Transcript lecture 5: Chapter 8 Sleep and the Older Adult

CHAPTER
8
Lecture Note PowerPoint Presentation
Sleep and the Older
Adult
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 1
Discuss the importance of obtaining
adequate sleep and the sleep cycle.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Proper Sleep Components
•
•
•
•
Proper architecture
Adequate total sleep time
Restful
Restorative: made up of Deep and REM sleep, provides
physical and emotional restoration, aids memory foundation and
storage, emotional processing and development of new skills.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Results of Sleep Deprivation
• Harmful physical and psychological
changes
• Daytime fatigue
• Irritability
• Impaired learning ability
• Delayed healing
• Visual and auditory hallucinations
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Normal Sleep Stages
• Stage 1
– Light sleep
– Feelings of drifting accompanied by feelings
of falling
– Easy to arouse
• Stage 2
– Brain waves slow
– Eye movements stop
– Easy to arouse
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Normal Sleep Stages
• Stage 3
– Slowing brain waves and sleep spindles (is a
burst of brain activity visible on an EEG that occurs during stage 2
sleep)
– Difficult to arouse
• Stage 4
– Deep sleep
– Difficult to arouse
– Stimulates physical restoration through the
release of growth hormone
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 2
Describe normal changes in sleep occurring
with aging.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Age-Related Changes in the
Nervous System Affecting Sleep
• Changes may be at the chemical,
structural, and functional levels
– Result in disorganization of sleep
– Cause disruption of circadian rhythms
 Declines in cerebral metabolic rate and cerebral
blood flow
 Reductions of neuronal cell counts
 Structural changes, such as neuronal degeneration
and atrophy
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Age-Related Changes in Sleep
• Greater difficulty falling asleep
• More frequent awakenings
• Decreased amounts of nighttime sleep,
especially deep sleep
• More frequent daytime napping
• Increased time spent trying to sleep as
sleep become less efficient
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Age-Related Sleep Requirements
• Most older adults require 6 to 10 hours per
night
• Less than 4 hours or more than 8 hours
associated with higher mortality rates
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 3
Identify potential causes of sleep disruption
in older persons.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Psychosocial Problems Associated
with Sleep Disturbances
• Life stresses combined with
– Depression
– Anxiety
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Psychosocial Influences That May
Disrupt Sleep
• Social isolation
• Caregiving stress and strain
• Grief and bereavement
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Causes of Sleep Problems in Older
Persons
• Personal characteristics
– Advancing age
– Female gender
– Depression
• Environmental characteristics
• A combination of personal and
environmental characteristics
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Older Women Are More Likely Than
Older Men to
• Take longer to fall asleep
• Wake more frequently after the onset of
sleep
• Stay awake longer during nighttime
awakenings
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Health Problems and Medications
That May Cause Sleep Disruption
• Health problems
– Physical discomfort or pain
– Dementia
 Breakdown of normal sleep-wake cycle
 Short periods of fragmented sleep
 Reduced stages 3, 4, and REM sleep
– Cardiac/respiratory problems
 Orthopnea
 Shortness of breath
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Health Problems and Medications
That May Cause Sleep Disruption
• Health problems
– Snoring
– Sleep apnea
– Urinary problems
 Nocturia
 Urinary frequency
 Benign prostatic hyperplasia
 Drugs and medications
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Health Problems and Medications
That May Cause Sleep Disruption
• Health problems
– Alcohol
– Caffeine
– Sleeping medications
– Decongestants
– Antihistamines
– Diet pills
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Health Problems and Medications
That May Cause Sleep Disruption
• Health problems
– Steroids
– Beta-blockers
– Beta-agonists
– Opioids
– Antidepressants
– Recreational drugs
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Hospitalization and Long-TermCare Placement and Sleep
• Complaints of sleep disruption
– Fragmented and disturbed sleep
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Hospitalization and Long-TermCare Placement and Sleep
• Causative factors
– Repetitive delivery of nursing care
– Excessive noise levels
– Bright lights
– Lack of sleep
– Enforced mobility
– Pain
– Poor communication with staff members
– Temperature
– Unfamiliar surroundings
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 4
Describe the risks and benefits of
pharmacological and nonpharmacological
interventions for sleep disturbance.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Psychotropic Medications
• Appropriate for short-term use
• Long-term use associated with side effects
– Falls
– Swallowing difficulties
– Constipation
– Dizziness
– Daytime sleepiness
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Psychotropic Medications
• Create altered sleep architecture
– Decrease REM sleep
