Chapter 19 Rest

Age-Related Alterations to Sleep Increased awakening during sleep: sleep stages III and IV less prominent Increased incidence of nocturia Altered perception of night environment resulting from visual and hearing deficits Increased incidence of muscle cramps during resting states

Changes to Sleep with Aging The circadian rhythm—the body’s natural day-night cycle changes. –Sleep at an earlier hour to achieve full night’s sleep requirements. Older people sleep less soundly. –Decline in stage IV sleep to the point that it is absent in many older adults. Older people are more sensitive to noise while they are sleeping.

Nursing Measures to Prevent Falls Place a night-light in the bedroom. Keep the bathroom light on. Remove clutter and furniture obstructing path to bathroom. Attach side rails to bed.

Non-Pharmacological Measures for Enhancing Sleep Include more stimulation and action during the day. Expose the person to sunlight during the day. Evaluate the amount of time allotted for sleep. Give a warm bath and back rub at bedtime. Provide a protein and carbohydrate snack.

Non-Pharmacological Measures for Enhancing Sleep (cont.) Provide a quiet environment at a temperature preferred by the individual. Eliminate caffeine and alcohol if sleep disorders are present. Identify medications that interfere with sleep. Give valerian root tea or herbal tincture 45 minutes before bedtime.

Changes in Sleeping Patterns A sudden change to earlier awakening or insomnia may be symptomatic of an emotional disturbance or alcohol abuse. Cardiac or respiratory problems may cause sleep disturbances. Restlessness and confusion during the night may indicate an adverse reaction to a sedative. Nocturnal frequency may signal the presence of diabetes.

Reported Symptoms of Insomnia Awakening at 5 AM Having difficulty falling asleep Not sleeping soundly Traveling to the bathroom several times during the night

Types of Insomnia Short Term Insomnia: associated with a changed environment, illness, added stress, or anxiety. Chronic insomnia: –Insomnia lasting 3 weeks or more –Can be related to physical or mental illnesses, substance abuse, or medications. –Sedatives may be unnecessary if the underlying cause of insomnia can be addressed.

Common Sleep Disorders Nocturnal Myoclonus: Jerking leg movements during sleep. Sleep apnea: –A significant disorder in which at least five episodes of cessation of breathing occur per hour of sleep. –Characterized by snoring and sudden awakening and gasping for air. –The prevalence is two times greater in men than women.

Common Treatments for Sleep Disorders Weight reduction Continuous positive pressurized air Surgery to remove obstructions or realign bite

Health Conditions Affecting Sleep Cardiovascular conditions Diabetes Gastroesophageal reflux disease (GERD) COPD and other respiratory conditions Musculoskeletal conditions Dementia Depression and other emotional disturbances

Measures to Promote Sleep Develop patterns that more equally distribute activity and rest throughout the day. Use nonpharmacologic measures to control pain. –Proper positioning, diversional activities, guided imagery, biofeedback, yoga, massage, therapeutic touch, acupuncture, and magnet therapy

Responses to Stress Mental alertness increases. Fingers, hands, and toes become cold as more blood goes to the body’s muscles. Glycogen converts to glucose. Heart rate and respirations increase. Pupils dilate. Hearing becomes more acute.

Responses to Stress (cont.) Blood-clotting activity increases. Sexual interest and drive is reduced; menstrual irregularities occur; testosterone level is lowered. Ability to concentrate decreases, causing more errors and irrational decisions. Anxiety, fear, or a sense that “something isn’t right” occurs.

Possible Results of Prolonged Stress Heart disease Hypertension Cerebrovascular accident Cancer Ulcers Skin eruptions Complications of existing illnesses Social and emotional problems

Measures to Reduce Stress Respond to stress in a healthy manner. Manage lifestyle. Relax. Pray.

Source Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN ).