Chapter 11: Sleep & Activity in Older Adults

Sleep is a vital restorative state regulated by the hypothalamus, characterized by distinct cycles of non-rapid eye movement (NREM) and rapid eye movement (REM) stages. As individuals age, they often experience shifts in sleep architecture, including increased sleep latency—the duration required to fall asleep—and reduced sleep efficiency, alongside a notable decline in deep, restorative stages. These changes are frequently exacerbated by altered circadian rhythms, which may lead to increased daytime napping and frequent nocturnal awakenings. The text explores insomnia as a multifaceted issue—transient, short-term, or chronic—and identifies environmental, psychological, and physiological triggers. Specific attention is given to sleep disorders prevalent in older populations, such as obstructive sleep apnea (OSA), which involves respiratory pauses and snoring, and periodic limb movement in sleep (PLMS). Nursing professionals play a critical role in managing these issues through comprehensive sleep histories, the promotion of sleep hygiene—which emphasizes consistent routines and sleep-friendly environments—and the implementation of non-pharmacologic interventions like relaxation therapy and stimulus control. Parallel to rest, physical activity is emphasized as a cornerstone of healthy aging, serving to prevent chronic conditions like cardiovascular disease, diabetes, and osteoporosis. The chapter distinguishes between basic activities of daily living (ADLs), such as hygiene and nutrition, and instrumental activities of daily living (IADLs), which include more complex tasks like managing finances or transportation. Furthermore, the discussion addresses how major life transitions—such as retirement, relocation to assisted living, or the loss of a spouse—can disrupt established routines and impact overall well-being. Special consideration is given to dementia care, where meaningful, failure-free activities are utilized to maintain cognitive function, reduce agitation, and preserve human dignity. Ultimately, the nurse’s goal is to help older adults maintain a healthy balance of rest and engagement to enhance their overall quality of life.