Judith A. Floyd

Age-related changes in initiation and maintenance of sleep: A meta-analysis

The purpose of this meta-analysis was to determine the magnitude of change over the adult life span in four key sleep characteristics and to explore research design features that may account for variability in reported age-related sleep change. Forty-one published studies (combined N = 3293) provided 99 correlational effect sizes. Waking frequency and duration increased with age as previously concluded by narrative reviewers. Although narrative reviewers were less certain whether nighttime sleep amount or the ability to initiate sleep decreased with age, the meta-analysis suggested that both decreased. When sleep variables were measured by polysomnography rather than self-report, larger age-related changes were found. Few researchers who studied normal sleep controlled for important health moderators or studied women.

Sleep and aging

Synthesis of studies of sleep and aging show major increases occur in nighttime awakening and major decreases occur in sleep depth over the life span. Fatigue and drowsiness during the day, with increased napping, and earlier bedtimes, are also prevalent in the elderly. Interventions that impact these sleep variables, as well as sleep variables that change less dramatically, are needed. All indications are that the promotion of restorative sleep and daytime well-being in older adults will continue to be an important part of nursing practice affecting even more people as the population ages. Although nurses have only begun to identify and study interventions that promote sleep in nursing environments, nursing is in a position to make major contributions to the health and well-being of older adults who experience sleep disruption, especially sleep disruptions secondary to illness and aging.

Outcomes research: an essential component of the advanced practice nurse role.

More research is needed that focuses on the effectiveness of nursing interventions in clinical settings. Advanced practice nurses are in the best position to conduct these studies, given their clinical expertise, access to subjects, master’s-level research education, and need to demonstrate the effectiveness of their own care practices. This article describes how to develop outcomes studies and to use and disseminate the findings. Advanced practice nurses are encouraged to develop and replicate outcomes studies and to broadly disseminate findings to build the evidence base needed to support advanced practice in nursing.

Nonlinear components of age-related change in sleep initiation

BACKGROUND Although primary studies suggest that ability to initiate sleep declines as people age, no systematic literature review has addressed the age(s) at which adults experience the greatest change in their ability to initiate sleep. OBJECTIVE To explore whether there are any points in time across the adult life span when the rate of change in ability to initiate sleep increases or decreases. METHODS Mathematical modeling was used to generate data points from information about central tendency, variance, and correlations between age and time to sleep onset provided by seven research reports. The reports represent 258 subjects ages 17 to 91 years. Smoothing splines were used to identify inflection points suggestive of major changes in sleep initiation across the life span. RESULTS Two mathematical models were generated. One model suggested that inflection points may exist around ages 30 and 50 years, respectively. With this model, the amount of time until sleep onset increased until the age of 30 years, but was unchanged from ages 30 to 50 years. Ability to initiate sleep appeared to decline steadily after the age of 50 years. The second model, with a p value of 0.05, lacked adequate power to identify a significant nonlinear trend. CONCLUSIONS Decline in ability to initiate sleep may not occur at a steady rate over the adult life span. Further research is needed to pinpoint thresholds of change and possible gender differences in thresholds.

Use of MindMapper® software for research domain mapping

The application of concept mapping software to facilitate the first steps of the research review process is discussed in relation to other software programs currently used for research synthesis. MindMapper® software was used to develop a strategy for organizing the results of a comprehensive literature search into discrete categories with relationships among concepts graphically displayed to reveal the structure of the research domain. A Mind Map® was developed for the scholarly literature on Web-based consumer health information. A second Mind Map® examined the subconcept of barriers to consumer use of the Internet for health information. MindMapper® has many features that facilitate description of the breadth and depth of literature in a domain of inquiry. It also facilitates identification of the number and nature of studies underpinning mapped relationships among concepts, thus laying the groundwork for systematic research reviews and meta-analyses.

Sleep and Dementia: Nursing Care Considerations

The sleep-wake process is a basic component of human experience. When a person’s life is altered by social or emotional upheaval or by physical illness, the quality and quantity of both sleep and waking undergo change. We know that sleep-wake patterns also undergo change as the individual grows older. When growing older coincides with an illness such as Alzheimer’s Disease the changes in sleep-wake patterns become more exaggerated.

Nurse-led care was non-inferior to physician-directed care in symptomatic moderate to severe obstructive sleep apnoea.

Is nurse-led care non-inferior to physician-directed care in patients with symptomatic moderate to severe obstructive sleep apnoea (OSA)? ### Design: randomised controlled trial (RCT). ACTRN 012605000064606. ### Allocation: concealed. ### Blinding: blinded (research assistants). ### Follow-up period: 3 months. ### Setting: 3 academic sleep medicine services in Australia. ### Patients: 195 patients (mean age 50 y, 74% men) 18–75 years of age, who had Epworth Sleepiness Scale (ESS) scores ⩾8, history of snoring “most nights” or “every night,” and oxygen saturation (SaO2) dip >2% at a rate of >27 dips/hour. Exclusion criteria were unstable cardiovascular disease, neuromuscular disease affecting or potentially affecting respiratory muscles, moderate to severe respiratory disease or documented hypoxemia or awake SaO2 <92%, and psychiatric disease. ### Intervention: nurse-led care (n = 100) or physician-directed care (n = 95). Nurse-led care involved autotitrating CPAP between 4 and 20 cm H2O for 4 consecutive …

Review: oral melatonin reduces jet lag in air travellers

(2001) Cochrane Database Syst Rev (1). Herxheimer A, Petrie KJ. . Melatonin for preventing and treating jet lag . ; . :CD001520 (latest version 22 Aug 2000). . 
 QUESTION: In people who travel by air across several time zones, can oral melatonin prevent or treat jet lag? Studies were identified by searching the Cochrane Controlled Trials Register, Medline, EMBASE/Excerpta Medica, and PsycLIT with the terms melatonin, jet-lag, jet lag, aviation, air travel, and airtravel. SciSearch was also accessed, 2 journals ( Aviation, Space and Environmental Medicine and Sleep from 1986–99) were hand searched, bibliographies of relevant studies were scanned, and authors of studies were contacted to identify further studies. Data and case reports of adverse effects of melatonin were also sought. Randomised controlled trials were selected if airline passengers, airline staff, or military personnel were studied; oral melatonin was compared with placebo or other medication; drugs were taken before, during, after, or a combination of times related to travel; and outcome data were provided. Data were extracted on study quality and participants, timing and dose of melatonin and other study medications, flight information, and …

Nursing Students’ Stress Levels, Attitude Toward Drugs, and Drug Use

Abstract This study investigated relationships among nursing students’ drug use and two variables usually assumed to contribute to the development of chemical dependency in nurses, i.e., stress and positive attitudes about drugs. Drug use was defined as the use of any psychoactive substance including prescription drugs, over‐the‐counter drugs, recreational drugs, nicotine, and alcohol. Questionnaires were distributed to senior‐year nursing students and a comparison group of seniors in liberal arts. The only significant difference in reported drug use was nursing students’ more frequent use of over‐the‐counter analgesics. There were no significant differences between nursing and liberal arts majors with regard to three symptoms of stress. Nursing students reported more positive attitudes toward the use of some drugs than peers.