Sleep Problems

Question 1

When it comes to sleep issues in the elderly, what is the biggest complaint?

Answer 1

Not being able to fall asleep, 40%

Question 2

What are four risk factors that account for insomnia?

Answer 2

1. chronic illness
2. mood disturbance
3. Less physical activity
4. Physical disability

Question 3

What are 3 screening questions used to assess for insomnia?

Answer 3

1. is the person satisfied with his or her sleep?
2. Does sleep or fatigue interfere with daytime activities?
3. Does the bed partner or others complain of unusual behavior during sleep, such as snoring, interrupted breathing, or leg movements?

Question 4

Apnea episodes characterized by cessation of breathing without associated respiratory effort

Answer 4

Central sleep apnea

Question 5

central sleep apnea can be a primary disorder but what else can it be associated with?

Answer 5

opioid use, stroke, heart failure, or other conditions

Question 6

characterized by complete or partial upper airway obstruction during sleep, with evidence of respiratory effort curing the events

Answer 6

Obstructive sleep apnea

Question 7

What is a major symptom of obstructive sleep apnea?

Answer 7

Daytime sleepiness

Question 8

Morning headache, personality changes, poor memory, confusion, and irritability are all symptoms of?

Answer 8

Obstructive sleep apnea

Question 9

What are two risk factors for obstructive sleep apnea?

Answer 9

High BMI and large neck circumference

Question 10

What is the main treatment for obstructive sleep apnea?

Answer 10

positive airway pressure (PAP)

Question 11

Is CPAP or biPAP better for obstructive sleep apnea?

Answer 11

CPAP

Question 12

Repetitive, stereotypic leg movements that occur during non-REM sleep

Answer 12

Periodic Limb Movement Disorder

Question 13

Characterized by an urge to move legs, usually with an unpleasant sensation in the legs that occurs with inactivity generally at night, and improves with movement

Answer 13

Restless Legs Syndrome

Question 14

What is the initial agent of choice for patients with PLMD and restless legs syndrome

Answer 14

a dopaminergic agent

Question 15

What does a delayed sleep phase mean?

Answer 15

Fall asleep late, awaken late

Question 16

What does an advanced sleep phase mean

Answer 16

Fall asleep early, awaken early

Question 17

If you have a patient who is suffering from insomnia and is taking a cholinesterase inhibitor, what time of the day should they take it?

Answer 17

Morning as they can exacerbate insomnia and cause vivid dreams

Question 18

What are four factors that contribute to insomnia in the hospital?

Answer 18

Illness, medications, change form usual routines, and sleep-disruptive environment

Question 19

What class of medications is commonly used to help sleep disturbances in the hospital?

Answer 19

Benzodiazepines

Question 20

should we use sedating antihistamines to help people sleep in the hospital?

Answer 20

Definitely not.

Question 21

If you are unable to fall asleep in the first 30 minutes of going to bed, what should you do?

Answer 21

Get up and perform a soothing activity (avoid bright light)

Question 22

What is the goal of a stimulus control intervention?

Answer 22

To recondition maladaptive sleep-related behaviors

Question 23

What is the goal of a sleep restriction intervention?

Answer 23

To improve sleep efficiency (time asleep divided by time in bed) by causing sleep deprivation

Question 24

The goal of this type of intervention is to change misunderstandings and false beliefs regarding sleep

Answer 24

Cognitive interventions

Question 25

The goal of this type of intervention is to recognize and relieve tension and anxiety

Answer 25

Relaxation techniques

Question 26

for this type of intervention the patient is exposed to sunlight or light box.

Answer 26

Bright light

Question 27

What is the goal of bright light therapy?

Answer 27

to correct circadian rhythm causes of sleeping

Question 28

What is the first-line treatment for chronic insomnia?

Answer 28

Cognitive Behavioral Therapy

Question 29

Combines sleep restriction, stimulus control, cognitive therapy, +/- relaxation techniques

Answer 29

Cognitive Behavioral Therapy

Question 30

Most sleep medications increase the risk of _____ in older adults

Answer 30

falls

Question 31

What is indicated if a primary sleep disorder is suspected, or patient doesn’t respond to treatment?

Answer 31

Polysomonography