Sleep Disorders - Demntia, Older adults, Insomnia, Sleep apnoea Flashcards
Dementia - sundowning
-what is this
-possible causes
-management
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
Dementia and sleep
-what happens
-management
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
Sleep disturbance in older adults
-management
1st line - melatonin
Avoid BZs and antipsychotics - increased risk of sedation and falls
Insomnia
-definition and types
-presentation
-risk factors
-diagnosis
-Short-term management
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
Sleep apnoea
-presentation
-risk factors
-diagnosis
-management
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