Rest and Sleep Flashcards
Exam 3
Rest
Rest refers to a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed
Sleep
Sleep is a state of rest accompanied by altered consciousness and relative inactivity
What is sleep a part of?
Sleep is part of what is called the sleep–wake cycle
What is sleep a period of?
Sleep is a period of inactivity and restoration of mental and physical function
Wakefulness
Wakefulness is a time of mental activity and energy expenditure
Reticular activating system (RAS) facilitates what?
Facilitates reflex and voluntary movements
Reticular activating system (RAS) controls what?
Controls cortical activities related to state of alertness
What is the control center for sleeping and waking?
Hypothalamus
Non-rapid eye movement (NREM)
How many stages?
Consists of four stages
Stages I and II of NREM:
Stages I and II: 5% to 50% of sleep, light sleep
Stages III and IV of NREM:
Stages III and IV—10% of sleep, deep-sleep states (delta sleep)
Delta sleep
Deep sleep states
Rapid eye movement (REM)- how long is it?
20% to 25% of a person’s nightly sleep time
What happens physiologically during REM
Pulse, respiratory rate, blood pressure, metabolic rate, and body temperature increase;
skeletal muscle tone and deep tendon reflexes are depressed
How does someone pass through the stages of sleep in NREM
The person passes consecutively through four stages of NREM sleep
After someone does through the four stages of NREM consecutively, what happens?
The pattern is then reversed
Return from stage IV to III to II
Enter REM sleep instead of re-entering stage I
What occurs during NREM when four stages are occurring in order? (I–>IV)
The person re-enters NREM sleep at stage II and moves on to III and IV.
Effects of Insufficient Sleep in children?
May affect normal growth and development in children
Effects of Insufficient Sleep in children and adults?
May increase obesity risk in both children and adults
Effects of Insufficient Sleep in adults?
Lowers leptin levels and elevates ghrelin levels
Leptin
hormone that tells the brain to stop eating
Ghrelin:
promotes continued eating
Factors Affecting Rest and Sleep
Developmental considerations
Motivation
Culture
Lifestyle and habits
Environmental factors
Psychological stress
Illness
Medications
How does exercise affect sleep?
Activity and exercise increase fatigue and can promote relaxation followed by sleep; increases both REM and NREM sleep; contributes to a more restful sleep
Dietary habits:
affect of sleep
Amino acid L-tryptophan promotes sleep
Small protein snack combined with a healthy complex carbohydrate before bed improves sleep
Large quantities of alcohol limit REM and delta sleep
Caffeine blocks the ability of adenosine to cause drowsiness
What is associated with poorer sleep?
Smoking and nicotine are associated with poorer sleep
Psychological Stress: What causes it?
Can be caused by illness or life situations
Psychological Stress: How does it affect sleep?
Disturbs sleep
Difficult to obtain the amount of sleep needed
REM sleep decreases, leading to anxiety and stress
What happens to REM sleep during psychological stress?
Difficult to obtain the amount of sleep needed
REM sleep decreases, leading to anxiety and stress
ICSD Classification of Sleep Disorders
Insomnia
Sleep-related breathing disorders
Central disorders of hypersomnolence
Circadian rhythm sleep–wake disorders
Parasomnias
Sleep-related movement disorders
Other sleep disorders
Insomnia
Characterized by difficulty falling asleep, intermittent sleep or difficulty maintaining sleep, despite adequate opportunity and circumstances to sleep
What percent of Americans complain of Insomnia?
As many as 30% to 35% of adults in the United States complain of insomnia
Who is most likely to experience insomnia?
People with a history of depression are more likely to experience insomnia
Many cases of insomnia are related to what?
Many cases of insomnia are related to disruptions in circadian rhythms
How long is insomnia?
