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Patho > chapter 7: sleep and sleep disorders > Flashcards

chapter 7: sleep and sleep disorders Flashcards

1
Q

sleep

A

state in which a person lacks conscious awareness of environmental surroundings, but can be easily aroused

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2
Q

physical and mental functions affected by sleep

A

mood, behavior, memory, hormone secretion, glucose metabolism, immune functions, body temperature

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3
Q

who’s most likely to have sleep disturbance?
what’s the dif bt sleep disturbance and sleep disorder?

A

chronically ill ppl

disturbance = broad term for poor sleep quality for whatever reason

disorder = problems unique to sleep: insomnia, sleep apnea, narcolepsy, periodic limb movement, circadian sleep disorders –> often missed or unreported

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4
Q

Sleep wake cycle - what controls it

A

controlled by forebrain (cerebral cortex, hypothalamus, thalamus) and brainstem

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5
Q

wake behavior

A

integrated network of arousal systems from brainstem and forebrain
–> ARAS (ascending reticular activating system) and other neurotransmitters

Histamines in hypothal

Orexin = imp neuropep in hypothal

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6
Q

issues with wake bahavior stuff

A

Alzheimers = lose cholinergic neurons in forebrain –> sleep probs

Parkinsons = loss of dopamine neurons in ARAS –> sleepy

Narcolepsy = lack of orexin

OTC can inhibit histamine sometimes –> sleepy

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7
Q

sleep behavior

A

neurons in hypothal inhibit ARAS

neurotransmitters and peptides promote sleep (GABA, GHRH)

infection = proinflammatory cytokines (ILs and tumor necrosis factor) –> sleepy

Postprandial = after food = peptides from GI after eating = sleepy

Melatonin= from pineal –> turns off wakefulness mechanisms when it gets dark

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8
Q

circadian rhythm

A

Regulated by suprachiasmatic nucleaus (SCN) in hypothalamus –> master clock
-light from retina –> SCN –> other brain parts

LIGHT IS STRONGEST TIME CUE

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9
Q

sleep architecture

A

Nighttime sleep recorded by polysomnography (PSG)
-brain waves
-eye movement
-muscle tone

Two sleep states
-REM and NREM
-go through 4-6 cycles bt them lasting 60 to 110 mins

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10
Q

NREM

A

75-80% of sleep

N1 = slow eye movement –> easy to wake
N2 = most time here = HR and temp drop= visible on EEG
N3 = deepes= slow wave sleep = delta waves on EEG = sleep intensity - not as common in old ppl

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11
Q

REM

A

20-25%

-brain waves resemble wakefulness
-postural muscles inhibited –> loss of muscle tone
-vivid dreams

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12
Q

effects of insufficient sleep

A

Neurologic
-cognitive impairment and behavioral changes (grumpy)

Immune
-worse

Respiratory
-asthma exacerbated

Cardiovascular
-Heart disease
-high BP
-stroke

GI
-higher risk for obesity
-GERD

Endocrine
-risk for type 2 diabetes
-insulin resistance
-low growth hormone

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13
Q

sleep disturbance in hospital

A

-noise and light 24/7
-illness keeps you awake
-boredom and daytime napping
-meds –> esp opiods –> can fuck with sleep

*lack of sleep makes you less tolerant to pain though

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14
Q

Insomnia

A

most common sleep disorder (1/3 adults)
-difficulty falling asleep/staying asleep –> wake up too early –> wake up not refreshed

Acute = 3 nights a week for less than a month
Chronic = acute symptoms and daytime problems for 3+ months (10-15% Amers)

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15
Q

insomnia prevelence

A

women more than men
divorced/widowed more than married
poor and less educted more than alternative

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16
Q

contributions to insomnia

A

-irregular sleep schedule
-afternoon naps
-being in bed awake for a long time
-sleeping in late
-exercising near bedtime
-stimulants
-Alc makes you sleepy, but fucks with REM, so you wake up during night
-meds (esp SSRIs)

