Chapter 19Rest

Chapter 19Rest

Age-Related Alterations to SleepAge-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 AgingChanges 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 FallsNursing 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 SleepNon-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.)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 PatternsChanges 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 InsomniaReported 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 InsomniaTypes 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 DisordersCommon 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 DisordersCommon Treatments for Sleep Disorders

• Weight reduction

• Continuous positive pressurized air

• Surgery to remove obstructions or realign bite

Health Conditions Affecting SleepHealth 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 SleepMeasures 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 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.)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 StressPossible Results of Prolonged Stress

• Heart disease

• Hypertension

• Cerebrovascular accident

• Cancer

• Ulcers

• Skin eruptions

• Complications of existing illnesses

• Social and emotional problems

Measures to Reduce StressMeasures to Reduce Stress

• Respond to stress in a healthy manner.

• Manage lifestyle.

• Relax.

• Pray.

SourceSource

• Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).