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Keywords:

  • Sleep;
  • older adults;
  • rehabilitation

Abstract

  1. Top of page
  2. Abstract
  3. Aging Changes in Sleep Patterns
  4. Common Sleep Disorders
  5. Factors that Impact Sleep in Older Adults in IRFs
  6. Treatment Options for Sleep Disorders in Older Adults
  7. Conclusion and Future Directions
  8. References

Purpose

The purpose of this article is to provide an overview of changing sleep patterns and common sleep disorders in older adults and to discuss treatment options of sleep disturbances within inpatient rehabilitation facilities (IRFs).

Methods

Through extensive review of the existing literature, common sleep disorders among older adults and several key factors that may impact sleep in older adults in inpatient rehabilitation facilities, such as behavioral and environmental factors, psychosocial and emotional factors, medical conditions, and medications were identified.

Findings

Current literature on the factors associated with sleep disturbance in older adults in IRFs is based on work with community-dwelling older adults and those in long-term care facilities. While interventions to address these disorders and research investigation key factors associated with sleep problems among older adults appear in the literature, there is very little work that applies these interventions within IRFs.

Conclusions and Clinical Relevance

Research is needed to examine the impact of sleep problems on older adults in IRFs, including work that focuses on intervention trials to identify successful treatments for these problems and translate those approaches into practice.

Twenty-five percent of all older adults are hospitalized each year, with many having health problems that could lead them to rehabilitation needs (Jacelon, 2007). These health problems include hip fractures (44%), cardiovascular accidents (36%), pulmonary disease (12%), and other medical conditions (8%) (Geddes & Chamberlain, 2001; Landi et al., 2002; Studenski, Brown & Hardy, 2008). The three main settings for posthospitalization rehabilitation for older adults are inpatient rehabilitation units, skilled nursing facilities, and home health services (Studenski et al., 2008), where the average length of stay in IRFs is seven times longer (2–3 weeks) (Valach, Selz & Signer, 2004) than acute care hospitals (2–3 days) (Poynter, Kwan, Sayer & Vassallo, 2008). This article focuses on inpatient rehabilitation facilities (IRFs). IRFs consist of multidisciplinary teams of physiatrists, nurses, dieticians, physical, occupational, recreational and speech therapists, as well as social service professionals who focus on improving both health and independence (Clay & Wade, 2003; Studenski et al., 2008). Though the goal is to restore the patients’ physical, psychological, and social functioning, it is imperative to recognize and address factors that affect the outcome of their care, such as their sleep disturbances. Studies have shown that the presence of disturbed sleep is related to prolonged stays in IRFs (Makley et al., 2008) and therefore treating sleep disturbance in older adult patients is critically important to reduce the cost of rehabilitation care.

This article describes sleep among older adults, particularly in IRFs, and includes a review of treatment options for this population. We begin by describing sleep patterns and common sleep disorders in older adults, and review factors that impact the quantity and quality of sleep in this population. We conclude with an exploration of treatment options for older adults and examine within the rehabilitation settings recommendations for nonpharmacological and pharmacological interventions that have the greatest affect on sleep disorders among older adults.

Aging Changes in Sleep Patterns

  1. Top of page
  2. Abstract
  3. Aging Changes in Sleep Patterns
  4. Common Sleep Disorders
  5. Factors that Impact Sleep in Older Adults in IRFs
  6. Treatment Options for Sleep Disorders in Older Adults
  7. Conclusion and Future Directions
  8. References

Circadian rhythms are physical, mental, and behavioral changes in a 24-hour endogenous cycle, in which several physiological variables, such as body temperature, blood pressure, melatonin secretion, and the sleep/wake cycle are included. The sleep/wake cycle is a cycle that is referred to as the “circadian pacemaker.” The circadian pacemaker is located in the suprachiasmatic nucleus in the anterior hypothalamus. Circadian rhythms adjust to the 24-hour day by a timekeeping system within the individual, and this timekeeping system prepares the body to anticipate changes in the environment known as the day/night cycle (Ancoli-Israel & Ayalon, 2009).

