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CC March 2016 Sleep Disorders in the Elderly

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echoecho's version from 2016-05-30 00:51

Section

Question Answer
Sleep disorders are common in the geriatric population, affecting about ____% of adults over 65 years of age?40
*** Does agining itself cause disturbed sleep?no
*** As one ages, the ability to sleep is _____, often due to conditions that are more common with aging?decreased
Older adults compared to younger adults, what can be said about their sleeping?Older adults 1) wake up at earlier hours 2) have increased sleep latency 3) spend increased time in bed 4) have multiple nighttime awakenings 5) take more naps
What do objective studies show about older adults?1) more fractured sleep 2) spend less time in "deep" sleep 3) more time in lighter stages of sleep
List the primary sleep disorders that are common in the elderly?1) sleep disordered breathing 2) RLS
Sleep disordered breathing disorders includes what?snoring and sleep apnea, both central (CSA) or obstructive (OSA)
Central sleep apnea results from what and is seen in what?1) results from reduced respiratory effort 2) heart failure or neurologic conditions such as stroke
Medications or drugs that cause central nervous system depression can also cause CSA, name some meds?opioids
Sleep apnea is diagnosed using what?polysomnography
How is central sleep apnea (CSA) diagnosed?if there are > 5 episodes of central apnea or hypopnea in 1 hour and the central events account for > 50% of the apnea/hypopnea episodes
How is OSA diagnosed?during a sleep study if the apnea-hypopnea index (number of apnea / hypopnea episodes/hour)is > 15. Diagnosis can be made with a lower index if there are associated symptoms (daytime, drowsiness, habitual snoring, waking gasping)
List OSA severity?Index 5-15 (mild), 15-30 (moderate), > 30 (severe)
In a series of community-dwelling adults > 65 years of age, ___% had AHI . 20, compared to ___% in community dwelling middle aged adults?68; 4
List risk factors for OSA?1) sedating medication use 2) obesity
List the complications of OSA that are more common in the elderly?1) HTN 2) heart failure 3) CAD
What treatment effectively treats OSA in the elderly?CPAP (continuous positive airway pressure)
What devices may be helpful in treating OSA?oral devices that advance the mandible
Has surgical intervention been well studied in older adults?no
The prevalence of RLS also increases with age. List the 4 cardinal features?1) a "crawling" sensation in the legs associated with an intense urge to move them 2) symptoms that are relieved by leg movement such as stretchin or walking 3) symptoms that begin or worsen with inactivity 4) symptoms that occur or are worse in the evening and night.
What is the etiology of RLS?unknown but it is thought to be due to derangement of the dopaminergic system
The use of what class of medications for RLS?dopamine agonists
What are the adverse effects of dopamine agonists?insomnia and daytime drowsiness
Insomnia may affect as many as ____ of all patients over the age of 60 years old?half
The most common types of insomnia in geriatric patients are?1) early morning awakenings with difficulty falling back asleep 2) maintenance (difficulty maintaining sleep throughout the night)
In older patients, insomnia is assocaited with what?1) greater fall risk 2) cognitive impairment 3) poor physical functioning 4) anxiety 5) depression 6) increased mortality
List the medical conditions that insomnia may result from?1) diabetes 2) chronic pain 3) primary psychiatric conditions (depression)
List the medications that sleep can be negatively affected by?1) beta-blockers 2) bronchodilators 3) corticosteroids 4) decongestants 5) diuretics 6) stimulating antidepressants
What is recommended for all patients with insomnia?sleep hygiene
List sleep hygiene suggestions?1) maintaining consistent sleep and wake times 2) getting out of bed if unable to sleep 3) avoiding naps 4) participating in regular exercise 5) increasing light exposure early in the day 6) avoiding caffeine, alcohol and tobacco after lunch 7) limiting intake of liquids before bed
*** The use of what therapy is effective for the treatment of insomnia?cognitive behaviorial therapy (CBT)
For older patients, _____ may be more effective than pharmacotherapy for long-term treatment of chronic insomnia?CBT
List the medications that are commonly suggested for treatment of insomnia in the elderly but have limited supporting evidence and can have significant side effects?antihistamines, antidepressants, and antipsychotics
List effective medications for treating insomnia for geriatric patients, although in head-to-head trials, psychological interventions outperform pharmacologic ones??1) benzodiazepine receptor agonists (Eszopiclone - Lunesta) 2) Zaleplon (Sonata) 3) Zolpidem (Ambien) 4) Ramelteon (Rozerem)
*** SUMMARY = List the sleep disorders that are common in the geriatric population, affecting about 40% of adults over 65 years of age?1) sleep disordered breathing 2) RLS (restless leg syndrome)
*** SUMMARY = Insomnia may affect as many as _____ of all patients over age 60 years?half
*** SUMMARY = In older patients, insomnia is associated with what?1) greater fall risk 2) cognitive impairment 3) poor physical functioning 4) anxiety 5) depression 6) increased mortality
*** SUMMARY = Insomnia may result from medical conditions, list these?1) diabetes 2) chronic pain 3) primary psychiatric conditions (depression)
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