SLEEP AND HIV INFECTION
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1 AGEING LIFE
2 SLEEP AND HIV INFECTION Dr.S.Ramnathan Iyer MD,FICP,FGSI,FISDA Consultant Physician&Consultant Sleep Medicine. Dr.Revati R Iyer,MS Consultant Gynaecologist&Obstetrician.
3 SLEEP AND HIV INFECTION Sleep in good quantity&quality essential for physical mental&emotional well being. Chronic potentially life threatening illnessess share many common features-commonest-sleep disorder.
4 SLEEP AND HIV INFECTION Sleep comforting-respite from distress,pain,fatigue.only phase when pt. can forget the disease. Sleep improves immunity. Sleep is reflected in daytime task.(end of life Tasks).Daytime sleepiness & Tiredness.
5 SLEEP AND HIV INFECTION Sleep complaints rated high by pts.(limited time due to competing medical issues often contrive to create an atmosphere of neglect in respect to sleep disorders.) In practice recognising & dissecting the sleep complaint helps in comprehensive management. Any disease which does not respond well to treatment employed- a sleep disorder must be suspected. Management of sleep disorder highly rewarding. Sleep comforting-respite from distress,pain,fatigue.
6 SLEEP AND HIV INFECTION Sleep deprivation common in HIV pts. Rubinstein & Selwyn -73%-J Acq Immun Defic.Syn1998 Cohen et al(hol Nurs Pract 1996)-60% pts dissatisfied sleep. Somatic sympt.-night sweats,chills,headache Risk factors-depression,anxiety,cognitive impairment.
7 SLEEP AND HIV INFECTION Obstructive sleep apnea-hypopnea syndrome- Prevalence-24% men and 9% women.(1993) Clinically-Snoring and Daytime sleepiness. HIV- Adenotonsillar hypertrophy-osahs. OSAHS risk factor for HTN,DM,IHD,Strokes.
8 AGEING LIFE Normally during sleep, the muscles which control the tongue and soft palate hold the airway open. If these muscles relax, the airway narrows, causing snoring and breathing difficulties. If these muscles relax too much, the airway can become completely blocked, preventing breathing.
9 OSA - IYER OSA APNOEIC EPISODE APNOEA TERMINATION APNOEA BP HR CO EARLY MIDDLE LATE BP HR CO VAGAL TONE SYMPAT TONE CATECHOL RELEASE SUCCESSIVE APNOEIC EVENTS DISASTROUS BP SYSTEMIC PULM METABOLIC EFFECTS
10
11 SLEEP AND HIV INFECTION OSAHS pts. Often REM sleep deficient. REM Sleep Deprivation Anxiety Increased Appetite. Hypersexuality.(Hypersexual behavior)-hiv risk. OSAHS Management-usually by Continuous Positive Airway Pressure. Outcomes-Highly rewarding.
12 Patient on Continuous Positive Airway Pressure Therapy
13 SLEEP AND HIV INFECTION Polysomnography in early HIV infec. Increased Slow wave sleep.(cytokine related). Fluctuating TNF alpha coupled to nocturnal cycles of delta activity in sleep.(darko et al 1995) Polysomnography in late HIV infec. Prolonged sleep latency. Decreased sleep efficiency. Increased Stage 1 sleep. Decreased slow wave sleep.(sws)
14 SLEEP AND HIV INFECTION Etiology of Sleep disturbances in HIV & AIDS Immune related. Endocrinal.(loss of circadian rhythmicity). Increased cytokine release. Psychiatric( Depression) Medications. CNS involvement.
15 SLEEP AND HIV INFECTION Management Comprehensive evaluation.sleep questionnaire,sleep logs. Identifying the sleep disorder-organic/functional. Identify sleep hygiene issues. Judicial daytime napping. Opiods, sedatives and hypnotics-caution-underlying OSAHS. Treat underlying sleep disorder.
