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MEDICAL NOTES Valerie J. Shereck, MSN, ANP-C SLEEP DISORDERS Sleep disorders are common among the elderly and occur in up to 50% of individuals over the age of 65. Sleep disorders are defined as the inability to fall asleep, stay asleep, sleeping too much, or having abnormal, sleep-related behaviors. The American Academy of Sleep Medicine categorizes them into the following major groups: insomnia, hypersomnia (excessive sleepiness), sleep-related breathing disorders, circadian rhythm sleep-wake disorders, parasomnias (sleep disorders that include unwanted events or experiences that occur while people are falling asleep, sleeping, or waking up), and sleep movement disorders. In this article, discussion will be limited to insomnia, obstructive sleep apnea, and restless leg syndrome. As people age, the timing and amount of sleep changes. Older individuals tend to fall asleep earlier and awaken earlier and are less tolerant of changes in the sleep-wake cycle (i.e., jet lag and daylight saving time). Daytime napping in older adults may compensate for poor nighttime sleep, but napping can also contribute to poor nighttime sleep. Sleep efficiency also decreases from 95% during adolescence to less than 80%. TWO TYPES OF SLEEP The two main types of sleep are non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. * NREM Sleep is divided into four stages based upon the amount and frequency of different types of brain waves (electrical activity of the brain). Stage I occurs as people become drowsy and fall into a light sleep. Stage II, where most sleep time is spent, is a continuation of light sleep. Stages III and IV are the deepest levels of sleep and are necessary for feeling rested. * REM Sleep is a very deep but active stage of sleep in which people dream. In this stage, the heart rate and breathing speed up and then slow down, and the individual’s eyes move rapidly. Older individuals reach the deepest stage of sleep (Stage IV) more slowly and spend less time in REM sleep. INSOMNIA is defined as the inability to fall or remain asleep. It can lead to restlessness and anxiety which can make obtaining sleep even more difficult. It can also interfere with the ability to function during the day. It is the most common sleep disorder in older adults; up to 40% report insomnia and approximately 20% report severe insomnia. It is more prevalent as age increases and is more common in women than men. Insomnia can be acute or short term or chronic and long term. Risk Factors for the Development of Insomnia: - Stress (may be acute or chronic) - Acute or chronic illness – Pain - Environmental changes Consumption of or withdrawal from caffeine, nicotine, or alcohol - Medications that have stimulant properties - Withdrawal from certain medications especially antianxiety medication or antidepressants - Inadequate sleep hygiene (habits and practices that are conducive to sleeping well) - Psychiatric disorders such as depression, anxiety, and post-traumatic stress disorder - Other sleep disorders. Treatment of insomnia depends on the cause. One of the most important things to alleviate insomnia is to educate individuals about good sleep hygiene habits. Ways to Improve Sleep: -Having a regular sleep schedule; going to bed at the same time and rising at the same time each day -Regular bedtime routine -Use of the bedroom primarily for sleep -Avoidance of substances that interfere with sleep such as caffeine, chocolate, and alcohol prior to bedtime -meditation, listening to calming music, deep breathing, and progressive relaxation. ST PATRICK’S DAY Pegi Schlis, CTRS, ACC, AC-BC March 17, 2020 HISTORY St. Patrick, the patron saint of Ireland, was not Irish. He was born in Scotland or Wales (depending on the source) as Maewyn Succat between 373 and 385 A.D. (depending on the source). (He later took the Latin name Patricus - Patrick is the English version - when he became a priest.) At the age of 16, he was captured by Irish raiders and brought to Ireland as a slave. During this time, he became deeply religious and began to have visions. Six years later, he escaped and settled in France. After having visions of bringing Christianity to the Irish people, he returned to Ireland in 432 A.D. and stayed there until his death on March 17 in 461 A.D. Legend has it that Patrick pounded a drum and banished all the snakes from Ireland. There are no snakes in Ireland today. The first St. Patrick’s Day celebration in America was in 1737 in Boston. The first St. Patrick’s Day parade was in 1779 in New York City. More than 100 U.S. cities hold St. Patrick’s Day parades now. IRISH FOOD & DRINK TRIVIA • The potato is not native to Ireland. It was originally brought to Ireland from the Americas by Sir Walter Raleigh in 1585. • A potato is sometimes called a Smiling Murphy. • Colcannon, a mashed potato dish (a Halloween specialty), is made with kale, scallions, butter, and hot cream. • Beef, not beer, is Ireland’s largest edible export. • Corned beef is not a traditional dish in Ireland, but it was popular with the Irish immigrants