1. The document discusses sleep, sleep disorders like sleep apnea, and how sleep changes with age. It covers the definition of sleep, sleep stages, consequences of sleep deprivation, and prevalence of sleep disorders.
2. Treatment options for sleep apnea are discussed, including CPAP, oral appliances, and surgery. Diagnosis involves a sleep study.
3. Sleep changes as people age, with less deep sleep and more nighttime awakenings. Medical conditions can also affect older adults' sleep. Seeking help from a sleep specialist is recommended for persistent sleep issues.
Peripheral Neurological Disorders & Central Nervous Centerjben501
This document provides an overview of several neurological disorders and related nursing care considerations. It discusses myasthenia gravis, Guillain-Barre syndrome, multiple sclerosis, Parkinson's disease, Alzheimer's disease, spinal cord injury, and seizures. For each condition, it summarizes key symptoms, pathophysiology, medical treatment, and important nursing care issues.
Dementia is a syndrome involving the deterioration of memory, thinking, behavior, and the ability to perform everyday tasks. It has various etiologies including hypoglycemia, arteriosclerosis, hydrocephalus, hypoxic or anoxic states, toxins, brain tumors, trauma, infections, genetic causes, and vitamin deficiencies. Diagnostic investigations include clinical history, neuroimaging, blood and CSF tests, and neurophysiology studies. Treatment involves managing symptoms, ensuring safety, providing structure, and addressing needs like nutrition, hygiene, toileting, and preventing accidents and wandering. Nursing care focuses on maintaining routines, orientation, proper nutrition, personal hygiene, toileting, fluid intake, and preventing injuries.
This document discusses Alzheimer's disease including:
- The incidence of Alzheimer's is increasing worldwide, currently affecting over 5 million Americans.
- The disease causes memory loss and cognitive decline and eventually affects basic tasks. Common risk factors include age, family history, head injuries, and medical conditions like diabetes.
- Pathophysiologically, Alzheimer's is characterized by amyloid plaques and neurofibrillary tangles in the brain that damage neurons. Stages range from mild cognitive impairment to severe dementia. Diagnosis involves medical history, exams, neuropsychological tests, and brain imaging. Currently, treatment focuses on medications to improve symptoms.
Alzheimer's disease is the most common cause of dementia, responsible for 50-70% of cases. It presents with a decline in cognitive abilities such as memory loss and impaired judgment. Over 44 million people worldwide have Alzheimer's or a related dementia, including over 5 million Americans. Risk factors include advanced age, family history, and head trauma. While there is no cure, current treatments can temporarily slow worsening symptoms and improve quality of life. Management focuses on maintaining function and quality of life through monitoring, treatments, and support for patients and their families.
This document discusses various sleep disorders and their treatments. It describes primary sleep disorders like insomnia, narcolepsy, sleep apnea, and circadian rhythm disorders. Insomnia is difficulty falling or staying asleep and affects many Americans. Narcolepsy involves extreme daytime sleepiness and may include cataplexy or hallucinations. Sleep apnea causes breathing to stop repeatedly during sleep. Treatments include lifestyle changes, medications, CPAP machines, and therapies. Maintaining good sleep hygiene can help prevent disorders by having a regular schedule and comfortable sleep environment.
Insomnia is a sleep disorder characterized by difficulty falling or staying asleep. There are different types of insomnia including acute, chronic, comorbid, onset, and maintenance insomnia. Insomnia can be caused by stress, poor sleep habits, lifestyle factors, mental health conditions, physical health conditions, and certain medications. Effects of insomnia include lower performance, higher risk of accidents, psychiatric problems, health issues, and substance abuse. Treatment may include improving sleep habits and lifestyle changes for mild insomnia or prescription sleeping pills for more severe insomnia.
Alzheimer's disease is a progressive neurological disorder that causes memory loss and cognitive decline. It is the most common cause of dementia and starts mildly but gets worse over time as more parts of the brain are damaged. In 2010, around 4.7 million Americans aged 65 and older had Alzheimer's. The disease is caused by death of brain cells and formation of amyloid plaques and tau tangles, which shrink the brain and impair communication between neurons. Risk factors include age, family history, genetics, and medical conditions that impact brain health. While there is no cure, current medications can temporarily improve cognitive symptoms.