Onset is usually after stressful life event

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17
Q

manifestations of insomnia

A

-difficulty falling asleep
-frequent awakening
-prolonged nighttime awakenings
-feeling unrefreshed in morning

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18
Q

diagnostic stdies

A

Self report = diary/log for 1-2 weeks or screening questionairre

Actigraphy = on wrist –>measures gross motor activity –> time awake and asleep

Polysomnography = PSG = muscle tone (EMG), eye movement (EOG), brain activity (EEG) –> all electodes –> only done if there’s symptoms of another sleep disorder (not insomnia)
**can also measure HR, RR, resp effort, airflow, pulse ox

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19
Q

Intrerprofessional care

A

-education on sleep hygiene
-CBT-I = stress management, limit non sleepy time in bed, no naps, no pre sleep excersise
-Drugs
-complementary/alt therapies = melatonin and valerian (not for insomnia), relaxation, white noise

20
Q

Drugs for insomnia

A

Benzodiazepine hypnotics = Triazolam (sleep onset) and Temazepam (onset and maintenance)
-activate GABA receptors
-only use for 2-3 weeks; don’t use other ones; interact with alc and CNS depressors

Nonbenzodiazepine hypnotics = Zaleplon (onset), Zolpidem and Eszopliclone (onset and maintenance)
-3 months to a year
-act as GABA receptors –> safer than benzos
-shorter half life -> don’t take with food though
-many forms

Orexin-receptor antagonists
-Suvorexant
-1 per night within 30 mins of sleep

Melatonin-receptor agonist
-Ramelteon
-fast, you dont get tolerant, doesn’t work great

Antidepresants
-Tricyclic ones (doxepin and amitriptyline) –> low doses for isomnia
-Trazadone –> sketchy

Antihistamines
-Diphenhydramine, OTC pain meds, doxylamine –> all kinda sketch

21
Q

Assessment of insomnia

A

sleep history
ask ab diet, caffeine, and alc intake
ask about sleep aids: OTC, Rx, herbal, supplements (kava is toxic to liver)
Sleep diary for 1-2 weeks
med history, works schedule, travel

22
Q

Nursing diagnoses

A

sleep deprivation
impaired sleep

23
Q

Implementation for insomnia

A

sleep hygiene and CBTI
-tell to decrease caffeine intake – half life is 6 hrs or up to 9 hrs in old ppl
-keep room dark and cool (avoid clock watching)
-teach ab meds: don’t take with fatty food, alc, or CNS depressants –> don’t plan skilled actiities for morning

24
Q

Sleep Disordered Breathing

A

snoring
apnea (90+% reduction in airflow)
hypopnea (30-90% airflow reduction)
obstructive sleep apnea

25
Q

Obstructive sleep apnea (…hypynea syndrome)

A

partial or complete upper airway obstruction and reduced tone during sleep; lasts 10-90 secs –> airway narrows due to muscle tone relaxation or tongue goes backwards

Can cause hypoxemia and hypercapnia –> ventilatory stimulants which cause arousal

Usually during REM when muscle tone is at lowest

26
Q

Risk factors for OSA

A

obesity (bmi over 30)
age (over 65)
neck circumference over 17”
craniofacial abnormalities
acromegaly
smoking

27
Q

OSA manifestations

A

frequent arousals
insomnia
daytime sleepiness
witnessed apneic episodes
snoring
morning headache
irritability
personality changes

28
Q

Complications of OSA

A

HTN
cardiac changes
poor concentraton/memory
impotence
depression

29
Q

link bt CV issues and sleep apnea

A

apnea = hypoxia and increased intrathoracic pressure ==> SNS activation and increased VR and reduced oxygenation of heart ==> HTN, dysrhythmias, HF

30
Q

Diagnosis of OSA

A

-usually use PSG
requires documentation of apna or hypopnea of at least 10 s
OSA = over 5 episodes an hour with 3-4% decrease in O2 sat

