Sleep Disorders in the Elderly Lecture Powerpoint

Question 1

NREM and REM sleep**

Answer 1

NREM is stage 1 (lightest) to 4 (deep sleep, 3 and 4 are restful and restorative physically), REM sees rapid eye movement, almost no muscle tension, and paralysis except for eyes and breathing (increased brain activity for mental restoration and dreaming)

Question 2

Sleep complaints in geriatric patients*****

Answer 2

Should be indication to perform comprehensive H&P to identify the cause, should always be pursued as a symptom of a health problem not a diagnosis in and of itself

Question 3

Sleep problems tend to increase with…

Answer 3

….comorbid conditions

Question 4

1 treatment choice for older adults with sleep problems

Answer 4

Cognitive behavioral therapy

Question 5

Sleep changes with age

Answer 5

Tend to need more sleep and sleep tends to be less restorative in nature as we get older BUT follows general health more closely than chronological age

Question 6

Insomnia

Answer 6

Taking a long time to fall asleep (30-45 min) or waking up many times at night or waking up early and not being able to go back to sleep

Question 7

Medications that affect sleep (6)

Answer 7

• alcohol
• antidepressants
• antihypertensives
• caffeine
• diuretics
• nicotine

Question 8

Advanced sleep phase syndrome and treatment options (2)**

Answer 8

• Entire circadian rhythm being off, go to bed much earlier in evening and wake up much earlier, many try to force themselves to stay awake, typically most common in young children and elderly
• bight light therapy and exercise

Question 9

Obstructive sleep apnea

Answer 9

Cessation of breathing briefly and repeatedly during sleep (apnea is a breathing pause that lasts at lesat 10 seconds) due to mechanical obstruction of airway, more common than central, combo of disturbed sleep and hypoxia may lead to hypertension, characterized by snoring, daytime drowsiness, observed apneic episodes

Question 10

Diagnostic gold standard study of sleep apnea

Answer 10

-polysomnogram**

Question 11

OSA treatment options (3)**

Answer 11

• CPAP
• dental appliances
• surgery

-do NOT give benzos as these decrease breathing, and lunesta

Question 12

Restless leg syndrome

Answer 12

Overwhelming urge to move legs when at rest accompanied by unpleasant sensations, can be worsened by some meds, alcohol or iron or b12 deficiency

Question 13

Restless leg syndrome treatment options (3) and what is the big ADR with these choices? (1)

Answer 13

• horizant
• mirapex
• requip

-dizziness and sedation and may fall asleep without warning!!!!

Question 14

Periodic limb movement disorder

Answer 14

Brief muscle twitches, jerking movements or upward flexing of feet in clustered episodes lasting minutes to hours, most of time cause is unknown, may occur along RLS and only treated when co-occurring, thought to be potentially due to kidney disease, DM, anemia, etc

Question 15

REM behavior disorder

Answer 15

Occurs when patient acts out dreams, other parasomnias may mimic so need eval at sleep center with polysomnogram, possible link to parkinsons

Question 16

REM behavior disorder treatment options (3)

Answer 16

• clonazepam
• antidepressants
• melatonin

Question 17

Sleep hygiene**

Answer 17

Try to go to bed and get up at the same time every day.
Try not to take naps longer than about 20 minutes.
Don’t have caffeinated drinks after lunch.
Don’t drink alcohol in the evening.
It might help you fall asleep, but it will probably make you wake up in the middle of the night.
Don’t lie in bed for a long time trying to go to sleep.
After 30 minutes of trying to sleep, get up and do something quiet for a while, like reading or listening to quiet music. Then try again to fall asleep in bed.
Ask your doctor if any of your medicines could be keeping you awake at night.
Ask your doctor for help if pain or other health problems keep you awake.
Try a little exercise every day
It helps many older people sleep better.