Sleep and Ageing Flashcards
What percentage of 65+ year old community dwelling adults report difficulty initiating or maintaining sleep?
42%
What are common complaints about sleep from the elderly?
- difficulty initiating sleep
- disrupted sleep
- early morning awakenings
- non-restorative sleep
What is sleep?
A reversible behavioural state of perceptual disengagement from and unresponsiveness to the environment.
What physiological parameters changes are associated with sleep?
- Electroencephaelogram (EEG): brain waves
- Electroculogram (EOG): eye movements
- Electromyogram (EMG): muscle tension
How do brain waves change with sleep? How does it compare to being awake?
Awake: alpha rhythm Stage 1 (drowsiness): alpha rhythm gone, slower waves, no spindles or K complexes Stage 2 (light sleep): :-complexes, sleep spindles Stage 3 (deep sleep): large, slow delta waves
What is a polysomnogram?
The simultaneous recording of multiple physiological variables related to sleep.
What is usually recorded during a polysomnogram?
- EEG
- EOG
- EMG (chin, leg, respiration)
- ECG
- Airflow
- Respiratory effort
- SpO2
What variables are measured during a home sleep study?
- EEG
- EOG
- ECG
- Position
- Breathing movements (RIP)
- Breathing (airflow)
- Oxygen level
- Leg movements (Pizeo-eletric)
How does total sleep time change with ageing?
Decreases
What happens to sleep latency with ageing?
Remains unchanged
What happens to sleep efficiency with ageing?
Decreases
How do the sleep stages change with ageing?
Increase in stage 1 and 2,
What percentage of your total sleep is made up by REM sleep?
20-25%
Does slow wave sleep (Stage 3+) decrease or increase with age?
Decreases
What factors influence the amount of sleep needed by an individual?
- Sleepiness
- Mood alteration
- Cognitive function
- Immune function
What is process is driven my sleep deprivation?
Homeostatic drive
What is involved in the two process model of sleep regulation?
- Sleep-wake cycle
- Circadian cycle
What controls the circadian rhythm?
Exposure to sunlight
What can suppress the circadian rhythm?
Artificial lights e.g. mobiles phones, laptops
What hormone is released…
Melatonin
What causes a decrease in melatonin levels as we age? What affect does this have on sleep?
Deterioration in the suprachiasmatic nuclei.
Decreases sleep homeostasis (drive to sleep)
What are zeitgebers?
External or environmental cues that entrains or synchronises our Circadian cycle
What zeitgebers can change with ageing?
Inconsistency of external cues:
- Bright light exposure
- Irregular meal times
- Nocturia
- Decreased mobility/exercise
What are the consequences of poor sleep in the elderly?
- Increased risk of falls
- Reduced quality of life
- Symptoms of anxiety and depression
- Cognitive impairment
- Deficits in attention, response times, short term memory and performance
- Reduced survival
What are the common sleep problems in the elderly?
- Insomnia
- Sleep apnoea
- Restless Legs Syndrome/Periodic Leg Movements
- REM behaviour disorder
- Circadian rhythm disorders
- Hypersomnias
What is insomnia?
A subjective complaint of difficulties initiating and/or maintaining sleep, or non-restorative sleep , lasting >1 month
What are the three factor types that contribute to the development of insomnia?
- Perpetunting factors
- Precipitating factors
- Predisposing factors
What are examples of perpetunting factors?
- Excessive focus on sleep
- Increased time in bed while awake
- Daytime naps
What are examples of precipitating factors?
- Pain
- Occupational change, acute stress
What are some examples of predisposing factors?
- Familial light or disrupted sleepers
- Over-concern with well-being
- Introspective and worrying disposition
What are some causes of insomnia?
- Medications
- Primary sleep disorders
- Psychiatric illness
- Psychosocial factors
- Behavioural/environmental factors
What percentage of people with chronic pain reported a sleep complaints in the study completed by Smith et al 2000?
88%
What is pre-sleep arousal levels like in chronic pain patients? What can they experience at this time?
High.
Cognitive subscale: racing thoughts, intrusive thoughts, depressive cognitions, worry
Somatic subscale: rapid heart rate, muscle tension, shortness of breath
What factors perpetuate insomnia?