This document provides guidelines for the comprehensive management of patients with amyotrophic lateral sclerosis (ALS). It discusses presenting the diagnosis, specific pharmacotherapies including riluzole and edaravone, symptomatic treatments, multi-disciplinary care, physical and speech rehabilitation, nutritional management, respiratory care, and end-of-life care. Key recommendations include using riluzole to prolong survival, considering non-invasive ventilation to prolong survival and slow respiratory decline, and providing home or hospice care for terminally ill patients to maintain dignity.
It focuses on sleep medicine - sleep disorders, sleep stages, DSM classification, types, classifications, and pharmacological and non pharmacological management.
The document discusses how sleep disorders increase during menopause. Approximately 16% of postmenopausal women have trouble falling asleep and 41% wake up frequently. The most common sleep disorders for menopausal women are insomnia, sleep apnea, snoring, narcolepsy and restless leg syndrome. Night sweats can also disrupt sleep. Establishing a regular bedtime routine, avoiding caffeine, exercise, and relaxation techniques can help alleviate sleep disorders. While prescription sleep aids may help short-term, natural remedies like herbal supplements, massage and aromatherapy may provide relief without long-term dependence.
- Multiple sclerosis (MS) is a neurological disease involving damage to the protective myelin sheath surrounding the nerves in the central nervous system. It presents with a variety of symptoms such as vision problems, tingling/numbness, muscle weakness, balance issues, and fatigue.
- There are several types of MS defined by patterns of relapse and progression of symptoms. Management involves medications to reduce inflammation and manage relapses as well as physiotherapy focusing on exercises, balance training, managing fatigue, and compensatory strategies to improve function and quality of life.
This document discusses insomnia, including its definition, types, symptoms, causes, and treatment options. It aims to help participants understand insomnia by recognizing the importance of sleep, identifying insomnia symptoms, examining statistics on insomnia prevalence, describing causes like stress or medications, discussing types such as chronic or transient, and identifying strategies to improve sleep quality like maintaining good sleep hygiene and lifestyle habits. The presentation provides an overview of insomnia for educational purposes.
This document summarizes traumatic brain injury (TBI), including its causes, types, symptoms, treatment and outcomes. It discusses the epidemiology of TBI, noting it is a leading cause of death and disability worldwide. It describes the two main types of TBI - open and closed head injuries. It also summarizes the potential psychiatric issues after TBI like depression, mania, psychosis, OCD, PTSD and personality changes. Finally, it discusses factors that can influence outcomes, noting that 30-35% of severe brain injury cases result in death.
The document provides an overview of dementia and Alzheimer's disease. It defines dementia and its main components. It describes the most common types of dementia, including Alzheimer's disease, vascular dementia, Lewy body dementia, frontotemporal dementia, and others. It covers the pathology, risk factors, stages, diagnosis, differential diagnosis, and workup for Alzheimer's disease.
Geriatric neurology focuses on neurological disorders common in older adults aged 60 and over. Diagnosis can be difficult as signs may mimic normal aging. Common disorders include dementia, epilepsy, headaches, multiple sclerosis, and Parkinson's disease. Alzheimer's disease is the most common cause of dementia, characterized by plaques and tangles that damage the brain over time. Parkinson's disease results from the death of dopamine-producing cells in the brain and causes movement-related symptoms. Epilepsy is also more common in the elderly, with stroke being a leading cause of new-onset epilepsy in older people.
This document discusses peripheral neuropathy, which refers to diseases that affect nerves outside the brain and spinal cord. It covers the types of peripheral nerves and classifications of neuropathies. Some key causes of peripheral neuropathy discussed include diabetes, nutritional deficiencies like B1/B12 deficiency, alcoholism, infections like HIV and leprosy, and certain drugs. Symptoms, clinical presentations, investigations, and treatment approaches for different types of peripheral neuropathies are also summarized.
- Alzheimer's disease (AD) is a progressive dementia characterized by cognitive decline and behavioral changes. It is the most common type of dementia and risk increases with age.
- The pathology of AD involves beta-amyloid plaques and tau neurofibrillary tangles in brain regions critical for memory and cognition. This leads to deficits in the neurotransmitter acetylcholine.
