Chapter 24

Chapter 24: Sleep and Rest

Age-Related Changes Affecting Sleep

  • Sleep Quality:

    • Decline in sleep efficiency after age 50.

    • Increased sleep latency and frequency of awakenings.

    • Diminished quality with less dreaming and deep sleep.

  • Sleep Quantity:

    • Less total sleep achieved in bed.

    • More time in bed and increased napping needed to achieve equivalent rest.

  • Circadian Rhythm Changes:

    • Advanced sleep phase leading older adults to feel sleepy earlier and wake up earlier.

Risk Factors Affecting Sleep

  • Psychosocial Factors:

    • Anxiety, boredom, social isolation, and environmental disturbances (noise, temperature).

  • Health Conditions:

    • Chronic conditions like nocturia, obstructive sleep apnea, restless leg syndrome can disrupt sleep.

  • Medication Effects:

    • Adverse effects of medications, alcohol, and caffeine.

Effects of Drugs on Sleep

  • Common Medications Affecting Sleep:

    • Alcohol: Suppresses REM sleep, causes early morning awakening.

    • Anticholinergics: Can lead to hyperactivity and muscle twitching.

    • Benzodiazepines: Can result in sleep apnea and nightmares.

    • Corticosteroids: Cause restlessness and sleep disturbances.

    • Diuretics: Lead to nocturia and sleep interruptions.

Insomnia

  • Defined as chronic or transient sleep disorders affecting quality with daytime impairment.

  • Chronic insomnia negatively impacts well-being in older adults.

  • Nonpharmacological approaches, like cognitive behavioral therapy, recommended over hypnotics.

Consequences of Sleep Disturbances

  • Symptoms include daytime sleepiness, decreased alertness, delayed reaction time, and cognitive decline.

  • Linked to higher risks of stroke, obesity, cardiovascular diseases, and depression.

Common Sleep Disorders

  • Insomnia: Characterized by inability to sleep well at night.

  • Obstructive Sleep Apnea: Episodes of airflow cessation for more than 10 seconds, causing loud snoring and daytime fatigue.

  • Restless Legs Syndrome: Urge to move legs, worsening during periods of rest.

  • Periodic Limb Movements: Jerky movements of limbs during sleep, affecting sleep quality.

Nursing Assessment of Sleep

  • Utilize STOP-BANG screening tool for obstructive sleep apnea.

  • Gather sleep history and observe for snoring, apnea, and excessive leg movements.

  • Use assessment tools like the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale to evaluate sleep quality.

Nursing Diagnoses and Planning Outcomes

  • Diagnoses include readiness for enhanced sleep, insomnia, and disturbed sleep patterns.

  • Desired outcomes: 6-8 hours of sleep, waking refreshed.

Nursing Interventions for Sleep Wellness

  • Teach proper sleep hygiene practices and lifestyle changes.

  • Modify environments for better sleep and educate about medications.

  • Individualize care plans, considering preferences and comfort measures.

Sleep Hygiene Practices

  • Establish a routine for sleep; limit naps to 10-15 mins.

  • Maintain a cool, quiet environment; avoid caffeine after 1 PM.

  • Recommended pre-sleep activities: warm bath, meditation, light snack.

  • Encourage moderate exercise and avoid smoking/alcohol.

  • Discuss potential effects of supplements like Melatonin with healthcare providers.

Evaluating Effectiveness of Interventions

  • Measure through improved feelings of being rested and better scores on sleep assessments.