Sleep and Rest Flashcards
Exam 3
Sleep and Aging:
Patterns of sleep are affected by what?
Patterns of sleep affected by complex interactions among physiologic, environmental, and psychosocial factors
Sleep and Aging
Age-related changes that affect sleep and rest include:
Sleep quantity
Sleep quality
Circadian rhythm: biologic clock
Sleep and Aging
Age-related changes that affect sleep and rest include: Sleep quantity - What does this include?
Sleep efficiency: percentage of time asleep in bed
Sleep and Aging
Age-related changes that affect sleep and rest include: Sleep quantity -
Diminished sleep efficiency is due to what?
Diminished sleep efficiency due to sleep latency and increased awakenings
Sleep and Aging
Age-related changes that affect sleep and rest include:
Sleep quality - What is this?
Sleep cycles and sleep stages *spend less time in deep sleep ( less REM)
Sleep and Aging
Age-related changes that affect sleep and rest include:
Circadian rhythm - What is this?
Biologic clock
Sleep and Aging
Age-related changes that affect sleep and rest include:
Circadian rhythm: What changes occur with age?
(What is there an increase of?)
increased sleep latency (greater difficulty falling asleep)
More frequent awakenings because of reduced slow wave sleep ( MORE Non- REM sleep)
More frequent daytime napping
Increased time spent trying to sleep as sleep becomes less efficient
Sleep and Aging
Age-related changes that affect sleep and rest include:
Circadian rhythm: What changes occur with age?
(What is there a decrease of?)
Less sound sleep, delay in onset of sleep
Decreased amounts of nighttime sleep, especially less deep sleep than younger adults
Sleep and Aging
What together contributes to decreased sleep efficiency associated with older age?
*Age-related changes and pathologic conditions together contribute to the decreased sleep efficiency associated with older age
Is the following statement true or false?
Age-related changes have little impact on the overall quantity of sleep of older adults, but they do have a significant impact on the quality of sleep and the quantity of rest.
True
Is the following statement true or false?
Age-related changes have little impact on the overall quantity of sleep of older adults, but they do have a significant impact on the quality of sleep and the quantity of rest.
True: Like what changes?
The time spent in bed increases, but the time spent asleep decreases.
Is the following statement true or false?
Age-related changes have little impact on the overall quantity of sleep of older adults, but they do have a significant impact on the quality of sleep and the quantity of rest.
True: When older adults are in bed more, what is happening?
Older adults spend increasing amounts of time in bed, not always attempting to sleep, with a decreasing proportion of time in actual sleep.
Is the following statement true or false?
Age-related changes have little impact on the overall quantity of sleep of older adults, but they do have a significant impact on the quality of sleep and the quantity of rest.
True: What happens to sleep efficiency?
Sleep Efficiency=(% of time asleep during the time spend in bed) diminishes starting at the age of 50.
Is the following statement true or false?
Age-related changes have little impact on the overall quantity of sleep of older adults, but they do have a significant impact on the quality of sleep and the quantity of rest.
True: How much rest does an older person obtain to get the same amount of sleep attained by younger adults?
Older adults spend an additional 3 to 4 hours resting in order to attain the same amount of sleep attained by younger adults
Risks Factors That Can Affect Sleep
Healthy People 2030: What is their goal?
Healthy People 2030:
Increase the proportion of adults who get enough sleep
Risks Factors That Can Affect Sleep
What are they?