- While the exact causes are unknown, genetic and environmental factors likely contribute. Treatment focuses on managing symptoms with cholinesterase inhibitors or memantine, which target acetylcholine and glutamate pathways respectively. Currently there is no cure for AD.
The document discusses sleep, insomnia, and their treatment. It defines insomnia as difficulty initiating or maintaining sleep. Insomnia can be transient, acute, or chronic. Common causes include medical, psychiatric, substance-related, and circadian issues. Treatment involves addressing underlying causes, improving sleep hygiene, cognitive-behavioral therapy including stimulus control and sleep restriction, and may include pharmacotherapy with hypnotics as a short-term option. Multicomponent cognitive behavioral therapy is most effective for insomnia.
Explores impact of disturbed sleep on symptom management in patients with concurrent serious illness and at the end of life. Presented during Hospice and Palliative Medicine Fellowship at the University of Kansas 2014
This document discusses various sleep disorders from pediatrics to geriatrics. It provides statistics on common sleep disorders like insomnia, sleep apnea, and narcolepsy. It describes risk factors, symptoms, and potential health consequences of obstructive sleep apnea, including increased risks of diabetes, heart disease, and stroke. The document also discusses screening questionnaires, medical conditions that can contribute to sleep disorders, and various treatment options like tonsillectomy, uvulopalatopharyngoplasty, and somnoplasty procedures.
Presented by The Royal's Dr. Elliott Lee at our annual Women in Mind Conference.
Dr. Elliott Lee is an Assistant Professor and Sleep
Specialist at The Royal, where he works in both the
Sleep Disorders Clinic and the Anxiety Disorders Clinic.
The document discusses various topics related to sleep including:
1. Sleep accounts for about 1/3 of our lifetime and 1/3 of the population has a sleep disorder.
2. Sleep is regulated by our circadian rhythm located in the hypothalamus and lasts approximately 24 hours.
3. A normal sleep cycle occurs every 90 minutes and includes NREM sleep, which accounts for 70-80% of sleep, and REM sleep, which accounts for 20-25% of sleep.
4. More than 80 known sleep disorders are classified as dyssomnias involving difficulties initiating or maintaining sleep or daytime sleepiness, or parasomnias involving abnormal events during sleep.
Palliative care aims to improve quality of life for patients facing life-limiting illness and their families through pain and symptom management, psychosocial and spiritual support from diagnosis until end of life. It focuses on preventing and relieving suffering through early identification and treatment of pain, and addresses physical, psychosocial and spiritual problems. Palliative care is applicable alongside curative treatments and aims neither to hasten nor postpone death.
Multiple sclerosis: Medical and Nursing ManagementsReynel Dan
Multiple sclerosis (MS) is a chronic, progressive neurological disease involving demyelination of the central nervous system. It is characterized by exacerbations and remissions of symptoms that vary depending on the location of lesions in the brain and spinal cord. Common clinical manifestations include fatigue, weakness, sensory disturbances, and impaired coordination. While the exact cause is unknown, it is thought to involve an autoimmune response. Treatment focuses on managing relapses, reducing disease progression, and alleviating symptoms. Nursing care emphasizes education, rehabilitation, and supportive measures to help patients maintain optimal functioning.
The document summarizes the International Classification of Sleep Disorders Second Edition which classifies sleep disorders into 8 main categories. It provides details on the categories of Insomnias, Sleep Related Breathing Disorders, Hypersomnias of Central Origin, Circadian Rhythm Sleep Disorders, Parasomnias, Sleep Related Movements Disorders and Other Sleep Disorders. Each category contains multiple subtypes of sleep disorders defined by their symptoms, polysomnography findings, risk factors and treatment.
This document summarizes the key points from a sleep presentation. It discusses what constitutes normal sleep, common sleep disorders like insomnia, sleep apnea, and consequences of abnormal sleep. It also covers how lifestyle factors like routines, medications, and naps can help improve sleep quality. Specific sections summarize findings on women's sleep, how their biology and life stages impact sleep, and the effects of poor sleep on health.