who settled in New York City because it was 5¢ a portion, making it affordable. • Boiled bacon and cabbage is considered Ireland’s most popular traditional dish. • Four million pints of Guinness® beer are produced daily. • All the grain used by Guinness® is grown in Ireland. • Ireland’s longest bar is the Grandstand Bar at Galway Race Course. It is 210 feet long. • Approximately 50% of a bottle of Bailey’s® Irish Cream is fresh Irish dairy cream. • Worldwide consumption of Bailey’s® Irish Cream is 1,000 glasses a minute. IRISH AMERICANS • The first census of the U.S., taken in 1790, recorded 44,000 Irish-born residents. More than half of them lived south of Pennsylvania. Now, it is estimated that more than 38 million Americans claim Irish ancestry. • As many as 25% of Americans claim pure Irish ancestry. • More than 40% of U.S. Presidents have claimed Irish ancestry. • Billy the Kid, the old West outlaw and gunfighter, was born Henry McCarty and was the son of Irish immigrants. • Daniel Boone descended from Donegal immigrants. • James Cagney was born in 1899 and raised on New York City’s Lower East Side by an Irish father and Norwegian mother. • Davy Crockett, a pioneer born in 1786, was an Irish American. • Richard Daley, born in 1902, served six terms as mayor of Chicago. Both of his parents’ families emigrated from Ireland in the 1840s. • Colorado-born Jack Dempsey, a heavyweight champion, was a descendent of Irish immigrants from County Kildare. • John Ford, the father of Henry Ford, immigrated to America after being evicted from Cork in 1847. • James Hoban, an Irishman from County Kilkenny, designed the White House in 1792. IRISH WORDS: • Small fragments SMITHEREENS (smithiríní) • Area where turf can be cut from BOG • Type of execution (last name of mayor and magistrate of Galway who convicted his own son to hang) LYNCH • Decrepit dwelling SHANTY (sean tigh pronounced shan tig) • Beverage traditionally associated with Ireland means “water of life” WHISKEY (uisce beatha pronounced ish-kuh ba-ha) • Word that describes the Irish way of speaking BROGUE (bróg. It entered the English language directly from the Irish word for shoe.) • St. Patrick use this to teach about the Trinity SHAMROCK (seamróg) • Word that comes from the name of the woods in County Wicklow from which oak clubs were believed to come SHILLELAGH. WOMEN’S HISTORY MONTH Shelley Evans, MT-BC, ACC, CDP, AC-BC HISTORY The month of March recognizes women’s contributions to society, culture, and history. The first observance of National Women’s Day was in New York City on February 28, 1909. It became known as International Women’s Day in 1911. In 1975, the United Nations adopted International Women’s Day. The Education Task Force of the Sonoma County (California) Commission on the Status of Women celebrated Women’s History Week in 1978. The organizers selected the week with March 8 to correspond with International Women’s Day. The movement spread across the country as other communities initiated their own Women’s History Week celebrations the following year. Women’s groups and historians led by the National Women’s History Project (now the National Women’s History Alliance) lobbied for national recognition. In February 1980, President Jimmy Carter issued a Presidential Proclamation declaring the week that includes March 8 as National Women’s History Week. By 1986, 14 states were celebrating March as Women’s History Month. Members of Congress were lobbied to declare the month of March as Women’s History Month. In 1987, there was a Congressional resolution to declare March as Women’s History Month. Programming for this year’s Women’s History Month can show honor and respect to the women of our past, recognize those of our present, and encourage and inspire the women of our future. The following women had the distinction of being welcomed into the National Women’s Hall of Fame in Seneca Falls, NY in 2019: attorney Gloria Allred, educator Angela Davis, educator Sarah Deer, actress Jane Fonda, Air Force colonel Nicole Malachowski, suffrage artist Rose O’Neill, congresswoman Louise Slaughter, associate justice Sonia Sotomayor, composer Laurie Speigel, molecular biologist Flossie Eong-Staal, and fashion designer Diane von Furstenberg. Learn more about the National Women’s Hall of Fame at www.womenofthe hall.org. WOMEN WHO HAVE CHANGED THE WORLD TRIVIA QUIZ Whether as activists, musicians, or scientists, women have changed the world. Host a discussion about these notable women. • Cleopatra was a ruler of which country? EGYPT • How old was Joan of Arc when she led a successful revolt for the French - 15, 17, or 19? 17 • Catherine the Great improved the welfare of the serfs in which country? RUSSIA • T/F: Mary Wollstonecraft was a pioneer in women suffrage and wrote a pamphlet titled, “A Vindication of the Rights of Women.” TRUE • Jane Austen defied the odds and became a popular author penning Emma and Pride and _____? PREJUDICE • T/F: Sojourner Truth campaigned for women’s rights and had a famous speech titled, “Ain’t I Fantastic?”.

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