CC May 2017 Geriatric Insomnia

echoecho's version from 2017-06-29 20:34


Question Answer
What are the 3 segments of normal sleep architecture?1) light sleep (stages 1 and 2) 2) deep sleep (stages 3 and 4) 3) rapid eye movement (REM)
Most cycle through REM and non-REM sleep in ____ to ____ minute periods throughout the night?90; 120
What changes as a function of aging in healthy older adults?sleep architecture
List the changes in sleep architecture in a healthy older adult?1) sleep initiation is difficult 2) total sleep time and sleep efficiency are reduced 3) deep sleep decreases 4) fragmentation of sleep is more common 5) more time is spent awake in bed
Is REM sleep preserved in the healthy older adult?yes
What two parts of sleep architecture in the healthy older adult is increased?1) frequency of daytime napping 2) duration of daytime napping
*** True or false? It is important to note, that sleep problems in the elderly are NOT considered to be a normal part of the aging process?true
Define insomnia?the subjective report of insufficient or nonrestorative sleep
Comment on which gender does insomnia occur in more? Is insomnia common in elderly patients?1) equally common in men and women 2) yes
What is the incidence of insomnia those over age 65?40-50%
Since there is no gold standard for determining the optimal amount of sleep needed by each person, what a must the provider rely on?1) the perception of the patient 2) the impact on daily functioning
Insomnia is classified according to its duration, name these classifications?1) transient (only a few nights) 2) acute (< 3-4 weeks) 3) chronic (> 3-4 weeks)
What is the cause of transient insomnia? It occurs in what patients?1) attributed to an identifiable cause 2) occurs in patients with no hx of sleep disturbances
What is acute insomnia a result of?1) acute medical illness 2) hospitalization 3) changes in sleep environment 4) medications 5) jet lag 6) psychosocial stressors
What are the causes of chronic insomnia?1) primary sleep disorders 2) secondary sleep disorders
What are examples of chronic insomnia (category = primary sleep disorders)?1) circadian rhythm disorders 2) OSA 3) RLS 4) periodic limb movement disorders 5) REM behavior disorder
What are the 4 categories of chronic insomnia (category = secondary sleep disorders)?1) physical illness 2) behaviorial 3) environmental 4) medications/substances
List the examples of chronic insomnia (category = secondary sleep disorders = physical illness)?1) chronic pain syndrome 2) heart failure 3) nocturnal angina 4) COPD 5) nasal obstruction 6) GERD 7) constipation 8) diarrhea 9) nocturia 10) urinary incontinence 11) CVA 8) Parkinson's disease 9) Alzheimer's disease 10) seizure disorder 11) anxiety 12) depression 13) dementia 14) delirium
List the examples of chronic insomnia (category = secondary sleep disorders = behaviorial)?1) excessive daytime napping 2) early retirement to bed 3) poor sleep hygiene 4) heavy meals 5) lack of exercise 6) sedentary lifestyle
List the examples of chronic insomnia (category = secondary sleep disorders = environmental) ?1) excessive noise 2) excessive light 3) extremes in temperature 4) uncomfortable bedding
List the examples of chronic insomnia (category = secondary sleep disorders = medications / substances)?1) CNS stimulants 2) antidepressants 3) Anti-Parkinsonian agents 4) decongestants 5) bronchodilators 6) beta-blockers 7) diuretics 8) corticosteroid 9) anticholinergics 10) benzodiazepines 11) alcohol 12) tobacco 13) herbal preparations
List the typical symptoms of insomnia?1) difficulty falling asleep 2) difficulty maintaining sleep 3) early morning awakening 4) excessive daytime sleepiness
*** Insomnia may increase the risks of what, resulting in higher mortality rate?1)falls and accidents 2) malaise 3) chronic fatigue 4) cognitive decline
*** Sleep deprivation has also been shown to raise what?1) BP 2) systemic markers for inflammation 3) prevalence of diabetes
After the presence of insomnia has been ascertained, what should be determined?the dominant sleep disturbance
A 1 to 2 week sleep diary may be helpful, what should be listed in the diary?1) patient's usual bedtime 2) waketime 3) timing and quantity of meals 4) exercise 5) medications (including OTC meds) 6) daily descriptions of duration and quality of sleep
List the nonpharmacologic sleep hygiene that should be given each patient?1) avoid or minimize the use of caffeine, cigarettes, stimulants and alcohol 2) increase daily physical activity (avoid close to bedtime) 3) increase exposure to natural light and bright light during day and early evening 4) avoid napping, especially after 2 pm 5) go to bed only when sleepy 6) maintain a comfortable bedroom temperature 7) minimize light and noise exposure in the bedroom 8) avoid heavy meals at bedtime 9) keep a regular schedule, including arising at the same time every day 10) employ stress management techniques 11) only use the bed for sleeping and intimacy
A number of large reviews have shown that elderly patients are more than ____ as likely to be prescribed sedative / hypnotic agents than younger adults?twice
Non-pharmacologic interventions are simple, have been shown to have greater long-term efficacy when compared to medication use and should be standard ____ - line therapy in the treatment of insomnia?first
*** Pharmacologic treatment which is often used as first-line therapy, should be reserved for what patient?those who failed non-pharmacologic therapy
*** The lowest effect dose should be used and meds should not be given _____?nightly
*** Short-term treatment should be advised, using meds with shorter ________ half-lives?elimination
*** SUMMARY =Alterations in sleep patterns in the elderly are common but is insomnia considered a normal part of the aging process?no
*** SUMMARY = attention to proper sleep ____ is essential prior to considering medical therapy?hygiene
*** SUMMARY = most hypnotics are associated with what, so their use should be avoided if possible?1) daytime sedation 2) fall risk and dependence