As people age, their circadian system is altered. One of the most common changes includes an advance in the sleep/wake cycle, also known as advanced sleep phase disorder (ASPD) (Wolcove, Elkholy & Baltzan, 2007). ASPD is characterized by a stable sleep condition in which an individual feels very sleepy and goes to bed early in the evening (e.g., 6:00 p.m.–8:00 p.m.) and is accompanied by an earlier morning awake signal (e.g., 1:00 a.m.–3:00 a.m.) (Sack et al., 2007). Carrier, Monk, Buysse and Kupfer (1997) studied 110 healthy adults and found that age was associated with an increase in waking up earlier in the morning and an objective decline in quality of sleep. Another normal aging change is the decrease in the amount of time spent in the nonrapid eye movement (NREM) phase, delta sleep (stage 3 and 4), which results in a decrease total number of hours sleep (Cole & Richards, 2007). In addition, older adults may wake more frequently at night and undergo fragmented sleep (Bliwise, Carroll, Lee, Nekich & Dement, 1993).

Research examining whether or not older adults actually need less sleep is inconclusive (Bliwise, Ansari, Straight & Parker, 2005); however, some evidence suggests that there is a decrease in older adults’ ability to initiate and maintain sleep (Martin, 2000). Changes in the ability to sleep in older adults may be caused by several factors, including specific sleep disorders such as, insomnia, sleep apnea, periodic leg movement in sleep, and restless leg syndrome, which have known to be common in an inpatient rehabilitation facility (Ouellet & Beaulieu-Bonneau, 2011). The next sections of this article provide more information on common sleep disorders and other factors impacting sleep as well as treatment options (see Tables 1 and 2).

Table 1. Pharmacological Treatment Options
TreatmentDescriptionOutcome
HypnosedativesClass of drugs that have both sedative (quieting, tranquilizing) and hypnotic (sleep producing) effects (e.g., zolpidem, zaleplon, temazepam, and triazolam).

Acute use of drug is associated with impairments in cognition, memory, coordination, and balance.

Long-term use is associated with tolerance of insomnia.

AntidepressantsA psychiatric drug used to alleviate mood disorders, such as major depression, dysthymia and anxiety disorders (e.g., amitriptyline and nortriptyline, citalopram, fluoxetine, paroxetine, and setraline).

Possible impaired performance and daytime drowsiness.

Decrease REM sleep.

Significant adverse effects, especially with TCAs, raise concern about the risk-benefit ratio when used to treat sleep problems in the absence of depression.

Antipsychotics

A tranquilizing psychiatric drug primarily used to manage psychosis, such as delusions, hallucinations, and disordered thoughts

(e.g., haloperidol, promethazine, risperidone, and quetiapine).

Significant risks.

Associated with hypnosedative outcome.

Sedation may diminish in 2–3 weeks.

AntihistaminesA pharmaceutical drug that inhibits action to the histamine. Exerts competitive antagonism of histamine for H1-receptors. Itching and sneezing are suppressed by antihistamine blockade of H1-receptors on nasal sensory nerves (e.g., chlorodiphenhydramine, promethazine, and diphenhydramine).

May impair daytime performance.

Increase drowsiness.

Table 2. Nonpharmacological Treatment Options
TreatmentDescriptionOutcome
Sleep restriction therapyA method used to limit the amount of time spent in bed versus actual sleep time.More consolidated and efficient sleep
Cognitive-Behavioral therapy

A psychotherapeutic method geared to changing beliefs and attitudes about sleep. The 6 strategies used:

 Keep realistic expectations

 Do not blame sleep disorders for all impairments

 Never force yourself to sleep

 Do not give too much importance to sleep

 Do not catastrophize after a poor night's sleep

 Do not have preconceived ideas about solutions of insomnia

Reduction in dysfunctional beliefs about sleep and such changes which are associated with other positive outcomes in sleep disorder treatments
Stimulus control

Five instructions to help reestablish sleep stimuli:

 Go to bed only when sleepy

 Use the bed for sleeping only

 Get out of bed when unable to sleep

 Get up at the same time every morning

 Do not nap during the day

Reestablish a consistent sleep-wake pattern
Relaxation therapy

A psychotherapeutic method focused on relaxation techniques.

