CHAPTER IINTRODUCTION
A. BackgroundIn the United States, the cost of accidents related to sleep disturbances per year approximately one hundred million dollars. Insomnia is a sleep disorder that is most often found. Each year an estimated 20% -50% of adults report sleep disturbance and approximately 17% had a serious sleep disorder. The prevalence of sleep disorders in the elderly is high at around 67%. However, only one of eight cases stating that his disorder has been diagnosed by a doctor.Irwin Feinberg said that since leaving adolescence, the need for naps become relatively fixed. Luce and Segal reveals that age is an important factor that affects the quality of sleep. It has been said that the complaints against the quality of sleep frequently with the growing age. In the elderly group (40 years old) found only 7% of cases complained of sleep problems (just can not sleep more than 5 hours a day). Encountered the same thing in 22% of cases in the age group of 70 years. Similarly, the elderly complain more waking up earlier than 05.00 am. In addition, there is a 30% 70-year age group were much terbagnun at night the day. Anka proved lenih 7x greater than 20 years age group.B. DestinationTo know the nursing care of the elderly with sleep problems (insomnia)
CHAPTER IIDISCUSSIONA. DefinitionSleep Disorders (Insomnia) is the inability to fall asleep or difficulty staying asleep, or sleeping disorder that makes sufferers have not had enough sleep when awakened.Disorders not only is the indication of the existence of early mental disorder but it is a complaint of nearly 30% of patients who went to the doctor, due to:1. Extrinsic factors (outside) eg less tranquil environment.2. Intrinsic factor, can mial organic and psychogenic.· Organic, eg pain, itching and certain diseases that make nervous.· Psychogenic, eg depression, anxiety and irritability.Elderly with depression, stroke, heart disease, lung disease, diabetes, arthritis, or hypertension, is often reported that poor sleep quality and duration of sleep less when compared with the healthy elderly. Sleep disorders can increase the overall cost of illness. Sleep disorders are also known to cause significant morbidity. There are some serious impact of sleep disorders in the elderly such as excessive daytime sleepiness, impaired attention and memory, mood depression, frequent falls, improper use of hypnotics, and decreased quality of life. Mortality, heart disease and cancer is higher in the old man more than 9 hours of sleep or less than 6 hours per day when compared with the old man sleeping between 7-8 hours per day.
B. CauseSleep disorder is not a disease, but a symptom that has a variety of causes, such as emotional disorders, physical disorders and drug use. Trouble sleeping is often the case, both at a young age and old age, and often occur together with emotional disorders, such as anxiety, restlessness, depression or fear. Sometimes a person have trouble sleeping simply because the body and brain are not tired. Pattern awoke in the early morning is more common in people aged lanjut.Beberapa normally asleep but woke up a few hours later and it's hard to fall asleep kembali.Kadang them in a state of restless sleep and was not satisfied tidur.Terbangun at dawn, at any age, is sign of depression. People who can experience disturbed sleep patterns are reversed sleep rhythm, they are not asleep at bedtime and wake up on time for sleep.In addition, the following behavior can also cause sleep disturbances in some people:
lack of sleep hygiene in general (face wash, etc?)
concerns can not sleep
Excessive caffeine consumption
drinking alcohol before bed
Smoking before bed
nap / afternoon excessive
schedule sleep / wake irregular
C. SymptomPatients have difficulty falling asleep or frequent waking at night and feel tired all day.Sleep disorders can be experienced in many ways:
difficult to sleep
no problem to sleep but had difficulty staying asleep (often wake up)
waking up too early
Difficulty sleeping is just one of several symptoms of insomnia. Symptoms experienced during the day are:
Slumber
Restless
Difficulty concentrating
Hard to remember
Irritable
Presumptive etiology, sleep disorders were divided into four groups, namely, primary sleep disorders, sleep disorders due to other mental disorders, sleep disorders due to general medical conditions, and sleep disorders induced by substance. Sleep-wake disturbances can be caused by physiological changes such as the normal aging process. History of sleep problems, sleep hygiene current, history of drug use, partner reports, records of sleep, as well as the evening polisomnogram need to be evaluated in the elderly who complained of sleep disorders. Complaints sleep disorder that is often expressed by elderly insomnia, sleep rhythm disorders, and sleep apneaD. Classification of Sleep Disorders
Primary sleep disorders
Primary sleep disorder is a sleep disorder that is not caused by other mental disorders, general medical condition, or substance. Sleep disturbance is divided into two disomnia and parasomnias. Disomnia characterized by disturbances in the amount, quality, and time to sleep. Parasomnias associated with sleep behavior or physiological events associated with sleep, specific sleep stages or sleep-wake displacement. Disomnia consists of primary insomnia, primary hypersomnia, narcolepsy, sleep disorders related to breathing, circadian rhythm sleep disorders, and isomnia which can not be classified. Parasomnia consisting of nightmare disorder, sleep terror disorder, night wakings, and parasomnia that can not be classified. Intangible. 157, 2007196
Related sleep disorders other mental disorders
Related sleep disorders is the presence of other mental disorders are prominent complaints of sleep disorders caused by another mental disorder (often for mood disorders) but do not qualify to be enforced as a separate sleep disorder. There are allegations that patofisiologik mechanisms underlying mental disorder also affect sleep-wake disturbances. This sleep disorder consists of: Insomnia related axis I or axis II and related Hypersomnia I or II.