Insomnia may be short term or chronic in nature
Sleep-Related Breathing Disorder: Obstructive Sleep Apnea (OSA)
Characterized by five or more predominantly obstructive respiratory events
Five or more predominantly obstructive respiratory events called OSA are:
(apnea)
(hypopnea)
Respiratory effort-related arousals during sleep, accompanied by sleepiness, fatigue, insomnia, snoring
Subjective nocturnal respiratory disturbance
Observed apnea and associated health disorders
Gasping for air during sleep
Apnea
The absence of breathing
Hypoapnea
Diminished breathing efforts (hypopnea)
Central Disorders of Hypersomnolence
- Idiopathic hypersomnia
- Narcolepsy
Idiopathic hypersomnia
Characterized by excessive sleep, particularly during the day
Narcolepsy is characterized by what?
Characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep
____% of people with narcolepsy also experience________
Up to 70% of people with narcolepsy also experience cataplexy,
Cataplexy
the sudden, involuntary loss of skeletal muscle tone lasting from seconds to one or two minutes
Characteristics of Circadian Rhythm Sleep–Wake Disorders
Chronic or recurrent pattern of sleep-wake rhythm disruption
Primary causes of chronic or recurrent pattern of sleep- wake disruption include an alteration of:
An alteration in the internal circadian timing system or misalignment between the internal circadian rhythm and the sleep-wake schedule desired or required
Other Primary causes of chronic or recurrent pattern of sleep- wake disruption include an alteration of:
- A sleep wake disturbance (ex; insomnia or excessive sleepiness)
- Associated distress or impairment, lasting for a period of at least 3 months (except for jet lag disorder)
Parasomnias
Somnambulism
REM sleep behavior disorder (RBD)
Sleep terrors
Nightmare disorder
Sleep enuresis
Sleep-related eating disorder
Sleep-Related Movement Disorders/Restless Legs Syndrome (RLS)
Restless legs syndrome (RLS), also known as Willis–Ekbom disease (WED),
Restless legs syndrome (RLS), also known as Willis–Ekbom disease (WED) affects who?
is a common sleep-related movement disorder that affects up to 15% of the population, most often middle-aged and older adults
What happens to people with RLS?
People with RLS cannot lie still and report unpleasant creeping, crawling, or tingling sensations in the legs
What is the treatment for RLS?
Nonpharmacologic treatments
Obtaining a Sleep History
Nature of problem
Cause of problem
Related signs and symptoms
When the problem began and how often it occurs
How the problem affects everyday living
Severity of the problem and how it can be treated
How the patient is coping with the problem and success of treatments attempted
Screening Tools to Assess Sleep Disturbances
Sleep Diary
The Epworth Sleepiness Scale
The Pittsburgh Sleep Quality Index (PSQI)
STOP-Bang Questionnaire (OSA)
Stanford Sleepiness Scale
Information Recorded in a Sleep Diary #1
Time patient retires
Time patient tries to fall asleep
Approximate time patient falls asleep
Time of any awakening during the night and resumption of sleep
Time of awakening in morning
Presence of any stressors affecting sleep
Information Recorded in a Sleep Diary #2
Record of food, drink, or medication affecting sleep
Record of physical and mental activities
Record of activities performed 2 to 3 hours before bedtime
Presence of worries or anxieties affecting sleep
Sleep Characteristics to Assess
Restlessness
Sleep activities
Sleep postures
Snoring
Leg jerking
Key Findings of Physical Assessment
Energy level
Facial characteristics
Behavioral characteristics
Physical data suggestive of sleep problems
Nursing Interventions 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
Treatment for Dyssomnias
Pharmacologic therapy
Nonpharmacologic therapy
Pharmacologic therapy
for Treatment for Dyssomnias
Sedatives
Hypnotics
NonPharmacologic therapy
for Treatment for Dyssomnias
Cognitive behavioral therapy (CBT)
NonPharmacologic therapy
for Treatment for Dyssomnias: Cognitive behavioral therapy (CBT)
Progressive muscle relaxation measures
Stimulus control
Sleep restriction; sleep hygiene measures
Biofeedback and relaxation therapy
