Exam 2- Sleep Flashcards
sleep
state where individuals lack conscious awareness of environmental surroundings but can easily aroused
provided healing & restoration
adequate sleep
amount of sleep one needs to be fully awake and alert the next day
insufficient sleep
obtaining less than the recommended amount of sleep
fragmented sleep
frequent arousals or actual awakenings that interrupt sleep continuity
nonrestorative sleep
sleep that is of adequate duration, but does not result in the individual feeling refreshed and alert the next day
circadian rhythms
managed by the suprachiasmatic nucleus in the hypothalamus
synchronized through light detectors in the retina
light is the strongest cue
sleep regulation
reticular activating system (RAS)
- facilitates reflex and voluntary movements
- controls cortical activities related to state of alertness
bulbar synchronizing region
- hypothesis that the release of serotonin from specialized cells in the raphe nuclei sleep system of the pons and medulla produce sleep
stages of sleep
Non-rapid eye movement- 75% of night
stage 1- lightest lvl of sleep, gradual fall of vital signs; easily aroused
stage 2- sound sleep; arousal relatively easy
stage 3 & 4- deepest sleep; difficult to arouse
REM 25% of nightly sleep time
- vivid full color dreaming occurs
- pulse, respiratory rate, blood pressure, metabolic rate & body temp increases; skeletal mm tone and deep tendon reflexes are depressed
sleep cycle
occurs when a person passes through 4 stages of of NREM
- the pattern is then reversed
- return from stages IV–III—II
- enter REM instead of re-entering stage 1
- the person re-enters NREM sleep at stage II and then moves to stage III and IV
insomnia
difficulty falling asleep
difficulty staying asleep
waking up too early
complaints of waking up feeling unrefreshed
acute insomnia
difficulty falling asleep or remaining asleep for at least 3 nights/ wk for less than a month
acute insomnia
difficulty falling asleep or remaining asleep for at least 3 nights/ wk for less than a month
chronic insomnia
fatigue, poor concentration, interference with social/ family activities
daytime symptoms that persist for 1 month or longer
insomnia can be caused by
nightmare
medications
irregular
exercising near bedtime
jet lag
mental health issues
stressful life event
alcohol to induce sleep
obstructive sleep apnea
partial or complete upper airway obstruction during sleep
-Apneic period may include hypoxemia and hypercapnia
clinical manifestations
- frequent arousals during sleep
- insomnia
- excessive daytime sleepiness
- witnessed apneic episodes
- snoring
- morning HA
- irritability
obstructive sleep apnea
Apnea is cessation of spontaneous respirations for longer than 10 seconds.
Hypopnea is shallow respirations (30% to 50% reduction in airflow).
Airflow obstruction in OSA occurs because of (1) narrowing of the air passages with relaxation of muscle tone during sleep and/or (2) the tongue and the soft palate falling backward to partially or completely obstruct the pharynx
Each obstruction may last 10 to 90 seconds.
Apnea and arousal cycles occur repeatedly. Apneic episodes occur most often during REM sleep when airway muscle tone is lowest.
Smokers are more likely to have OSA.
OSA is more common in men than in women until after menopause, when the prevalence of the disorder is the same in both genders.
Women with OSA have higher mortality rates. OSA patients with excessive daytime sleepiness have increased mortality.
obstructive sleep apnea can result in
hypertension
cardiac changes
poor concentration/memory
impotence
depression
mild sleep apnea management
sleeping on one side
elevating head of bed
avoid sedatives and alcohol 3-4 hr b4 bed
wt loss
oral appliance
severe sleep apnea
more than 15 apnea/ hypopnea events
- CPAP
- poor compliance
-BiPAP
- surgery
narcolepsy
brain unable to regulate sleep- wake cycles normally
causes uncontrollable urges to sleep, often go into REM within 15 min of falling asleep
type 1- with cataplexy (sudden loss of skeletal mm tone.. mm wkness)
type 2- without cataplexy
narcolepsy nursing interprofessional management
- teach proper sleep hygiene
- take naps throughout the day
- avoid heavy meals and alcohol
- ensure pt safety
parasomnias
unusual and undesirable behaviors that occur while falling asleep
-night terrors
- nightmares
- bruxism
- enuresis
circadian rhythm disorder
- occurs when the circadian time-keeping system loses synchrony with environment
jet lag disorder, shift work sleep disorder
symptoms=
insomnia, excessive sleepiness
periodic limb mvmt disorder
involuntary continual mvmt of the limbs that affects people during sleep
- causes poor sleep quality
gerontologic considerations for sleep
old age is associated with overall shorter total sleep time
- decreased sleep efficiency
- more awakenings
- insomnia symptoms
- awakening during the night increases risk for falls
– medications used by older adults can contribute to sleep problems
- avoid long acting benzos
screening tools to asses sleep distrubances
the Epworth sleepiness scale
the pittsburg sleep quality index
sleep disturbance questionnaire
key findings of physical assessments
energy level
facial characteristics
behavior characteristics
physical data suggestive of sleep problems
sleep disturbances in the hospital
- hospitalization associated with decreased sleep time
- environmental sleep-disturbances
- psychoactive meds
- acute and critical illness
nursing rituals to promote sleep
Prepare a restful environment.
Promote bedtime rituals.
Offer appropriate bedtime snacks and beverages.
Promote relaxation and comfort.
Respect normal sleep–wake patterns.
Schedule nursing care to avoid disturbances.
Use medications to produce sleep.
Teach about rest and sleep.