Psychosocial factors
Environmental conditions
Pathophysiological Factors Affecting Sleep
Effects of bioactive substances
Risks Factors That Can Affect Sleep
Psychosocial factors:
Anxiety,
boredom,
and social isolation
Depression, anxiety, delirium, psychosis
* Life stressors/response to stress
* Sleep-related beliefs
* Sleep habits (daily sleep/activity cycle, napping)
* Loneliness
* Loss of partner
* Poor sleep hygiene
Risks Factors That Can Affect Sleep
Environmental conditions:
Noise,
lack of privacy,
temperature of room,
light, and
hot or humid conditions
- Environmental noises, institutional routines
- Caregiving for a dependent older adult
- Limited exposure to sunlight
- New environment
Risks Factors That Can Affect Sleep
Pathophysiological Factors Affecting Sleep:
Chronic conditions,
nocturia,
obstructive sleep apnea,
restless leg syndrome
and periodic limb movement
- Age-related changes in sleep architecture
- Comorbidities (cardiovascular disease, diabetes, pulmonary disease, musculoskeletal disorders); CNS disorders (Parkinson’s disease, seizure disorder, dementia); GI disorders (hiatal hernia, GERD, PUD); urinary disorders (incontinence, BPH)
- Pain
- Polypharmacy
- Lack of exercise
- Excessive napping
- Sleep disorders (sleep apnea, restless legs syndrome, periodic leg movement, smoking)
Risks Factors That Can Affect Sleep
Effects of bioactive substances:
Adverse effects of medications, caffeine, and alcohol
Risks Factors That Can Affect Sleep
Effects of bioactive substances: What are sleep complaints often linked to?
Sleep complaints are linked to other health problems or disorders.
Risks Factors That Can Affect Sleep
Effects of bioactive substances:
Older adults sleep better when they what?
*are in general good health *have a positive mood
*are engaged in an active lifestyle *perform meaningful activities.
Risks Factors That Can Affect Sleep
Healthy People 2030:Increase the proportion of adults who get enough sleep
What is lack of sleep linked to?
This is linked to an increased risk of obesity, diabetes, heart disease, cancer, and death. Adults who don’t get enough sleep are also at higher risk for problems related to the brain, like stroke or dementia.
Risks Factors That Can Affect Sleep
Healthy People 2030: Increase the proportion of adults who get enough sleep
What may help people get enough sleep?
Interventions to improve sleep environments and teach people about the importance of sleep may help more adults get enough sleep.
Risks Factors That Can Affect Sleep
What are other medical conditions that affect sleep?
Cardiopulmonary disease
Dementia
Mood disorders
Physical discomfort from osteoarthritis or hot flashes
Nocturia
Risks Factors That Can Affect Sleep
Other medical conditions that affect sleep:
Cardiopulmonary disease:
In Cardiopulmonary disease the older adults cannot lie flat.
Risks Factors That Can Affect Sleep
Other medical conditions that affect sleep:
Dementia:
In dementia we have day and night switch.
So they don’t sleep at night.-Circadian rhythm disturbances.
Risks Factors That Can Affect Sleep
Other medical conditions that affect sleep:
Mood disorders like depression:
Mood disorders like depression for example they sleep either too much or too little.
Risks Factors That Can Affect Sleep
Other medical conditions that affect sleep:
Nocturia:
*Nocturia isa condition in which you wake up during the night because you have to urinate.
Risks Factors That Can Affect Sleep
Other medical conditions that affect sleep:
Nocturia: What can be causes of this?
Causes can include high fluid intake, sleep disorders and bladder obstruction.
Risks Factors That Can Affect Sleep
Other medical conditions that affect sleep:
Nocturia: What is treatment of this?
Treatment of nocturia includes certain activities, such as restricting fluids and medications that reduce symptoms of overactive bladder.
Risks Factors That Can Affect Sleep
Other medical conditions that affect sleep:
Medications affecting sleep:
Selective serotonin reuptake inhibitors (SSRIs)
Antihypertensives (clonidine, beta blockers, reserpine, methyldopa)
Anticholinergics
Sympathomimetic amines
Diuretics
Opiates
Cough and cold medications
Thyroid preparations
Phenytoin
Cortisone
Levodopa
The nurse is caring for an older adult client with a fractured hip. When developing the client’s plan of care, which realistic goal will the nurse include?
A. The client’s self-report of pain will remain below 5 on a 0 to 10 scale.
B. The client will not request breakthrough analgesia for pain.
C. The client will state being in a state of comfort.
D. The client will experience full relief from pain.
The goal that the client’s self-report of pain will remain below 5 on a 0 to 10 scale is realistic, specific, and achievable.
