Chapter 16: Sleep Disorders

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Chapter 16 Sleep Disorders
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Learning Objectives

• Discuss the importance of sleep to successful
  aging.
• Describe the potential impact of sleep
  disturbance on quality of life in older adults.
• Discuss changes in sleep associated with the
  normal aging process.
• Obtain a basic sleep history, including
  identification of risk factors for sleep
  disturbance.

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Learning Objectives (contd)

• Use basic and selected specific sleep screening
  instruments to assess sleep in older adults.
• Discuss common sleep disorders in older adults,
  including those associated with geropsychiatric
  disorders.
• Identify geriatric implications of pharmacologic
  interventions for sleep disorders.
• Discuss nonpharmacological interventions used in
  the management of sleep disorders in older
  adults, including cognitive, behavioral, and
  complementary alternative therapies.

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Sleep and Quality of Life

• Sleep and the Aging Process
• Bedtime and wake time of older adults earlier
  than younger adults
• 21 of adults over the age of 65 rated their
  
• sleep as fair or poor
• Assessment of Sleep
• History
• General survey
• Insomnia
• Daytime sleepiness

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Common Sources of Geriatric Sleep Disturbance

• Geropsychiatric Disorders and Sleep
• Sleep disturbance is a common problem in older
  adults with mental health conditions.
• Sleep disturbance in older adults is geriatric
  syndrome, often occuring with depression,
  anxiety, dementia, and other neurological
  disorders such as Parkinsons disease, mental
  health conditions, and substance abuse

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Common Sources of Geriatric Sleep Disturbance

• Common Sources of Geriatric Sleep Disorders
• Insomnia
• Sleep-related breathing disorders
• Hypersomnias
• Circadian rhythm disorders
• Parasomnias
• Restless legs syndrome

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Common Sources of Geriatric Sleep Disturbance

• Sleep Management
• Pharmacologic management of sleep disorders in
  older adults is sometimes needed for relief of
  symptoms not amenable to nonpharmacologic
  methods. (Table 16-2)
• Older adults may be more sensitive to side
  effects of sleep medications, especially CNS
  effects, which may predispose to cognitive
  impairment and falls

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Common Sources of Geriatric Sleep Disturbance

• Sleep Management Medications
• Sedative-hypnotics
• Anti-anxiety
• Hormone
• Sedating antidepressants
• Antihistimines
• Antipsychotics

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Common Sources of Geriatric Sleep Disturbance

• Complementary Alternative Medicine (CAM)
• Acupuncture
• Mind-body modalities Cognitive behavioral tx.
• Biological-based products
• Melatonin shows no significant benefit
• Manipulative and Body-based modalities
• Slow-stroke back and hand massage
• Tai Chi
• Energy fields manipulation of energy, light tx.
• Cranial electrical stimulation

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Nursing Management

• Maintain a regular routine and sleep-wake
  schedule every day.
• Regular exercise
• Get exposure to natural light for several hours
  per day.
• Reduce the use of caffeine, alcohol, tobacco,
  especially late in the day.
• Develop a bedtime routine for each night (read,
  watch TV, take a warm bath)
• Listening to classical or relaxing music at
  bedtime can promote relaxation.
• A glass of warm milk
• Reduce noise levels at night
• Use medication as a last resort.

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Question

• At 0300, the nurse finds an elderly hospitalized
  client sitting in a chair beside the bed. When
  the client says she is unable to sleep, the best
  action on the part of the nurse is

Ask about strategies the client has used successfully in the past to fall asleep.
2. Call the physician to obtain an order for a hypnotic.
3. Assist the client back to bed.
4. Provide a glass of warm milk and offer a back rub.
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Summary

• Disturbed sleep has a bidirectional relationship
  with disease processes in older adults such as
  depression, anxiety, heart disease, hypertension,
  and diabetes, and with many medications
• Treatment requires holistic approach
• Sleep should routinely assessed and monitored in
  older adults