Sleep

Question 1

Sleep determined by

Answer 1

Sleep latency: how long to fall asleep
How often one wakes up at night
Ease of waking up

Question 2

Consequences of poor sleep

Answer 2

Increased BP, cortisol, cytokines (signal molecules—> inflammatory response)

Question 3

Stages of Sleep

Answer 3

-Non-REM sleep: most things decrease during this cycle (pulse, RR, BP, brain activity, nervous activity, muscle tone, blood flow to brain etc)
Lasts 90 mins at beginning of night
Body repairs itself and rests

-REM (rapid eye movement): most things are increased or vary compared to non-REM sleep
Cognitive processes, dreaming

Question 4

Physiological changes in NREM

Answer 4

Decrease in brain activity, HR and BP, sympathetic nerve activity, muscle tone, blood flow to brain, respiration, swallowing

• Increased airway resistance
• body temp is regulated at lower level

Question 5

Physiological changes with REM

Answer 5

• Increased: brain activity, HR and BP, SNS activity, blood flow to brain, respiration, airway resistance,
• swallowing is suppressed
• body tmep is not regulated

Question 6

Expected sleeping trends?

Answer 6

Duration – 7-9hrs

Question 7

Latency?

Answer 7

Average 10 mins
Less than 5 = sleep deprivation
30 or more = insomnia

Question 8

How many nocturnal awakenings?

Answer 8

Nocturnal awakenings: 1-2 per night

Question 9

What is circadian rhythm

Answer 9

body hormones (cortisol, melatonin) function on a  24 hr clock, signal body to sleep at night
Night shift messes this up

Question 10

Newborn, Infant sleep info

Answer 10

circadian rhythm develops around 2-3 months, 6-9 months they sleep through the night, sleep 13hrs/ day

Question 11

Toddler/ preschool

Answer 11

largest amount of REM sleep (30%), sleep time decreases

Question 12

School age/ adolescent

Answer 12

School age: average 9 hrs

Adolescent: REM reaches adult average, still need 9 hrs but rarely do (screen time, hormone changes, school start times)

Question 13

Adult

Answer 13

7 hrs average, more nocturnal awakenings

Question 14

older adult

Answer 14

increased sleep latency, increased time in bed, sleep problems related to medical issues

Question 15

Environment impact on sleep

Answer 15

Noise
Light — melatonin decreases
Temp – avoid hot or cold
Relationships – infants, family with cognitive conditions, break ups, healthcare providers coming in and out

Question 16

Nutrition/ elimination impact on sleep

Answer 16

Mealtime
Gastrointestinal reflux – acidic stomach contents regurgitated, don’t eat within 3 hrs of bed
Caffeine – last caffeine 6 hrs before bed
Elimination education – teach kids to urinate before bed
Nocturia- reduce fluids after dinner

Question 17

Medication impact on sleep

Answer 17

• Benzodiazepines – reduces latency period but sedatives depress normal function so no REM sleep
• Alcohol – also sedative (less REM), inhibits ADH —> nocturia —> frequent awakenings
• Insomnia medications: exogenous hormones (melatonin)
• Melatonin: body’s signal that it’s dark outside; light impacts this hormone and impacts sleep

Question 18

Insomnia

Answer 18

increased sleep latency —> decreased sleep time overall

contributes: stimulants, med side effects, hospital environment
treatments: CBT-1, medications

Question 19

Obstructive sleep apnea

Answer 19

includes both apnea + hypopnea
apnea = not breathing
hypopnea = shallow breathing
results in frequent awakening, decreased REM sleep (stop breathing, jerk awake briefly, never reach deep sleep)
symptoms: daytime sleepiness, excessive snoring
consequences: HTN, increased risk of stroke (no O2 gets in, heart works harder to pump—> HTN—>stroke, impaired concentration

Question 20

Narcolepsy

Answer 20

autoimmune neurological sleep disorder
cataplexy: profound weakness – in 70% of people
sleep attacks- urge to fall asleep that they can’t resist
sleep paralysis
REM- within 20 minutes of falling asleep
Consequences: reduced quality of life, poor work performance, negative relationship impacts

Question 21

restless leg syndrome + periodic limb movement disorder

Answer 21

make sure to maintain iron levels**
RLS – urge to move leg
PLMD – the actual movement of your leg during sleep

Question 22

BEARS approach sleep evaluation tool

Answer 22

Bedtime
Excessive fatigue
Awakenings
Regularity of sleep duration
Snoring

Question 23

Recommendations

Answer 23

Referral – sleep study
Educate on sleep habits
Establish sleep routine
Limit caffeine, fluids,  screen time before bed
Limit light
Dedicated sleep space
Use bathroom before bed
Sleep journal