Sleep and Activity Sleep is a natural, periodically, recurring, physiologic state of rest for the body and mind.

mind. Is a state of inactivity or repose that is required to remain active. Includes the things we do while awake, such as personal care, daily tasks, exercise, and recreation. The kind, amount, and intensity of the activities pursued vary widely among individuals according to personal choices, lifestyle, and health status. Sleep and Older Adults Biologic brain Functions Responsible for Sleep Hypothalamus Regulation of sleep and wakefulness. Consists of several masses of nuclei, interconnected with other parts of the nervous system, and is located below the thalamus. Sleep state of consciousness characterized by physiologic changes (reduced BP, PR and RR with decreased response to external stimuli). Stages of Sleep Sleep and Circadian Rhythm 24 hour period Release of certain hormones Factors affecting: Insomnia Inability to sleep, is a complex phenomenon. Reports: Difficulty falling asleep Difficulty staying asleep Frequent nocturnal awakenings Early morning awakening Daytime somnolence 1 Perception of time Travel across time zones Light exposure Seasonal changes Living habits Stress - Illness - Medication

Activity

Types: Transient lasts only a few nights r/t situational stress Short- term lasts less than a month r/t pain or grief. Chronic lasts more than a month r/t age, medical, psychological, environmental factors. May affect the older adults quality of life associated with the ff: Excessive daytime sleepiness Attention and Memory problems Depressed mood Nighttime falls Overuse of hypnotic / OTC medications

Age Related Changes in Sleep Increase sleep latency A delay in the onset of sleep. Takes longer to fall asleep at the start of the night and after being awakened during the night. Reduced sleep efficiency Percentage of time in bed spent asleep Sleep efficiency decreases Older adults = 75% Young adults = 90%

Increased nocturnal awakenings Contribute to an overall decrease in the average number of hours of sleep Causes: Trips to the bathroom Dyspnea Chest pain Arthritis pain - Snoring - Leg cramps - Noise - Coughing

Increased early morning awakenings Increased period of wakefulness following nocturnal awakening. Due to frequent nocturnal awakening or other sleep disturbances. Underlying disease Motor vehicle accidents Cognitive dysfunction Medication side effects 2 Increased daytime sleepiness

Factors Affecting Sleep Environment Noise Sleep deprivation Alteration in comfort Pain Stress or difficulty concentrating, which can interfere with the enjoyment of activities. Lighting Darkened rooms Cold is No! No! At night, decreased core body temperature Pajamas, Nightgowns, bed socks and nightcaps. Decreased sleep quality Administration of analgesics Alternative sleeping places: Cushion chairs Rocking chair More pillow = Good sleep Temperature Environments conducive to relaxation are likely to be soporific. Low levels of stimuli, Dimmed lights, Silence, Comfortable furniture Home environments Hospitals and Long term Care Facilities

Pain and Discomfort

Lifestyle Changes Loss of Spouse Widowhood is a common life event in the older adult population. Older women than males Widowhood leaves older adults without touch partners Loss of a bed partner can make sleep psychologically less comforting The change in bedtime routine may interfere with the onset of sleep. Changes in schedule and activities 3

Retirement

Decades that older adults times for going to bed and waking were influenced by he work schedule.

Relocation Sleep is adversely affected by the transition to these unfamiliar surroundings. Roommate relationships Lighting Different interests and lifestyles Having a Roommate

Dietary Influences Sleep is influenced by what we eat and drink Caffeine containing beverages Alcohol Hunger and thirst

Drugs Influencing Sleep Drugs Used to Promote Sleep Tranquilizers and Sedatives = decrease activity and calm the recipient. Hypnotics = produce drowsiness and facilitate the onset system depression. Benzodiazepines = safe and efficient, increases the total of sleep time. Antihistamines Tricyclic antidepressants May cause insomnia and nightmares

Drugs with Drowsiness Side effect

Drugs causing Insomnia Nasal decongestants Amphetamine like substances Analgesics containing caffeine Herbal remedies have been recommended as aids for securing a good nights sleep. Drug to Drug interactions

Natural or Herbal Remedies

Depression Among older adults depression is treatable and is frequently associated with insomnia. Clients are waken in the early morning and are unable to return to sleep. Excessive daytime somnolence. 4

Dementia and Disturbed Sleep Increased confusion at night, nocturnal wandering, agitation Bed routines

Sleep Disorders and Conditions Sleep Apnea Recurrent episodes of cessation respiration lasting for 10 seconds to 2 minutes, number of apneic episodes may range from 10 to 100 per hour of sleep. More common in men than in women