31
Q

Treatment of mild sleep apnea

A

sleep on side
elevate head
avoid sedatives and alc 3-4 hrs b4 sleep
weight loss
oral appliance –> special mouth guard

meds tend to make it worse

32
Q

Severe sleep apnea treatment

A

more than 15 apnea events/hr
-Continuous Positive Airway Pressure (CPAP) is effective, but poor adherence
-Bilevel Positive Airway Pressure (BiPAP) is similar but with lower exhale pressure
-need to wear 4 hrs/night to reverse CV risk

If in hospital, still should wear CPAP and cautious use of narcotics/sedatives

33
Q

Surgical treatment for OSA

A

Uvulopalatopharyngoplasty (UPPP or UP3) = removes tissue
Genioglossal advancement and hyoid myotomy (GAHM) tonge/mandible atch

Radiofrequency ablation (RFA) = least invasive

Neurostimulators = imlants that stimulate hypoglossal nerve to increase muscle tone in airway

Post op = risk of airway obstruction and hemorrhage

34
Q

Periodic limb movement disorder (PLMD)

A

involuntary repetitive movement of limbs that affects ppl during sleep (usually legs)
-causes poor sleep
-treated with meds aimed at reducing limb movement/muscle activity and improving sleep quality

35
Q

Circadian rhythm disorders

A

Occur when circadian time-keeping system loses synchrony with environment
-jet lag
-shift work sleep disorder
-symptoms = insomnia and excessive sleepiness

36
Q

Narcolepsy

A

brain unable to regulate sleep-wake cycles normally
-causes uncontrollable urges to sleep –> straight into REM
Causes unknown –> assoc w/ destruction of orexin neurons –> happens after head injury, infection, or change in sleep

37
Q

2 types of narcolepsy

A

Type 1 = with cataplexy (brief and sudden loss of muscle tone)
Type 2 = without cataplexy

Symptoms = sleep paralysis, cataplexy, fragmented nighttime sleep

38
Q

Narcolepsy diagnosis

A

history
PSG
Multiple sleep latency test (MSLTs) = PSG and 4-5 naps every 2 hrs next day

39
Q

Interprofessional management of narcolepsy

A

uncurable
reach ab sleep hygiene
take naps
avaid heavy meals and alc
ensure safety
teach ab meds

40
Q

Narcolepsy drug therapy

A

Nonamphetamine wake-promoting
-modafinil and armodafinil = wake promoting drugs
-sodium oxybate (Xyrem) = metabolite of GABA –> for wakefulness and prevents cataplexy

SSRIs (fluoxetine and canlafaxine) treat cataplexy

41
Q

Parasomnias

A

unusual and often undesirable behaviors that occur while falling asleep, transitioning bt sleep stages, or during arousal from sleep

-due to CNS activation

-In ICU might be misinterpreted as ICU psychosis

42
Q

Parasomnia includes:

A

Sleepwalking - no memory of it

Sleep terror = sudden awakening; loud cry and panic

Nightmare = frightful or disturbing dream
-in critical care, some meds contribute to nightmares (sedative hypnotics, beta adrenergic antagonists, dopamine antagonists, amphetamines)

43
Q

Gerontologic considerations of sleep

A

old age assoc w/
-overall shorter total sleep time
-decreased sleep efficiency
-more awakenings
-sleep disordered breathing may manifest with insomnia symptoms
-circadian shift

44
Q

Circumstation stuff that fucks with old ppl’s sleep

Results of poor sleep in old ppl

A

medical probs/ chronic conditions/ medications

-awakening during night increases fall risk
-chronic sleep disturbance = disorientation, delerium, impaired cognition, accidents injury

AVOID LONG-ACTING BENZODIAZEPINES –> old ppl are more sensitive

45
Q

Shift work sleep disorder

A

insomnia, sleepiness, fatigue
-increased stress, health risks, patient safety issues

Strategies
-on site napping
-consistent sleep-wake schedule
-sleep hygiene

Patho (44 decks)

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