This document summarizes the key points from a sleep presentation. It discusses what constitutes normal sleep, common sleep disorders like insomnia, sleep apnea, and consequences of abnormal sleep. It also covers how lifestyle factors like routines, medications, and naps can help improve sleep quality. Specific sections summarize findings on women's sleep, how their biology and life stages impact sleep, and the effects of poor sleep on health.
Insomnia is defined as difficulty initiating or maintaining sleep, or both, despite adequate opportunity and time to sleep, leading to impaired daytime functioning. There are two types of insomnia: primary insomnia not associated with any other condition, and secondary insomnia caused by another condition like depression. Insomnia can be acute (lasting 1-3 weeks) or chronic (lasting over a month at least 3 times a week). Chronic insomnia is treated with relaxation techniques, sleep restriction therapy, and medication, while acute insomnia may not require treatment. Good sleep habits like regular sleep schedules and avoiding stimulants before bed can help treat insomnia.
Introduction
The sleep – wakefulness cycle is genetically determined rather than learned and is established sometime after birth.Sleep is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity and [inhibition of nearly all voluntary muscle during REM sleep] reduced interactions with surroundings.
Sleep can be regarded as a physiological reversible reduction of conscious awareness. Nearly one third of human life is spent in sleep. Disorders of sleep can affect activities of daily living (ADL) of an individual.
Definition
It is an easily reversible state of relative unresponsiveness and serenity which occurs more or less regularly and repetitively each day.
The EEG recordings show typical features of sleep which is broadly divided into two broadly different phases:
1. D-sleep (desynchronised or dreaming sleep), also called as REM- sleep (rapid eye movement sleep),active sleep, or paradoxical sleep.
2. S-sleep (synchronised sleep), also called as NREM-sleep (non-REM sleep), quiet sleep, or orthodox sleep. S-sleep or NREM-sleep is further divided into four stages, ranging from stages 1 to 4. As the person falls asleep, the person fifi rst passes through these stages of NREM-sleep.
Stages of sleep
The EEG recording during the waking state shows alpha waves of 8-12 cycles/sec. frequency. The onset of sleep is characterised by a disappearance of the alpha-activity.
Stage 1, NREM-sleep is the first and the ligh test stage of sleep characterised by an absence of alphawaves, and low voltage, predominantly theta activity.
Stage 2, NREM-sleep follows the stage 1 within a few minutes and is characterised by two typical EEG changes:
i. Sleep spindles: Regular spindle shaped waves of 13-15 cycles/sec. frequency, lasting 0.5-2.0
seconds, with a charac teristic waxing and waning amplitude.
ii. K-complexes: High voltage spikes present intermittently.
Stage 3, NREM-sleep shows appearance of high voltage, 75 μV, δ-waves of 0.5-3.0 cycles/sec.
Stage 4, NREM-sleep shows predominant δ-activity in EEG. NREM-sleep is followed by REM-sleep, which is a light phase of sleep. The EEG is characterised by a return of α-waves (α-wave sleep); other changes are similar to stage 1 NREM-sleep. One of the most characteristic features of the REM-sleep is presence of REM or rapid (conjugate) eye move ments. The other features include generalised mus cular atony, penile erection, autonomic hyperactivity (increase in pulse rate, respiratory rate and blood pressure), and movements of small muscle groups, occurring intermittently. Although it is a light stage of sleep, arousal is diffificult. These stages occur regularly throughout the whole duration of sleep. The first REM period occurs typically after 90 minutes of the onset of sleep, although it can start as early as 7 minutes after going off to sleep, e.g. in narcolepsy, in major depression, and after sleep deprivation.
Insomnia is a condition where an individual has trouble falling asleep or staying asleep. There are two main types - primary insomnia which is not caused by another condition, and secondary insomnia which is caused by an underlying medical, physical, or psychological condition. Common causes of secondary insomnia include illnesses, pain, anxiety, depression, certain medications, caffeine, alcohol, and sleep disorders. Insomnia can be diagnosed through a medical history, physical exam, and potentially a sleep study. Treatment options include lifestyle changes, cognitive behavioral therapy, and medication to establish a regular sleep schedule. Insomnia is a common problem that can negatively impact daytime functioning if left untreated.
Sleep is an essential component of our lives. It helps us to recharge our energy and restore our physical and mental health. However, millions of people around the world struggle to get adequate, restful sleep.
