rest, sleep and activity

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Prittyrick
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303651
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rest, sleep and activity
Updated:
2015-06-04 21:50:53
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  1. Purpose of sleep and rest
    • Sleep and rest help the body to"
    • - conserve energy
    • - prevent fatigue
    • - provide organ respite
    • - relieve tension
    • sleep is a basic need, rest occurs with sleep
    • - spend 1/3 lives sleeping
    • - sleep deprivation /fragmented sleep is associated with risk to physical and emotional health
    • healthy people 2020: sleep health goals
    • as u age the needs for sleep does not reduce. u still need that deep sleep
  2. Biorhythm and sleep
    • Circadian sleep-wake rhythm
    • - circadian endogenous response (body temp, pulse, BP, hormonal levels awake for 16, sleep 8)
    • - sleep architecture= stages
    • * stage 1: lightest level, easy to awaken
    • * stage 2: deeper stage of relaxation
    • * stage 3: early phase of deep sleep
    • * stage 4: deep sleep and relaxation
    • * REM sleep- once every 90 mins of stage 4
    • - 85% of dreaming occur
    • the sleep cycle is repeated several times during the night
  3. Sleep and aging BOX 11-2
    • Changes begin between 20-30yrs
    • - less time in spent in stage 3+4
    • 40-60 even less time is spent in 3/4 and more time is in stage 1+2 or awake
    • - more sensitive to noise, light and room temp- easily awaken (keep it quiet and dark)
    • - more difficult to fall asleep
    • Circadian rhythm changes:
    • - less responsive to external stimuli such as light- sleep times become altered- early bed early to rise
    • increase in sleep fragmentation (waking in the middle of the night)
    • REM sleep shorter, less intense more evenly disturbed
  4. Other considerations
    • time spent in REM declines w/age- may not feel rested upon awakening
    • day time naps may be needed to compensate
    • ? frustration if elders are unable to stay awake during times when other family members are or wide awake when everyone is sleeping
    • consider increasing natural light to push circardian rhythm back
    • consider noise, lighting and room temp with elders in facilities
    • sleep complaints are linked to other health problems or disorder
  5. Sleep disorders
    • insomonia
    • sleep apnea
    • restless leg syndrome
    • REM sleep behavior
    • circadian rhythm sleep disorder
  6. Sleep problems in older adults: contributing
    • age related changes in sleep architechure
    • co-mobidities: CV, DM, pulmonary disease, MS disorders, CNS disorders (parkinson seizure, dementia), GI GERD hernia GU
    • depression anxiety delirium, psychosis
    • pain
    • polypharmacy
    • life stressors
    • limited exposure to sun light
    • environmental noises
    • poor sleep hygiene
    • lack of excerise
    • excessive napping
    • caregiver for a dependent elder
    • sleep apnea
    • restless leg syndrome
    • periodic leg movement
    • REM behavior disorder
    • alcohol, smoking
  7. Insomnia
    • disturbed sleep in presence of adequate opportunity and circumstance for sleep
    • Dx: difficulty falling asleep at least one month
    • w/resulting impaired daytime functioning
    • May be:
    • - primary insomnia (no other causes of sleep disturbance)
    • - co morbid insomnia- more common
    • nurse- schedule, relaxation technique (mediation), caffiene, eating before bed, foods that incre your dopamine/serotonin levels like protein/carbs crackers/milk, use bed for sleep only, no alcohol)
  8. Sleep Apnea
    • 5 episode of no breathing for at least 10sec per hour of sleep with daytime sleepiness
    • 3 types:
    • - obstructive airway
    • - central sleep apnea- the brain fails to signal the muscles to breath or cardiac dysfunction this is dangerous- u can see organ damage.