 Autonomic relaxation techniques include the following: progressive muscle relaxation, autogenic training, and biofeedback

 Cognitive relaxation techniques: imagery training, meditation, and thought stopping

Relaxation techniques reduce 2 types of arousal (autonomic and cognitive) that interfere with sleep
Sleep hygiene

Guidelines about health practices and environmental factors that may promote sleep:

 Avoid caffeine and alcohol in the evening

 Avoid smoking near bedtime and night awakenings

 Do not exercise too close to bedtime

 Minimize noise, light, and excessive temperatures

Recognize and minimize factors that impact sleep by changing the sleep patterns and activity routines to promote sleep

Common Sleep Disorders

  1. Top of page
  2. Abstract
  3. Aging Changes in Sleep Patterns
  4. Common Sleep Disorders
  5. Factors that Impact Sleep in Older Adults in IRFs
  6. Treatment Options for Sleep Disorders in Older Adults
  7. Conclusion and Future Directions
  8. References

Insomnia

Insomnia is the most common sleep disorder, especially with those aged 65 years and older, and the consequences have been shown to decrease the quality of life (Ancoli-Israel & Cooke, 2005; Kyle, Morgan & Espie, 2010; Voyer, Verreault, Mengue & Morin, 2006). Insomnia is defined as difficulty falling asleep (initiating sleep) or staying asleep (maintaining sleep) (Cole & Richards, 2007). Approximately 20%–40% of older adults report some difficulty falling asleep and/or staying asleep during the past 12 months, about 10%–15% affected are identified as having severe insomnia, and 12%–20% of older adults report what could be considered the clinical disorder of insomnia (Alessi et al., 2008). Although insomnia has been identified as a common sleep disorder, it is usually the result of a maladaptive behavior beyond any initial precipitating factor (Morin, 2004). Older adults with insomnia no longer respond to typical sleep stimuli, and physiological changes associated with aging (McCurry, Logsdon, Teri & Vitiello, 2007) must be considered when treating this disorder. The most common treatment for insomnia has been the pharmacological approach (see Table 1), but the most effective has been nonpharmacological (see Table 2) and will be explained later in this article.

Sleep Apnea

Sleep apnea, also known as sleep disorder breathing, is prevalent in older adults (Ancoli-Israel & Ayalon, 2009). As much as 45%–62% of older adults experience some form of sleep disorder breathing compared with 4%–9% of middle-aged adults (Young et al., 1993). It is characterized by repeated nighttime arousals associated with hypopnea and/or apnea. The number of apneas (complete cessation of respiration) and hypopneas (partial respiration) per hour of sleep is called “apnea-hypopnea” index or AHI (Ancoli-Israel & Ayalon, 2009). A patient is clinically diagnosed with sleep apnea when they have an AHI ≥ 10–15 (10–15 respiratory disturbances) in 1 hour (Ahmedi, Chung, Gibbs & Shapiro, 2008). Sleep apnea may result in sleep fragmentation, excessive daytime sleepiness, cognitive impairment, agitated behaviors, and increased mortality risk (Martin & Ancoli-Israel, 2008). Most patients who suffer with sleep apnea are not aware of their condition until someone observes their interrupted breathing or if it effects their daytime functioning. Continuous positive airway pressure (CPAP) is recognized as the most common treatment for sleep apnea, but should not be the only treatment of choice. CPAP involves wearing a mask over the face, primarily the nose, and connecting a hose to the mask to generate positive air pressure, which acts as a splint that holds the airway open.