The document discusses insomnia, including its definition as difficulty falling or staying asleep, types such as chronic or short-term, common causes like stress or medications, symptoms like fatigue, and treatments including cognitive behavioral therapy, relaxation techniques, and sometimes prescription medications. Diagnosis involves keeping a sleep log and may include tests like a sleep study to evaluate nighttime sleep patterns.
This document provides information about breathing related sleep disorders including definitions, symptoms, risk factors, diagnosis, and treatment. It discusses obstructive sleep apnea (OSA), central sleep apnea, and hypoventilation sleep apnea. OSA is characterized by partial or complete collapse of the upper airways during sleep causing breathing pauses. Central sleep apnea involves a lack of breathing effort. Hypoventilation refers to insufficient breathing during sleep leading to high carbon dioxide levels. Diagnosis involves sleep studies and treatment depends on the underlying cause but may include positive airway pressure therapy or supplemental oxygen.
3. Definition of Sleep Wakefulness Awareness of the environment Ability to respond rapidly to external stimuli Sleep Sleep is a reversible complex state Actively generated by specific neuronal system Characteristics: Unresponsiveness to the environment. Recumbence Quiescence Closed eyes
4. Light & deep sleep REM (dreaming) and non-REM Sleep Stages
5. Amount of Sleep Changes with age Quantity Infant (14-16 hours) Young Adults (7-8 hours) Elderly (7 hours) Quality Elderly Young Sleep accounts one third of our life time Sleep is essential for life
6. Sleep Deprivation Types of sleep deprivation Acute and total sleep loss Chronic and Partial sleep loss Insufficient sleep time Fragmented sleep
7. Consequences of Sleep Loss Acute and total sleep loss Death Experimental Animal Familial Insomnia
8. Consequences of Sleep Loss Chronic partial sleep loss Decrease quality of life Decreased concentration and memory Fatigue and sleepiness in the day Depression and anxiety Safety Accidents Cardiovascular risks: Increased diabetes, hypertension, CVD, strokes, and pain
9. Sleep Deprivation In Society Americans sleep 1.5 hours less than our ancestors 100 years ago. We need the same amount as they did. Factors: Travel, electric lights, shift work, all night TV and computers Misperception that sleep is negotiable…wasted time. Sleeping less is “macho” and desirable.
10. General population 1 in 15 has moderate to severe OSA T Young 2004 9% women and 24% men in the middle-aged working population have OSA T Young 1993 Type 2 diabetes 50% of males, 20% females D Einhorn 2005 97% of obese diabetics G Foster 2005 ~85% of patients are not diagnosed T Young 1997 Prevalence of Obstructive Sleep Apnea (OSA)
11. Prevalence of Sleep Apnea 80% 50% 35% 50% Diabetes Obesity All Hypertension Atrial Fibrillation Congestive Heart Failure Drug-Resistant Hypertension Sjostrom et al, Thorax, 2002 Logan et al, J. Hypertension, 2001 Javaheri et al, Circulation, 1999 O'Keeffe & Patterson, Obes Surgery, 2004 Einhorn et al. Endocrine Prac, 2007 50% Somers et al, Circulation, 2004 77% Coronary Artery Disease 30% 59% Pacemakers Garrigue et al. Circulation 2007 Schafer et al. Cardiology 1999
12. Sleep Apnea Affects about 10% of all adults over 18 Over age 65, affects about 25% of adults Risk factor include: Family history Obesity Thyroid disease Age History of smoking
13. Sleep Disordered Breathing The Apnea Cycle: Breathing stops. Blood oxygen level drops. Waking briefly occurs to resume breathing. Repeat many times per night. Snoring is never normal! 25% of apnea patients do not snore
21. Consequences of OSA Decrease quality of life Fatigue and sleepiness in the day Decreased concentration and memory Depression and anxiety Safety Accidents Cardiovascular risks: Increased diabetes, hypertension, CVD, strokes, and pain
22. Symptoms of Sleep-disordered Breathing Symptoms Tired Run-down No energy Fatigued Fall asleep when not trying (Sleepiness) Snoring Witnessed apneas Gasping for breath during sleep Frequent trips to bathroom at night (Nocturia) Mood, memory, or learning problems Impotence Morning headache Dry mouth or dry throat in the morning
