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Gero > Gero- Sleep-Chapter 17 > Flashcards

Gero- Sleep-Chapter 17 Flashcards

1
Q

What is the most important biorhythm?

A

Circadian sleep-wake rhythm

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2
Q

As people age what happens to the circadian rhythm?

A
  • May become less responsive to external stimuli
  • For instance, changes in light

**Pt will want to stay awake all night and sleep all day

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3
Q

What Endogenous changes take place during sleep?

A
  • Diminish of melatonin (less sleep efficacy)

- Diminish ability to sleep or sleep well

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4
Q

What are the five stages of normal sleep pattern the body progresses through consisting of?

A
  • 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
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5
Q

What are the five stages of normal sleep pattern the body progresses through?

A

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.

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6
Q

What are age-related changes according to sleep?

A
  • 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
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7
Q

What is insomnia?

A
  • Most common sleep disorder
  • Interferes with sleep quality and quantity
  • subjective complaints of sleep categorized by:
  • initiation
  • duration
  • consolidation
  • quality
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8
Q

What are the physical risk factors for sleep disturbance?

A
  • Age-related changes in sleep architecture
  • Comorbidities
  • Pain
  • Polypharmacy
  • Lack of exercise
  • Sleep disorders
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9
Q

What are the psychological risk factors for sleep disturbance?

A
  • Depression, anxiety, delirium, psychosis
  • Life stressors/response to stress
  • Sleep habits (Daily sleep, activity cycle, napping)
  • Loneliness
  • Loss of partner
  • Poor sleep hygiene
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10
Q

What are the physical environment risk factors for sleep disturbance?

A
  • Environmental noises, institutional routines
  • Caregiving for a dependent older adult
  • Limited exposure to light (sunlight)
  • New environment
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11
Q

What happens with patients that have Insomnia and Alzheimer’s disease?

A

-want to sleep all day and stay awake all night (Circadian rhythm)

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12
Q

How many people w/ dementia experience sleep dysregulation?

A

3 quarters (75%)

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13
Q

What happen to care givers taken care of patients who want to sleep all day and stay awake all night?

A
  • experience poor sleep quality, leading to stress, and health problems
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14
Q

What is associated (INCREASED) w/ sleep disruption?

A
  • Neuropsychiatric symptoms
  • Functional decline
  • Morbidity
  • Mortality
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15
Q

What are contributing factors to assess for with sleep disorder?

A
  • Pain
  • Chronic illness
  • Medications
  • Alcohol use
  • Depression
  • Anxiety

***Encourage a sleep dairy to assess sleep and w/ suggestions of further interventions

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16
Q

What are some interventions (non-pharmacological) to help w/ insomnia?

A

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!!!

17
Q

What are some interventions (pharmacological) to help w/ insomnia?

A
  • 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

18
Q

What is the most common form of sleep apnea and how many are affected?

A
  • 25 % affected

- OSA (Obstructive sleep apnea)

19
Q

What happens when OSA is left untreated?

A
  • 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)
20
Q

What predispose older adults to OSA?

A

-Decline in the activity of the upper airway muscles, resulting in compromised pharyngeal patency.

21
Q

What the risk factors for OSA?

A
  • Increase with age
  • Neck circumference (measure on assessment)
  • Men 17 in or larger
  • Women 15 in or larger
22
Q

What are you looking for on assessment with a pt. who has OSA?

A

-present w/ complaints of insomnia or daytime sleepiness, and assessment of insomnia complaints

23
Q

What do you do if OSA is suspected?

A
  • referral for a sleep study
24
Q

Why is recognition of OSA in older adults is more difficult?

A

-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

25
Q

What does therapy for OSA depend on?

A
  • Severity
  • Type
  • Presence of comorbid Illness
26
Q

How can we treat OSA?

A
  • CPAP (RECOMMENDED AS INITIAL THERAPY)

- UP3’s (does not really deal w/ apnea fully so pt. will end up on CPAP)

27
Q

What teaching should you do for a patient that has OSA?

A
  • Effects of untreated OSA (wreck, accident, HA..etc)

- Emphasize need for treatment

28
Q

What is restless leg syndrome called?

A

-Willis Ekbom disease

29
Q

What kind of disorder is restless leg syndrome?

A

-Neurological disorder (going w/o oxygen throughout the body for long periods of time over and over again will affect health)

30
Q

What is the diagnosis for RLS based on?

A

-Sleep study

31
Q

What is REM?

A

-Loss of normal voluntary muscle atone (muscle turns off) during REM sleep, associated w/ complex behavior while dreaming (Eyes dart; brain is active)

32
Q

What is Circadian rhythm sleep disorder?

A

-Relatively normal sleep occurs at abnormal times (may be sleep during day and up during night)

33
Q

What is the most common sleep disorder?

OSA insomnia
RLS
Insomnia
Circadian Rhythm sleep disorder

A

-Insomnia

34
Q

Untreated OSA can lead to all of the following, Except:

Heart Disease
Cardiac Dysrhythmias
Stroke
Type2 diabetes

A
  • Heart disease

Gero (7 decks)

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