Periodic Leg Movement in Sleep and Restless Leg Syndrome

The prevalence of periodic limb movement in sleep (PLMS) increases with age. For example, in one study the prevalence PLMS was estimated at 45% in a sample of community-dwelling older adults compared with 6% in younger adults (Ancoli-Israel et al., 1991). PLMS is represented by a group of repeated leg movements that may occur specifically during sleep, causing a brief awakening. A patient is diagnosed when they are awakened with at least five kicks/jerks occurring every 20–40 seconds throughout the night. Another similar disorder is restless leg syndrome (RLS). It, too, has the same prevalence of as much as 45% in older adults (Phillips et al., 2000). RLS is characterized as a “creeping/crawling sensation” or “pin and needles” which may be relieved with some type of movement (Ancoli-Israel & Ayalon, 2009; Walters et al., 1995). The most common complaints of older adults with PLMS and RLS are difficulty falling asleep, staying asleep, and excessive daytime sleepiness (Ancoli-Israel & Ayalon, 2009). Pharmacological treatments, particularly dopaminergic agents, such as ropinirole (Requip) and pramipexole (Mirapex) have been found to be the most effective for RLS (Hening, Allen, Earley, Picchietti & Silber, 2004). In some cases, ropinirole and gabapentin also appears to reduce PLMS symptoms in the initial stages of sleep (Ancoli-Israel & Cooke, 2005), but these drugs have not been as effective in overall treatment in comparison with their impact on as RLS.

Factors that Impact Sleep in Older Adults in IRFs

  1. Top of page
  2. Abstract
  3. Aging Changes in Sleep Patterns
  4. Common Sleep Disorders
  5. Factors that Impact Sleep in Older Adults in IRFs
  6. Treatment Options for Sleep Disorders in Older Adults
  7. Conclusion and Future Directions
  8. References

Sleep disturbances are more prevalent in the older population and have been associated with a decrease in the quality of life (Leger, Scheuermaier, Philip, Paillard & Guilleminault, 2001). Although aging is associated with changes in circadian rhythms resulting in disturbed sleep (Sack et al., 2007), there are several other factors that may also impact the quality of sleep, such as cognitive impairment, dependence on others for personal care needs, depression, pain, and lack of family support (Ancoli-Israel & Cooke, 2005; Cuellar, Strumpf & Ratcliffe, 2007; Haynes, McQuaid & Ancoli-Israel, 2006; Makley et al., 2008; Orwelius, Nordlund, Nordlund, Edell-Gustafsson & Sjoberg, 2008). In fact, many older adults will have more than one risk factors. In a survey study of 9,000 participants over the age of 65, sleep disturbance was predicted by the presence of physical disabilities, use of over-the-counter medications, depression, and poor self-perceived health (Foley, Ancoli-Israel, Britz & Walsh, 2004). Alessi et al. (2008) studied 245 inpatient rehabilitation patients aged 65 years and older and identified several of these factors which also disturbed sleep/wake patterns during inpatient postacute rehabilitation. These factors were found to be common in this population. Moreover, older adult patients exhibited more daytime sleeping during the rehabilitation stay and less functional recovery for up to 3 months postrehabilitation. Another study identified a variety of factors related to disturbed sleep in older adults, including behavioral and environmental factors, psychosocial and emotional factors, medical conditions, and medication. The same article also acknowledged the expertise of rehabilitation psychologists in helping to apply new treatment advances to the growing number of older adult patients in IRFs (Stepanski & Wyatt, 2003). This presents an opportunity for nurses and psychologists to work together to assist older patients in IRFs.