27. Treatment of OSA Most patients don’t know they have it Diagnose by history from patient and family, exam and testing with polysomnogram at accredited sleep center Treatment with surgery, oral appliance or CPAP Lifestyle changes such as weight loss
28. Baseline Arm Therapeutic Arm Effect of CPAP on Blood Pressure n = 60 patients Becker et al 2003 Circulation Ineffective therapy- no change in mean blood pressure Effective therapy corresponds to a 10 mm Hg drop in blood pressure
29. Oral Appliances Indications Snoring Sleep Apnea (Mild to moderate) Side effects TMJ discomfort Dental misalignment Salivation
37. Diagnostic Process Evaluation/Consult Treatment Plan and Patient Follow-Up Clinician Referral to Sleep Lab Sleep Study Titration Night Therapy Dispensed by Homecare Company Clinician Identifies Sleep Apnea Symptoms in Patient Discuss Results/Treatment Option
40. Insomnia Insomnia is a disorder Typically co-morbid with other diseases May be difficulty falling asleep, staying asleep, or waking up earlier than planned Transient, short-term, or chronic Has many causes: medical, psychological, lifestyle The longer it lasts, the harder to treat
42. Restless Legs and Periodic Limb Movement Disorder PLMD: Repeated leg jerks every 5-90 seconds in sleep RLS: Uncomfortable sensations at rest while awake with compulsion to move to relieve this Diagnosed by history and PSG Treat with dopamine agents, iron, caffeine avoidance
44. Sleep Changes as We Age Sleep architecture changes with age Nighttime sleep is more likely to be disturbed, especially late teens and again after age 35. Persons 55+ tend to experience more conditions that reduce sleep quality and quantity Older people tend to nap more
45. Normal Sleep Non-REM Sleep Stage 1, drowsiness Stage 2, light sleep Stage 3 and 4, deep sleep (delta or slow wave) REM Sleep “ dream” sleep
46. Other Sleep Changes with Age Less deep sleep, especially men Total sleep time increases slightly Takes longer to fall asleep (13% men and 36% women take >30 minutes after age 45 REM sleep is stable Men have more passive, inward dreams Women have active, outward dreams
47. Changes in Sleep Quantity Less melatonin and growth hormone Flattening of the temperature cycles Less exposure to natural light Changes in diet Less exercise Insufficient mental stimulation
48. Changes in Sleep Quality More shallow, fragmented sleep More awakenings More trips to the bathroom to void However, many healthy people do sleep quite well!
49. When To Get Help Some age-related changes mask sleep disorders Insomnia or daytime drowsiness is never normal or acceptable regardless of age. Differentiating the cause of these problems often requires a sleep specialist to determine cause and treatment Many people do not seek help…assume poor sleep is inevitable
51. Pain in Sleep Arthritis pain at night occurs in 30%, 60% over age 50 Arthritis patients lose over 20 hours of sleep per month from pain Common night pain: back, headaches, muscles, leg cramps, sinuses 44-56%
52. Menopause and Sleep Hot flashes occur in 75% of women for average of 5 years Sharp increase in sleep apnea More daytime fatigue and sleepiness
53. Owls and Larks Advanced sleep phase syndrome: early bedtime and rise-time Delayed sleep phase syndrome: late bedtime and rise-time Treated with light boxes, medication, and chronotherapy
54. Sleep and Dementia Differentiate Alzheimer’s and senile dementia from symptoms of sleep apnea and other sleep disorders which affect mood and mentation Sleep is affected adversely by degenerative CNS disorders with nocturnal confusion and wandering then daytime sleepiness.
59. Conclusions Sleeping enough and well is essential to our mental and physical health at any age It takes more thoughtful effort as adults to be sure we get the sleep we need. With current sleep evaluation and treatment, there is help available for anyone needing better sleep! SLEEP IS A NECESSITY, NOT A LUXURY…SLEEP WELL!
60. Medical Director Ibrahim Sultan-Ali, MD Board Certified: Sleep Disorders & Internal Medicine
62. How to Make an Appointment Call 865.429.8042 to schedule an appointment with Dr. Sultan-Ali Visit us online for more information www.fssevier.com/fss-sleepcenter