    • - mixed
    • Apnea: hypoxemia and hypercapnea- changes in ANS activity, incr systemic and pulmonary arterial pressure and changes in cerebral blood flow- fragmented sleep and excessive daytime sleepiness
    • avoid sleeping on your back
  9. Effects of sleep apnea
    • Affects 20% adult LTC 70-80%
    • elders: significant cognitive decline
    • - poor memory, irriablity, personality changes, difficulty concentrating
    • Untreated sleep apnea can cause hypertension, stroke or heart failure
    • excessive daytime sleepiness leads to increase accidents
  10. risk factors for sleep apnea
    • increasing age
    • increased neck circumference
    • male
    • anatomical abnormalities of the upper airway
    • upper airway resistance/obstruction
    • family hx
    • excess weight
    • use of alcohol, sedatives, tranquilizers
    • smoking
    • hypertension
  11. Dx and Tx of sleep apnea
    • Sleep study (PMS) polysomnogram
    • treatment depends on severity, type of apnea
    • comorbid disorders
    • - weight loss
    • - avoid alcohol & sedative
    • - smoking cessation
    • - avoid alcohol & sedatives
    • - smoking cessation
    • - avoid supine sleeping
    • - wearing CPAP (continous positive airway pressure device) allows to breath without obstruction
  12. Restless Leg Syndrome
    • sensormotor neurological disorder
    • - unpleasant leg sensations: paresthesia, creeping sensations, cramping burning pain, indescribable sensations
    • May be:
    • - primary (idiopathic)- affects younger aged
    • - Secondary results from, iron deficiency, end stage renal disease, pregnancy, dopamine dysregulation
  13. Considerations
    • prevalence: 10-20% more in women
    • contributing factors:
    • - BMI, caffeine and tobacco use, sedentary lifestyle
    • Antidepressants and neuroleptic medication may aggravate RLS (avoid)
    • Treatments include:
    • - FE supplements, gabapentin (treat)
    • - stretch, physical activity
    • - hot baths, relaxation
  14. Implication for gerontological nursing
    • Assessment includes sleep history:
    • review sleep patterns
    • - time spent in sleep and naps, quality of sleep
    • - bed time routines
    • Presence of sleep disturbances? length present?
    • contributing factors to poor sleep?
    • - pain, chronic illness
    • - medication, alcohol use
    • - depression, anxiety
    • suggestion
    • - be more active during the day
    • - less time taking naps
    • - good sleep hygiene- relaxation, avoiding screen time
  15. other pt consideration
    • Nurses need to be aware of pt's
    • - time he/she retires to bed time awakes
    • - types of daily excerise sleep log
    • - sleeping position
    • - room environment- temp, lighting, noise
    • - medications/management if any?
    • management directed at identifiable causes
  16. Non pharmacological intervention
    • stress management
    • do not disturb periods
    • usual bedtime routines
    • use of white noise (background noise)
    • **encourage patterns of equalizing activity and rest periods throughout the day
    • exposure to sunlight
    • pain management- heat/cold therapy. guided therapy
    • good sleep hygiene box 11-6
  17. Pharmacological treatment
    • benzo receptor agonist (drug of choice)
    • - zolpidem (ambien), eszopiclone (zunesta) and zaleplon (sonata)
    • --- full night sleep, no alcohol, no driving, avoid antichol or antihistamine, empty bladder before bed)
    • - shorter half lives more favorable for older adults
    • - rapid action take right before bed
    • - ramelteon: melatonin receptor against DFA
    • medications should be used short term
    • avoid sedative, hypnotics (benzo and barbituriates)
    • OTC:
    • - avoid benadryl or tylenol PM- antihistamine and antichol side effects
  18. Activity
    • improves health outcomes/emotional health, functional status and quality
    • decrease chronic illness and functional limitations
    • lack of physical activity leads to frail health and loss of function
    • only 1/3 men, 25% 65-74yo engage in leisure time activity/strengthing activities
    • - less participation with advancing age
    • less likely to receive exerise counseling
    • improves cognitive functioning
    • health people 2020
    • - increase participation in aerobic physical activity
    • - decre # of adults who do not engage in physical activity
  19. Assessment
    • functional abilities
    • screenings:
    • - to identify medical problems and maximize benefit
    • - to identify functional limitations
    • - minimize injury/others adverse effect
  20. Guidelines for physical activity
    • all adults should:
    • - 30 mins/24 hr of moderate intensity aerobic activity
    • - even if 10 mins at a time
    • Adults > 65 yo
    • - 2 1/2 hours/week of moderate intensity aerobic activity
    • - brisk walk, swim, bicycling
    • and muscle stregthening at least 2x a weel
    • - t'ai chi excerises- improves flexibility and balance
    • - wii games, home programs
  21. Other consideration
    • Physical activity can be adapted to all adults even those in wheelchair
    • muscle weakness and atrophy primary concern
    • exercise prescription
    • - focus on endurance, strength, balance, flexibility
    • - varied activities involving interaction with peers, fit person's lifestyle & culture
    • - inform of community resources: YMCA COA
    • benefits are immediate
    • evidence- based interventions focus on adequate rest, activity and sleep

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