Behavioral and Environmental Factors

Behavioral factors, such as sleep hygiene, diet, and physical exercise, may have an effect on sleep disturbance in IRFs. In the case of older adults who are in IRFs, their presleep rituals are not individualized. They are required to go to bed at a set time as well as receive skilled nursing care, medication administration, and blood draws based on the IRF's schedule (Studenski et al., 2008). These changes in the older adults' presleep rituals may fluctuate or impede sleep (Haynes et al., 2006). Recommendations may include, maintaining their presleep ritual of regular bedtimes and rising times, limiting naps, and decreasing interruptions during the night (Deschenes & McCurry, 2009). Diet and physical exercise may also cause sleep disturbance in IRFs. For example, the ingestion of high-caffeine beverages, such as coffee and tea, which are often offered during dinner, can be felt in 15–20 minutes, and the effects can last for 4 hours (Eliopoulos, 2010). Patients may be recommended to avoid diets that are high in caffeine at least 5–7 hours before bedtime (Deschenes & McCurry, 2009); this also allows the bladder to be empty before bedtime. Although exercise has been linked to promote sleep in older adults (King, Roy, Brassington, Bliwise & Haskell, 1997), physical exercise 3–4 hours before sleep, such as evening strenuous physical recreational activities, can also affect the onset of sleep (Ceolim & Menna-Barreto, 2000). It is recommended not exercise too close to bed time because the body needs time to “come down” from the adrenalin/endorphin rush produced by exercise. In addition, sleep can be interrupted by environmental factors such as noise, lighting, room temperature, cohabitation, and imposed therapy schedules (Orwelius et al., 2008; Ouellet & Beaulieu-Bonneau, 2011). Some of these are magnified in IRFs and can have detrimental effects as the level and strangeness of the facilities’ environment becomes inappropriate for rest (Freter & Becker, 1999; Orwelius et al., 2008). Altering daily routines and the environment should be performed to reduce excessive sleep disturbances in an IRF. For example, Alessi et al. (2005) reported that 5 days of exposure to a behavioral and environmental intervention that included resident exposure to outdoor bright light, keeping residents out of bed during the day, daily participation in a low-level physical activity program, consistent bedtime routine, and reduction in nighttime noise and light in the rooms led to an increase in rest/activity rhythms and a reduction in the length of nighttime wakefulness.

Psychosocial and Emotional Factors

Psychosocial factors such as retirement, isolation, loneliness, bereavement or grief may promote sleep disturbance in older adults (Alessi et al., 2005; Haynes et al., 2006; Orwelius et al., 2008). These factors may become recurring due to maladaptive behaviors and attitudes about sleep (Morin et al., 1999). Emotional disturbances, such as depression and anxiety, are common among older adults in IRFs. For example, in stroke patients depression and anxiety was found to be present in 18%–27% of patients (Apperlros & Viitanen, 2004; Barker-Collo, 2007) and is a frequent contributor to sleep disturbances (Birrer & Vemuri, 2004). Anxiety can also be a result of other medical conditions as well as a new environment or planned life changes (Frazier, Waid & Finke, 2002). At this time, pharmacologic treatment remains the mainstay of short-term treatment of sleep disturbances in individuals with psychosocial and emotional factors (Mendelson, 2005).

Medical Conditions and Medications

Key medical conditions that impact sleep include dementia, chronic pain, pulmonary diseases, and genitourinary disorders (Foley et al., 2004). Sleep disturbance and insomnia were found to be prevalent in dementia associated with Alzheimer's disease (Dauvillers, 2007) affecting up to 44% of patients in clinic and community-based samples (McCurry et al., 1999). The number of demented patients, with primary rehabilitation diagnosis such as hip fractures, is increasing as the older age population increases (Huusko, Karppi, Avikainen, Kautiainen & Sulkava, 2000). Other medical conditions which are common to rehabilitation patients that may produce pain (e.g., hip fractures, arthritis, and lower back pain) are also known to cause sleep disturbance. Research has found 80% of the patients in residential care reported at least one complaint of pain (Parlmalee, Smith & Katz, 1993). Studies have also examined complaints of difficulty falling asleep in 66% of patients with chronic pain, and 85% have difficulty staying asleep (McCracken & Iverson, 2002). Obstructive sleep apnea is also common in older people, especially those who exhibit daytime fatigue (Bailes, Baltzan & Alain, 2005). Obstructive sleep apnea is a respiratory disorder that may exhibit repeated upper airway obstruction (Wolcove et al., 2007), and may lead to disturbed, poor quality sleep, decrease oxygen saturation, and reduced REM sleep. Studies among older patients admitted to IRFs after a stroke has shown that obstructive sleep apnea is common with this disease (Kaneko, Hajek, Zivanovic, Raboud & Bradley, 2003). Nocturia, nighttime awaking to void, may have a significant impact on sleep disturbance, based on the number of times people wake up at night to void (Haylen et al., 2010). Nocturia is associated with aging and may be a result from comorbidities behavioral influences, such as diet (Weiss, Blaivas & Stember, 1998). Various medications prescribed in an IRF may have an impact on the quality and quantity of sleep. Older adults may have a low tolerance for medications that may impact the ability to initiate and maintain quality sleep. Some medications have stimulating side effects, which can also disturb the quality of sleep. Thiazide diuretics are advocated as first-line regimens in older patients in IRFs (Chobanian et al., 2003) because they have proven to decrease cardiovascular mortality (ALLHAT, 2002); however, if given late in the day, these drugs may contribute to wakefulness as well as nocturia (Cole & Richards, 2007). In addition, hypnotic medications may cause early awakening through nightmares and hallucinations (Stepanski & Wyatt, 2003) and have been shown in IRFs to be associated with daytime drowsiness, confusion and, increased falls (Freter & Becker, 1999).

