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32 Cards in this Set
- Front
- Back
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Sleep Disorders: definition
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disturbance sleep
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Dysomnias
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insomnia, obstructive sleep apnea, narcolepsy, restless leg syndrome
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Parasomnias
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sleepwalking, night terrors etc
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Medical insomnia
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psychiatric sleep disorders
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Insomnia: Prevalance
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Insomnia: 36% prevalence, 9% consider the insomnia serious; increases with age
Pain and fatigue affect quality of life and social functioning |
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Nearly _____ of older adults report difficulty initiating and maintaining sleep.
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Nearly half of older adults report difficulty initiating and maintaining sleep.
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With age, several changes occur that can place one at risk for sleep disturbance including:
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increased prevalence of medical conditions,
increased medication use, age-related changes in various circadian rhythms, and environmental and lifestyle changes. |
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Although sleep complaints are common among all age groups, older adults have increased prevalence of many primary sleep disorders including:
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sleep-disordered breathing,
periodic limb movements in sleep, restless legs syndrome, rapid eye movement (REM) sleep behaviour disorder, insomnia, and circadian rhythm disturbances. “ |
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Primary insomnia: define
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In and of itself. Meaning it is not related to symptoms or another disorder
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Secondary Insomnia: define
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Related to something else, such as disorders like asthma, or depression, cancer, GERD, meds or alcohol.
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What are some causes of secondary insomnia?
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Pain or discomfort, including emotional
Life loss or change in a loved one or living arrangement Illness Environment such as light, noises, temperature Meds for allergies, decongestants,antidepressants, asthma can interfere with sleep Interference with normal sleep schedule such as long distance travel or working a night shift. |
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Acute Insomnia: Define
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Duration 1 night to a few weeks, including it being intermittent
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Chronic Insomnia: Define
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Duration “at least 3 nights per week for a month or longer”
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Sleep duration and insomnia severity were associated with
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Sleep duration and insomnia severity were associated with all-cause death and CVD events
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Optimal sleep duration of ______ hours per night was predictive of fewer deaths.
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Optimal sleep duration of 7-8 hours per night was predictive of fewer deaths.
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A study found that after a night in which the subject experienced _________ total sleep time he or she experienced below-average pain ratings
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study found that after a night in which the subject experienced above-average (>7-8 hours) total sleep time he or she experienced below-average pain ratings
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Primary prevention: Insomnia
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Insomnia is a symptom, not a diagnosis
May be attributable to poor sleep habits Sleep hygiene Awaken and bed at regular times Avoid napping Sleep environment should be quiet, stress-free, dark, somewhat cool Bed should be comfortable, only used for sleep/sex Exercise at least 6 hours before sleep (epinephrine) Avoid caffeine/etoh/nicotine/heavy night meal Go to bed only when tired Avoid emotional stim immediately prior to bed Sleep ritual: yoga, biofeedback, bath to promote sleep |
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Symptom of insomnia may entail
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Difficulty falling asleep
Difficulty returning to sleep after mid-night awakening Early morning awakening earlier than preferred |
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Patient with insomnia complain of....
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Individual c/o nonrestorative sleep, fatigue, daytime sleepiness, difficulty concentrating
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_________ aids in the determination of those individuals for whom less than average sleep is normal and restorative, and those for whom it is not.
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Sleep history aids in the determination of those individuals for whom less than average sleep is normal and restorative, and those for whom it is not.
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When assessing a patient with insomnia its important to assess
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Assess for normal sleep patterns
sleep hygiene issue medical conditions psychological/physical/social events at time of onset Assess for treatment already used and success |
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Insomnia: Management and interventions
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Sleep hygiene measures – initiate 1-3 at a time
Sleep log: 24 hour logs for 1-2 weeks Treat underlying disorders e.g. GERD Use sedative/hypnotics sparingly, all but zolpidem alter various stages of sleep But caution with this med 2013 warning re: memory impairment If awake after 30 min attempt at sleep, to get out of bed and perform mundane task e.g. reading until feeling sleepy, then reattempt bed sleep Avoid clock watching Light evening snack may assist sleep NB: Chronotherapy: delay bedtime by 3 hours q night, until normal pattern resumed Light exposure 30-60 min before awakening, will help set circadian rhythm Short acting, short term hypnotics e.g. Zaleplon for insomnia in elderly |
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How many sleep hygiene measures should you initiate at one time
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1-3
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How long should you prescribe a sleep log for
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24 hour logs for 1-2 week
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How should you use sedative/hypnotics for in insomnia patients
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Use sedative/hypnotics sparingly, all but zolpidem alter various stages of sleep
But caution with this med 2013 warning re: memory impairment |
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What should you instruct a patient to do if they are awake after 30 minutes after attempting to sleep
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If awake after 30 min attempt at sleep, to get out of bed and perform mundane task e.g. reading until feeling sleepy, then reattempt bed sleep
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Warn patient to avoid ____ (action) when trying to sleep
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clock watching
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Chronotherapy*****
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delay bedtime by 3 hours q night, until normal pattern resumed
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Referral to Sleep Disorder Center when:
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Unable to control insomnia
Suspicion of underlying disorder such as narcolepsy or obstructive apnea |
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Polysomnography (PSG)
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usually overnight, sleep evaluated by video/electrodes
(EEG, HR, RR, O2 sat, body movement: eye, jaw, legs, resp effort) |
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Multiple Sleep Latency Test (MSLT)
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quantifies sleep latency, identifies certain sleep disorders
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Insomnia: Case management: economic, psychologic considerations
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Very common and potentially serious disorder
May compromise safe driving or work May diminish qol due to tiredness, lack of energy for activities Often overlooked in health evals |
