Ch 42: Sleep Flashcards
What is sleep
Sleep is a cyclical physiological process that alternates with longer periods of wakefulness.
Circadian Rhythm
It influences the pattern of major biological and behavioral functions. People experience cyclical rhythms as part of everyday lives, the most familiar rhythm is the 24-hr day-night cycle known as circadian rhythm or diurnal.
What factors affect circadian rhythm?
light, temperature, social activities, and work routines
Where is the major sleep center in the body?
Hypothalamus. It secretes hypocreatins that promote wakefulness and rapid eye movement sleep.
What hormones control sleep?
Prostaglandin D2, L-tryptophan, and growth factors
whether a person remains awake or falls asleep depends on…
A balance of impulses received from higher centers (thoughts), peripheral sensory receptors (sound or light stimuli), and the limbic system (emotions)
What are the two phases of normal sleep
Nonrapid eye movement (NREM) 4 stages
Rapid eye movement (REM)
What is Stage 1: NREM
- Lasts a few minutes
- It includes lightest level of sleep
- Decreased physiological activity begins with gradual fall in vital signs and metabolism
- Sensory stimuli such as noise easily arouses person
- Awakened, person feels as though daydreaming has occured.
What is Stage 2: NREM
- Lasts 10-20 minutes
- Period of sound sleep
- Relaxation progresses
- Body functions continue to slow
- Arousal remains relatively easy
What is Stage 3: NREM
- Lasts 15-30 minutes
- Involves initial stages of deep sleep
- Muscles are completely relaxed
- Vital signs decline but remain regular
- Sleeper is difficult to arouse and rarely moves
What is Stage 4: NREM
- Lasts ~ 15-30 minutes
- Deepest stage of sleep
- If sleep loss has occurred, sleeper spends considerable portion of night in this stage.
- Vital signs are significantly lower than during waking hours
- Sleepwalking and enuresis (bedwetting) sometimes occur
- Difficult to arouse sleeper
- Body releases human growth hormone for repair and renewal of epithelial and specialized cells (brain)
- Especially important in children, they experience more stage 4 sleep.
What is REM sleep
- Stage usually begins about 90 minutes after sleep has begun
- Duration increases with each sleep cycle and averages 20 minutes
- Vivid, full color, elaborate dreaming occurs; less vivid dreaming occurs in other stages
- Stage is typified by rapidly moving eyes, fluctuating heart and respiratory rates, increased or fluctuating blood pressure, loss of skeletal muscle tone, and increase of gastric secretions.
- Very difficult to arouse sleeper
- Necessary for brain tissue restoration and appears to be important for cognitive restoration
Sleep disorders
Conditions that if untreated generally cause disturbed nighttime sleep that results in one of three problems:
- Insomnia
- Abnormal movements or sensation during sleep or when awakening at night
- Excessive daytime sleepiness (EDS): results in impaired waking function, poor work performance, accidents, and emotional problems.
Sleep Cycle
Presleep lasts 10-30 minutes. Once asleep the person usually passes thru 4 or 5 complete sleep cycles per night, each consisting of four stages of NREM and a period of REM sleep. Each cycle lasts ~ 90-100 minutes. See picture for pattern of stages:42-2 pg 941
Insomnias
Most common sleep complaint, signaling an underlying physical or psychological disorder. Disorders related to difficulty falling asleep. Chronic. Examples:
- Adjustment sleep disorder
- Inadequate sleep hygiene
- Behavioral insomnia of childhood
- Insomnia caused by medical condition
8 Categories of sleep disorders
- Insomnias
- Sleep related Breathing Disorder (Central Sleep Apnea Syndromes
- Hypersomnias Not Caused by sleep related breathing disorder (Narcolepsy)
- Parasomnias (disorders of arousal; ex sleepwalking, sleep terrors) Also, nightmare disorder, sleep related hallucinations, and enuresis.
- Circadian Rhythm Sleep Disorders: Delayed sleep phase, jet lag leg, shift work type.
- Sleep related movement disorders: Restless leg, sleep related bruxism(teeth grinding)
- Isolated symptoms, unresolved issues: Long sleeper, sleep talking
- Other: Physiological and Environmental sleep disorder.
Hypersomnolence
Inadequacies in either quantity or quality of nighttime sleep, causing Excessive Sleepiness
Polysomnogram
Involves use of EEG, EMG, and EoG to monitor stages of sleep and wakefulness during nighttime sleep.
Sleep apnea
Disorder characterized by the lack of airflow through the nose and mouth for periods of 10 sec or longer during sleep. There are 3 types:
- Central- Involves dysfunction in the respiratory control center of the brain. Impulse to breathe fails temporarily. common with brainstem injury, muscular dystrophy
- Obstructive- (Most Common) Risks are obesity and hypertension. Occurs when muscles or structures of the oral cavity or throat relax during sleep. Upper airway becomes part or completely blocked, diminishing or stopping nasal airflow.
- Mixed-
Narcolepsy
Dysfunction of mechanisms that regulate sleep and wake states. Excessive daytime sleepiness is most common complaint. Person falls asleep at inappropriate times.
Parasomnias
Sleep problems more common in children than adults. Somnambulism (sleepwalking), night terrors, nocturnal enuresis (bedwetting), bruxism (teeth grinding)
Sleep requirements by age:
Neonates: ~16 hrs/day
Infants: ~ 15 hrs/day; 8-10 @ night w/ naps
Toddlers: ~ 12 hrs/day
Preschoolers: ~ 12 hrs/day
School Age: ~9-12 hrs; depending on age. average decreases as gets older.
