1. Sleep / Rest for Older Adults

2. Objectives Describe the normal changes in sleep patters associated with age. Describe the normal changes in sleep patters associated with age. Identify the causes of sleep disturbance among older adults. Identify the causes of sleep disturbance among older adults. Assess sleep in older adults. Assess sleep in older adults. Provide nursing interventions to restore sleep quality among older adults. Provide nursing interventions to restore sleep quality among older adults.

3. Review of sleep cycle Non Rapid Eye Movement (NREM) – Non Rapid Eye Movement (NREM) – –Stage 1 - period of drifting –Stage 2 - relaxation and light sleep – Stages 3 and 4 - restorative Rapid Eye Movement (REM), sometimes called paradoxical sleep There are 4 stages in a REM cycle: 1, 2, 3, and 4. Rapid Eye Movement (REM), sometimes called paradoxical sleep There are 4 stages in a REM cycle: 1, 2, 3, and 4. Each cycle is about 90 minutes Each cycle is about 90 minutes

4. Changes in sleep patterns 50% of older adults have reported sleep disturbances, but 1 in 8 are diagnosed by a physician 50% of older adults have reported sleep disturbances, but 1 in 8 are diagnosed by a physician 12% - 25% of HEALTHY older adults 12% - 25% of HEALTHY older adults 22% - 61% of HOSPITALIZED older adults 22% - 61% of HOSPITALIZED older adults Common complaints: daytime fatigue; difficulty falling asleep Common complaints: daytime fatigue; difficulty falling asleep

5. Changes in sleep patterns Increased REM Stage 1 wakefulness Increased REM Stage 1 wakefulness Decreased NREM (Stage 3 and 4) slow wave deep sleep Decreased NREM (Stage 3 and 4) slow wave deep sleep Increase in nighttime awakenings: nocturia, restless legs syndrome, periodic limb movements in sleep (PLMS), sleep apnea Increase in nighttime awakenings: nocturia, restless legs syndrome, periodic limb movements in sleep (PLMS), sleep apnea

6. Circadian rhythm Regular variation in physiologic parameters that occur over the course of a 24-hour day Regular variation in physiologic parameters that occur over the course of a 24-hour day Irregular Sleep/Wake Pattern Irregular Sleep/Wake Pattern –Irregular sleep/wake timing –Daytime napping Advanced Sleep Phase Syndrome Advanced Sleep Phase Syndrome –Intractable early evening sleepiness –Awakening between 2 and 4 a.m.

7. Sleep Disturbances 1. Dyssomnias 2. Parasomnias 3. Disorders associated with medical or psychiatric disorders 4. Proposed sleep disorders

8. Causes of sleep disturbances Periodic limb movements in sleep (PLMS) Periodic limb movements in sleep (PLMS) Acute and Chronic Illness Acute and Chronic Illness Commonly Occurring Problems Commonly Occurring Problems –Nocturia –Dementia –Alcoholism –Depression

9. Assess Sleep Sleep history Sleep history Medical history Medical history Diet and drug history Diet and drug history Psychosocial history Psychosocial history The Pittsburgh Sleep Quality Index (PSQI).pdf The Pittsburgh Sleep Quality Index (PSQI).pdf The Pittsburgh Sleep Quality Index (PSQI).pdf The Pittsburgh Sleep Quality Index (PSQI).pdf PSQI Try This Assessment Series available on Hartford Institute website at www.hartfordign.org

10. Nursing Interventions Refer for sleep-related disorders with PLMS or other medical psychological and other symptoms Refer for sleep-related disorders with PLMS or other medical psychological and other symptoms Nonpharmacologic Option Nonpharmacologic Option –Remove contributing factors –Educate the patient; implement Sleep Hygiene Measures; expose to light upon awakening –CPAP –Cognitive behavior therapy

11. Nursing Interventions Pharmacologic Option Pharmacologic Option –Temazepam –Triazolam Benzodiazepines, behavioral approaches – short term Benzodiazepines, behavioral approaches – short term Close monitoring and reassessment Close monitoring and reassessment

12. Summary Normal changes in sleep patterns Normal changes in sleep patterns Causes of sleep disturbances Causes of sleep disturbances Assessment of sleep Assessment of sleep Nursing interventions: pharmacologic and no pharmacologic; sleep hygiene measures Nursing interventions: pharmacologic and no pharmacologic; sleep hygiene measures

13. QUESTIONS?