sleep

• Sleep is natural, necessary, involves a shift in physiologic and neurological activity, and is intended to be restorative ▪ Sleep is not a period of inactivity
• The scope of sleep ranges from restorative sleep, which results in an individual feeling rested, to impaired sleep, which leaves the individual not feeling rested or refreshed ▪ Impaired sleep can be intermittent or chronic with chronic sleep being associated with physical, cognitive, and social challenges
• Commonly occurring physiological consequences of poor sleep include:

  ▪ Hypertension

  ▪ Heart disease and Heart Failure

  ▪ Stroke

  ▪ Obesity

  ▪ Developmental disorders such as alterations in growth

  hormone

  ▪ Reproductive disorders due to disruption in hormonal

  regulation

  ▪ Increased mortality
• Populations at risk:

  ▪ Middle-aged and older adult

  ▪ Women

  ▪ Pregnant and perimenopausal women

  ▪ Men have highest risk for obstructive sleep apnea (OSA)

  ▪ Obesity
• Insomnia - difficulty falling/staying asleep
• Sleep related breathing disorders

  ▪ Sleep apnea

  ▪ CPAP (Continuous Positive Airway Pressure)
• Sleep related movement disorder: restless leg syndrome
• Parasomnias (undesirable sleep problems): sleep walking, sleep terrors
• Hypersomnia – i.e. Narcolepsy
• Potential risks of shiftwork: ▪ Excessive sleepiness ▪ Fatigue in the work place ▪ Chronic illness ▪ Difficulty of balancing sleep, work, and personal/family time
• Night Terrors

  ▪ Sudden episodes of intense fear, screaming, panic, and

  confusion while still asleep

  ▪ ↑ HR; ↑ RR; Dilated pupils; Diaphoresis

  ▪ Not associated with dreams during REM and no recall

  with awakening

  ▪ Early to middle childhood or associated with stress or

  substance abuse
• Sleep

  Deprivation

  Adults

  ▪ Students; shift workers; travelers

  ▪ Acute stress; depression; chronic pain

  ▪ Working long hours, multiple jobs

  ▪ Parents impacted by children's’ sleep habits

  ▪ Teach self soothing for sanity

  ▪ Caregivers

  ▪ Women; pregnancy; menses; peri-menopausal period
• Older Adult

  ▪ Older adults frequently complain of the inability to sleep

  ▪ Experience a high prevalence of sleep disorders

  ▪ Need assistance in getting to and staying asleep

  ▪ Normal aging changes result in ↓total hrs of sleep,

  ↑nocturnal awakenings, and shorter periods of sleep

  ▪ Help residents in a hospital or LTC adjust to the

  environment

  ▪ Daytime napping may need to be discouraged in this

  population

  ▪ Short-term sleep aids
• History

  ▪ When a sleep problem presents, questions about how

  the person feels upon awakening are important.

  ▪ A thorough review of systems to identify underlying

  sleep problems.

  ▪ Family history and social history are very helpful.
• Physical

  ▪ Few physical findings directly indicate a sleep disorder.

  ▪ Some helpful assessments include:

  ▪ Neck circumference

  ▪ Weight / BMI > 30

  ▪ Respiratory and cardiac function

  ▪ Neurological changes
• Common Diagnostic Tests

  Definitive tests for sleep problems measure activity and events

  related to sleep and wakefulness:

  ▪ Actigraph is useful but not a definitive diagnostic tool; worn on

  the wrist to detect movement “FitBit”

  ▪ Polysomnogram (PSG) while sleeping; electrodes and

  monitoring devices for EEG, Respirations, muscle activity, SaO2,

  body position, videotaping

  ▪ Diagnosing OSA - Obstructive Sleep Apnea
• Primary prevention focuses on:

  ▪ Good sleep hygiene

  ▪ Good sleep environment

  ▪ Reviewing personal behaviors

  ▪ Consistent bedtime and awakening time

  ▪ Good dietary habits

  ▪ Regular exercise
• Secondary

  Prevention

  (Screening)

  ▪ Adapt tools to the developmental level of the

  patient.

  ▪ Likert Sleep Rating Scale 0-10 (Worst to Best)

  ▪ Subjective answers from patients in response to simple questions help determine sleep issues.

  ▪ The Pittsburg Sleep Quality Index
• Collaborative

  Interventions

  ▪ Sleep hygiene

  ▪ Pharmacological Agents

  ▪ Common Pharmacological Agents for Sleep Disorders

  ▪ Invasive procedures to open airway

  ▪ Adenoidectomy - dentists and oral surgeons (adenoids

  are lymph tissues in your upper airway b/t nose and the

  back of the throa