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