16 AGEING LIFE Contact : sramiyer@gmail.com Mobile : , Tel. : ,
17 FALLS IN THE ELDERLY 6 TH LEADING CAUSE OF DEATH 40%ADMISSIONS IN NURSING HOMES PREVENTING A FALL 1.ADEQUATE ILLUMINATION 2.NON SKID FLOORS.(OIL/SOAP SPILLAGE IN BATHROOM /TOILET) 3.HAND RAILS. contd
18 SLEEP MEDICINE - IYER JAI SHREE KRISHNA
19 AS WE AGE WE BECOME DISSIMILAR AGEING LIFE
20 AGEING LIFE TREATMENT FOR OSA CONTINUOUS POSITIVE AIRWAY PRESSURE
21 AGEING AGEING LIFE OLD IS GOLD OLD WINE, OLD WIFE WILL NOT BETRAY THE MASTER ELDERLY ARE REQUIRED IN SOCIETY EXPERIENCE GUIDANCE BLESSINGS VANPRASTH ASHRAM RETIREMENT SIMPLE LIVING HIGH THINKING AN ATTEMPT TO FEEL AND UNDERSTAND GOD ELDERLY CARE - A STEP IN THIS DIRECTION
22 IYER SLEEP MEDICINE - IYER CONTINUOUS POSITIVE AIRWAY PRESSURE UNIT (CPAP)
23 Tkhou AGEING LIFE OkDr :drk ugha] mez Fkerh ugha] Ckhrs gq, fnuksa dh ;kn lrkrh gs- bl iy dks ml iy ls tksm+dj] ykbzq LVkbZy dk pknj vks<+dj] ge ftaunxh dsk ;wwa gh latks;s gq, gs- ykbzq LVkbZy dks cnyrs odr ugh yxrk],d rjq iqjkuh chekjh] ml ij mldk u;k :Ik u;k psgjk] etcwj djrs gs geas ml vuu; kfdr dks ;kn djus dks] Åxrk lwjt gks ;k f{krht es fcnkbz nsrk lwjt Lkknj iz.kke gs ml Ikz[kaM rst dks IzkkFkZuk gs ml lq[k kkafr lq[kn LoLFk thou L=ksr dks
24 AGEING LIFE YOU ARE A THOROUGHLY SPOILT BRAT! WHY DON T YOU CARRY YOUR BOOKS YOURSELF LIKE OTHER CHILDREN.?
25 WHAT IS AGEING? (Contd.) HOMEOSTATIC MECHANISMS- LESS SENSITIVE LESS ACCURATE SLOWER LESS WELL SUSTAINED ANY CHALLENGE EG: INFECTION, BLOOD CLOTS UNABLE TO DEAL DEATH
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Milena Pavlova, M.D., FAASM Department of Neurology, Brigham and Women's Hospital Assistant Professor of Neurology, Harvard Medical School Medical
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Participant ID: If you had no responsibilities, what time would your body tell you to go to sleep and wake up?
What does your sleep look like on a typical week? Total Sleep Time: Bedtime:, Sleep onset latency:, Number of Awakenings:, Wake time after sleep onset:, Rise time:, Out of bed:, Naps:? Notes: Is your sleep
Presented By Dr. Ramesh. Adverse Health Effects of Sleep Deprivation
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Commissioning Policy Individual Funding Request
Commissioning Policy Individual Funding Request Continuous Positive Airway Pressure (CPAP) Treatment of Obstructive Sleep Apnoea/Hypopnoea Syndrome (OSAHS) Criteria Based Access Policy Date Adopted: 13
POLICY All patients will be assessed for risk factors associated with OSA prior to any surgical procedures.
Revised Date: Page: 1 of 7 SCOPE All Pre-Admission Testing (PAT) and Same Day Surgery (SDS) nurses at HRMC. PURPOSE The purpose of this policy is to provide guidelines for identifying surgical patients
2016 Physician Quality Reporting System Data Collection Form: Sleep Apnea (for patients aged 18 and older)
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