Gerontological Nursing, ch. 15 Rest and Sleep
Terms in this set (33)
Inability to fall sleep, difficulty staying asleep, or premature waking.
Condition characterized by at least five leg jerks or movements per hour during sleep. Associated with the use of tricyclic antidepressants and chronic renal failure.
Falling asleep earlier in the evening and awakening earlier in the morning.
Restless leg syndrome
Neurological disorder characterized by an uncontrollable urge to move the legs when one lies down. It can be caused by iron deficiency anemia, uremia, Parkinson's disease, rheumatoid arthritis, diabetes, or neurological lesions; it is believed to be associated with alterations in dopamine and iron metabolism.
Disorder in which at least five episodes of cessation of breathing, lasting at least 10 seconds, occur per hour of sleep, accompanied by daytime sleepiness. This disorder can be caused by a defect in the central nervous system that affects the diaphragm (central sleep apnea), a blockage in the upper airway that interferes with normal air flow (obstructive sleep apnea), or a combination of both (mixed). Supine position should be avoided because it allows the tongue to fall back and block the airway.
Delay in the onset of sleep.
Age-related changes in sleep
Insomnia, daytime sleepiness, and napping are all highly prevalent among the older adults.
Increasing natural light is useful in pushing the circadian rhythm toward a later hour of sleep.
Reductions in non-rapid eye movement stage sleep and rapid eye movement (REM) stage sleep begin to occur after midlife.
Sleep efficiency and quality
Older adults are more likely to awakened by noises (ie, a busy street or staff in the hallway). Older individuals are also more likely than the young to be awakened by having lights turned on and having changes in room temperature.
Pittsburgh Sleep Quality Index
Tool that can be used to measures the quality and patterns of sleep in older adults.
Changes in stage I
More time spent in this stage, most likely due to frequent awakening; increased number of arousals and shifts into non-rapid eye movement (REM) sleep.
Changes in stage II
No significant change, although older adult may spend more time in this stage.
Changes in stage III
Changes in stage IV
Changes in stage V
Decreased due to reduced amount of sleep time in general.
Insomnia can be a short-term (transient) problem associated with a changed environment, illness, added stress, or anxiety.
Chronic insomnia (i.e., insomnia lasting 3 or more weeks) can be related to physical or mental illnesses, environmental factors, substance abuse, or medications.
Medical conditions that affect sleep
Cardiovascular conditions, fluctuating glucose levels in a diabetic, gastric pain in gastroesophageal reflux disease, COPD, and musculoskeletal conditions.
Cardiac or respiratory problems
May produce difficulties such as such as orthopnea and pain related to poor peripheral circulation.
May cause nocturnal frequency.
Drugs that affect sleep
diphenhydramine HCl (Benadryl capsules); nicotine (NicoDerm Nicotine Transdermal System); fluoxetine HCl (Prozac); theophylline (Theo-X Extended-Release tablets); and alprazolam (Xanax).
A sleep assessment should include
A review of time spent in sleep and naps, quality of sleep, medication review, bedtime routines, and the presence of sleep disturbances.
Dangers of barbituates
They lower basal metabolic rate more than it already is and decrease blood pressure.
Activity and rest schedules
Satisfying, regular activity promotes rest and relaxation. Greater amounts of rest are required by older people and should be interspersed with periods of activity throughout the day.
Nonpharmacologic measures to promote rest
Evaluation of activity and rest, environment, food and supplements, stress management, and pain control.
Electric blankets should be used to preheat the bed and should be turned off when the individual enters the bed to reduce the health hazards associated with electromagnetic fields.
Food and supplements
Foods high in carbohydrates tend to raise the level of serotonin in the brain, which could have a sedating effect; therefore, a protein and carbohydrate snack at bedtime may encourage sleep.
3 measures to help older adults fall asleep naturally
Regular exercise, exposure to sunlight during the day, and non-caffeinated herbal teas at bedtime are three measures to help older adults fall asleep naturally.
Includes responding to stress in a health manner, managing their lifestyle, relaxation, and prayer.
Unrelieved chronic stress
Unrelieved chronic stress can lead to heart disease, hypertension, cerebrovascular accident, ulcers, and other health disorders.
May inhibit sleep. Massages, warm soaks, relaxation exercises, guided imagery, and diversion can provide effective relief of many types of pain.
Sleep and cognition study
It was found that women with sleep apnea were almost twice as likely to become cognitively impaired.
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