chap 35 rest & sleep Flashcards
circadian rhythms
rhythm that completes a full cycle every 24 hrs; synonym for diurnal rhythm
enuresis
involuntary urination; most often used to refer to a child who involuntarily urinates during the night
hypersomnia
condition characterized by excessive sleeping, especially daytime sleeping
insomnia
-most common sleep disorder
-difficulty in falling asleep, intermittent sleep, or early awakening from sleep
-more likely w depression and stress
-usually related to disruptions in circadian rhythms
-can be either short-term or chronic
-sleep hygiene
-stop misuse of ETOH and caffeine
-CBT
-Relaxation techniques
-Pharmacological treatment might be necessary
melatonin
a natural chem produced at night that decreases wakefulness and promotes sleep
narcolepsy
-a condition characterized by an uncontrolled desire to sleep
-inadvertent daytime lapses into sleep
-sudden involuntary loss of skeletal muscle tone (cataplexy)
-hallucinations and sleep paralysis
-lack hypocretin in CNS
non-rapid eye movement (NREM)
-non-rapid eye movement that characterizes four stages of sleep
-stages I-III: 5-50% of sleep, light sleep
-stages III-IV: 10% of sleep, deep sleep
sleep
state of altered consciousness throughout which varying degrees of stimuli preclude wakefulness
obstructive sleep apnea (OSA)
in adults, five or more predominantly obstructive respiratory events (the absence of breathing; apnea; or diminished breathing efforts; hyponea; or respiratory effort-related arousals) during sleep, accompanied by sleepiness, fatigue, insomnia, snoring, subj nocturnal respiratory disturbance, or observed apnea and associated health disorders (hypertension, coronary artery disease, atrial fibrillation, congestive heart failure, stroke, diabetes, cognitive dysfunction, or mood disorder)
-subjective nocturnal respiratory disturbance
parasomnias
-patterns of waking behavior that appear during sleep (sleep walking, sleep talking, nocturnal erections)
-Somnambulism (sleep walking)
-REM sleep behavior disorder
-sleep/night terrors
-nightmare disorder
-sleep enuresis
-sleep paralysis
-sleep-related eating disorder
rapid eye movement (REM) sleep
stage that constitutes 20% to 25% of a person’s nightly sleep; person is difficult to arouse during this stage
-increased: HR, RR, BP, metabolic rate, temp
-decreased: skeletal muscle tone, DTRs
restless legs syndrome (RLS)
-a condition in which patients are unable to lie still and report experiencing unpleasant creeping, crawling, or tingling sensations in the legs
-usually affects middle-aged & older adults, 15% of US pop
sleep cycle
passage through the four stages of NREM sleep (I, II, III, IV), then reversal (IV, III, II), and finally, instead of reentering stage I and awakening, entering REM sleep and returning to stage II
sleep hygiene
nonpharmacologic recommendations such as reviewing and changing lifestyles and environment that help an individual get a better night’s sleep
somnambulism
sleep walking
Reticular activating system (RAS)
controls sleep, waking, and flight-or-flight waking
Bulbar synchronizing region
the release of serotonin from specialized cells in the raphe nuclei sleep system of the pons and medulla produces sleep
hypothalamus
control center for sleeping and waking
Control of sleep-wake cycle is either by NT release (Ne, Ach, DA, 5-HT, histamine) and hormone release (melatonin) or by…
circadian rhythm
sleep hygiene practices
-consistent sched of bedtime and waking
-no exercise 1 hr before bed, start to relax and unwind 90 min before bed
-avoid ETOH, heavy meals 2 hrs before bed
-nap only briefly and in mid-afternoon
-sleeping environment: remove distractions, cooler temp, no screens or blue lights, dim/warm light only
-leave bed if you don’t fall asleep w/i 15-20 min
-reserve the bed for sleep and sexual act only
Dev Patterns of Sleep - Infants
12-16 hrs per day
Dev Patterns of Sleep - Toddlers
11-14 hrs per day
Dev Patterns of Sleep - Preschoolers
10-13 hrs per day
Dev Patterns of Sleep - School-aged
9-12 hrs per day
Dev Patterns of Sleep - Teens
8-10 hrs per day
Dev Patterns of Sleep - Adults
7 or more hrs per day
Dev Patterns of Sleep - Older adults
7-9 hrs per day (more likely to have insomnia and medical condition that interrupt sleep)
For infants…
-Should sleep in separate area
-No pillows, crib bumpers, quilts/blankets, stuffed animals
For toddlers…
-Establish a regular routine w minimal variation
-Attention to safety once out of the crib
For preschoolers…
-cont consistent bedtime routines
-nightmares and night terrors are common
-night lights can be helpful
For school-aged…
-sleep needs increase during growth spurts
-starting school might disrupt sleep patterns
-relaxed bedtime routine works well
-child’s awareness of concept of death can complicate
For teens…
-sleep needs vary widely due to growth spurts and external stresses
-time of high risk for sleep deprivation (more prone to accidents and behavioral problems due to sleep deprivation)
For adults…
-need to develop good sleep habits and sleep hygiene
-affected by physical health, occupation, exercise, lifestyle choices
-relaxation techniques, avoid dependence on sleep-inducing meds
For older adults…
-sleep is less sound, Stage IV either absent or considerably decreased
-shorter periods of REM
-risk of initial insomnia and late insomnia (factors: decline in physical health, psychological factors, meds)
-need extra attention to safety
-extreme caution w pharmacologic sleep aids
-encourage to discuss sleep problems w provider
insufficient sleep effects
lowers leptin levels and elevates ghrelin levels
interventions that can help obstructive sleep apnea
CPAP, BiPAP, custom-made oral appliance, surgical procedures
idiopathic hypersomnia
unknown reasons for excessive sleep, particularly during the day
circadian rhythm sleep -wake disorders
-delayed sleep phase disorder
-advanced sleep phase disorder
-jet lag disorder
-shift-work disorder
-irregular sleep-wake rhythm
interventions that can help circadian rhythm sleep-wake disorders
-sleep hygiene
-sleep training
-light therapy
-CBT
-meds
interventions that can help restless legs syndrome
-avoiding caffeine and ETOH before bed
-good sleep hygiene
-walking/stretching/massage
-relaxation techniques and yoga
-meds to correct DA abnormalities
screening tools
-sleep diary
-Epworth Sleepiness Scale (EPS)
-Pittsburgh Sleep Quality Index (PSQI)
-STOP-Bang questionnaire (OSA)
-Stanford Sleepiness Scale (SSS)
Central sleep apnea
reduction of brain sensors to send to respiratory muscles
often caused by opioid overdoses and heart failure
During sleep…
the brain and neurons work together to take out toxins from the brain
A person who does the night shift is at higher risk for what 3 complications?
diabetes mellitus, obesity, and cardiovascular disease
OTC (over-the-counter sleep aid medication)
causes urinary retention, daytime drowsiness, dry mouth, visual disturbance, and constipation
thalamus
transmits data (images, sounds, sensations) to cerebral cortex to form dreams
sleep helps increase _____ to help prevent weight gain (hunger feeling)
leptin
