4 Sleep and the Older Adult

8/8/2019 4 Sleep and the Older Adult

1/22

Geriatric Nursing


2/22

Nonrapid Eye Movement(NREM)Rapid Eye Movement (REM)


3/22

` Stage I Transitional period of very light sleep

Easily aroused Lasts less than 7 mins.

` Stage II Period of deeper relaxtation and light sleep

Predominant NREM stage in older adults


4/22

` Stage III

` Stage IV Restores the individual physically, and tissue heling

occurs during this time

Most sensitive to advancing age; begins to decline during

the 30s


5/22

` Follows the 4 stages of NREM

` Deepest state of relaxation

` Large muscles become immobile

` Active autonomic nervous system` RR, BP, and HR becomes erratic

` Same brainwave patterns as those of wakefulness

` State of dreams

` Restoration of mental and emotional states


6/22

` 90 mins long


7/22

` Regulates sleep

` Governed by the Suprachiasmic Nucleus (SCN) in

the hypothalamus

` Melatonin Hormone produced by the Pineal Gland at night

Released in response to darkness

Inhibits neurotransmitters involved in arousal

` Lack of sleep can lead to delirium in older adults


8/22


9/22

` Insomnia

` Sleep Apnea Caused by CNS control mechanism disturbance

Narrowing or loss of tone in the pharyngeal airway

O2 decrease CO2 increase acidic pH of Blood

HR drops brain interprets as fluid overload

hormone release to wake individual get rid of

fluid and sodium nocturia

` Restless Leg Syndrome


10/22

` Must be referred to a sleep center for: Polysomnography overnight evaluation of sleep events

` Continuous Positive Airway Pressure (CPAP) Consistently improves symptoms of sleep apnea

Decreases the individuals risk for somatic diseases


11/22


12/22

` Hygiene

` Sleep habits Time of going to bed

Rituals prior to bedtime

Established sleep environment` Daytime sleepiness

` Depression

` Anxiety` Thorough physical examination

` Medication history


13/22

` Measures sleepiness uninfluenced by

emotional state or pain

` Useful for clients who are unable to read


14/22


15/22

Sleep HygieneEnvironmental Restructuring

Relaxation

Aroma Therapy

Herbal TherapyMedications


16/22

` Hospital Nursing duties should be

timed

`

Avoid Caffeine` Avoid Alcohol

` Smoking


17/22

` Florence Nightingale First to address environmental restructuring for optimal

health outcomes

` Consider

Lighting

Noise (less than 35 db)

Sensory stimulation

Room color (soft mix of blue, green, and violet)

Nature scene Artwork (decreases use of pain meds,

lower BP and increase relaxation)


18/22

` Music therapy Most common independent nursing

intervention for sleep

` Massage


19/22

` Enhances immunity and promotes relaxation

` Examples: Lavander

Chamomile

Peppermint

Thyme

Geranium

Eucalyptus

` Consider allergies before prescribing

aromatherapy to older clients


20/22

Calming effect and reduces

insomnia

Effective as tranquilizers

Produces a sedative effect

similar to benzodiazepines

Safest of all oils with no irritation

or sensitivity reported

When inhaled olfactory bulb

limbic system increase inGABA (same effect as

diazepam)

Lavander (Lavandula angustifolia)


21/22

` Preparations using Valerian Enhances sleep by influencing

activities at GABA, adenosine,

serotonin receptors promoting

normal sleep

Promotes relaxation and depth

and quality of sleep

` Should be used with caution

Drug-drug interaction can occurhepatotoxicity


22/22

` Not Recommended Benzodiazepines - long half-life

Triazolam (Halcion) & Temazepam (Restoril) long half-life

Flurazepam (Dalmane) long half-life and accumulatesin the body over time; assoc. with confusion and falls inthe elderly

Benadryl hangover effects in the elderly

` Recommended Zolpidem (Ambien) Zaleplon (Sonata)

Eszopiclone (Lunesta)

Documents

4 Sleep and the Older Adult