- Excessive time in bed
- Irregular timing of retiring and arising
- Unpredictability of sleep
- Worry over daytime deficits
- Multiple bouts of sleep (naps)
- Maladaptive conditioning
- Increased caffeine consumption
- Hypnotic and alcohol ingestion
What kind of therapy has found to be effective for the treatment of insomnia?
Cognitive behavioural therapy
What are the aspects involved in cognitive behavioural therapy for the treatment of insomnia?
- Stimulus control
- Sleep restriction
- Sleep hygiene
- Relaxation training
- Cognitive therapy
What are the instructions for stimulus control in CBT?
- Lie down intending to go to sleep only when you are sleepy
- Do not use your bed for anything except sleep; that is, do not read, watch television, eat, or worry in bed. Sexual activity is an exception.
- If you find yourself unable to sleep (after about 15 minutes) get up and go into another room.
- Wait until you are sleepy or relaxed and then return to bed
- Repeat step 3 if unable to sleep. Do this as often as is necessary throughout the night.
- Set your alarm to wake you at the same time every morning irrespective of the amount of sleep you have had.
- Do not nap during the day.
How long does it take for improvements in sleep to occur?
Approximately one week
What techniques can be used to deal with a racing mind?
- Allow time to unwind (1hr)
Putting the day to rest - Relaxation and imagery
- Give up trying to sleep
What are some tips for maintaining sleep hygiene?
- Have a bedtime ritual
- Use relaxation techniques
- Do not use bed as a place to solve problems
- Banish clocks from the bedroom
- Do exercise during the day
- Do not exercise within 4 hours of sleep
- Do not eat large meals close to bedtime
- Limit alcohol and caffeine consumption after 3pm
- Dark room
What is obstructive sleep apnoea?
Repeated episodes of partial or complete obstruction of the pharynx during sleep
What does RDI stand for?
Respiratory Disturbance Index
What does AHI stand for?
Apnoea Hypopnea Index: number of respiratory events per hour of sleep
How is the severity of sleep apnoea graded?
AHI <5/hr: normal 5-14/hr: mild 15-30/hr: moderate >30/hr: severe
What is the Respiratory Disturbance Index?
The number of apneas, hypopneas, and respiratory effort–related arousals (RERAs) per hour of sleep (RDI = AHI + RERA index
What is the Apnoea Hypopnea Index?
The number of apneas and hypopneas per hour of sleep
What are the potential health effects of OSA in the elderly?
- Mortality
- Cardiovascular dysfunction
- Cognitive impairment and dementia
- Symptoms
What are some of the possible symptoms of OSA?
- Sleepiness
- Concentration, memory and learning problems
- Daytime fatigue/ reduced energy
- Unrefreshing sleep
- Nocturnal choking or gasping for breath
- Nocturia and enuresis
- Mood problems and depression
- Decreased libido and erectile dysfunction
- Recent weight gain
- Dry mouth or throat in the morning
- Morning headache
What are the associations and risk factors for OSA?
- Overweight and obesity
- Neck circumference
- Facial shape
- Family history
- Age and gender
What are the treatment options for OSA?
- Lifestyle changes
- Positional therapy
- Oropharyngeal exercises
- Oral appliances
- Provent
- Surgery
- CPAP/APAP
What are the outcomes of CPAP for OSA?
- Improvements in subjective and objective sleepiness
- Improvements in neurocognitive function
- Improvements in QOL measures
- Reductions in blood pressure
- Reductions in arrhythmia
- Improves cardiac function in heart failure
- Improves insulin sensitivity
What are the outcomes of CPAP for OSA?
- Improvements in subjective and objective sleepiness
- Improvements in neurocognitive function
- Improvements in QOL measures
- Reductions in blood pressure
- Reductions in arrhythmia
- Improves cardiac function in heart failure
- Improves insulin sensitivity
What is restless legs syndrome?
Characteristed by unpleasant sensations in the legs when in a relaxed and restful state, described as ‘creepy-crawly’ sensations that only relieve with movement.
What is the incidence of restless legs syndrome?
10-20% of older adults
What is periodic leg movements?
Legs kick or jerk for between 0.5 to 5 seconds at 4-90% intervals during sleep.
What is the incidence of periodic leg movements?
Approximately 45% in the elderly
What treatment has shown to decrease the severity of restless legs syndrome?
Treadmill and resistance training three times a week