Treatment Options for Sleep Disorders in Older Adults

  1. Top of page
  2. Abstract
  3. Aging Changes in Sleep Patterns
  4. Common Sleep Disorders
  5. Factors that Impact Sleep in Older Adults in IRFs
  6. Treatment Options for Sleep Disorders in Older Adults
  7. Conclusion and Future Directions
  8. References

Pharmacological

Pharmacological interventions have been used for various sleep disorders in older adults. Within IRFs, pharmacological interventions for older adults with sleep disorders are hypnosedatives, antidepressants, antipsychotics and antihistamines, (Freter & Becker, 1999) with the risks often times outweighing the benefits (see Table 1). For example, it is important to consider that these medications may increase the medical and cognitive risks for adverse effects (e.g., falls, confusion, and increase fatigue) (Ray, Thapa & Gideon, 2000; Schneeweiss & Wang, 2005). Moreover, physiologic alteration in how older adults metabolize some of these medications may produce either a higher peak of concentration or longer duration of drug activity (Martin, 2000) leading to residual daytime sedation (Alessi et al., 2005). Withdrawals from these medications may also be associated with rebound insomnia, although the symptoms usually do not last more than 1–2 days (Roehrs, Vogel & Roth, 1990).

In a recent meta-analysis by Glass, Lanctot, Hermann, Sproule and Busto (2005) of using hypnotic drugs in the older age group, the clinical benefits related to sleep medication were identified as being small, and in some situations were outweighed by the adverse effects (ataxia, falls, and memory impairments). The use of short-term hypnotic agents has been indicated in treating transient insomnia in an acute care setting and may continue after admission into an IRF (Lin & Armour, 2004). Studies examining the use of antidepressant drugs, such as tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) for sleep have been limited. Side effects are common in antidepressant drugs and can be serious enough to warrant discontinuation of the medication. Adverse effects associated with TCAs include ventricular arrhythmias, hypotension with syncope, and cardiac conduction disturbance (Witchel, Hancox & Nutt, 2003), whereas SSRI side effects were found to include nausea, insomnia and anxiety (Nowell & Buysse, 2001). In addition, there are several risks associated with antipsychotic medications. For example, the dosage for treatment of insomnia has been unpredictable, the risk of side effects is high, and the results of these agents may lead to hyperglycemia—thereby increasing the risk of hyperglycemic reactions in older adults with diabetes (Guo et al., 2006). Antihistamines are commonly used over-the-counter drugs to treat insomnia (Erman, 2007). These drugs are found to be inappropriate for use in older aged adults due to their anticholinergic properties, which may result in confusion, urinary retention and constipation (Fick et al., 2004). Despite this, the treatment of choice for sleep promotion used by physicians and other healthcare providers remains pharmacological interventions (Sivertsen & Nordhus, 2007).