Sleep disorders due to general medical condition
Disruption due to general medical condition is a prominent complaint of sleep disorders caused by the direct physiological effects of medical conditions common to the sleep-wake cycle.
Sleep disorders due to substance
Namely the existence of a prominent sleep complaints are a result of use or stop using substances (including medications). Systematic assessment of a person who had complaints of sleep such as evaluation of specific forms of sleep disorders, current mental disorders, general medical conditions, and substance or medication that is used, it should be doneE. Normal Sleep PhysiologyThe average healthy adult takes 7 ½ hours of sleep every night. However, there are some people who need more or less sleep. Normal sleep is affected by several factors such as age. Someone younger tend to sleep more when compared with the elderly.Elderly sleep time is reduced by a factor related to aging. Physiology of sleep can be seen through the picture ekektrofisiologik brain cells during sleep. Polysomnography is a tool that can detect brain activity during sleep. Polysomnography examinations are often performed at night to sleep. The tool can record the EEG activity, elektrookulografi, and electromyography. Electromyography is useful for assessing peripheral abnormal movements during sleep. Stage of sleep - measured by polysomnography - sleep consists of rapid eye movement (REM) sleep and non-rapid eye movement (NREM).REM sleep is also called D sleep or dreaming because dreaming or associated with paradoxical sleep because EEG is active during this phase. NREM sleep is also called orthodox sleep or slow-wave sleep or sleeping S. Both of these stadia alternately in a cycle that lasts between 70 and 120 minutes. Generally there are 4-6 REM-REM cycle that happens every night. First REM sleep period lasts between 5-10 minutes. The more late nights, the longer REM periods. NREM sleep consists of four stages, namely stage 1,2,3,4.F. Sleep Hygiene In ElderlySleep disorders can be shaped to poor sleep hygiene and specific sleep disorders. Evaluation of elderly sleep complaints shall always done. Sleep complaints should not be ignored even though they are old. Poor sleep hygiene can be caused by excessive expectations on sleep or sleep schedule. As a result, the elderly are often spent his time in bed or asleep intermittently during the day.G. Sleep stages Normal In Adults1. Stage 0Stage 0 is the period in a state of awake but eyes still shut. This phase is characterized by a wave of low voltage, fast, 8-12 cycles per second. Increased muscle tone. Alpha activity decreased with increasing drowsiness. In the sleepy phase contained a mixture of alpha waves.2. Stage 1Stage 1 is called sleep onset. Starts with NREM sleep stage. Stage 1 NREM sleep is a transition from wake to sleep. He occupied approximately 5% of total sleep time. In this phase decreased alpha wave activity (alpha waves decreased less than 50%), low-amplitude, mixed-signal, predominantly beta and theta, low voltage, the frequency of 4-7 cycles per second. Activity slowed eyeball, decreased muscle tone, lasts about 3-5 minutes. At this stage a person easily awakened and when woke up feeling like half asleep.
