Gero- Sleep-Chapter 17 Flashcards
(34 cards)
What is the most important biorhythm?
Circadian sleep-wake rhythm
As people age what happens to the circadian rhythm?
- May become less responsive to external stimuli
- For instance, changes in light
**Pt will want to stay awake all night and sleep all day
What Endogenous changes take place during sleep?
- Diminish of melatonin (less sleep efficacy)
- Diminish ability to sleep or sleep well
What are the five stages of normal sleep pattern the body progresses through consisting of?
- REM (Rapid Eye Movement)- 25% of night, occurs first 90 minutes after falling asleep, every 90 minutes after and become longer. Restore energy to brain/body, support daytime performance, brain active, Eyes dart, body immobile/relaxed.
- NON REM- 75% of night as we fall asleep we begin NREM stages 1-4
What are the five stages of normal sleep pattern the body progresses through?
N1= Being awake/falling asleep (light sleep)
N2= Sleep (disengage from surroundings, RR/HR regular, decrease in body temp (sleep in cold environment especially w/ sleep apnea)
N3-N4 = Deep sleep, BP drops, Breathing slows, muscles relaxed, Blood supply increases, Tissue growth repair occurs, restored energy, growth hormone released.
What are age-related changes according to sleep?
- More time spent in bed awake than sleep
- Decrease in sleep time & efficiency
- Awakens frequently, increase after age 50
- Day time napping
- Changes in circadian rhythm (early to bed/early rise)
- Sleep is subjectively/objectively lighter (more stage 1, little stage 4 w/ more disruptions)
- REM short, less intense more easily distributed
- Freq or abnormal breathing events increased
- Freq leg movements during sleep increased
What is insomnia?
- Most common sleep disorder
- Interferes with sleep quality and quantity
- subjective complaints of sleep categorized by:
- initiation
- duration
- consolidation
- quality
What are the physical risk factors for sleep disturbance?
- Age-related changes in sleep architecture
- Comorbidities
- Pain
- Polypharmacy
- Lack of exercise
- Sleep disorders
What are the psychological risk factors for sleep disturbance?
- Depression, anxiety, delirium, psychosis
- Life stressors/response to stress
- Sleep habits (Daily sleep, activity cycle, napping)
- Loneliness
- Loss of partner
- Poor sleep hygiene
What are the physical environment risk factors for sleep disturbance?
- Environmental noises, institutional routines
- Caregiving for a dependent older adult
- Limited exposure to light (sunlight)
- New environment
What happens with patients that have Insomnia and Alzheimer’s disease?
-want to sleep all day and stay awake all night (Circadian rhythm)
How many people w/ dementia experience sleep dysregulation?
3 quarters (75%)
What happen to care givers taken care of patients who want to sleep all day and stay awake all night?
- experience poor sleep quality, leading to stress, and health problems
What is associated (INCREASED) w/ sleep disruption?
- Neuropsychiatric symptoms
- Functional decline
- Morbidity
- Mortality
What are contributing factors to assess for with sleep disorder?
- Pain
- Chronic illness
- Medications
- Alcohol use
- Depression
- Anxiety
***Encourage a sleep dairy to assess sleep and w/ suggestions of further interventions
What are some interventions (non-pharmacological) to help w/ insomnia?
Nonpharmological treatment
- directed at identifiable cause (must have a cause before giving medication)
-"first line treatment for insomnia" \+Sleep habits \+Relaxation techniques \+ CCBT \+Tai chi/ quigong \+sleep in hospitals/nursing homes (difficult: odd surrounding, very noisy, people coming/ going)
BOX 17-9 in book READ!!!
What are some interventions (pharmacological) to help w/ insomnia?
- OTC sleeping aids, prescription sedatives, hypotonic medications
- BENZODIAZEPINES (should not be used in older adults as a first choice of treatment in insomnia)- avoid if possible
- BENZODIAZEPINES most abused drug - do not use w/ opiates
Pharmocological/ behavior interventions used together
What is the most common form of sleep apnea and how many are affected?
- 25 % affected
- OSA (Obstructive sleep apnea)
What happens when OSA is left untreated?
- Heart failure
- Cardiac dysrhythmias
- Stroke
- Type 2 diabetes
- Osteoporosis
- Death (r/t accidents central episode when brain does not tell respiratory to breath obstruction can cause central sleep apnea)
What predispose older adults to OSA?
-Decline in the activity of the upper airway muscles, resulting in compromised pharyngeal patency.
What the risk factors for OSA?
- Increase with age
- Neck circumference (measure on assessment)
- Men 17 in or larger
- Women 15 in or larger
What are you looking for on assessment with a pt. who has OSA?
-present w/ complaints of insomnia or daytime sleepiness, and assessment of insomnia complaints
What do you do if OSA is suspected?
- referral for a sleep study
Why is recognition of OSA in older adults is more difficult?
-Because they may not have a sleeping parter
If you have a partner you have someone that can monitor you or video you sleeping, can take something home to measure breathing SPO2 on finger
