Tabloski ch08 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

Sleep and the Older Adult

8

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Discuss the importance of obtaining adequate sleep and the sleep cycle.

2. Describe normal changes in sleep occurring with aging.

3. Identify potential causes of sleep disruption in older persons.


Learning Objectives

4. List the risks and benefits of pharmacological and nonpharmacological interventions for sleep disturbance.

5. Formulate appropriate nursing interventions to improve or restore sleep.


Introduction

• Sleep is a natural periodic state of rest for the mind and body necessary for health and human function.

• Sleep complaints are common among older people.


Introduction

• Older adults experience age-related changes in the nature of their sleep.

• In order to assist persons with sleep disturbances, nurses need scientific knowledge about sleep.


Sleep Architecture

• Normal sleep physiology is composed of four distinct stages when measured by electroencephalography.


Figure 8-1a Sleep stages. Electroencephalograph tracings of awakeness, REM, and non-REM sleep.


Figure 8-1b Sleep stages. Sleep cycles during nighttime sleep.


Normal Changes in Aging

• Age-related changes in the nervous system can affect sleep.

• These changes may be at the chemical, structural, and functional levels and may result in a disruption of circadian rhythms.


Normal Changes in Aging

• The amount of time spent in deeper levels of sleep diminishes with aging.

• There is an associated increase in awakenings during sleep and an increase in the total time spent in bed trying to sleep.


Healthy Aging Tips

• Stay busy during the daytime.• Stay positive.• Exercise regularly.• Limit caffeine, alcohol, and other

stimulants.• Get a few minutes of sunlight every

day.


Sleep Disruption

• This group of abnormal sleep behaviors requires evaluation from neurologists or sleep specialists.

• The time it takes to fall asleep serves as a good indicator of whether a person is getting enough sleep.


Sleep Disruption

• When an older person’s sleep requirements are not met, a sleep deficit accumulates with resulting loss of overall daytime function.


Health Problems and Sleep Disruption

• Mental health problems associated with poor sleep include anxiety, depression, and substance abuse disorders.

• Older women are more likely than older men to experience sleep disruption.

• Various health problems and the medications used to treat them are associated with sleep disruption in older persons.


Dementia

• Older persons with dementia endure even more sleep disruptions than other older persons.

• Sleep disturbances in older persons with dementia cause caregiver stress.


Snoring

• Snoring can signal a potentially serious condition known as sleep apnea, or temporary interruption of breathing during sleep.


Sleep Apnea

• Sleep apnea can be caused by problems with the central nervous system and the brain or may be caused by partial obstruction of the airway when the muscles in the throat, soft palate, and tongue relax during sleep.


Sleep Apnea

• If sleep apnea is suspected, the older person should be referred to a sleep center for an overnight sleep study using polysomnography.


Urinary Problems

• Older persons may be awakened from sleep because of the need to urinate.

• With aging, nighttime urine flow rates may equal or exceed daytime rates.

• Older persons who report urgency, frequency, burning on urination, foul odor, and cloudy urine should seek medical evaluation.


Sleep Problems in Hospitals and Nursing Homes

• Nurses contribute to their patients’ sleep disruption.

• It is often difficult to distinguish between sleep pattern disturbances caused by the hospital environment and those caused by the illness itself.


Alcohol and Caffeine

• Both caffeine and nicotine increase the number of nighttime awakenings and the length of time it takes to fall back to sleep.

• Because alcohol, caffeine, and nicotine typically are used in conjunction with one another, the sedating and arousal effects frequently interact, creating multiple sleep disturbances.


Nursing Assessment

• Nursing assessment of sleep problems in older persons should utilize a holistic approach.

• The components of a sleep assessment should include a health history, a physical examination, daily sleep diaries, and polysomnography testing if sleep apnea is suspected.


Additional Nonpharmacological Measures

• After the nurse and the older person have identified an appropriate goal, a schedule is established for time to bed and time to arise.– Use the bed only to sleep.– If you are unable to sleep, get up and go

to another room.


Additional Nonpharmacological Measures

• After the nurse and the older person have identified an appropriate goal, a schedule is established for time to bed and time to arise.– Get up at the same time every day,

regardless of the amount or quality of sleep obtained the night before.

– Do not nap during the day.

Tabloski ch08 lecture

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