REST AND SLEEP

Question 1

Rest

Answer 1

A state of mental, physical and spiritual activity that leaves a person feeling refreshed.
Ex. reading, being activate in a way that leaves you aware of the environment and feeling refreshed

Question 2

Sleep

Answer 2

Rest that is accompanied by altered consciousness and relative inactivity
Restorative process both emotionally and physically. A sense of well being
Naps are beneficial 20-90 mins

Question 3

hypothalamus

Answer 3

Circadian Rhythm (sleep wake cycles)
hormones, fluctuations in vital, cognitive function, sensitive to changes in our environment (like/dark, warm/cool)
Temp will drop through vasodilation during the night.

Question 4

Brainstem

Answer 4

important for waking up. Reticular Activating System (RAS) & the Bulbar Synchronizing Region

Question 5

neurotransmitters

Answer 5

inhibit of the CNS

Question 6

hormones

Answer 6

Melatonin: released when the eyes see change in light. Dark so its time to sleep

Question 7

Non-REM

Answer 7

~75% of sleep time
Parasympathetic Nervous System is in control
Divided into four stages
- Stage I & II are light sleep
- Stage III & IV are deep sleep/delta sleep/slow wave sleep

Question 8

REM

Answer 8

Remaining 25% of sleep
Fluctuation or increase in vital signs
Increase in cerebral
blood flood and oxygen
consumption
Relaxation of skeletal muscles

Question 9

REM rebound

Answer 9

when you don’t get enough sleep and you finally get a good night’s rest, you spend more time in REM to catch up.

Question 10

Stage 1 of sleep

Answer 10

Transitional state between wakefulness and sleep. Muscle relaxation, HR slows
Lasts only minutes. May feel like you were never sleeping and just “closing your eyes”

Question 11

Hypnic Jerk: stage 1

Answer 11

feels like you are falling, or head falls and you jump. Transition from awake to sleep. If we fall asleep too quickly, our brain will startle us to make sure we are okay.

Question 12

stage 2

Answer 12

Asleep, but a light stage if sleep, easily awakened
Makes up about half of all sleep time

Question 13

stage 3: slow wave/ delta

Answer 13

Deeper sleep, more difficult to awaken
Increased relaxation → snoring

Question 14

Stage 4

Answer 14

Deepest stage, brain activity slows (slow wave sleep)
Realistic dreams

Question 15

EOG

Answer 15

ocular exam.

Question 16

EEG

Answer 16

brain exam

Question 17

EMG

Answer 17

muscular exam

Question 18

Infancy

Answer 18

Newborns sleep approximately 16 hours/24 hours
“Sleeps through the night” between 2-4 months of age
REM constitutes much of the sleep cycle of infants
ABCs of safe sleep
Alone, on their back, in
a crib

Question 19

Toddlers/ preschoolers

Answer 19

11-14 hours/24 hours
Transition from crib to bed
Establish bedtime routine: helps slow body down and get ready for bed

Question 20

School-age children

Answer 20

9-12 hours/24 hours
Increased need for sleep related to growth spurts

Question 21

Adolescents

Answer 21

8-10 hours/24 hours recommended, but rarely achieved
Make poor decisions related to sleep.

Question 22

Adults

Answer 22

7-9 hours/24 hours
Decrease in Non-REM Stage IV sleep starts in middle age and is absent by older adulthood. Increased time to fall asleep and stay asleep as we age

Question 23

Insomnia

Answer 23

Adequate time to sleep but can’t sleep. Experience daytime sleepiness and other impairments
most common sleep
disorder. women> men

Question 24

insomnia acute/chronic

Answer 24

Occur longer than 1 month. 50% of people over 65 experience chronic illness that lasts more than a month.

Question 25

Tx of insomnia

Answer 25

Non-Pharmacologic first: Cognitive Behavioral Therapy (CBT) Helps with maladaptive sleep. It helps relax body Sleep restriction, no naps. Getting out of bed at the same time every day is the best way to improve insomnia Pharmacologic: z- drugs

Question 26

OSA (obstructive sleep apnea)

Answer 26

Frequent (100s) mini-arousals during sleep, decreased SWS (slow wave sleep) and REM 10 second-2 minute apneic episodes

Question 27

Sx of apnea

Answer 27

Sx: Excessive sleepiness, fatigue, depressed mood, difficulty concentrating, poor memory

Question 28

tx of apnea

Answer 28

CPAP. 46-83% do not use it! Surgery Weight loss Position changes

Question 29

risks of apnea

Answer 29

Strongly linked to CV disease (HTN, ischemic heart disease, CVA) and to cognitive impairments (attention deficit, impaired concentration, memory problems) Judicious use of sedatives (hypnotics, ETOH)

Question 30

hyper-somnolence: hypersomnia

Answer 30

Excessive (daytime) sleep Naps do not relieve symptoms** Awaken disoriented, irritated, slowed thoughts and speech

Question 31

hyper-somnolence: narcolepsy

Answer 31

Excessive daytime sleepiness and frequent overwhelming urges to sleep Most also experience cataplexy (involuntary loss of skeletal muscle tone) sx: Hallucinations and sleep paralysis

Question 32

shift work disorder

Answer 32

working different shifts every week

Question 33

Tx. of circadian rhythm sleep-wake disorders: shift work

Answer 33

CBT (avoiding naps, maintaining regular sleep-wake times, avoiding stimulants within several hours of bedtime) Shifting the sleep-wake cycle by an hour or 2 over several weeks is ideal

Question 34

Parasomnias

Answer 34

REM behavior disorder (RBD): acting out dreams Sleep terrors: occur in deepest sleep stage

Question 35

Somnambulism

Answer 35

sleep walking

Question 36

Bruxism

Answer 36

teeth grinding

Question 37

enuresis

Answer 37

bed wetting

Question 38

sleep-related eating disorder

Answer 38

consumes food but has no recollection Priority is the safety of the pt.

Question 39

restless leg syndrome: aka Willis-Ekbom disease (WED)

Answer 39

Mostly middle aged and older adults Cannot lie still Unpleasant, creeping, crawling, or tingling sensation No known cure Massage, walking, stretching seems to help Leads to chronic sleep loss

Question 40

Assessment/ screening tools

Answer 40

STOP-Bang Questionnaire: further assess the risk for sleep apnea The Pittsburgh Sleep Quality Index: measures quality of sleep pt gets The Epworth Sleepiness Scale: measures the sleepiness of the pt.

Question 41

Interventions: environment

Answer 41

60-67 degrees (fans?) Dark (or night-light) Clean linen/Blankets Privacy Sleep masks & ear plugs

Question 42

interventions: bedtime rituals

Answer 42

HS care → warm bath/shower/face cloth Bedtime stories Prayer Blankie/Bear

Question 43

interventions: snacks

Answer 43

Tryptophan and Complex Carbohydrates (milk and cookies, peanut butter crackers)

Question 44

Interventions: nursing care

Answer 44

Cluster care Provide care when patient is already awake Manage alarms→ iv pumps going off

Question 45

Medications to sleep

Answer 45

Use non-pharmacologic first Usually PRN Be knowledgeable about onset and duration when considering administration time