Disordered Sleep Flashcards
Complaints associated with poor sleep
daytime fatigue, difficulty concentrating, low energy, depressed mood and problems with relationships.
Drugs
- benzos
- Zopiclone
Now you can’t get a continuous
Medication management should supplement not replace behavioural interventions and other therapy.
Start with low doses, titrate slowly, watch for drug-drug interactions and side effects, use for short periods (up to 10 days) and discontinue.
Medications include
- antidepressants,
- nonbenzodiazepine hypnotics (e.g. zopiclone)
- Histamine receptors/benzodiazepines generally should be avoided for older adults.
- Melatonin not recommended for people with dementia.
When discontinuing sedative-hypnotic medications remember – physiological withdrawal and taper off, replace with sleep hygiene and address expectations.
prescription for sleep meds
Borbley(1982)
Two Process Model
1) homeostatic process
2) circadian rhythm
People who are blind or in unnatural environments can therefore become sleep disorderd
Ie: ICUs – sleep induced psychosis
homeostatic process
driven by sleep debt and need for sleep (different from fatigue with lethargy, low energy and anergia)
circadian rhythm
where light triggers wakefulness and darkness triggers melatonin, in a rhythm of peaks and valleys. Hormones (like melatonin) and neurotransmitters control circadian cycle and regulate timing of sleep.
Five stages of sleep:
Stage 1 – transition, drifting to sleep,
Stage 2 – light sleep,
Stage 3 &4 – progressively deeper and more restorative where pulse, respirations and metabolism slow, and
Stage 5 – REM vital signs similar to wakeful, where dreams occur, large muscle paralysis, inactivity.
As we age REM becomes _____.
With aging, the stage that tends to shorten the most is the REM stage (important for learning and memory).
Phase-advanced sleep pattern
enactment of sleep too early in the day – going to sleep too early for the circadian day.
Phase-delayed sleep pattern
difficulty in getting to sleep and difficulty in getting up in the morning.
Sleep initiation relies heavily on sleepiness, reflected in a ____ homeostatic drive or sleep debt, while sleep maintenance relies on a _____ circadian drive.
Sleep initiation relies heavily on sleepiness, reflected in a high homeostatic drive or sleep debt, while sleep maintenance relies on a low circadian drive.
Elderly tends in sleep
- Sleep is less efficient
- Decline in deeper states of sleep
- Increased nocturnal awakening
- Reduction in REM
- After the age of 50 sleep declines by 27 minutes per decade
- More ferq/longer nighttime awakenings
List 5 Common Disorders/Conditions in Older adults that may affect sleep
- psychological issues – anxiety, depression, bipolar disorders, dementia, delirium, psychosis or unrealistic sleep expectations.
- Pain
- Shortness of breath
- GERD, constipation, diarrhea
- Narcolepsy
- Behavioral issues such as daytime napping, smoking, heavy meals near bedtime, inactivity
- Environmental issues- watching TV in bed, noise, excessive light, bedding
- Stimulant medications such as caffeine, nicotine, decongestants/antihistamines
- Steroid medications
- Antidepressants such as Wellbutrin, SSRI’s, Effexor
- Alcohol (tends to cause waking during night)
- Obstructive Sleep Apnea
- Restless Leg Syndrome
Restless Leg Syndrome
uncomfortable sensations in lower legs, attempt to relieve during sleep by moving legs or rising and walking. Associated with kidney failure, iron deficiency, vitamin deficiencies(e.g. magnesium),
Assessment of Sleep Disorders includes looking at:
Full medical work-up. Medical hx, medications, substance use, physical examination, labs (thyroid, iron, etc.).
Routine sleep patterns, normal bedtime, rising time
Habits before bed – food, drink, medications….
Bedtime activities once in bed
Nocturnal awakenings
Quality of sleep – scale 1-10
Daytime sleepiness
Daytime napping
Environment at hours of sleep – light, noise, temp
Symptoms at hour of sleep – pain, anxiety, fear, SOB
Sleep diary very helpful
Sleep History includes
define sleep problem: not being able to fall asleep (sleep latency), stay asleep (sleep efficiency), early morning awakening, not feeling refreshed, assess onset and clinical course, evaluate patterns, question partner, determine presence of other sleep disorders, obtain family history.
