Chapter 19 Flashcards
The subjective report of difficulty staying awake. Serious enough to impact social and vocational functioning.
Excessive sleepiness
The major consequence of acute or chronic sleep curtailment is…
Excessive sleepiness
Excessive sleepiness can increase the risk for ______ and _______
Accident, injury
A discrepancy between hours of sleep obtained and hours of sleep required for optimal functioning causes a state of
Sleep deprivation
*Applies only to impaired functioning due to sleep loss
Getting ______________ hours of sleep at night is associated with:
Impaired glucose tolerance
Elevated cortisol levels
Alterations in sympathetic nervous system activity
Increase risk of cardiovascular disease and diabetes.
Less than 6 hours
Daytime wakefulness in excess of ___________ hours can produce psychomotor deficits equivalent to BACs of 0.05-0.1%
17-19
A dynamic neurological process that involves complex interaction between the central nervous system and the environment.
Sleep
The time it takes to fall asleep
Sleep latency
During this stage of sleep, body temperature declines, muscles relax, and eyes slowly roll. Awareness is lost but the person is easily aroused.
NREM1
During this stage of sleep, the heart rate and respiratory rate decline.
NREM2
This stage of sleep is known as slow wave sleep or delta sleep. It is a short phase and heart rate, respiratory rate, and blood pressure decreases. Response to external stimuli is limited
NREM3
This stage is considered to be “restorative sleep” and sympathetic activity is reduced.
NREM3
This stage of sleep is characterized by reduction and absence of skeletal muscle tone (muscle atonia), bursts of rapid eye movement, myoclonic twitches of the face and limbs, and autonomic nervous system variability. Dreaming is reported during this stage.
REM
There are typically _______ cycles of NREM/REM during the sleep period.
4-6
The structural organization of NREM and REM sleep often displayed graphically as a hypnogram.
Sleep architecture
The distribution of sleep and wakefulness across the sleep period.
Sleep continuity
What medication suppresses slow wave sleep and what medication suppresses REM sleep?
Benzodiazepines, serotonergic
The homeostatic process that promotes sleep
Sleep drive
The homeostatic process that promotes wakefulness
Circadian drive
Patients who take _______ frequently report difficulty sleeping.
SSRIs
Long sleepers need _______ hours of sleep per night while short sleepers need _____ hours of sleep per night. The amount of sleep necessary to feel fully awake and able to sustain normal levels of performance during the periods of wakefulness is known as ________.
Over 10hours, Less than 6 hours, Basal sleep requirements
What is the most accurate way to determine sleep requirements?
Allow oneself to sleep undisturbed without an alarm for several days. The average of several nights’ undisturbed sleep is a good estimate of basal sleep requirement
The most common sleep test used to diagnose and evaluate patients with sleep-related breathing disorders and nocturnal seizure disorders.
Polysomnography
A daytime nap test used to objectively measure sleepiness in a sleep-conductive setting.
MSLT
Used to document adequate alertness in individuals with careers for which sleepiness would pose a risk to public safety.
MWT
Uses a wristwatch-type device to record body movements. Used in patients with circadian rhythm disorders and insomnia.
Actigraphy
These sleep disorders are associated with excessive daytime sleepiness. They are chronic disorders.
Hypersomnolence disorders
Clinical manifestations of Hypersomnolence disorders:
- Recurrent periods of sleep
- Unintended lapses into sleep
- Frequent napping
- Prolonged main sleep period (greater than 9 hours)
- Non-refreshing, non-restorative sleep regardless of amount slept
- Difficulty with full alertness during wake period
Symptoms of this sleep disorder include attacks of refreshing sleep, cataplexy, hypnagogic hallucinations, and sleep paralysis.
Narcolepsy
Characterized as repeated episodes of upper airway collapse and obstruction that result in sleep fragmentation.
OSA
Symptoms of OSA
- Loud, disruptive snoring
- Excessive daytime sleepiness
- Apnea episodes
Treatment for OSA
CPAP
Occur when there is misalignment between the timing of the individual’s normal circadian rhythm and external factors that affect the timing or duration of sleep.
Circadian rhythm sleep disorders
Characterized by long, frightening dreams from which people awaken scared.
Nightmare disorders
Characterized by absence of muscle atonia during sleep. patients display elaborate motor activity associated with dream mentation (acting out dreams)
REM sleep behavior disorder
Sensory and movement disorder characterized by an unpleasant, uncomfortable sensation in the legs accompanied by urge to move.
RLS (restless leg syndrome)
Sleep disorder characterized by difficulty with sleep initiation, sleep maintenance, early awakening with difficulty returning to sleep, or nonrefreshing nonrestorative sleep.
Insomnia disorder
Insomnia disorder symptoms must be present at least ___ times per week for a period of at least ____ months despite ___________ to be diagnosed.
3, 3, adequate sleep
Sleeping less than ____ hours per night may have significant impact on cardiovascular, endocrine, immune, and neurological function.
6
OSA is associated with…
Hypertension
Diabetes
Cardiovascular disease
Stroke
Many patients complain of ______, __________, _______, or __________ instead of directly complaining of sleep disturbance.
Fatigue
Decreased concentration
Mood disturbance
Physical ailments
In order to help assess the patient, the nurse may assign….
patient to complete a 2 week sleep diary.
Assessment tools for sleep disturbances are the ________________ and ___________ and scores that determine issues in sleep are…
- -Pittsburgh Sleep Quality Index (sum of 5+ indicates poor quality/patterns of sleep)
- -Epsworth Sleepiness Scale (Scores of less than 10=normal, 10-15= moderately sleepy, 15+=excessively sleepy)
Nursing diagnosis for sleep disturbance include… (4)
Insomnia
Sleep deprivation
Disturbed sleep pattern
Readiness for enhanced sleep
Nursing diagnosis that relates to a disruption in amount and quality of sleep that impairs function
Insomnia
Nursing diagnosis described by prolonged periods of time without sleep
Sleep deprivation
Nursing diagnosis described by changes in sleep routines that cause impairment in social or vocational functioning
Disturbed sleep pattern
Nursing diagnosis characterized by a pattern of natural, periodic suspension of consciousness that provides adequate rest, sustains a desired lifestyle, and can be strengthened
Readiness for enhanced sleep
Overall sleep efficiency is calculated by…
Time in bed divided by total sleep time x 100
Limiting the total sleep time to create a temporary, mild state of sleep deprivation and strengthen the sleep homeostatic drive. Helps to decrease sleep latency and improve sleep continuity and quality.
Sleep restriction (should not be reduced to below 5 hours)
The five basic principles of stimulus control are:
- Go to bed only when sleepy
- Use bedroom only for sleep/intimacy
- Get out of bed if unable to sleep and do a quite activity
- Maintain regular sleep/wake schedule
- Avoid daytime napping
