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Sleep and Activity Sleep

is a natural, periodically, recurring, physiologic state of rest for the body and mind. Is a state of inactivity or repose that is required to remain active.

Activity Includes the things we do while awake, such as personal care, daily tasks, exercise,

and recreation. The kind, amount, and intensity of the activities pursued vary widely among

individuals according to personal choices, lifestyle, and health status.

Sleep and Older Adults

Biologic brain Functions Responsible for Sleep Hypothalamus

Regulation of sleep and wakefulness. Consists of several masses of nuclei, interconnected with other parts of the

nervous system, and is located below the thalamus. Sleep state of consciousness characterized by physiologic changes (reduced

BP, PR and RR with decreased response to external stimuli). Stages of Sleep

Sleep and Circadian Rhythm 24 hour period Release of certain hormones Factors affecting:

Perception of time - Illness Travel across time zones - Medication Light exposure Seasonal changes Living habits Stress

Insomnia Inability to sleep, is a complex phenomenon.

Reports: Difficulty falling asleep Difficulty staying asleep Frequent nocturnal awakenings Early morning awakening Daytime somnolence

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Types: Transient lasts only a few nights r/t situational stress Short- term lasts less than a month r/t pain or grief. Chronic lasts more than a month r/t age, medical, psychological, environmental

factors.

May affect the older adults quality of life associated with the ff: Excessive daytime sleepiness Attention and Memory problems Depressed mood Nighttime falls Overuse of hypnotic / OTC medications

Age Related Changes in Sleep Increase sleep latency

A delay in the onset of sleep. Takes longer to fall asleep at the start of the night and after being awakened during

the night. Reduced sleep efficiency

Percentage of time in bed spent asleep Sleep efficiency decreases

Older adults = 75% Young adults = 90%

Increased nocturnal awakenings Contribute to an overall decrease in the average number of hours of sleep Causes:

Trips to the bathroom - Snoring Dyspnea - Leg cramps Chest pain - Noise Arthritis pain - Coughing

Increased early morning awakenings Increased period of wakefulness following nocturnal awakening.

Increased daytime sleepiness Due to frequent nocturnal awakening or other sleep disturbances. Underlying disease

Motor vehicle accidents Cognitive dysfunction Medication side effects

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Factors Affecting Sleep Environment

Environments conducive to relaxation are likely to be soporific. Low levels of stimuli, Dimmed lights, Silence, Comfortable furniture Home environments Hospitals and Long term Care Facilities

Noise Sleep deprivation Alteration in comfort Pain Stress or difficulty concentrating, which can interfere with the enjoyment of

activities. Lighting

Darkened rooms Temperature

Cold is No! No! At night, decreased core body temperature Pajamas, Nightgowns, bed socks and nightcaps.

Pain and Discomfort Decreased sleep quality Administration of analgesics Alternative sleeping places:

Cushion chairs Rocking chair More pillow = Good sleep

Lifestyle Changes Loss of Spouse

Widowhood is a common life event in the older adult population. Older women than males Widowhood leaves older adults without touch partners Loss of a bed partner can make sleep psychologically less comforting The change in bedtime routine may interfere with the onset of sleep.

Retirement Changes in schedule and activities

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Decades that older adults times for going to bed and waking were influenced by he

work schedule. Relocation

Sleep is adversely affected by the transition to these unfamiliar surroundings. Having a Roommate

Roommate relationships Lighting Different interests and lifestyles

Dietary Influences Sleep is influenced by what we eat and drink

Caffeine containing beverages Alcohol Hunger and thirst

Drugs Influencing Sleep Drugs Used to Promote Sleep

Tranquilizers and Sedatives = decrease activity and calm the recipient. Hypnotics = produce drowsiness and facilitate the onset system depression. Benzodiazepines = safe and efficient, increases the total of sleep time.

Drugs with Drowsiness Side effect Antihistamines Tricyclic antidepressants May cause insomnia and nightmares

Drugs causing Insomnia Nasal decongestants Amphetamine like substances Analgesics containing caffeine

Natural or Herbal Remedies

Herbal remedies have been recommended as aids for securing a good nights sleep. Drug to Drug interactions

Depression Among older adults depression is treatable and is frequently associated with insomnia. Clients are waken in the early morning and are unable to return to sleep. Excessive daytime somnolence.

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Dementia and Disturbed Sleep Increased confusion at night, nocturnal wandering, agitation Bed routines

Sleep Disorders and Conditions Sleep Apnea

Recurrent episodes of cessation respiration lasting for 10 seconds to 2 minutes,

number of apneic episodes may range from 10 to 100 per hour of sleep. More common in men than in women

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