3. Stage 2Stage 2 is characterized by specific EEG waves are dominated by theta activity, low-medium voltage, coil sleeping and complex K. Coil bed is short rhythmic waves with a frequency of 12-14 cycles per second. K is sharp wave complexes, negative, high voltage, followed by a slower wave, frequency 2-3 cycles per minute, positive activity, with a duration of 500 ms. Low muscle tone, pulse and blood pressure tends to decrease. Stage 1 and 2 are known as shallow sleep. This stage occupies about 50% of total sleep.4. Stage 3Stage 3 is characterized by 20% -50% delta activity, frequency of 1-2 cycles per second, high amplitude, and is also called delta sleep. Increased muscle tone but no movement of the eyeball.5. Stage 4Stage 4 occurs when delta waves more than 50%. Stage 3 and 4 are difficult to distinguish. Stage 4 is slower than stage 3. EEG recordings in the form of delta. Stage 3 and 4 is also called slow-wave sleep or sleep in. This stage spending about 10% -20% of total sleep time. This bed occurs between one-third to half of the night early in the evening. Sleep duration was increased when a person experiences sleep deprivation. REM sleep is characterized by EEG recordings similar to stage 1 sleep. At this stage there is a periodic burst of rapid eye movements. Weakened tendon reflexes intangible. 157 2007 197
Sleep Disorders Elderly or missing. Increased blood pressure and breathing. Penile erection in men. On REM sleep are dreams. This phase uses about 20% -25% of the time sleeping. REM Ratensi approximately 70-100 minutes in normal subjects, but in patients with depression, eating disorders, schizophrenia, personality disorder threshold, and alcohol use disorders shorter duration. Most delta sleep (NREM) occurred in the early half of the night and REM sleep on the night before the morning half.REM and NREM sleep differ in terms of psychological and physiological dimensions. REM sleep associated with dreams while NREM sleep with abstract thought. Autonomic function varies in REM sleep but slow or settled in NREM sleep. So, starting in stage 1 sleep, go to stage 2, 3, and 4. Then go back to stage 2 and finally into REM period 1, usually lasts 70-90 minutes after onset. Turn of the cycle of NREM to REM cycle usually lasts 90 minutes. Increased duration of REM periods early in the morning 2.Daytime sleep condition can be assessed by multiple sleep latency test (MSLT). The subjects were asked to lie down in a dark room and not be stifled a yawn. This test was repeated several times (five times during the day). Sleep latency is the time it takes to fall tidur.Waktu is measured for each test and is used as an index of physiological sleep. The opposite of the MSLT maintenance of wakefulness test (MWT). The subjects were placed in a quiet room, dim the lights, and instructed to remain awake. This test was also repeated several times. Sleep latency was measured as an index of an individual's ability to maintain fixed up.
Some terminology standard polysomnography size1. Sleep continuityIe a balance between continuity sleep wake sleep for one night. Continuity was said to be good if more sleep than wake up and say bad when sleep is often interrupted or awakened. Specific continuity size bed is sleep latency (the amount of time it takes to fall asleep, usually counted in minutes). Intermittent waking the amount of time awake after sleep onset (within minutes).2. Sleep efficiencySleep efficiency is the ratio between the actual time used to sleep with the time spent in bed - is measured in percentages. Higher numbers indicate better sleep efficiency.3. Sleep architectureThe amount of sleep architecture and sleep stage distribution. Its size is the absolute amount of REM sleep and each NREM sleep, calculated in minutes. Human sleep varies throughout life. In children and adolescents the beginning, the amount of slow-wave sleep is relatively stable. Reduced sleep continuity and depth as an adult. The reduction is characterized by an increased frequency of wake, stage 1 sleep, and decreased stages 3 and 4. Therefore, age should be considered in the diagnosis of sleep disorders. Circadian sleep-wake cycle can affect neuroendocrine functions such as the secretion of cortisol, melatonin, and growth hormone. In the normal adult, the body temperature circadian rhythm; peak in the afternoon and lowest at night. Temperature cycle disorders associated with insomnia. Age, premorbid sleep patterns, and overall health status affects sleep. When compared with subjects with a young age sleep, sleep less in the elderly, often waking, decreased delta sleep, and sleep is not effective. Daytime sleepiness is common in the elderly. This condition can affect sleep schedule-downs at night. However, some individuals do have shorter sleep duration or need less sleep. This individual does not have a complaint difficult to enter sleep and no typical signs such as frequent waking insomnia, fatigue, difficulty concentrating, and irritability. Daytime function is not compromised even though he slept less than seven hoursSeniors Sleep Disorders sleep. Very prominent change is a reduction in slow wave, especially stage 4, wave alpha decreases, and the increasing frequency of waking at night or increasing fragmentation of sleep due to frequent waking. Disruption also occurs in the elderly