A2

Sedative-hypnotic fall risk

Skilled sleep assessment found a sedative-hypnotic sleep aid causing next-day grogginess and unsteadiness in an older adult with a recent near-fall. Findings indicate a sleep aid creating fall risk. Provider notified at 12:00 with the next-day sedation, the unsteadiness, and the fall risk; order received to taper and discontinue the sedative-hypnotic and substitute behavioral measures. Sleep hygiene, fall precautions, and the deprescribing plan were taught; teach-back accurate. Reassessment of sleep, sedation, and fall risk planned next visit. (Fall-risk mitigation in the Safety reference.)

A3

Positive sleep-apnea screen

Skilled sleep assessment found loud snoring with witnessed apneas, gasping, morning headache, and excessive daytime sleepiness; the STOP-Bang screen is positive. Findings indicate likely obstructive sleep apnea with cardiovascular risk. Provider notified at 10:30 with the screen result and the associated features; order received to refer for a sleep evaluation. The patient was educated on the significance and the warning signs; teach-back accurate. Reassessment and referral coordination planned, with sleep-hygiene measures reinforced in the interim.

A4

Insomnia from anxiety

Skilled sleep assessment found difficulty with sleep onset and racing thoughts at bedtime attributable to anxiety, with reduced total sleep and daytime fatigue; no risk on mental-health screen. Findings indicate insomnia driven by anxiety. Provider notified at 11:45 with the sleep disruption and the anxiety contributor; order received to address the anxiety and reassess sleep. Sleep hygiene and relaxation strategies were taught and the mood contributor coordinated; teach-back accurate. Reassessment of sleep and anxiety planned next visit. (Anxiety assessment in the Psychiatric / Mental Health reference.)

A5

Nocturia fragmenting sleep

Skilled sleep assessment found sleep fragmented by frequent nocturia — four awakenings nightly to void — with reduced total sleep and daytime fatigue; evening fluid timing and a possible medical cause are implicated. Findings indicate sleep disruption from nocturia. Provider notified at 12:15 with the nocturia pattern and the sleep impact; order received to evaluate the nocturia and review diuretic timing. Sleep hygiene and evening fluid and diuretic timing were taught; teach-back accurate. Reassessment of nocturia and sleep planned next visit. (Urinary evaluation in the Urinary / Renal reference.)

A6

CPAP nonadherence

Skilled sleep assessment found CPAP nonadherence — the patient has stopped using the device because of mask discomfort and leak — with returning daytime sleepiness and snoring. Findings indicate nonadherence with recurrence of apnea symptoms. Provider notified at 10:50 with the nonadherence and the interface problem; order received to address the mask fit and reinforce therapy. The interface was adjusted, CPAP benefits and care were taught, and troubleshooting was reviewed; return demonstration accurate. Reassessment of CPAP adherence and daytime symptoms planned next visit.