Sleep Disorders - Demntia, Older adults, Insomnia, Sleep apnoea

Question 1

Dementia - sundowning
-what is this
-possible causes
-management

Answer 1

Change in behaviour in the evenings
-disorientation
-anxiety
-agitation
May lead to difficulties sleeping

Tiredness, hunger, pain
Not enough sun exposure during the day
Overstimulation
Circadian disturbances
Sensory impairment
Med SEs

Assess for unmet needs
Verbal deescalation

Question 2

Dementia and sleep
-what happens
-management

Answer 2

Body clock is damaged by dementia => more sleepy during the day, less sleepy at night

Manage any underlying issues
Routine
Sun exposure
Fun activities
Avoid stimulants - caffeine, cigarettes, alcohol
Avoid being too hungry, thirsty or full
Sleep friendly bedroom
Reduce screentime

Can consider melatonin

Question 3

Sleep disturbance in older adults
-management

Answer 3

1st line - melatonin
Avoid BZs and antipsychotics - increased risk of sedation and falls

Question 4

Insomnia
-definition and types
-presentation
-risk factors
-diagnosis
-Short-term management

Answer 4

Difficulty in starting/maintaining sleep
Early morning waking => poor sleep quality/quantity => impaired functioning

Acute - linked to a life event, resolves without treatment
Chronic - min 3 nights/week for 3 months+

Female, older age
Lower educational attainment
Unemployment/economic inactivity
Widowed/separated/divorced

Substance/stimulant use
CS use
LTCs/chronic pain
Psych illness
Poor sleep hygiene

Diagnosed through patient interview
-can consider sleep diary?

Identify causes
No driving whilst sleepy
Sleep hygiene
-no screens 30-60mins before bed
-bedtime routine
-dim lights
-relaxation techniques
-physical activity during the day
-reduce caffeine, alcohol

When to consider meds - for SHORT TERM use when daytime impairment is severe
-short acting BZ - temazepam
-zopiclone, zolpidem, zaleplon

Review after 2 weeks, consider CBTi

Question 5

Sleep apnoea
-presentation
-risk factors
-diagnosis
-management

Answer 5

Daytime sleepiness
Snoring, periods of apnoea => compensated resp acidosis, HTN

Obesity
Macroglossia - acromelagly, hypothyroidism, amyloidosis
Large tonsils
Marfans

Epworth Sleepiness Scale
Sleep studies (polysomnography)

Weight loss
1st line - CPAP
2nd line - mandibular advancement
DVLA informed if causing excessive daytime sleepiness