Chapter 20: Sleep and Rest

Normal sleep is governed by the 24-hour circadian or diurnal rhythm, influenced by hormones like melatonin and growth hormone, and involves distinct NREM and REM stages. As adults age, decreasing hormonal efficiency leads to a reduction in restorative deep NREM sleep (Stages 3 and 4), increased nocturnal awakenings, and a shift known as phase advance, causing earlier bedtimes and morning wake-ups. The most frequent sleep complaint is insomnia, which can manifest as difficulty falling asleep (onset problems), staying asleep (maintenance problems), or premature awakening (terminal insomnia). Insomnia in older adults is often secondary to underlying health conditions such as chronic pain, respiratory issues like orthopnea, frequent elimination (nocturia), or psychological factors like anxiety and depression. Additionally, many prescribed and over-the-counter medications, including corticosteroids and certain antihypertensives, are known to disrupt sleep architecture. The chapter also addresses serious specific disorders like obstructive sleep apnea, which poses cardiovascular risks, and REM sleep-behavior disorder, which involves acting out vivid dreams and may precede neurodegenerative diseases. Nursing interventions prioritize nonpharmacologic treatments, with Cognitive Behavioral Therapy for Insomnia (CBTI) being the preferred method, emphasizing consistent sleep hygiene, managing environmental stimuli, and coordinating care schedules to allow for uninterrupted rest, reserving hypnotic or sedative medications as a last resort due to the heightened risk of adverse effects in the older population.