Gero- Sleep-Chapter 17 Flashcards
What is the most important biorhythm?
Circadian sleep-wake rhythm
As people age what happens to the circadian rhythm?
- May become less responsive to external stimuli
- For instance, changes in light
**Pt will want to stay awake all night and sleep all day
What Endogenous changes take place during sleep?
- Diminish of melatonin (less sleep efficacy)
- Diminish ability to sleep or sleep well
What are the five stages of normal sleep pattern the body progresses through consisting of?
- REM (Rapid Eye Movement)- 25% of night, occurs first 90 minutes after falling asleep, every 90 minutes after and become longer. Restore energy to brain/body, support daytime performance, brain active, Eyes dart, body immobile/relaxed.
- NON REM- 75% of night as we fall asleep we begin NREM stages 1-4
What are the five stages of normal sleep pattern the body progresses through?
N1= Being awake/falling asleep (light sleep)
N2= Sleep (disengage from surroundings, RR/HR regular, decrease in body temp (sleep in cold environment especially w/ sleep apnea)
N3-N4 = Deep sleep, BP drops, Breathing slows, muscles relaxed, Blood supply increases, Tissue growth repair occurs, restored energy, growth hormone released.
What are age-related changes according to sleep?
- More time spent in bed awake than sleep
- Decrease in sleep time & efficiency
- Awakens frequently, increase after age 50
- Day time napping
- Changes in circadian rhythm (early to bed/early rise)
- Sleep is subjectively/objectively lighter (more stage 1, little stage 4 w/ more disruptions)
- REM short, less intense more easily distributed
- Freq or abnormal breathing events increased
- Freq leg movements during sleep increased
What is insomnia?
- Most common sleep disorder
- Interferes with sleep quality and quantity
- subjective complaints of sleep categorized by:
- initiation
- duration
- consolidation
- quality
What are the physical risk factors for sleep disturbance?
- Age-related changes in sleep architecture
- Comorbidities
- Pain
- Polypharmacy
- Lack of exercise
- Sleep disorders
What are the psychological risk factors for sleep disturbance?
- Depression, anxiety, delirium, psychosis
- Life stressors/response to stress
- Sleep habits (Daily sleep, activity cycle, napping)
- Loneliness
- Loss of partner
- Poor sleep hygiene
What are the physical environment risk factors for sleep disturbance?
- Environmental noises, institutional routines
- Caregiving for a dependent older adult
- Limited exposure to light (sunlight)
- New environment
What happens with patients that have Insomnia and Alzheimer’s disease?
-want to sleep all day and stay awake all night (Circadian rhythm)
How many people w/ dementia experience sleep dysregulation?
3 quarters (75%)
What happen to care givers taken care of patients who want to sleep all day and stay awake all night?
- experience poor sleep quality, leading to stress, and health problems
What is associated (INCREASED) w/ sleep disruption?
- Neuropsychiatric symptoms
- Functional decline
- Morbidity
- Mortality
What are contributing factors to assess for with sleep disorder?
- Pain
- Chronic illness
- Medications
- Alcohol use
- Depression
- Anxiety
***Encourage a sleep dairy to assess sleep and w/ suggestions of further interventions
What are some interventions (non-pharmacological) to help w/ insomnia?
Nonpharmological treatment
- directed at identifiable cause (must have a cause before giving medication)
-"first line treatment for insomnia" \+Sleep habits \+Relaxation techniques \+ CCBT \+Tai chi/ quigong \+sleep in hospitals/nursing homes (difficult: odd surrounding, very noisy, people coming/ going)
BOX 17-9 in book READ!!!
What are some interventions (pharmacological) to help w/ insomnia?
- OTC sleeping aids, prescription sedatives, hypotonic medications
- BENZODIAZEPINES (should not be used in older adults as a first choice of treatment in insomnia)- avoid if possible
- BENZODIAZEPINES most abused drug - do not use w/ opiates
Pharmocological/ behavior interventions used together
What is the most common form of sleep apnea and how many are affected?
- 25 % affected
- OSA (Obstructive sleep apnea)
What happens when OSA is left untreated?
- Heart failure
- Cardiac dysrhythmias
- Stroke
- Type 2 diabetes
- Osteoporosis
- Death (r/t accidents central episode when brain does not tell respiratory to breath obstruction can cause central sleep apnea)
What predispose older adults to OSA?
-Decline in the activity of the upper airway muscles, resulting in compromised pharyngeal patency.
What the risk factors for OSA?
- Increase with age
- Neck circumference (measure on assessment)
- Men 17 in or larger
- Women 15 in or larger
What are you looking for on assessment with a pt. who has OSA?
-present w/ complaints of insomnia or daytime sleepiness, and assessment of insomnia complaints
What do you do if OSA is suspected?
- referral for a sleep study
Why is recognition of OSA in older adults is more difficult?
-Because they may not have a sleeping parter
If you have a partner you have someone that can monitor you or video you sleeping, can take something home to measure breathing SPO2 on finger
What does therapy for OSA depend on?
- Severity
- Type
- Presence of comorbid Illness
How can we treat OSA?
- CPAP (RECOMMENDED AS INITIAL THERAPY)
- UP3’s (does not really deal w/ apnea fully so pt. will end up on CPAP)
What teaching should you do for a patient that has OSA?
- Effects of untreated OSA (wreck, accident, HA..etc)
- Emphasize need for treatment
What is restless leg syndrome called?
-Willis Ekbom disease
What kind of disorder is restless leg syndrome?
-Neurological disorder (going w/o oxygen throughout the body for long periods of time over and over again will affect health)
What is the diagnosis for RLS based on?
-Sleep study
What is REM?
-Loss of normal voluntary muscle atone (muscle turns off) during REM sleep, associated w/ complex behavior while dreaming (Eyes dart; brain is active)
What is Circadian rhythm sleep disorder?
-Relatively normal sleep occurs at abnormal times (may be sleep during day and up during night)
What is the most common sleep disorder?
OSA insomnia
RLS
Insomnia
Circadian Rhythm sleep disorder
-Insomnia
Untreated OSA can lead to all of the following, Except:
Heart Disease
Cardiac Dysrhythmias
Stroke
Type2 diabetes
- Heart disease
