Unit 9 Chapter 13 Rest, Sleep, and Activity
Purpose of Sleep and Rest to help the body to
• Conserve energy
• Prevent fatigue
• Provide organ respite
• Relieve tension
• Sleep is a basic need, and rest occurs with sleep
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
• Poor sleep is not an inevitable consequence of aging.
• It is an indicator of health status and necessitates investigation.
Sleep Disorders
• Insomnia
• Sleep apnea
• Restless leg syndrome
• REM sleep behavior disorder
• Circadian rhythm sleep disorder
Insomnia
• Condition that interferes with sleep quality and quantity and is associated with
subjective complaints of sleep disturbance that are difficulty initiating sleep, difficulty
maintaining sleep, premature morning awakening, or nonrestorative sleep
• Requires that a person has difficulty falling asleep for at least 1 month and that
impairment in daytime functioning results from difficulty sleeping
Internal
• Age-related changes in sleep architecture
• Chronic Illness
• Sleep disorders (SDB, OSA, RL/WED, RBD, CRSD)
• Pain, chronic pain can interfere with sleep quality and quantity
• Worry, anxiety
• Depression, delirium, dementia, psychosis
• Sleep-related beliefs
External
• Medications
• Life stressors/response to stress
• Loss of spouse
• Relocation to new environment
, • Sleep habits (daily sleep/activity cycle, napping)
• Poor sleep hygiene
• Lack of exercise
• Lack of socialization/stimulation
• Excessive napping
• Caregiving for a dependent elder
• Environmental noise, institutional routines
• Limited exposure to sunlight
• Alcohol
• Smoking
Insomnia and Alzheimer’s Disease
• Occurs in about half of those with dementia
• Associated with agitation, wandering, comorbid illnesses, primary sleep disorders, or
the medications used to treat dementia
• Caregivers of individuals with dementia also experience poor sleep quality
• Behavioral techniques to enhance sleep for individuals with Alzheimer’s disease include
sleep hygiene education, daily walking, and increased light exposure
Implications for Gerontological Nursing and Healthy Aging
• Assessment
• Review of sleep patterns
• Presence of contributing factors such as pain, chronic illness, medications,
alcohol use, depression, and anxiety
• Sleep diaries or logs
• Self-rating scales
• Pittsburgh Sleep Quality Index
• Epworth Sleepiness Scale
• Polysomnography conducted in sleep laboratories
Medications and Sleep
• Prescriptions and nonprescription medications can impact sleep.
• Drugs and alcohol account for 10-15% of insomnia cases.
• Timing of medication can impact sleep.
• Interventions
• Nonpharmacologic treatment
• First-line treatment isCognitive behavioral therapy
• Pharmacologic treatment
• Used cautious with older adults
• May be used with behavioral interventions
• Make sure if patient is on sleep medications that Fall precautions are in
place!
• Avoid sedative-hypnotics
, Interventions
Sleep Hygiene
• Develop a regular physical exercise regimen for those who are able; regular exercise can
deepen sleep, increase daytime arousal, and decrease depression.
• Avoid exercise before bedtime.
• Limit computer use before bedtime.
• Limit tobacco, caffeine, and alcohol use before bedtime.
• Avoid heavy meals before bedtime. If waking caused by hunger, eat light carbohydrate
snack.
• If you have reflux, eat the evening meal 3–4 hours before bedtime.
• Reduce or eliminate fluids in the evening (reduce nocturia).
• Ensure bed and bed coverings are comfortable, not too restrictive.
• Keep bedroom temperature comfortable, not too warm and well ventilated.
• Minimize light exposure in bedroom while trying to sleep
• Remove hearing aids or use earplugs to reduce noise.
• Limit sleeping partner's disruptive nighttime activities and pets from bedroom.
• Review all medications with health care provider; evaluate administration times, review
side effects/interactions/effect on sleep.
Relaxation Techniques
• Diaphragmatic breathing
• Progressive relaxation
• White noise or music
• Guided imagery
• Stretching
• Yoga or tai chi
Sleep Restriction Measures
• Limit or avoid daytime napping; napping should not exceed 2 hours.
• Limit opportunities for unplanned napping or dozing, particularly in the evening.
• Limit time in bed to more closely match the number of hours of actual sleep.
Stimulus Control
• Create bedtime sleep rituals, such as taking a warm bath and eating a small snack.
• Go to bed only when sleepy.
• Avoid falling asleep in places other than own bed (e.g., couch, recliner).
• If unable to fall asleep in a reasonable time (15–20 min), get out of bed and pursue
relaxing activities (e.g., reading) and return to bed only when sleepy.
• Use the bedroom for sleep and sex only; do not watch television from bed or work in
bed.
Circadian Interventions
• Reestablish connection with various environmental signals to cue the circadian rhythm
(light exposure, meals, physical activity, social interactions).
• Establish a regular bedtime and waking time.
• Maintain stable daytime routines in regard to meals, activity, medications.
• Increase duration and intensity (2500–5000 lux) of bright light or sunlight exposure
during the day. In patients with dementia, evening bright light may help with
advanced sleep phase disorder.
