Chapter 20 Sleep Disorders And Sensory Disorders Flashcards
REM sleep is characterized by what?
Muscle atonia and rapid eye movements.
What are the two phases of sleep?
REM or rapid eye movement and non-REM sleep
Non-REM sleep is divided into four stages. Describe?
Stages one and two being light sleep and stages three and four being deep sleep.
Describe the typical sleep pattern.
Normal sleep goes through stages one through four and back to stage two and finally to REM. This pattern occurs every 90 minutes and repeat several times during a sleep period.
Older adults experience a decrease in what stages of sleep?
Deep sleep-stage 4 and REM. Consequently, they are more easily awakened.
What is it called when it takes longer to fall asleep and you spend more time in bed but less time sleeping. Also you tend to wake up early in the morning and if bedtimes are earlier, You may waken in the middle of the night.
Circadian advancement
Possible causes of insomnia can be determined by what?
Sleep patterns
Patient’s having difficulty falling asleep at night may be due to?
Anxiety or bereavement.
Patients who wake up too early in the morning maybe suffering from?
Depression
Most older adults use which OTC medication to help them sleep at night?
Benadryl
Benadryl is heavily sedating in most older adults and can lead to what?
Increased risk of falls and cognitive impairment.
What substance might older adults also used to improve sleep however this usually causes more sleep fragmentation?
Alcohol
This is characterized by upper airway collapse, resulting in decreased ventilation despite continued effort to breathe.
Obstructive sleep apnea or OSA
Some risk factors for obstructive sleep apnea include?
Obesity, alcohol, sedatives, sleeping supine.
Obstructive sleep apnea is often suspected when one or more the following symptoms are present.
Daytime fatigue, loud snoring at night, morning headaches, poor attention, memory or both, personality changes.
Left untreated obstructive sleep apnea can lead to what?
Hypoxemia which can lead to cardiac complications such as arrhythmias, hypertension, heart failure, and even sudden cardiac death. Also patients may fall asleep at undesirable time such as when driving, leading to the fatal accidents.
Diagnosis of obstructive sleep apnea is made by?
Polysomnogram or overnight sleep study.
The most effective treatment for obstructive sleep apnea is?
Nocturnal continuous positive airway pressure
Because managing a CPAP is difficult for some older adults, They often decline this therapy. The most cost-effective way to ensure that someone does not sleep on his or her back is referred to as what and what is one intervention for this?
Position therapy. One intervention would be too so tennis balls into the back of a sleepshirt or nightgown.
Name two sleep related movement disorders.
Periodic leg movements of sleep or PLMS. Restless leg syndrome or RLS.
With this sleep related movement disorder the patient experiences an uncontrollable desire to move their legs while at rest in bed before falling asleep. Some sort of paresthesia usually accompanies the movement such as aching, itching, or sense of bugs crawling on me.
Restless leg syndrome
This sleep related movement disorder is often reported by a bed partner who is getting kicked during the night. Patients will often experience symptoms similar to those of persons with OSA, such as daytime somnolence and poor concentration, although they think they’re sleeping fine.
Periodic leg movements of sleep or PLMS.
PLMS is usually diagnosed by?
Overnight PSG.
Some interventions to improve sleep related movement disorders include?
Exercise, warm bath, avoid caffeine and alcohol, analgesics at bedtime such as Tylenol, Sinemet, Lyrica, Mirapex, and clonazepam.
Recommendations for sleeping medications prescribed for older adults include?
Use the lowest effective dose possible, inform the older person of the fall risk, prescribe the agent for no more than 3 to 4 weeks, and the dosage should be tapered down to prevent rebound insomnia and wean the patient off the medication gently.
Name two sleeping myths that should be addressed with the older adult.
Poor sleep at night requires daytime naps, or that getting in bed earlier facilitate’s or improve sleep.
Hearing loss affects what percentage of adults age 65 and older and what percentage of those over age 85?
30% and 50% respectively
Name some sleep hygiene measures.
Consistent bedtime
Avoid daytime naps
Exercise daily, but early in the day
Avoid food or fluids before bedtime
Avoid caffeine, nicotine, or alcohol in the evening.
Develop a bedtime routine, including hot bath.
Don’t read or watch TV in bed.
Don’t get into bed until sleepy.
Increase bright light exposure during the evening
This type of hearing loss is caused by dysfunction of the inner ear, eighth cranial nerve, brainstem, or cortical auditory pathways; causes include age, previous noise exposure, and medications.
Sensorineural
This type of hearing loss occurs as the impaired transmission of sound through the Auditory canal, Tympanic membrane, or middle ear; causes include earwax and tympanic membrane perforation.
