Chapter 11 Rest, Sleep, and Activity

Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Objectives Identify age-related changes that affect rest, sleep, and activity Discuss the importance of sleep and activity to the health and well-being of older adults Describe the beneficial effects of exercise and appropriate exercise regimens for older adults Use evidence-based protocols in the assessment and development of interventions for rest, sleep, and the promotion of activity

Purpose of Sleep and Rest Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Purpose of Sleep and Rest Sleep and rest helps the body to: Conserve energy Prevent fatigue Provide organ respite Relieve tension Sleep is a basic need, and rest occurs with sleep.

Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Biorhythm and Sleep Biorhythms vary from individual to individual and with age. With aging, the natural circadian rhythm may become less responsive to external stimuli such as light. The amplitude of all circadian endogenous responses, such as body temperature, pulse, blood pressure, and hormonal levels, reduces.

Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Sleep and Aging Sleep architecture is the predictable pattern of normal sleep. Sleep has five stages. As an individual ages, the time spent in rapid-eye movement (REM) sleep declines. Sleep complaints are linked to other health problems or disorders. Older adults sleep better when they: Are in general good health Have a positive mood Are engaged in an active lifestyle Perform meaningful activities

Sleep Disorders Insomnia Sleep apnea Restless leg syndrome Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Sleep Disorders Insomnia Sleep apnea Restless leg syndrome REM sleep behavior disorder Circadian rhythm sleep disorder

Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Insomnia Is defined as a complaint of disturbed sleep in the presence of an adequate opportunity and circumstance for sleep. Diagnosis of insomnia requires that a person has difficulty falling asleep for at least 1 month and that impairment in daytime functioning results from his or her difficulty sleeping. Is classified as primary or co-morbid insomnia.

Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Primary Insomnia No other cause of sleep disturbance has been identified.

Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Co-Morbid Insomnia Is more common and associated with psychiatric and medical disorders, medications, and primary sleep disorders such as sleep apnea or restless leg syndrome. Prevalence is higher in older adults than it is in younger adults.

Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Sleep Apnea Is a condition in which people stop breathing while sleeping. Episodes are terminated by arousal. Fragmented sleep and daytime sleepiness are the results. Symptoms include loud periodic snoring, gasping and choking upon wakening, unusual nighttime activities such as sitting upright or falling out of bed, morning headaches, poor memory, irritability, and personality changes.

Types of Sleep Apnea Obstructive sleep apnea Central sleep apnea Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Types of Sleep Apnea Obstructive sleep apnea Is the most common type and is caused by an obstruction of the airway. Central sleep apnea Is due to central nervous system or cardiac dysfunction. Age-related decline of individuals promotes the delay of this diagnosis in older adults.

Diagnosis and Treatment of Sleep Apnea Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Diagnosis and Treatment of Sleep Apnea Sleep study is performed to diagnose sleep apnea. Treatment includes: Losing weight Avoiding alcohol and sedatives Stopping smoking Avoiding supine sleeping Wearing a continuous positive airway pressure device (CPAP) at bedtime

Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Restless Leg Syndrome Is a sensorimotor neurological disorder characterized by unpleasant leg sensations that disrupts sleep. Symptoms include paresthesia, creeping sensations, crawling sensations, tingling, cramping, burning pain, pain, or indescribable sensations. Can be temporary and relieved by movement. Disrupted sleep is the reason individuals seek help. Antidepressants and neuroleptic medications can relieve the symptoms. Nonpharmacological therapies include stretching the lower extremities, taking hot baths, performing relaxation techniques, and avoiding alcohol.

Rapid Eye Movement Sleep Behavior Disorder Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Rapid Eye Movement Sleep Behavior Disorder Is common in older adults. Characteristics include the loss of voluntary muscle atonia during REM sleep and violent behaviors while dreaming (punching or kicking) with potential injury to the partner. May be observed in disorders such as Parkinson disease, diffuse Lewy body disease, Alzheimer disease, or progressive supranuclear palsy. Treatment includes a complete neurological examination, the removal of aggravating medications, and educating the client on safety measures in the sleep environment.

Circadian Rhythm Sleep Disorders Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Circadian Rhythm Sleep Disorders Normal sleep occurs at abnormal times. Types include: Advanced sleep phase disorder (ASPD) Irregular sleep-wake disorder (ISWD) Treatments for ASPD include hygiene practices and methods to delay the timing of sleep and wake; bright light therapy for 1 to 2 hours daily. Treatments for ISWD include increasing the duration and intensity of light exposure during the daytime; avoiding exposure to bright lights during the nighttime.

Implications for Gerontological Nursing and Healthy Aging Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Implications for Gerontological Nursing and Healthy Aging Assessment Review of sleep patterns Contributing factors to poor sleep include pain, chronic illness, medications, alcohol use, depression, and anxiety. Subjective and objective measures include: Visual analog scales Subjective rating scales Questionnaires regarding sleep distribution Interviews Daily sleep charts

Awareness of the Client Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Awareness of the Client Nurses need to be aware of the client’s: Number of wakeful events during the night Time he or she retires to bed Bedtime rituals Types of daily exercise Sleeping position Room environment Medications http://consultgerirn.org/topics/sleep/need_help_stat/ This will take you to a “Try This” article and video. There are 2 different tools.

Interventions Nonpharmacological treatment Pharmacological treatment Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Interventions Nonpharmacological treatment Pharmacological treatment Activity

Implications for Gerontological Nursing and Healthy Aging Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Implications for Gerontological Nursing and Healthy Aging Purpose of screening is to: Identify medical problems while achieving benefit from physical exercise. Identify functional limitations. Minimize injury or adverse effects.

Interventions Physical activity Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Interventions Physical activity Special considerations for nonambulatory older adults

Physical Activity Interventions Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Physical Activity Interventions Begin with a history and assessment 30 minutes of moderate-intensity physical activity for 5 or more days of the week Brisk walking Swimming Bicycling Stretching and balance exercises for people at risk of falls Yoga T’ai Chi

Physical Activity Interventions Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Physical Activity Interventions Non-ambulatory persons All programs Endurance Strength-training Resources in community Motivational interventions

Conclusion Adequate sleep and activity Maintain biological health Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. Conclusion Adequate sleep and activity Maintain biological health Meets higher needs Safety and security Belonging and attachment Self-esteem and self-efficacy Self-actualization and transcendence

Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. In Class Activity Break into small groups and review Box 11-6, Steps to Good Sleep Hygiene Discuss with each other your own sleep hygiene and ways it can be improved 5 minutes and report

Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc Mosby items and derived items © 2014, 2010, 2005 by Mosby, Inc., an imprint of Elsevier Inc. References Touhy, T.A., & Jett, K.F. (2014). Ebersole and Hess' Gerontological Nursing & Healthy Aging (4th ed.). St. Louis, Elsevier. Touhy & Jett PowerPoint www.youtube.com www.consultgerirn.org