Chapter 20 Sleep Disorders And Sensory Disorders

Question 0

REM sleep is characterized by what?

Answer 0

Muscle atonia and rapid eye movements.

Question 1

What are the two phases of sleep?

Answer 1

REM or rapid eye movement and non-REM sleep

Question 2

Non-REM sleep is divided into four stages. Describe?

Answer 2

Stages one and two being light sleep and stages three and four being deep sleep.

Question 3

Describe the typical sleep pattern.

Answer 3

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.

Question 4

Older adults experience a decrease in what stages of sleep?

Answer 4

Deep sleep-stage 4 and REM. Consequently, they are more easily awakened.

Question 5

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.

Answer 5

Circadian advancement

Question 6

Possible causes of insomnia can be determined by what?

Answer 6

Sleep patterns

Question 7

Patient’s having difficulty falling asleep at night may be due to?

Answer 7

Anxiety or bereavement.

Question 8

Patients who wake up too early in the morning maybe suffering from?

Answer 8

Depression

Question 9

Most older adults use which OTC medication to help them sleep at night?

Answer 9

Benadryl

Question 10

Benadryl is heavily sedating in most older adults and can lead to what?

Answer 10

Increased risk of falls and cognitive impairment.

Question 11

What substance might older adults also used to improve sleep however this usually causes more sleep fragmentation?

Answer 11

Alcohol

Question 12

This is characterized by upper airway collapse, resulting in decreased ventilation despite continued effort to breathe.

Answer 12

Obstructive sleep apnea or OSA

Question 13

Some risk factors for obstructive sleep apnea include?

Answer 13

Obesity, alcohol, sedatives, sleeping supine.

Question 14

Obstructive sleep apnea is often suspected when one or more the following symptoms are present.

Answer 14

Daytime fatigue, loud snoring at night, morning headaches, poor attention, memory or both, personality changes.

Question 15

Left untreated obstructive sleep apnea can lead to what?

Answer 15

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.

Question 16

Diagnosis of obstructive sleep apnea is made by?

Answer 16

Polysomnogram or overnight sleep study.

Question 17

The most effective treatment for obstructive sleep apnea is?

Answer 17

Nocturnal continuous positive airway pressure

Question 18

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?

Answer 18

Position therapy. One intervention would be too so tennis balls into the back of a sleepshirt or nightgown.

Question 19

Name two sleep related movement disorders.

Answer 19

Periodic leg movements of sleep or PLMS. Restless leg syndrome or RLS.

Question 20

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.

Answer 20

Restless leg syndrome

Question 21

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.

Answer 21

Periodic leg movements of sleep or PLMS.

Question 22

PLMS is usually diagnosed by?

Answer 22

Overnight PSG.

Question 23

Some interventions to improve sleep related movement disorders include?

Answer 23

Exercise, warm bath, avoid caffeine and alcohol, analgesics at bedtime such as Tylenol, Sinemet, Lyrica, Mirapex, and clonazepam.

Question 24

Recommendations for sleeping medications prescribed for older adults include?

Answer 24

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.

Question 25

Name two sleeping myths that should be addressed with the older adult.

Answer 25

Poor sleep at night requires daytime naps, or that getting in bed earlier facilitate’s or improve sleep.

Question 26

Hearing loss affects what percentage of adults age 65 and older and what percentage of those over age 85?

Answer 26

30% and 50% respectively

Question 27

Name some sleep hygiene measures.

Answer 27

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

Question 28

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.

Answer 28

Sensorineural

Question 29

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.

Answer 29

Conductive Hearing loss

Question 30

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.

Answer 30

Prebyscusis

Question 31

Functional changes in hearing loss involved?

Answer 31

The loss of ability to hear Tones and inability to understand speech in the presence of background noise.(Loss of cocktail conversation)

Question 32

Tinnitus is a symptom of what type of hearing loss?

Answer 32

Sensorineural hearing loss

Question 33

This type of tinnitus is audible only to the patient, and is characterized by buzzing, ringing, or humming.

Answer 33

Subjective tinnitus

Question 34

This type of tinnitus is audible to patient and examiner, most commonly referred to as vascular noise from a heart murmur or carotid bruit

Answer 34

Objective tinnitus

Question 35

Tinnitus is often most notable at what time is the day?

Answer 35

Night time. It can be masked by various forms of ambient White noise, Such as a loud clock ticking, fan, or soft music.

Question 36

Tinnitis can be a symptom of another condition such as?

Answer 36

Ménière’s disease or a tumor.

Question 37

This is considered the gold standard for assessing hearing loss.

Answer 37

Audiological evaluation in a soundproof room

Question 38

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.

Answer 38

Cerumen impactions.

Question 39

What is the whisper test?

Answer 39

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.

Question 40

Name the two tests that are helpful from distinguishing conductive from sensorineural hearing loss

Answer 40

The Rhinne and Weber tests

Question 41

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

Answer 41

Rinne test. 2:1 Air to bone ratio is normal

Question 42

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.

Answer 42

The Weber test

Question 43

To improve communication with older adults, the following steps are recommended.

Answer 43

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.

Question 44

Visual acuity of less than what is Defined as vision impairment?

Answer 44

20/40

Question 45

Blindness is defined as a visual acuity of what in the good Eye?

Answer 45

20/200

Question 46

Loss of vision has been associated with the following problems.

Answer 46

Depression, inability to perform activities of daily living, inability to drive, falls, medication errors, increased risk of injury.

Question 47

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.

Answer 47

Presbyopia

Question 48

This is the most common ocular disease of aging and result from the cumulative effect of UVB light exposure plus other risk factors.

Answer 48

Cataracts

Question 49

The best prevention of cataracts includes?

Answer 49

Protecting the eyes from sunlight and modifying risk factors.

Question 50

Name some risk factors for cataract formation

Answer 50

Smoking, age, heavy alcohol consumption, low educational level, diabetes, sun exposure, Corticosteroids

Question 51

This is the second most common cause of blindness in the United States and the leading cause of blindness in African-Americans.

Answer 51

Primary open angle glaucoma

Question 52

Glaucoma causes what changes in vision?

Answer 52

Progressive loss of peripheral vision due to increased intraocular pressure that produces a gradual optic neuropathy

Question 53

Risk factors for glaucoma include?

Answer 53

Family history, race (black), enlarged optic cup, diabetes, cardiac vascular disease.

Question 54

This type of glaucoma develops slowly and is generally asymptomatic.

Answer 54

Primary open angle glaucoma

Question 55

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.

Answer 55

Closed angle glaucoma

Question 56

Treatment for primary open angle glaucoma include?

Answer 56

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.

Question 57

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.

Answer 57

Macular degeneration

Question 58

Risk factors for macular degeneration are the same as those for?

Answer 58

CAD or coronary artery disease

Question 59

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.

Answer 59

Wet macular degeneration

Question 60

This type of macular degeneration accounts for 90% of the cases.

Answer 60

Dry macular degeneration

Question 61

Treatments for macular degeneration include?

Answer 61

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.