sleep so it is very sensitive to environmental stimuli. During sleep the night, a young adult would normally wake up around 2-4 times. Not so with the elderly, she is awake. However, the average total sleep time is almost the same as the older young adults. Circadian sleep-wake rhythm is often disturbed elderly. Biological clock elderly shorter and more advanced sleep phase. Frequent waking during the night leads to lethargy, drowsiness, and easy to fall asleep during the day.In other words, increasing age was also associated with a tendency to sleep and wake up early. Tolerance to phase or decreased sleep-wake schedule, such as highly vulnerable to the displacement of working hours. The existence of a circadian rhythm sleep disorder also affects the levels of hormones that decrease the secretion of growth hormone, prolactin, thyroid, and cortisol in the elderly. These hormones are released during sleep inside. Melatonin secretion is also reduced.Melatonin controls the circadian sleep function. Secretions, especially at night. When exposed to bright light, melatonin secretion is reduced 2.H. Clinical manifestationAs previously stated the majority of the elderly are at risk of sleep disturbances due to various factors. Npatologi processes associated with aging can interfere sleep patterns. Sleep disorders strike 50% of people aged 65 years or older who were living at home or living facilitated 66% long-term care. Sleep disorders affect the quality of life and is associated with a higher mortality rate.During aging sleep patterns undergo changes characteristic that distinguishes from those younger. The changes also include patience sleeping, waking in the early hours and increasing the number of naps. The amount of time spent on a deeper sleep also decreased. There is a relationship between increased waking during sleep by the number of total time spent awake during the night. It is seen as the sleeping arrangementsAmong the healthy elderly some of them experienced symptoms associated with sleep changes, the distribution of sleep and waking behavior. But many seniors who have medical and psychological problems with the sleep disorder. Konidis conditions include:
Psychiatric diseases mainly despresi
Alzaimer disease and other neuro diseases
Cardiovascular disease and post-surgical treatment of heart
Incompetence of the upper airway
Pulmonary disease
Pain syndrome
Prostatic disease
Endokrinopati
I. DiagnosisTo diagnose insomnia, conducted an assessment of:
sleep patterns of patients
use of drugs, alcohol or drugs
levels of psychological stress
medical history
physical activity.
J. TreatmentTreatment of insomnia depends on the cause and severity of insomnia. Insomniacs should remain calm and relaxing few hours before bedtime and create a comfortable atmosphere in the bedroom; dim light and not noisy.Insomnia treatment usually begins with:
Eliminating habits (move the bed, wearing only a bed to sleep, etc.).
If not successful can be given drugs known as hypnotics (should consult with a psychiatrist).
K. Sleep Disorders Treatment In Elderly1. Primary preventiona. Sepenunya sleep, but not excessive, in order to feel refreshed and healthy from the next day, restriction of sleep can strengthen sleep, excessive time spent in bed seems to be related to the itudr disjointed and shallowb. Regular waking time in the morning meperkuat sirkandian cycle and cause irregular sleep onsetc. Stable amount of exercise each day can deepen sleep Namu exercise done only sometimes can not sleep at night next fix.d. Nature noises can sometimes disrupt sleep even if the sound does not wake people up who were asleep and could not remember it in the morning. Kendap bedroom membagu can sound sleep for people who have to sleep near the noise.e. Although the room is too warm can interfere with sleep, but there is no evidence to suggest that the room is too cold may help sleep.f. Hunger interfere sleepingg. Sleeping pills can sometimes be used provide benefit, but chronic pengguynaan not effective in most patients with insomnia.h. Caffeine can disrupt sleep in the day, even though the people who figured that way.i. Alcohol helps tense people to help fall asleep more easily, but sleep would then falter.j. Those who feel angry and frustrated because they can not sleep must not be trying hard to sleep but had to turn the lights on and do other things differently.k. Terbakau who chronically use can interfere with sleep.Other action in the primary prevention among other things:a. Mattress allows proper body alignment.b. The room temperature must be cold enough (less than 240C) to feel comfortablec. Caloric intake should minbimal at bedtimed. Moderate exercise during the day or late afternoon is a recommended thing.2. Secondary preventionAssessment by the nurse should include the following factors:a. How well the elderly at home sleeping?b. When the elderly go to bed and wake up?c. What happens ritual before bed?d. What is the number and exercise every day?e. Is that the best position is preferred when in bed?f. What type of environment preferred treason?g. What is the temperature like?h. How much ventilation is desired?i. What activities can be done several hours before bed?j. What are the sleeping pills or other drugs used at bedtime routine?k. How much time is spent on the people in the