It is not practical to expect full relief following a surgical procedure.
The goal for the client to express being in a state of comfort is neither realistic nor measurable.
The option stating the client will not request breakthrough analgesia is not practical, expected, or needed. The client should request pain medication as needed to maintain control of their pain level
Pathological conditions affecting sleep
Obstructive Sleep Apnea (OSA): What will the pt report?
awakening unrefreshed,
morning headaches,
daytime irritability and personality changes,
daytime naps, and periods of nighttime wakefulness.
Pathological conditions affecting sleep
Obstructive Sleep Apnea (OSA): Untreated obstructive sleep apnea (OSA) is related to what?
Untreated obstructive sleep apnea (OSA) is related to heart failure, cardiac dysrhythmias, stroke, type 2 diabetes, cognitive decline, osteoporosis, and even death
Pathological conditions affecting sleep
Obstructive Sleep Apnea (OSA): What is used to identify risks of OSA?
Identifying persons at risk for OSA
STOP-BANG (Snoring, tired, observed gaps in breathing, high blood pressure, BMI > 35, age >50, neck circumference > 40 centimeters, gender male. )
Pathological conditions affecting sleep
Obstructive Sleep Apnea (OSA):
STOP-BANG stands for?
(Snoring,
tired,
observed gaps in breathing,
high blood pressure,
BMI > 35,
age >50,
neck circumference > 40 centimeters,
gender male. )
Pathological conditions affecting sleep
Sleep-related movement disorders: What occurs?
Awakening caused by recurrent involuntary leg movement
Pathological conditions affecting sleep
Restless legs syndrome (RLS) (aka Willis Ekbom Dis.) - What occurs? How do symptoms change overtime?
Irresistible urge to move the limb, often accompanied by discomfort in the legs. Other symptoms include paresthesia; creeping sensations; crawling sensations; tingling, cramping, and burning sensations; pain.
Symptoms become more frequent and last longer with age.
Pathological conditions affecting sleep
Periodic limb movements during sleep (PLMD) (aka Nocturnal Myoclonus) - What is it?
brief muscle contraction 20-40 sec ,muscles foot/leg
Pathological conditions affecting sleep
Periodic limb movements during sleep (PLMD) (aka Nocturnal Myoclonus) -
Lifestyle changes –Nonpharmacologic therapies
Nursing: Lifestyle changes –Nonpharmacologic therapies include
stretching the lower extremities,
taking hot baths,
performing relaxation techniques,
reduce caffeine and avoiding alcohol.
Pathological conditions affecting sleep
Periodic limb movements during sleep (PLMD) (aka Nocturnal Myoclonus) -
Pharmacological:
Anticonvulsants:
Dopamine agonist :
Pathological conditions affecting sleep
Periodic limb movements during sleep (PLMD) (aka Nocturnal Myoclonus) -
Pharmacological: Anticonvulsants include?
Gabapentin
Pathological conditions affecting sleep
Periodic limb movements during sleep (PLMD) (aka Nocturnal Myoclonus) -
Pharmacological: Dopamine agonist includes
Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)
Pathological conditions affecting sleep
Periodic limb movements during sleep (PLMD) (aka Nocturnal Myoclonus) -
What specifically occurs in this? What can it also effect sometimes?
Periodic limb movement disorder (PLMD) is a rare sleep disorder characterized by periodic, repetitive movements of the legs and feet during sleep.
In some cases, the disorder also affects the arms.
Pathological conditions affecting sleep
Periodic limb movements during sleep (PLMD) (aka Nocturnal Myoclonus) -
What can this condition occur with?
PLMD can disrupt sleep and co-occur with other sleep disorders. PLMD can be a primary or secondary disorder,
Pathological conditions affecting sleep
Periodic limb movements during sleep (PLMD) (aka Nocturnal Myoclonus) -
Primary: What causes this?
In the case of primary PLMD, scientists still do not know what causes the condition.
