Sleep

Question 1

Sleep and wakefulness are outcomes of the relationship between (3)

Answer 1

– Environment
– The body’s timing system
– Other factors experienced by the individual

Question 2

Two Process Model
*
Sleep is a dynamic process that adjusts to the body’s needs every day. What time you fall asleep, how long you sleep, and how well you sleep all result from the combined effects of two forces.

Answer 2

1) homeostatic process 
driven by sleep debt and need for sleep (different from fatigue)
*
2) circadian rhythm 
where 
light triggers wakefulness 
\+
darkness triggers melatonin 
in a rhythm of peaks and valleys

Question 3

Homeostatic process

Answer 3

Physiological process whereby internal body systems are maintained at equilibrium, despite variations in the external conditions

Question 4

Circadian rhythm

Answer 4

A daily rhythmic activity cycle, based on 24-hour intervals.

Question 5

What does light help do?

Answer 5

Maintain alignment b/w
environmental day-night cycles
and
body rhythms

Question 6

Sleep initiation relies heavily on sleepiness, reflected in…

Answer 6

a high homeostatic drive or sleep debt

this is reduced by napping

Question 7

Sleep maintenance relies on…

Answer 7

a low circadian drive

Question 8

Phase-advanced sleep pattern refers to..

Answer 8

the enactment of sleep too early in the day – going to sleep too early for the circadian day

Question 9

Phase-delayed sleep pattern refers to…

Answer 9

difficulty in getting to sleep and difficulty in getting up in the morning

Question 10

5 effing sleep stages yet again.

Answer 10

1 – transition (drifting)
2 – light sleep
3 & 4 – progressively deeper + more restorative (pulse, resps, metab slow)
5 – REM
(vital signs similar to wakeful, dreams occur, large
muscle paralysis, inactivity)

Question 11

Common Sleep Disturbances in Older Adults

Fran’s main one is first.

Answer 11

Unrealistic sleep expectations
pain, anxiety, depression,
SOB, obstructive sleep apnea

Question 12

Assessment of Sleep Disorders - general hx

POPP Question

Answer 12

Problem (define..latency/efficiency)
Onset and clinical course
Patterns
Presence of other sleep disorders?
Question partner

Question 13

Sleep latency versus sleep efficiency

Answer 13

Latency - not being able to fall asleep

Efficiency - not being able to stay asleep

Question 14

Assessment of Sleep Disorders - specific

RHA DQ

Answer 14

Routine sleep patterns – normal bed/rising time
Habits before bed – food, drink, meds
Activities once in bed
Daytime napping/sleepiness
Quality of sleep – 1-10

Question 15

3 types of interventions

Answer 15

Behavioural, Complementary, Pharmacologic

Question 16

3 behavioural interventions

Answer 16

Sleep hygiene
Stimulus control
Sleep restriction

Question 17

Sleep hygiene reminders

Answer 17

• Avoid caffeinated drinks after lunch
• Avoid alcohol in evening
• Avoid heavy meals within 3 hrs before bed
• Avoid naps longer than 20 mins
• Go to bed get up at same time very day

Question 18

3 complementary interventions

Answer 18

Exercise, Light Therapy, Massage Therapy

Question 19

Pharmacologic Intervention - medication management should…

Answer 19

Supplement not replace behavioural interventions and other therapy.
*
“Not an option unless everything else tried first. Take time to figure out the individual and their challenges.”
“When you start, already have a plan to discontinue. Make sure doctors have a plan too.”

Question 20

Pharmacologic Intervention - understand? and address?

Answer 20

Understand potential sources of sleep problems
and address the issues.
correct dx = correct intervention.

Question 21

Pharmacologic Intervention - focus on? address? educate regarding?

Answer 21

Focus on proper sleep hygiene.

Address sleep expectations…. Educate regarding sleep physiology.

Question 22

Pharmacologic Intervention - proper administration 4 points

Answer 22

Start with low doses
Titrate slowly
Watch for drug-drug interactions and s/e
Use for short periods (up to 10 days) and discon’t

Question 23

Managing discontinuing sedative-hypnotic medications. (3)

Answer 23

Remember physiological withdrawal and taper off Replace with sleep hygiene
Address expectations

Question 24

In a nutshell. (4) AAEC

Answer 24

Alter environments
Address sleep expectations
Educate
Change behaviours