Ch. 8 and 12: Sleep and Meds Flashcards
Sleep hours needed for adults?
Not enough =
Interrupted=
Enough time but not refreshed=
7-8
Sleep deprivation
Fragmented
Insufficient
Explain sleep disturbance vs disorders
Disturbance: poor sleep quality caused by stress, caffeine, pain, devices, sleep hygiene/practices
Disorder: abnormalities unique to sleep, long term health effects, safety, lowered productivity
-sleep apnea, narcolepsy
Explain ARAS and how it affects the sleep-wake cycle
Ascending Reticular Activating System
-promotes cerebral cortex activity
-Mostly excitatory neurotransmitters
-OREXIN neuropeptide
Explain Orexin
excitatory neuropeptide used by the ARAS- wakefulness
Explain an Orexin Receptor Antagonist for sleep
What are special considerations?
Are the effects more common in men or women?
Suvorexant (Belsomra)
-prevents orexin from binding to the receptor- prevents wakefulness
12-hour duration of action
- can cause daytime sleepiness
-impacts safety
-Unconscious nighttime behaviors due to long half-life
women
How do infections affect the sleep-wake cycle?
Proinflammatory cytokines contribute to sleepiness- Lethargy
Which peptide mediates sleepiness after eating?
Postprandial
Explain a melatonin agonist for sleep
Is it a controlled substance?
What is it’s indication?
Can it cause daytime sleepiness?
Rozerem (ramelteon)
-Not controlled
-Indication: impaired sleep onset
-Helps you fall asleep, but not stay asleep
-Doesn’t cause daytime sleepiness as much
The average person goes through - sleep cycles of NREM and REM sleep
Each cycle lasts __-___ minutes
After age ___, NREM stage ___ decreases
4-6 cycles
lasts 60-110 mins each
age 60, stage 3
Explain the sleep stages
During which stage does Obstructive Sleep Apnea cause episodes?
N1= easily aroused
N2=light sleep-lowered temperature, pain wakes you easily
N3=Deep sleep- hardest to wake
NREM= Vivid dreaming, limp body, hard to wake up, OSA episodes due to tongue relaxation
Insomnia is a ____ syndrome, involving difficulty either ____ or _____ asleep, waking up _______ or feeling ______
Acute:
Chronic:
Is it more prevalent in men or women?
____-term is more easily treatable
Most ____ sleep disorder
Nonspecific syndrome
Difficulty either falling or staying asleep
Feeling unrefreshed
Acute: 3/nights/week for < 1 month
Chronic: greater than 3 months
Women > Men
Short-term
Most common sleep disorder
Insomnia is not usually diagnosed with a ______, instead with a _______ , a comprehensive _______, or a ______
Sleep study (polysomnography)
Self-report
Comprehensive sleep history
Actigraphy (on wrist)
What is a Benzodiazepine for sleep?
What is the mechanism of action?
What is the onset of action?
Is it controlled?
Temazepam (Restoril)
-Sedative-hypnotic- reduces excess stimulation and induces sleep
CNS depressant- enhances GABA binding to receptors (inhibitory neurotransmitter)
Long onset of action: 30-60 mins
Controlled substance
What are some contraindications for benzodiazepines? What are some AEs?
Why is caution necessary when going off the med?
Narrow-angle glaucoma
Pregnancy (category D- high risk)
AEs: headache, paradoxical excitement/nervousness, cognitive impairment, dizziness, hangover effect/daytime sleepiness
Can cause life-threatening withdrawal-symptoms (seizures) if stopped suddenly
What are benzodiazepine toxicity/overdose symptoms?
What can happen when taken with other CNS depressants?
How are they treated?
What is the antidote?
Somnolence- coma
Confusion
Diminished reflexes
Hypotension and respiratory depression can be caused when taking other CNS depressants
Treatment is symptomatic/supportive
Antidote: Flumazenil (romazicon)
How do benzodiazepines interact with other CNS depressants?
What kind of food causes high interactions?
Alcohol/opiods amplify depressive effects
Grapefruit
Explain Kava
What are its AEs and Contraindications?
Herbal product used for anxiety, stress, restlessness, insomnia
AEs: similar to benzodiazepams, temporary yellow skin discoloration
Contraindications: liver disease, alcohol use disorder (liver toxic)
Explain Valerian
What are some things it interacts with?
What are its AEs and Contraindications?
Herbal product used for the same things as kava
Interacts with MAOIs (antidepressants), warfarin, phenytoin
AEs: = kava, hepatotoxicity, N/V, restlessness, insomnia
Contraindications: cardiac, renal, liver disease
Explain Zolpidem (Ambien)
What is the longer acting form?
What is one possible concern of this drug?
Nonbenzodiazepam Sedative-Hypnotic
Controlled substance
Short-acting
Less daytime sleepiness than benzodiazepines
Longer-acting: Ambien CR (continual release)
Concern: somnambulation (sleepwalking)
Explain Eszopiclone (Lunesta):
MOA
Long term use?
Designed to cause?
Is it a long or short acting agent?
MOA: unknown, maybe GABA
long-term use is approved
Causes a full 8 hours of sleep
-short to immediate acting agent
What are the impacts of sedative-hypnotic meds?
REM interference- reduced total REM
-daytime fatigue
REM rebound after stopping- abnormally large amounts of REM
-frequent and vivid dreams
Decreased awareness of environmental sensory stimuli, harder to awaken
List some nursing implications for sleep aid meds
Give sedative hypnotics 30-60 mins before bedtime for max effectiveness
Fall precautions
Instruct patients to:
-avoid alcohol/other CNS depressants
-check before taking other meds/OTC
-rebound insomnia possible if
stopped after long-term use
What 2 things stimulate ventilation and arousal?
Hypoxemia and Hypercapnia
What are the risk factors for obstructive sleep apnea?
-Obesity: BMI 30+
-65+ years of age
-Neck circumference 17”+
-Male
-Postmenopausal women
Explain the pathology of obstructive sleep apnea
What is a diagnosis based on?
Tongue relaxation into oropharynx causes airway obstruction
Sleep and medical history
Polusomnography
What are some manifestations of OSA?
How do others report their observations of OSA?
Frequent wakings/insomnia
Daytime sleepiness
Morning headaches
Irritability
Personality changes
Witnessed apnec episodes
Snoring
Explain PLMD and Restless Leg Syndrome
Involuntary and repetitive limb movement
Causes poor sleep quality
Meds reduce limb movements and muscle activity
Explain ways that the environment affects the circadian rhythm
Extrinsic: jet lag, shift work sleep disorder
Intrinsic: aging
Neuro or psychological: depression
Metabolic or cadiovascular: diabetes, cardiovascular disease
Explain narcolepsy
Chronic neurological disorder
Uncontrollable urges to sleep
Often go directly into REM
Unknown etiology
-destruction of neurons that produce orexin
Explain parasomnias
Unusual + undesired behaviors during sleep
-falling asleep, transitioning between sleep stages, or during arousal
Goal directed
Due to CNS activation
-Sleepwalking
-Sleep terrors
-Nightmares
Explain how the following affect sleep:
Alzheimer’s
Parkinson’s
Narcolepsy
Alzheimer’s: decreased cholinergic neurons in forebrain
Parkinson’s: degeneration of dopamine neurons- daytime sleepiness
Narcolepsy: decreased orexin (hypocretin)
What are some strategies for nursing who work night shift to prevent sleepiness while driving home?
Nap on site
Consistent sleep-wake schedule
Sleep hygiene