Purpose of Sleep and Rest to help the body to
• Conserve energy
• Prevent fatigue
• Provide organ respite
• Relieve tension
• Sleep is a basic need, and rest occurs with sleep
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
• Poor sleep is not an inevitable consequence of aging.
• It is an indicator of health status and necessitates investigation.
Sleep Disorders
• Insomnia
• Sleep apnea
• Restless leg syndrome
• REM sleep behavior disorder
• Circadian rhythm sleep disorder
Insomnia
• Condition that interferes with sleep quality and quantity and is associated with
subjective complaints of sleep disturbance that are difficulty initiating sleep, difficulty
maintaining sleep, premature morning awakening, or nonrestorative sleep
• Requires that a person has difficulty falling asleep for at least 1 month and that
impairment in daytime functioning results from difficulty sleeping
Internal
• Age-related changes in sleep architecture
• Chronic Illness
• Sleep disorders (SDB, OSA, RL/WED, RBD, CRSD)
• Pain, chronic pain can interfere with sleep quality and quantity
• Worry, anxiety
• Depression, delirium, dementia, psychosis
• Sleep-related beliefs
External
• Medications
• Life stressors/response to stress
• Loss of spouse
• Relocation to new environment
, • Sleep habits (daily sleep/activity cycle, napping)
• Poor sleep hygiene
• Lack of exercise
• Lack of socialization/stimulation
• Excessive napping
• Caregiving for a dependent elder
• Environmental noise, institutional routines
• Limited exposure to sunlight
• Alcohol
• Smoking
Insomnia and Alzheimer’s Disease
• Occurs in about half of those with dementia
• Associated with agitation, wandering, comorbid illnesses, primary sleep disorders, or
the medications used to treat dementia
• Caregivers of individuals with dementia also experience poor sleep quality
• Behavioral techniques to enhance sleep for individuals with Alzheimer’s disease include
sleep hygiene education, daily walking, and increased light exposure
Implications for Gerontological Nursing and Healthy Aging
• Assessment
• Review of sleep patterns
• Presence of contributing factors such as pain, chronic illness, medications,
alcohol use, depression, and anxiety
• Sleep diaries or logs
• Self-rating scales
• Pittsburgh Sleep Quality Index
• Epworth Sleepiness Scale
• Polysomnography conducted in sleep laboratories
Medications and Sleep
• Prescriptions and nonprescription medications can impact sleep.
• Drugs and alcohol account for 10-15% of insomnia cases.
• Timing of medication can impact sleep.
• Interventions
• Nonpharmacologic treatment
• First-line treatment isCognitive behavioral therapy
• Pharmacologic treatment
• Used cautious with older adults
• May be used with behavioral interventions
• Make sure if patient is on sleep medications that Fall precautions are in
place!
• Avoid sedative-hypnotics
, Interventions
Sleep Hygiene
• Develop a regular physical exercise regimen for those who are able; regular exercise can
deepen sleep, increase daytime arousal, and decrease depression.
• Avoid exercise before bedtime.
• Limit computer use before bedtime.
• Limit tobacco, caffeine, and alcohol use before bedtime.
• Avoid heavy meals before bedtime. If waking caused by hunger, eat light carbohydrate
snack.
• If you have reflux, eat the evening meal 3–4 hours before bedtime.
• Reduce or eliminate fluids in the evening (reduce nocturia).
• Ensure bed and bed coverings are comfortable, not too restrictive.
• Keep bedroom temperature comfortable, not too warm and well ventilated.
• Minimize light exposure in bedroom while trying to sleep
• Remove hearing aids or use earplugs to reduce noise.
• Limit sleeping partner's disruptive nighttime activities and pets from bedroom.
• Review all medications with health care provider; evaluate administration times, review
side effects/interactions/effect on sleep.
Relaxation Techniques
• Diaphragmatic breathing
• Progressive relaxation
• White noise or music
• Guided imagery
• Stretching
• Yoga or tai chi
Sleep Restriction Measures
• Limit or avoid daytime napping; napping should not exceed 2 hours.
• Limit opportunities for unplanned napping or dozing, particularly in the evening.
• Limit time in bed to more closely match the number of hours of actual sleep.
Stimulus Control
• Create bedtime sleep rituals, such as taking a warm bath and eating a small snack.
• Go to bed only when sleepy.
• Avoid falling asleep in places other than own bed (e.g., couch, recliner).
• If unable to fall asleep in a reasonable time (15–20 min), get out of bed and pursue
relaxing activities (e.g., reading) and return to bed only when sleepy.
• Use the bedroom for sleep and sex only; do not watch television from bed or work in
bed.
Circadian Interventions
• Reestablish connection with various environmental signals to cue the circadian rhythm
(light exposure, meals, physical activity, social interactions).
• Establish a regular bedtime and waking time.
• Maintain stable daytime routines in regard to meals, activity, medications.
• Increase duration and intensity (2500–5000 lux) of bright light or sunlight exposure
during the day. In patients with dementia, evening bright light may help with
advanced sleep phase disorder.
