Chapter 12: Sleep and Rest Flashcards
Condition characterized by at least five leg jerks or movements per hour during sleep
Nocturnal Myoclonus
Falling asleep earlier in the evening and awakening earlier in the morning
phase advance
Neurological disorder characterized by an uncontrollable urge to move the legs when one
restless legs syndrome
Delay in the onset of sleep
sleep latency
A person spends __ of his/her lifetime sleeping.
1/3
__, ___, and ___ are all highly prevalent among the older adults. (tired)
Insomnia, daytime sleepiness, and napping
In most cases, insomnia, daytime sleepiness, and napping result from age-related changes in :
circadian sleep–wake cycles
sleep architecture (stages)
sleep efficiency
sleep quality
Reductions in non–rapid eye movement stage sleep and rapid eye movement (REM) stage sleep begin to occur after __.
midlife
Older or younger adults spend more time in stages I and II sleep?
Older
Older or younger adults have a decline in the proportion of time spent in the deeper stages III and IV sleep?
Older
What Stage?
Begins nodding off
Can be easily awakened
If undisturbed, will reach next stage in a few minutes
Stage 1
Deeper stage of relaxation reached
Some eye movement noted through closed lids
Can be easily awakened
Stage 2
Early phase of deep sleep
Reduced temperature and heart rate
Muscles relaxed
More difficult to be awakened
Stage 3
Deep sleep and relaxation
All body functions reduced
Considerable stimulation needed to be awakened
Insufficient stage IV sleep can cause emotional dysfunction
Stage 4
-Increased vital signs (sometimes irregular)
Decreased due to reduced amount of sleep time in general
REM
Insufficient REM sleep can cause ___
emotional dysfunction, including psychosis
People will enter REM sleep approximately once every __ minutes of stage __ sleep.
90 min
IV
The nurse can assess for sleep disturbances in the older adult by using a self-rating tool such as the ___.
Pittsburgh Sleep Quality Index
Research has shown that ___ is a better predictor of suicide in older adults than depressive symptoms.
poor sleep quality
In addition, shorter sleep duration and restless sleep have been found to be associated with higher levels of beta amyloid in the brain, which is a biomarker for ___
Alzheimer’s disease
Insomnia can be a short-term, which is also known as ___.
transient
A changed environment, illness, added stress, or anxiety is associated with with problem?
Transient insomnia
Chronic insomnia is:
insomnia lasting 3 or more weeks
Physical or mental illnesses, environmental factors, substance abuse, or medications can be related to __ __.
Chronic insomnia
Nocturnal Myoclonus is associated with:
the use of tricyclic antidepressants and chronic renal failure.
People with restless legs syndrome may describe the sensations with terms such as:
uncomfortable electrical itching pins and needles pulling creepy-crawly painful
- This condition can be caused by iron deficiency anemia, uremia, Parkinson’s disease, rheumatoid arthritis, diabetes, or neurological lesions
- it is believed to be associated with alterations in dopamine and iron metabolism.
- Antidepressants, antihistamines, antipsychotics, alcohol, caffeine, hypoglycemia, and simple and refined carbohydrates can contribute to this syndrome.
- Dehydration worsens symptoms
Restless legs syndrome
This condition is characterized by snoring and sudden awakening and gasping for air
sleep apnea
The prevalence of sleep apnea is __x more prevalent in men than women.
3
This disorder can be caused by a defect in the central nervous system that affects the diaphragm, a blockage in the upper airway that interferes with normal air flow, or a combination of both.
Sleep apnea
3 types of sleep apnea:
- central sleep apnea: a defect in the central nervous system that affects the diaphragm
- obstructive: a blockage in the upper airway that interferes with normal air flow
- mixed: combo of both
Sleep apnea: Sleeping in a supine position should be avoided because it __-
allows the tongue to fall back and block the airway.
People with dementia have minimal stage__ and __ sleep, no stage __ sleep, and frequent arousals from sleep.
II and REM
IV
A sudden change to earlier awakening or insomnia may be symptomatic of an emotional disturbance or __
alcohol abuse
Examples of drugs that can interrupt sleep include:
anticholinergics antidepressants antihypertensives (centrally acting ones), benzodiazepines β-blockers diuretics levodopa steroids theophylline thyroid preparations
___ interfere with REM and deep sleep stages and can cause daytime drowsiness (due to their extended half-lives in older people), thereby creating difficulties in falling asleep for the patient
Hypnotics
Many of the top nonprescription sleep aids contain ___ as a primary ingredient
diphenhydramine (Benadryl)
5 drugs that can affect sleep include:
BE Xtra NICe PROposed THEO
- diphenhydramine (Benadryl)
- nicotine
- alprazolam (Xanax)
- fluoxetine HCl (Prozac)
- theophylline (Theo-X Extended-Release tabs)
Benadryl carries a high risk of ____ and it should be avoided.
anticholinergic side effects in older adults
Every assessment needs to include a sleep history, which includes:
- Review of time spent in sleep and naps, quality of sleep
- Medication review
- Bedtime routines
- Presence of sleep disturbances (if present)
If sleep disturbances are present, what are the characteristics involved?
- Length of time present
- Characteristics (e.g., falling asleep, staying asleep, and early awakening)
- Type of bedding and sleep environment
- Food and fluid consumed several hours prior to bedtime
- Medications used to address sleep disturbances
- Factors interfering with sleep (e.g., pain, voiding, and nightmares)
- Effects (e.g., daytime drowsiness, irritability, and fatigue)
- Management
___ are general depressants, especially to the central nervous system, and they can significantly depress some vital body functions, lowering basal metabolic rate more than it already is and decreasing blood pressure, mental activity, and peristalsis to the extent that other problems may develop.
Barbiturates
T/F: Exposure to sunlight during the day can facilitate sleep at night
True
Foods high in carbohydrates tend to raise the level of __ in the brain, which could have a sedating effect.
serotonin
T/F: A protein and carbohydrate snack at bedtime may encourage sleep.
True
The supplement melatonin (a synthetic form of the hormone that is naturally stimulated by darkness) has gained popularity for improving the quality of sleep in adults of all ages by ___
correcting imbalances in the body’s circadian rhythm.
Are demands and activity levels correlated with stress?
Not necessarily
Regardless of the source of the stress, the body reacts by stimulating the ___
Sympathetic nervous system.
The Sympathetic nervous system causes:
- stimulation of the pituitary gland
- the release of adrenocorticotropic hormone
- an increase in the body’s adrenaline supply.
4 measures to control stress:
- respond to stress in a healthy manner
- manage lifestyle
- relax
- pray
___ of pain is the essential first step to controlling it.
Identifying the cause
If nonpharmacologic means of pain relief are ineffective and drugs are necessary, it is advisable to begin with ___
the weakest type and dosage of analgesic and gradually increase as necessary.
Older adults tend to fall asleep and wake up ___.
earlier than in younger years
Older adults sleep more/less soundly?
less
Older adults have a reduction in stage __ sleep.
IV
__, __, __, and __ are among the most common disturbances to the sleep of older adults.
Insomnia, nocturnal myoclonus, restless legs syndrome, and sleep apnea
The variety of factors that can affect sleep requires that a ___ be done as part of the comprehensive assessment.
thorough sleep history
A variety of measures can be used to promote sleep, including:
- adjustment to activities and nap times
- limitation of caffeine consumption
- soft music
- back rubs
- decaffeinated herbal teas
- stress management
- control of noise and lighting.
Restless legs syndrome is believed to be associated with alterations in __ and ___
dopamine and iron metabolism.