– Decrease level of arousal
– Increase slow wave sleep
– sleep architecture: represents the structure of sleep and is
generally composed of a somewhat cyclical pattern of the
various NREM and REM sleep stages.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Management of Sleep Apnea
• Weight reduction (if indicated)
• Side-lying positions for sleeping
• Place a tennis ball in a pocket sewn on the
back of the night shirt
• Avoidance of sleeping pills
• Avoid alcohol before sleeping
• Avoid smoking
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Management of Sleep Apnea
• Surgery
– Uvulopalatopharyngoplasty
 Used to enlarge the pharyngeal air space
• Continuous positive airway pressure
(CPAP)
– Noninvasive treatment
– Administered through a nasal mask
– Pressure keeps airway open
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Hypnotic Medications
• Recommended for use of 2 weeks or less
• Long-term use may reduce medication’s
effectiveness
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Over-the-Counter Sleep
Medications
• Active ingredient is often diphenhydramine
(Benadryl)
• Side effects
– Daytime sleepiness
– Dizziness
– Blurred vision
– Increased risk of falls and injury
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Sleep Hygiene
• Encouraged for any older person
experiencing a sleep problem
• Promotes improvement and correction of
problem behaviors or inadequate
environmental conditions
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Sleep Hygiene
• Includes
– Addressing environmental problems
– Dietary modification
– Lifestyle modification
– Exercise
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Sleep Restriction
• Identifies appropriate goal
• Establishes a schedule
• Associated with improved quality of sleep
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cognitive Therapy
• Focuses on changing person’s
expectations about sleep
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Benzodiazepine Therapy
• Potential for abuse
• Side effects
– Daytime sedation
– Falls
– Memory impairment
• Shorter-acting options
– Lorazepam
 Better for older adults
 Liver damage less likely
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Sedating Antidepressants
• May be used if signs and symptoms of
depression are noted
• May worsen sleep-related movement
disorders
– Restless leg syndrome
– Disruption of sleep architecture
– Increased risk of falls
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Sedating Antidepressants
• Potential complications
– Postural hypotension
– Anticholinergic side effects
 Constipation
 Dry mouth
 Tachycardia
 Changes in cognitive status
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Barbiturates, Sedatives, Hypnotics,
Opiates, and Antipsychotics
• Should not be used for routine treatment
of sleep disorders
• Potential for
– Abuse
– Overdose
– Severe withdrawal symptoms
– Movement disorders
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Herbal or Natural Remedies
• Melatonin
– Improves sleep onset in older persons
– Does not affect sleep quality
– Does not affect number of awakenings after
sleep onset, total sleep time, or sleep
architecture
• Chamomile tea
– Contraindicated if allergic to ragweed or
daisies
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Herbal or Natural Remedies
• Lemon balm
• Valerian
– NIH studies concluded no evidence to support
effectiveness for use with insomnia
– Side effects
 Headache
 Dizziness
 Itchiness
 Gastrointestinal upset
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
• Valerian
Herbal
or Natural Remedies
– Potential toxic interactions
 Alcohol
 Sedating drugs
 Benzodiazepines
 Barbiturates
• Evening snack
– Tryptophan (is one of the 20 standard amino acids, as well
as an essential amino acid in the human diet.) -containing
foods: eg milk, cheese, yogurt .
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Herbal or Natural Remedies
• Turkey
• Cognitive–behavioral therapy (CBT)
– Short-term goal-focused therapy
– Interventions include
•
•
•
•
Limiting time spent in bed
Stimulus formation
Biofeedback
Relaxation techniques
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 5
Describe appropriate nursing interventions
to improve or restore sleep.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Components of a Sleep
Assessment
•
•
•
•
History and physical
Physical examination
Sleep diaries
Polysomnography testing
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Goals of Care to Promote Healthful
Sleep
• Minimize sleep disruption
• Promote older person’s dignity
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Sleep Hygiene
• Reduce environmental problems
• Review dietary intake
• Promote lifestyle changes
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Bedtime Rituals
•
•
•
•
Relaxation exercises
Music
Praying
Reading
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Interventions for the Nursing Care
Unit/Healthcare Facility
• Establish nighttime routines
• Reduce noise and light disruption
• Turn down volume on televisions, radios,
and phones
• Avoid using intercoms and beepers during
sleep hours
• Regulate night lights
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Interventions for the Nursing Care
Unit/Healthcare Facility
• Occupy residents during the day
• Do not put residents to bed immediately
after supper
• If residents are unable to sleep, assist
them to move away from those who are
sleeping
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.