Two potential causes are dopamine deficiency or miscommunication between nerves along the spinal cord.
Pathological conditions affecting sleep
Periodic limb movements during sleep (PLMD) (aka Nocturnal Myoclonus) -
Secondary: What causes this?
In cases of secondary PLMD, the condition may be attributed to:
Diabetes, Iron deficiency, Caffeine use, Spinal cord injury or tumor, Uremia, Anemia, Neurodevelopmental disorders like attention deficit hyperactivity disorder (ADHD) or William’s syndrome.
Pathological conditions affecting sleep
Periodic limb movements during sleep (PLMD) (aka Nocturnal Myoclonus) -
What else can cause this?
Side effect of certain medications, including tricyclic antidepressants, neuroleptics, anti-nausea drugs, and lithium, Withdrawal from sedative medications, including barbiturates and benzodiazepines
Nursing Assessment of Sleep
What should be identified?
Identifying opportunities for health promotion
Evidence-based assessment tools:
Nursing Assessment of Sleep
Identifying opportunities for health promotion
Essential aspect of wellness and quality of life
Guidelines for assessing sleep and rest
Nursing Assessment of Sleep
Identifying opportunities for health promotion: Hospitalization often disrupts normal sleeping patterns- so what must be done?
Hospitalization often disrupts normal sleeping patterns; therefore, reestablishing those patterns is the best first step to improving the quality of sleep in the hospital
Nursing Assessment of Sleep
Identifying opportunities for health promotion: What should be observed? What should be identified?
Observe behavioral indicators of sleep and rest
Identify self-care measures to improve sleep
Nursing Assessment of Sleep
Evidence-based assessment tools:
Epworth Sleepiness Scale (ESS)
Pittsburgh Sleep Quality Index (PSQI)
Nursing Assessment of Sleep
Evidence-based assessment tools: Epworth Sleepiness Scale (ESS) scoring?
(ESS) >10 –excessive daytime sleepiness –client needs further evaluation
Nursing Assessment of Sleep
Evidence-based assessment tools: Pittsburgh Sleep Quality Index (PSQI) scoring?
Pittsburgh Sleep Quality Index (PSQI) >5 indicates poor sleeper
Nursing Assessment of Sleep
What do older adults tend to experience?
Older adults tend to experience both increased sleep latency (time required to fall asleep) and increased numbers of awakening during the night.
Nursing Assessment of Sleep
Older adults tend to experience both increased sleep latency (time required to fall asleep) and increased numbers of awakening during the night.
What does this mean?
Therefore, it is important to first assess and determine sleep patterns and hygiene so that appropriate sleep practices (hygiene) can be taught and encouraged.
Nursing Interventions for Sleep Wellness
Nonpharmacologic treatment
Pharmacologic treatment
Health promotion teaching about sleep:
Nursing Interventions for Sleep Wellness
What is the first line treatment?
Nonpharmacologic treatment - First-line treatment
Nursing Interventions for Sleep Wellness
Nonpharmacologic treatment - First-line treatment: What does this include?
Cognitive behavioral therapy
- Relaxation Techniques
- Diaphragmatic breathing
- Progressive relaxation
- White noise or music
- Guided imagery
- Stretching
- Yoga or tai chi
*Melatonin (0.3 mg up to 2 mg) given 1 h before bedtime may be helpful. valerian root, chamomile, Kava Kava.
Nursing Interventions for Sleep Wellness
Pharmacologic treatment: What can they be used with? What should be avoided?
- caution with older adults
*May be used with behavioral interventions
*Try to avoid sedative-hypnotics
Nursing Interventions for Sleep Wellness
Educating older adults about medications:
What are the two groups?
Sedative-Hypnotics: Benzos
Non-Benzos “Z-drugs”
Nursing Interventions for Sleep Wellness
Educating older adults about medications:
Sedative-Hypnotics: Benzos include?
