Psychotropic medication, exercise and sleep
Working with behaviors in nursing home residents can be challenging. Research has shown antipsychotic medications do very little to help residents with behaviors other than sedating them. While getting to the root cause of the behavior can be challenging, have you ever given any thought that our nursing home residents might be exhibiting the side effects of decreased mobility and sleep deprivation?
First, let's consider the effects of decreased mobility. Decreased mobility essentially effects all of our body processes and when it comes to behaviors, several side effects should be considered. Immobility leads to decreased oxygen saturation which leads to hypoxia. Hypoxia leads to confusion which can develop quickly and can fluctuate during the day and worsen in the evening and at night. Nursing home resident behaviors tend to escalate towards the end of the day into the early evening hours.
Also, the effects of decreased mobility on our nervous system leads to sensory deprivation, depression, disorientating, confusion, restlessness, agitation, aggression, anxiety, reduced pain threshold, difficulty problem solving and loss of motivation. Hmm… sound like any of your residents?
The effects of decreased mobility leads to insomnia. For normal body function we need at least 16 hours of activity and 7 to 8 hours of sleep. Consistently sleeping for more than 9 hours or fewer than 7 hours has a negative impact on physiological, psychological and cognitive functions. When we look at the routines of our residents, many are lying down several times throughout the day and put to bed for the night in the early evening. Which brings us to the second concern, sleep deprivation. Even though they are spending greater than 9 hours in bed are they really getting effective sleep?
For optimal functioning, humans need 7 to 8 hours of sleep that contain 4 to 5 uninterrupted sleep cycles. If the sleep cycle is continually interrupted, for example every two hours for rounds, this leads to sleep deprivation. The side effects of sleep deprivation are disorganized thinking, problems with processing things you see and hear, increased irritability, loss of emotional control, agitation, increased behavioral expressions of discontent and loss of social appropriateness. Again, hmm…. does this sound like any of your residents?
As we work with residents with behaviors, it is imperative to get to the root cause. We need to continue to look at the resident's immediate needs, such as bathroom urges, pain or hunger as potential root causes. However, it is also worth looking at the resident's mobility level and sleep patterns. Many of our elders may be inappropriately treated for psychosis with antipsychotics, when it could be a combination of decreased mobility and sleep deprivation.
Jeri Lundgren, RN, BSN, PHN, CWS, CWCN is the President of Senior Providers Resource and works with facilities on senior specific exercise programs and promoting sleep.