hobby?l. The people's perception of life satisfaction and health status?As usual, validate assessment history with a family member or caregiver is the most remedy to ensure the accuracy and assessment if the patient is not considered kompoten to provide its own report.Catatam of sleep daily is the way most large spotless assessment for the elderly at home alone. This information provides an accurate record of trouble sleeping. To get a true picture of the sleep disturbance experienced by elderly people at home or health facility daily record was made 3 to 4 mingu. The record must include the following factors:a. How often the assistance provided to give obatnyeri, unable to sleep or use the bathroom.b. When the person gets out of bed?c. How nkali the person awake or asleep at the time observed by the nurse or care giver.d. Occurrence of confusion or disorientatione. The use of sleeping pillsf. Estimates of the morning Yor
Tertiary Prevention
If there is a sleep disorder such as sleep apnea is a life threatening, the patient's condition requires rehabilitation through measures such as the removal of the tissue in the mouth that affect clog the airway. Today many sleep disorders centers are available throughout the state to help evaluate sleep disorders. These places are usually associated with lembag Clinical research and medical or university., Dilengkapin with medical devices that can detect sophisticated electrical recording in the brain and respiratory obstruction. These data are the best treatment to help remedy overcome difficulties and mengrehabilitasi elderly so that they can enjoy berlkualitas sleep to the end of his lifeL. Therapeutic managementBootzin and Nicassio advocated such rules to maintain normalcy sleep patterns:
Go to bed only when sleepy
Use the bed only for sleeping, not reading, watching TV or eating in bed
If you can not sleep, get up and move the other spatial. Wake up you really sleepy, then return ketampat sleep, if sleep is still not able to be easily wake up from sleep it takes place, the goal is to connect temapt with sleep quickly, Repeat this step as often as necessary sepanjag night.
Prepare alarm and wake up every morning actualised the same regardless of a lot of you sleep at night. This helps the body sleep wake rhythm menatapkan constant.
M. Nursing interventionsThe following nursing interventions are recommended:
Maintain constant conditions for sleep menakup attention to environmental factors and bedtime rituals
Help the person to relax just before bed to give back massage strokes kak. Passive motion exercises and rubbed giving effect to euthanize.
Provide proper positioning and provide pain relief kengatan with conventional blankets and electric blankets can also help.
Do not let the patient drink caffeine (coffee, tea, chocolate) in the afternoon and evening,
Perform actions such sensible diradio lebut play music or offering warm drinks warm milk atapun to improve sleep in older people without the use of hypnotics. At night time cup brandy wine or beer can provide internal kengatan and relaxation of the elderly who need to sleep. Efal than one drink lasted only two-thirds subs sleep cycle.
Napping is the right thing, but the amount of sleep sing should not be more than two hours
Exercise every emotion should also be encouraged. This merupak best way for increased sleep. Exercise should be done in the morning than at bedtime because at these hours will only effect of invigorating rather than euthanize.
Warm bath sometimes can relax the elderly but some of them do not like the intervention complained of dizziness when waking up from the tub.
If the above measures fail to improve the quality of sleep, medications can be useful for a while, but it should only be a last resort mnejadi. Ebersole and Hess have identified a variety of selected drugs to induce sleep.Skilled nurses must have a high vigilance associated with the use of these drugs and should assess the elderly with frequent remedy ensures that the drowsiness and disorientation in the daytime berkebihan not happen. If there is any evidence of the condition iniobat drugs should be stopped gradually and do non-pharmacological measures.
CHAPTER IIICONCLUSION
Sleep is a brain process that is required by a person to be able to function properly. Ordinary people have not so familiar with sleep disorders so rarely seek help. Opinion stating that there is no one who died from not sleeping is not true.
Some sleep disorders can be life threatening either directly (eg insomnia which is hereditary and fatal and obstructive sleep apnea) or indirectly as accidents due to sleep disorders.
Disorders not only is the indication of the existence of early mental disorder but it is a complaint of nearly 30% of patients who went to the doctor, due to:
a. Extrinsic factors (outside) eg less tranquil environment.b. Intrinsic factor, can be organic and psychogenic.· Organic, eg pain, itching and certain diseases that make nervous.· Psychogenic, eg depression, anxiety and irritability.
REFERENCES
Darmojo, Boedhi, and Martono, Hadi. Textbook of Geriatric (Elderly Health Sciences), 2nd Edition. 2000. Publisher FKUI hall. Jakarta.SKM, Hardiwinoto, Stiabudi, Tony. Overview Of The Various Aspects. , 2005. PT Gramedia Pustaka Utama. Jakarta.www.google.com (online) accessed on October 26, 2009.
