Sleep Flashcards
Sleep and wakefulness are outcomes of the relationship between (3)
– Environment
– The body’s timing system
– Other factors experienced by the individual
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.
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
Homeostatic process
Physiological process whereby internal body systems are maintained at equilibrium, despite variations in the external conditions
Circadian rhythm
A daily rhythmic activity cycle, based on 24-hour intervals.
What does light help do?
Maintain alignment b/w
environmental day-night cycles
and
body rhythms
Sleep initiation relies heavily on sleepiness, reflected in…
a high homeostatic drive or sleep debt
this is reduced by napping
Sleep maintenance relies on…
a low circadian drive
Phase-advanced sleep pattern refers to..
the enactment of sleep too early in the day – going to sleep too early for the circadian day
Phase-delayed sleep pattern refers to…
difficulty in getting to sleep and difficulty in getting up in the morning
5 effing sleep stages yet again.
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)
Common Sleep Disturbances in Older Adults
Fran’s main one is first.
Unrealistic sleep expectations
pain, anxiety, depression,
SOB, obstructive sleep apnea
Assessment of Sleep Disorders - general hx
POPP Question
Problem (define..latency/efficiency) Onset and clinical course Patterns Presence of other sleep disorders? Question partner
Sleep latency versus sleep efficiency
Latency - not being able to fall asleep
Efficiency - not being able to stay asleep
Assessment of Sleep Disorders - specific
RHA DQ
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
3 types of interventions
Behavioural, Complementary, Pharmacologic
3 behavioural interventions
Sleep hygiene
Stimulus control
Sleep restriction
Sleep hygiene reminders
- 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
3 complementary interventions
Exercise, Light Therapy, Massage Therapy
Pharmacologic Intervention - medication management should…
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.”
Pharmacologic Intervention - understand? and address?
Understand potential sources of sleep problems
and address the issues.
correct dx = correct intervention.
Pharmacologic Intervention - focus on? address? educate regarding?
Focus on proper sleep hygiene.
Address sleep expectations…. Educate regarding sleep physiology.
Pharmacologic Intervention - proper administration 4 points
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
Managing discontinuing sedative-hypnotic medications. (3)
Remember physiological withdrawal and taper off Replace with sleep hygiene
Address expectations
In a nutshell. (4) AAEC
Alter environments
Address sleep expectations
Educate
Change behaviours