Nonpharmacological

A growing amount of evidence has shown nonpharmacological interventions to be readily available and superior in short- and long-term management of older patients with sleep disorders (Flaherty, 2008; Glass et al., 2005; Sivertsen et al., 2006; Smith et al., 2002). The treatment of choice has been multicomponent cognitive–behavioral therapy (CBT) (Edinger & Sampson, 2003; Harvey, 2002; Morin et al., 2006) that encompass a combination of two or more intervention strategies, ranging from education to behavioral techniques (McCurry et al., 2007; Montgomery & Dennis, 2009).

A recent meta-analysis by McCurry et al. (2007) describes evidence-based psychological treatments for insomnia in older adults. Following the American Psychological Association on coding procedures, sleep restriction-sleep compression therapy and multicomponent cognitive–behavioral therapy were the two treatments found to meet evidence-based psychological treatments criteria for insomnia in older adults. Other studies identified cognitive–behavioral relaxation therapy, and sleep hygiene education (see Table 2) (Harvey, 2002; Martin, 2000; Montgomery & Dennis, 2009; Morin, 2004; Morin et al., 1999). However, only one research study has been related to treatments of disturbed sleep in IRFs (Freter & Becker, 1999). This study examined the effect of hypnotic use on self-rated quality of sleep and therapist-rated level of alertness in an inpatient rehabilitation setting as well as other factors predictive of a restful sleep in this population. These findings recognized evidence of objective improvement in sleep or therapy performance the next day, particularly in view of the cost and side effect profile of these medications. However, there is evidence supporting the use of nonpharmacological interventions, which are preferable to the use of sedating drugs because of the risk associated with their use (Flaherty, 2008). Nonpharmacological interventions to enhance sleep usually target specific areas in an attempt to improve sleep in IRFs. When older adults have difficulty sleeping, a thorough assessment should be made to identify sleep problems and aspects of good sleep hygiene.

Key Practice Points
  • Sleep disturbance has an impact on the quality and quantity of life in older adults in a variety of settings.
  • Common sleep disorders among older adults are insomnia, sleep apnea, and periodic leg movement in sleep/restless leg syndrome.
  • Other key factors that have an impact on sleep are behavioral and environmental factors, psychosocial and emotional factors, medical conditions, and medications.
  • Research is sorely needed to address and treat sleep problems in older adults within inpatient rehabilitation facilities.
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Conclusion and Future Directions

  1. Top of page
  2. Abstract
  3. Aging Changes in Sleep Patterns
  4. Common Sleep Disorders
  5. Factors that Impact Sleep in Older Adults in IRFs
  6. Treatment Options for Sleep Disorders in Older Adults
  7. Conclusion and Future Directions
  8. References

A significant amount of research on sleep disturbances among older adults has emerged in the last two decades, including research investigating the relationship between sleep problems and decreased quality of life for community-dwelling older adults and those in long-term care facilities. Although there has been some research that has shown the importance of sleep in older adults in IRFs, there has been minimal research conducted in IRFs. There is no doubt that older adults have sleep disturbances in any type of setting, but with the growing number of older adults entering into IRFs and staying seven times longer than in acute care settings, nurses have a unique opportunity to lead interdisciplinary teams to identify and address sleep disturbances in older patients through the introduction and evaluation of treatment options reviewed here. Unfortunately, there have not been any published studies, to date, that focus on treatment of disturbed sleep in older adults within IRFs. Therefore, preliminary research is needed to examine the impact of sleep problems on older adults in IRFs. Research then needs to focus on intervention trials to identify successful treatments for these problems and translate successful approaches into practice.

References

  1. Top of page
  2. Abstract
  3. Aging Changes in Sleep Patterns
  4. Common Sleep Disorders
  5. Factors that Impact Sleep in Older Adults in IRFs
  6. Treatment Options for Sleep Disorders in Older Adults
  7. Conclusion and Future Directions
  8. References
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