A nurse is caring for an older adult client who is having difficulty sleeping and has a new prescription for a medication to help them sleep. Which of the following medications should the nurse identify as a first-line sleep aid for older adults?

A. This is a defining feature of hypersomnia. Clients experience excessive daytime sleepiness despite getting adequate or even prolonged sleep at night. The sleep is often non-restorative, meaning the client wakes still feeling tired, and additional sleep does not resolve the fatigue. This distinguishes hypersomnia from simple sleep deprivation.

B. While circadian rhythm disorders (like delayed sleep phase or shift work sleep disorder) can cause sleepiness, hypersomnia is not primarily caused by circadian rhythm disruption. It is a sleep disorder characterized by excessive sleepiness even with a normal sleep-wake schedule.

C. Hypersomnia actually impairs attention, concentration, and cognitive performance due to persistent sleepiness. Clients may experience difficulty focusing, memory lapses, and slowed mental processing, so a longer attention span is incorrect.

D. Lack of hypocretin (orexin) is primarily associated with narcolepsy type 1 (NT1), which includes cataplexy, not hypersomnia. Hypersomnia generally occurs without hypocretin deficiency.

A. Hypersomnia, or excessive daytime sleepiness, is a common symptom of obstructive sleep apnea, not a risk factor. It results from repeated arousals during sleep due to airway obstruction, leading to non-restorative sleep. While important to recognize clinically, it does not contribute to the development of OSA.

B. Obesity is the most significant risk factor for OSA in adults. Excess fatty tissue, especially in the neck and pharyngeal area, narrows the upper airway and increases the likelihood of airway collapse during sleep. Additionally, obesity can exacerbate comorbid conditions like hypertension, insulin resistance, and metabolic syndrome, which are commonly seen in OSA patients. Research shows that even modest weight loss can significantly reduce the severity of OSA.

C. The glossal (tongue) muscles help maintain airway patency. Active and well-toned muscles protect against airway collapse during sleep. Conversely, decreased muscle tone or neuromuscular dysfunction increases risk. Therefore, active glossal muscle function is protective, not a risk factor.

D. Enlarged tonsils can obstruct the airway, particularly in children, and contribute to OSA. Tonsillectomy often reduces or resolves OSA symptoms by removing this obstruction. A history of tonsillectomy, therefore, lowers risk rather than increasing it.