Triazolam(Halcion)
Flurazepam(Dalmane)
Temazepam(Restoril)
Estazolam (ProSom)
Nursing Interventions for Sleep Wellness
Educating older adults about medications:
Non-Benzos “Z-drugs” :
Non-Benzos “Z-drugs”
Zolpidem(Ambien, Ambien CR, Edluar, and Zolpimist)
Eszopiclone(Lunesta)
zaleplon(Sonata)
OTC Benadryl (diphenhydramine)
Unisom(doxylamine)
Nursing Interventions for Sleep Wellness
Educating older adults about medications:
Having to do with meds, what else can contribute to sleep problems?
The times of day that medications are given can also contribute to sleep problem
What are some things that should be done to promote sleep?
*Teaching about management of sleep disorders
*Maintaining the same daily schedule for waking resting and sleeping
*Avoid caffeine, alcohol, and tobacco in the late afternoon or evening
*after 1:00 PM avoid foods beverages and medications that contain caffeine or stimulants
- Reduce fluid intake before bedtime
*Avoid exercising before bedtime *Establish a relaxing bedtime routine.
Nursing Interventions for Sleep Wellness
If sleeping meds are used, when should they be taken? How long is it recommended they be taken
If sleeping medications are used, they should be taken immediately before bedtime because of their rapid action.
Short-term use (2 to 3 weeks, never more than 90 days) is recommended.
Nursing Interventions for Sleep Wellness
What should not be used to induce sleep? Why?
*Benzodiazepines should not be used to induce sleep; these substances are highly addictive, and if their administration is suddenly withdrawn, then rebound insomnia can occur.
Nursing Interventions for Sleep Wellness
Adults that take benzos are at risk for experiencing what?
In addition, older adults who take benzodiazepines for sleeping are more likely to experience a “hangover” after waking that can increase the risk of accidents and injuries.
Nursing Interventions for Sleep Wellness
What specific effect does benzos have on sleep and latency?
Benzodiazepines reduce sleep-onset latency by 4.2 min and modestly increase total sleep duration, but the latter effect tends to wear off after 4 weeks.
Adverse effects of benzos include?
Benzodiazepines are associated with significant adverse effects, such as cognitive decline, delirium, falls, fractures, and dependence.
Non-Benzodiazepines “The Z-drugs”
How are they compared to Benzos? What are these drugs associated with?
Are not safer alternatives to benzodiazepines because they are also associated with a significant risk of adverse events, such as delirium, falls, and fractures, with minimal improvement in sleep latency and duration.
Nursing Interventions for Sleep Wellness
(OTC) over-the-counter medications: What are the most frequently used nonprescription products for sleep? Should they be used for this purpose? Why?
Antihistamines such as diphenhydramine were identified as the most frequently used nonprescription products for sleep in a subset of older adults, however, these drugs should be avoided for this purpose because tolerance develops when they are used as hypnotics, and they carry strong anticholinergic properties.
Nursing Interventions for Sleep Wellness
*General adverse effects of sleep medications, including over the counter medications:
include problems with daily function, changes in mental status, motor vehicle accidents, daytime drowsiness, and increased risk of falls with only minimum improvement in sleep.
Nursing Interventions for Sleep Wellness
What can be encouraged for a better sleep?
*A regular exercise regimen, for those who are able, can deepen sleep, increase daytime arousal, and decrease depression. It is important, however, to avoid exercise before bedtime but rather implement a relaxing bedtime routine
Nursing Interventions for Sleep Wellness(cont.)
Improving sleep for older adults in institutional settings: modifying the environment to promote sleep. example:
temp 72F, partitions between roommates, low-level night-lights in the bathrooms, keep day light bright.noise
Nursing Interventions for Sleep Wellness(cont.)
Teaching older adults about interventions for sleep wellness example:
*environmental modifications and comfort and relaxation strategies
Nursing Interventions for Sleep Wellness(cont.)
Nonpharmacological intervention to improve sleep. example:
Nonpharmacological intervention to improve sleep. *allowing residents to awake/sleep according to their own routines and NOT based on the most efficient use of nursing and dietary time
