men and women
→ periodic leg movement could be a genetic condition and same with RLS but we don’t know enough about it yet
What are the risk factors of RLS?
- Iron deficiency, rheumatoid arthritis, renal failure, and a variety of neurologic lesions
How do we manage RLS?
- Treatments are slightly more limited because it’s not understood very well
- Reduce medications and caffeine-containing foods and drinks
- Iron supplements
- Medications (but can have many side effects; very tricky)
What is snoring? What are its risk factors / outcomes?
- Weakening and loss of tone of upper airway muscles leads to snoring
- Prevalence increases with age
- might be a side effect of sleep apnea
- Risk factors/outcomes:
→ Obesity, cardiovascular disease, hypertension, stroke
How do we manage with snoring?
→ Weight loss, cessation of smoking, abstinence from alcohol
→ Using a humidifier or nasal steroids
→ Sleeping on side vs the back
→ Surgical options
What is obstructive sleep apnea?
- The upper airway is repeatedly obstructed during sleep, which reduces air flow (hypopnea) or stops it (apnea)
→ breathing stops up to 10-60 seconds and the amount of oxygen in the blood drop is often very low
→ alerts the brain, causing arousal (waking) and then the breathing resumes; these stops can occur frequently, which causes multiple sleep disruptions throughout the night, and causes excessive daytime sleepiness and impairment
What is the prevalence of obstructive sleep apnea? Elaborate on this number.
- Prevalence of 45-62%
→ may be much higher because people who are much older may think it’s normal to have this occur, especially if it starts off minimal and increases over time, you (and your partner) might just grow accustomed to it
What are the risk factors / outcomes of obstructive sleep apnea?
- Obesity, male, reduced muscle tone
→ untreated sleep apnea puts the person at risk for cardiovascular disease, memory loss, depression
How do we manage obstructive sleep apnea?
- similar to options for snoring
- nCPAP machine
→ nasal continuous positive airway pressure
→ better airflow, keeps the airways open
→ improved sleep quality, better energy
What are the physical health impacts of poor sleep? (3)
- As we age, poor sleep quality and disorders become more common and are associated very closely to…
1) Cardiovascular Disease
→ An increased risk of cardiovascular diseases, including hypertension, coronary artery disease, and heart failure
→ good sleep is crucial for maintaining your heart health by regulating the correct amount of blood pressure and reducing inflammation
→ lead to deactivation of sympathetic nervous system which can elevate blood pressure
2) Diabetes
→ Negatively affects glucose metabolism and insulin sensitivity resulting in higher blood sugar levels (type 2 diabetes)
3) Obesity
→ Influences the balance of hunger-regulating hormones (leptin), resulting in increased appetite and caloric intake
→ minimizes movement as well, leading to more weight gain
What are the cognitive impacts of poor sleep?
1) Memory Decline
→ Decreases in memory consolidation (i.e., memories are not transferred from short-term to long-term storage)
→ Difficulties are observed in forming new memories and retrieving existing ones
2) Impaired Executive Function
→ Declines in executive functions, including attention, and problem-solving
→ Difficulties in managing complex tasks and making decisions are also observed
3) Attention and Concentration
→ Impairments are observed in attention and concentration
→ Difficulties focusing on tasks, sustaining attention, and processing information efficiently
4) Emotional Regulation
→ Increased irritability, mood swings, as well as increased stress and anxiety
→ Continuous exposure to impaired emotional regulation can increase risk for or exacerbate mental health issues (e.g., depression and anxiety)
