Unit 9: Key Concepts Chapter 13: Rest, Sleep and Activity
Sleep and Aging
Changes include less time spent in stages 3 and 4 sleep (slow-wave sleep) and more time spent
awake or in stage 1 sleep. Time spent in REM sleep also declines with age, and transitions
between stages 1 and 2 are more common.
Box 13.2 Changes in Sleep with Age (pg. 171)
Box 13.3 Risk factors for sleep disturbances (pg. 172)
Internal
Age-related changes in sleep architecture
Chronic illness
Sleep disorders
Pain
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 (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 is characterized by (pg. 172):
Difficulty initiating sleep
Difficulty maintaining sleep
Premature morning awakening
Nonrestorative sleep
Insomnia and Alzheimer’s disease: Behavioral techniques to enhance sleep (pg. 172)
Sleep hygiene education
Daily walking
Increase light exposure
Interventions for Insomnia Box 13. 7 (pg. 174)
Cognitive behavioral therapy for insomnia is a multidimensional approach combining
psychological and behavioral therapies that include sleep hygiene, sleep restriction, stimulus
control, relaxation techniques, circadian interventions, and cognitive therapy.
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.
• Remove hearing aids/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.
• Melatonin 1–2 hours before bedtime may be helpful.
Pharmacological Treatment
Pharmacological treatments for sleep disorders may be used in combination with behavioral
interventions. Medications must be chosen carefully, started at the lowest possible dose, and
monitored closely for untoward effects.
Effects of benzodiazepines and benzodiazepine receptor agonists (pg. 175):
Zolpidem, escopiclone, zaleplon
They can have detrimental effects like delirium, falls, fractures, daytime sleepiness, (if driving
they get into accidents), minimal improvement in sleep latency and duration
-dose should be cut in half
Sleep Apnea
The individual with sleep apnea stops breathing while asleep.
What are the results of this? Signs/symptoms? (pg. 176)
Sleep and Aging
Changes include less time spent in stages 3 and 4 sleep (slow-wave sleep) and more time spent
awake or in stage 1 sleep. Time spent in REM sleep also declines with age, and transitions
between stages 1 and 2 are more common.
Box 13.2 Changes in Sleep with Age (pg. 171)
Box 13.3 Risk factors for sleep disturbances (pg. 172)
Internal
Age-related changes in sleep architecture
Chronic illness
Sleep disorders
Pain
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 (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 is characterized by (pg. 172):
Difficulty initiating sleep
Difficulty maintaining sleep
Premature morning awakening
Nonrestorative sleep
Insomnia and Alzheimer’s disease: Behavioral techniques to enhance sleep (pg. 172)
Sleep hygiene education
Daily walking
Increase light exposure
Interventions for Insomnia Box 13. 7 (pg. 174)
Cognitive behavioral therapy for insomnia is a multidimensional approach combining
psychological and behavioral therapies that include sleep hygiene, sleep restriction, stimulus
control, relaxation techniques, circadian interventions, and cognitive therapy.
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.
• Remove hearing aids/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.
• Melatonin 1–2 hours before bedtime may be helpful.
Pharmacological Treatment
Pharmacological treatments for sleep disorders may be used in combination with behavioral
interventions. Medications must be chosen carefully, started at the lowest possible dose, and
monitored closely for untoward effects.
Effects of benzodiazepines and benzodiazepine receptor agonists (pg. 175):
Zolpidem, escopiclone, zaleplon
They can have detrimental effects like delirium, falls, fractures, daytime sleepiness, (if driving
they get into accidents), minimal improvement in sleep latency and duration
-dose should be cut in half
Sleep Apnea
The individual with sleep apnea stops breathing while asleep.
What are the results of this? Signs/symptoms? (pg. 176)