Conductive Hearing loss
The most common form of hearing loss in older adults, characterized by bilateral, symmetric loss of high-frequency tones. Several risk factors can accelerate this loss including history of frequent middle ear infections, previous noise exposure, heredity, and arterial sclerosis.
Prebyscusis
Functional changes in hearing loss involved?
The loss of ability to hear Tones and inability to understand speech in the presence of background noise.(Loss of cocktail conversation)
Tinnitus is a symptom of what type of hearing loss?
Sensorineural hearing loss
This type of tinnitus is audible only to the patient, and is characterized by buzzing, ringing, or humming.
Subjective tinnitus
This type of tinnitus is audible to patient and examiner, most commonly referred to as vascular noise from a heart murmur or carotid bruit
Objective tinnitus
Tinnitus is often most notable at what time is the day?
Night time. It can be masked by various forms of ambient White noise, Such as a loud clock ticking, fan, or soft music.
Tinnitis can be a symptom of another condition such as?
Ménière’s disease or a tumor.
This is considered the gold standard for assessing hearing loss.
Audiological evaluation in a soundproof room
This is a very common cause of conductive hearing loss in older adults and is why it is important for physical examination of the ear using an otoscope.
Cerumen impactions.
What is the whisper test?
The examiner stands one to 2 feet from the patient on one side and whispers one or two syllable words, then has the patient repeat the words.
Name the two tests that are helpful from distinguishing conductive from sensorineural hearing loss
The Rhinne and Weber tests
This test involves striking a tuning fork and placing it on the mastoid bone. The patient indicates when he or she can no longer hear the sound, and that time is noted. The tuning fork is then held in front of the ear, and again the patient indicates when it can no longer be heard. If the air to bone ratio is less then 2 to 1 then sensorineural loss is present
Rinne test. 2:1 Air to bone ratio is normal
This hearing test involves striking tuning fork and placing it in the middle of the patience for head. Sound will lateralized to the ear with a conductive loss if there is no Sensoruneural loss. If sensorineural loss is present, sound the lateralize to the better ear.
The Weber test
To improve communication with older adults, the following steps are recommended.
Face patients directly when speaking, use normal volume and tone, enunciate clearly, don’t cover the mouth with the hand, if asked to repeat, rephrase the question or instruction. Ensure that hearing aids are in place and batteries working, encourage eyeglasses when needed.
Visual acuity of less than what is Defined as vision impairment?
20/40
Blindness is defined as a visual acuity of what in the good Eye?
20/200
Loss of vision has been associated with the following problems.
Depression, inability to perform activities of daily living, inability to drive, falls, medication errors, increased risk of injury.
This age associated vision loss that starts in the fourth decade, occurs as a result of increased lens density and loss of lens elasticity. Other effects include higher light requirements, decreased contrast sensitivity, and increased susceptibility to Glare.
Presbyopia
This is the most common ocular disease of aging and result from the cumulative effect of UVB light exposure plus other risk factors.
Cataracts
The best prevention of cataracts includes?
Protecting the eyes from sunlight and modifying risk factors.
Name some risk factors for cataract formation
Smoking, age, heavy alcohol consumption, low educational level, diabetes, sun exposure, Corticosteroids
This is the second most common cause of blindness in the United States and the leading cause of blindness in African-Americans.
Primary open angle glaucoma
Glaucoma causes what changes in vision?
Progressive loss of peripheral vision due to increased intraocular pressure that produces a gradual optic neuropathy
Risk factors for glaucoma include?
Family history, race (black), enlarged optic cup, diabetes, cardiac vascular disease.
This type of glaucoma develops slowly and is generally asymptomatic.
Primary open angle glaucoma
This type of glaucoma is caused by a sudden increase in pressure due to blockage of the vitreous outflow, which is caused by a foreign body or pupil dilation from medications.
Closed angle glaucoma
Treatment for primary open angle glaucoma include?
Topical medications, surgery, or lasers. Medications include beta blockers, prostaglandin analogs, carbonic anhydrase inhibitors, and alpha-2 agonist. Note that medications given in the eye may be absorbed systemically and thus, cause side effects.
This condition occurs in the fovea of the macula and results in central vision loss. It is the leading cause of blindness in older adults in the developed world. It affects whites more than other racial groups.
Macular degeneration
Risk factors for macular degeneration are the same as those for?
CAD or coronary artery disease
This type of macular degeneration is caused by growth of new blood vessels beneath the macula that often break and leak blood and fluid causing a more abrupt loss of vision.
Wet macular degeneration
This type of macular degeneration accounts for 90% of the cases.
Dry macular degeneration
Treatments for macular degeneration include?
There are no medical treatments for either type of macular degeneration however, wet macular degeneration can be treated with laser photocoagulation and anti VEGF injections into the globe may slow vision loss.
