Chapter 17 Sleep Flashcards
Sleep
Occupies a third of our lives and is a vital function that affects cognition and performance
Sleep is a barometer of health and sleep assessment and interventions for sleep concerns should receive as much attention as other vital signs
Insufficient sleep is a public health epidemic and the Centers for Disease Control and Prevention has called for continued public health surveillance of sleep quality, duration, behaviors, and disorders to monitor for sleep difficulties and their health impact
Biorhythm and Sleep
The most important biorhythm is the circadian sleep-wake rhythm
As people age, the natural circadian rhythm may become less responsive to external stimuli, such as changes in light during the course of the day
Endogenous changes in the production of melatonin are diminished, resulting in less sleep efficacy
Sleep and Aging
The body progresses through five stages of normal sleep pattern consisting of rapid eye movement (REM) sleep and non–rapid eye movement sleep
Sleep complaints are linked to other health problems and sleep disorders
Sleep Disorders
Insomnia Most common sleep disorder worldwide Interferes with sleep quality and quantity and is associated with subjective complaints of sleep characterized by: Sleep initiation Sleep duration Sleep consolidation Sleep quality
Insomnia and Alzheimer’s disease (AD)
About three-quarters of individuals with dementia experience sleep dysregulation
Caregivers also experience poor sleep quality, leading to stress and health problems
Sleep disruption is associated with increased neuropsychiatric symptoms, functional decline, morbidity, and mortality
Assessment
Nurses are in an excellent position to assess sleep and suggest interventions to improve the quality of the older person’s sleep
Assessment for sleep disorders and contributing factors to poor sleep (pain, chronic illness, medications, alcohol use, depression, anxiety) are important
Complete assessment data (Box 17-5)
Sleep diary
Interventions
Nonpharmacological treatment
-Directed at identifiable cause
-Considered first-line treatment for insomnia
-Nonpharmacologic interventions (Box 17-8)
Sleep habits
Relaxation techniques
CCBT
Tai chi/quigong
Interventions
Pharmacological treatment
Use of over-the-counter sleep aids and prescription sedatives and hypnotic medications is increasing in the United States
Benzodiazepines are one of the most abused drugs, along with opiates, in the older population
Benzodiazepines or other sedative hypnotics should not be used in older adults as a first choice of treatment for insomnia
Pharmacological interventions and behavioral interventions should be used together
Sleep Disordered Breathing and Sleep Apnea
Affects approximately 25% of older adults with obstructive sleep apnea (OSA) being the most common form.
Untreated OSA is related to heart failure, cardiac dysrhythmias, stroke, type 2 diabetes, osteoporosis, and even death
Age-related decline in the activity of the upper airway muscles, resulting in compromised pharyngeal patency, predisposes older adults to OSA
Assessment
The individual may present with complaints of insomnia or daytime sleepiness, and assessment should include assessment of insomnia complaints
If OSA is suspected, a referral for a sleep study should be made
Recognition of OSA in older adults may be more difficult because they may not have a sleeping partner
Interventions
Therapy depends on the severity and type of sleep apnea, as well as the presence of comorbid illness
Continuous positive airway pressure is recommended as initial therapy
Teaching should include the effects of untreated OSA and emphasize the need for treatment
Sleep Disorders (3 of 3)
Restless legs syndrome/Willis Ekbom disease
Neurological movement disorder of the legs
Diagnosis is based on a sleep study
REM sleep behavior disorder
Loss of normal voluntary muscle atonia during REM sleep, associated with complex behavior while dreaming
Circadian rhythm sleep disorder
Relatively normal sleep occurs at abnormal times
What is the most common sleep disorder? A. OSA insomnia B. Restless leg syndrome C. Insomnia D. Circadian rhythm sleep disorders
C. Insomnia
Untreated OSA can lead to all of the following, EXCEPT: A. heart disease. B. cardiac dysrhythmias. C. stroke. D. type 2 diabetes.
A. heart disease.
