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8/8/2019 4 Sleep and the Older Adult
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Geriatric Nursing
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Nonrapid Eye Movement(NREM)Rapid Eye Movement (REM)
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` 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
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` 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
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` 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
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` 90 mins long
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` 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
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` 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
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` 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
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` Hygiene
` Sleep habits Time of going to bed
Rituals prior to bedtime
Established sleep environment` Daytime sleepiness
` Depression
` Anxiety` Thorough physical examination
` Medication history
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` Measures sleepiness uninfluenced by
emotional state or pain
` Useful for clients who are unable to read
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Sleep HygieneEnvironmental Restructuring
Relaxation
Aroma Therapy
Herbal TherapyMedications
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` Hospital Nursing duties should be
timed
`
Avoid Caffeine` Avoid Alcohol
` Smoking
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` 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)
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` Music therapy Most common independent nursing
intervention for sleep
` Massage
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` Enhances immunity and promotes relaxation
` Examples: Lavander
Chamomile
Peppermint
Thyme
Geranium
Eucalyptus
` Consider allergies before prescribing
aromatherapy to older clients
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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)
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` 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
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` 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)