Adolescents: ~ 7.5 hrs/night
Young Adults: 6-8.5 hrs/night
Middle Adults: Amt of stage 4 sleep declines
Older adults: Complaints of sleeping difficulties increase with age.
Factors Influencing Sleep
Drugs, Lifestyle, Usual Sleep patterns, emotional stress, environment, exercise, and fatigue, food and caloric intake.
Tools for Sleep Assessment
Two effective subjective measure of sleep:
- Epworth Sleepiness Scale: evaluates the severity of EDS
- Pittsburgh Sleep Quality Index: assesses sleep quality and sleep patterns.
What are the common symptoms that a person with Obstructive sleep apnea would report?
Headache, excessive daytime sleepiness, snoring
Older adults are cautioned about long term use of sedatives and hypnotics because these meds can :
Lead to sleep disruption
Vivid dreaming occurs during which sleep phase?
REM sleep
Benzodiazepine causes which symptom of a sleep problem
Grogginess and feeling hung over
What is sleep hygiene
Practices that the patient associates with sleep. Insomnia is often associated with poor sleep hygiene, or practices that a patient associates with sleep. I condition continues, the fear of not being able to sleep is enough to cause wakefulness.
Biological clock
synchronizes sleep cycles
NREM
Sleep that progresses thru four stages (light to deep)
REM
Rapid eye movement (REM) phase at the end of each sleep cycle
Dreams
More vivid and elaborate during REM sleep and are functionally important to learning
Nocturia
Urination during the night, which disrupts the sleep cycle
Cataplexy
Sudden muscle weakness during intense emotions at any time during the day.
Sleep deprivation
Problem patients experience as a result of dyssomnia.
Describe affects on sleep and give example:
Drugs and illicit substances
Sleepiness, insomnia, and fatigue as a result of meds: ex hypnotics, diuretics, beta blockers, benzodiazepines, narcotics, antidepressants
Describe affects on sleep and give example:
Lifestyle
rotating shifts cause difficulty adjusting to altered sleep schedule, performing unaccustomed heavy work, engaging in late night social activities, and changing evening mealtimes.
Describe affects on sleep and give example:
Usual sleep patterns
Most persons are sleep deprived and experience excessive sleepiness during the day, which can become pathological when it occurs at times when individuals need or want to be awake
Describe affects on sleep and give example:
Emotional Stress
Personal problems or certain situations frequently disrupt sleep.
Describe affects on sleep and give example:
Environment
Good ventilation is essential for a restful sleep, as are the size and firmness of the bed; light levels affect the ability to fall asleep
Describe affects on sleep and give example:
Exercise and fatigue
Exercise 2 hrs or more before bedtime allows the body to cool down and maintain a state of fatigue that promotes relaxation.
Describe affects on sleep and give example:
Food and caloric intake
Eating a large, heavy, or spicy meal at night often results in indigestion that interferes with sleep, caffeine, alcohol, and nicotine produce insomnia.
What are the components of a sleep history
- Description of sleeping problems
- Usual sleep pattern
- Physical and psychological illness
- current life events
- emotional and mental status
- bedtime routines
- bedtime environment
- behaviors of sleep deprivation
List the common nursing diagnoses related to sleep problems
- anxiety
- ineffective breathing pattern
- acute confusion
- compromised family coping
- ineffective coping
- fatigue
- insomnia
- readiness for enhanced sleep
- sleep deprivation
- disturbed sleep pattern
Factors affecting adequate rest and sleep:
Environmental controls
eliminate distracting noises; promote comfortable room temp, ventilation, bed and mattress to provide support and firmness
Factors affecting adequate rest and sleep:
Promoting bedtime routines
sleep when fatigued or sleepy, bedtime routines for children and adults need to avoid excessive mental stimulation before bedtime.
Factors affecting adequate rest and sleep:
Promoting safety
use a small night light and a bell at the bedside to alert family members.
Factors affecting adequate rest and sleep:
promoting comfort
clothing, extra blankets, void before retiring
Factors affecting adequate rest and sleep:
establishing periods of rest and sleep
increasing daytime activity lessens problems with falling asleep
Factors affecting adequate rest and sleep:
stress reduction
pursue a relaxing activity for adults; children need comforting and night lights.
Factors affecting adequate rest and sleep:
bedtime snacks
dairy product that contains l-tryptophan is often helpful to promote sleep; do not drink caffeine, tea, colas, and alcohol before bedtime
Factors affecting adequate rest and sleep:
pharmacologic approaches
melatonin, valerian, kava
Two nursing measures that will promote sleep for:
environmental controls
Reduce lights, reduce, noise
Two nursing measures that will promote sleep for:
promoting comfort
keep beds clean and dry, application of dry or moist heat
Two nursing measures that will promote sleep for:
establishing periods of rest and sleep
plan care to avoid awakening patients for on essential tasks; allow patients to determine the timing and delivery of basic care
Two nursing measures that will promote sleep for:
promoting safety
reduce risk of postop complications for patients with sleep apnea; use of CPAP
Two nursing measures that will promote sleep for:
stress reduction
giving patients control over their health care minimizes uncertainty and anxiety; back rubs
