Chapter 12 Sleep Flashcards
Stage 2 sleep cycle
Decreases with age
High voltage activity on EEG
Comprises 15% of sleep elders
Stage 1 sleep cycle
Lightest level
Easy to awaken
Comprises 5% of sleep in young
Stage 3 sleep cycle
Decreases and may cease with age
High Voltage activity on EEG
Stage 4 sleep cycle
Decreases with age
High voltage on EEG
15% of sleep in elders
REM sleep
Rapid Eye Movement
Vivid dreams happen here
First trip to REM is the shortest
In an 8 hour night, 2 hours are spent in REM sleep
What does sleep deprivation do to the body?
- Decline in physical and mental activity
- Nothing works as well
- Immune system suffers
- Do not deal with everyday problems as well
- Dementia and Depression symptoms
Problems older adults have with sleeping
- Need just as much sleep as younger adults
- Sleep is lighter and fragmented
- Frequent waking
- More time spent getting to sleep
- Increased daytime solomence
What is the importance of the pineal gland?
The pineal gland produces melatonin, which puts you to sleep.
Comorbid Insomnia is associated with
-Psychiatric disorders
-Medications (10-15% of all cases of insomnia)
==SSRI, Anti-HTN, Levedopa, Anticholinergics, Sympathomimetic amines (epinephrine, norepinephrine, dopamine), Diuretics, Opiates, Cough and cold meds, Thyroid preps, Phenytoin, Cortisone
Interventions for alterations in sleep patterns
- Weight loss
- Avoidance of alcohol and sedatives
- Smoking cessation
- Avoiding supine positioning during sleep
- CPAP (continuous positive airway pressure) for known sleep apnea
- Limit day-time napping to 30 minutes or less
- No exercise within 4 hours of sleep
- Snacks: light and easily digestible
Restless leg syndrome
- Uncontrollable need to move legs, often accompanies by discomfort
- Rule out and treat contributing medical condition
- Medication review (Antidepressants and Neuroleptic meds)
Pharmacologic treatment of Restless Leg Syndrome
Dopamine Receptor Agonists: pramipexole, ropinirole
Non-pharmacologic treatment for Restless Leg Syndrome
- Mild to Mod. physical activity, hot baths, mental exercise prior to sleep
- Avoid caffeine
- Elevate legs
Rapid Eye Movement Sleep Behavior Disorder (RBSD)
- Elaborate enactment of dreams
- Potential for violence
- May be precursor to Parkinson’s disease
- Assessment and treatment focuses on: Neurological assessment, Removal of aggravating meds, Safety measures in sleep environment
Circadian Rhythm Sleep Disorders (CRSD)
- Relatively normal sleep at abnormal times
- Irregular sleep-wake patterns
- Most commonly found in individuals with dementia
- Serious safety risk at night for cognitively impaired individuals that wander
Interventions for Circadian Rhythm Sleep Disorders (CRSD)
- Increase light exposure during day and avoid bright light at night.
- Structured activity during day and quiet sleep environment at night.
Sleep apnea
-Sleep is fragmented and incomplete
-Repetitive cessation (>10 seconds) of respiration during sleep
=Hypopnea: transient reduction in airflow with diminished O2 sat for greater than 10 seconds during sleep
=Obstructive Sleep Apnea (90% of cases, 25% of adults older than 65)
S/Sx seen in the day as a result of sleep apnea
- Daytime sleepiness
- Cardiopulmonary function altered (right sided heart failure, HTN, arrhythmia, death)
- Increase in accidents, decreased performance, depression, decreased quality of life
Risk factors of sleep apnea
Increasing age, Enlarged neck circumference, Male, Anatomical abnormalities, Family Hx, Obesity, Snoring, ETOH or Sedative use, Smoking, Cardiac disorders, HTN, Nocturia, Cognitive dysfunction, Upper airway obstruction/resistance
Treatment for Sleep Apnea
- Reducing morbidity and mortality
- Increasing quality of life
- Reduction of risk factors
- Avoid sleeping in the supine position (use pillows or chair)
- CPAP
- Decongestants, nasal steroids, antihistamines, SSRI’s and Tricyclic antidepressants
- Surgery: reconstruct upper airway, removal of tonsils, dental devices, pacemakers
Pharmacological management for sleep disorders
-Used in combination with behavioral interventions
-Monitored closely for side effects
-Avoid sedatives, hypnotics, and certain OTC (antihistamines) drugs for their adverse effects on older adults
Meds to use: Benzodiazipine receptor agonists (zolpidem, eszopiclone, and zaleplon. Melatonin may cause less psychomotor and cognitive impairments
Xerosis
- Extremely dry, cracked skin
- Most common skin disorder in elders
- Primarily seen in extremities
- Problem: Dry skin may be just dry skin, but can also be indicative of a serious health problem…DM, hypothyroidism, renal disease, dehydration
Scabies
- Parasitic disorder
- Similar to lice
- Curved linear ridges in skin
- Itching is more intense
Purpura
- Thinning of dermis
- Fragility of capillaries
- Blood vessels rupture easily, with minimal trauma
