Sleep Flashcards
Sleep determined by
Sleep latency: how long to fall asleep
How often one wakes up at night
Ease of waking up
Consequences of poor sleep
Increased BP, cortisol, cytokines (signal molecules—> inflammatory response)
Stages of Sleep
-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
Physiological changes in NREM
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
Physiological changes with REM
- Increased: brain activity, HR and BP, SNS activity, blood flow to brain, respiration, airway resistance,
- swallowing is suppressed
- body tmep is not regulated
Expected sleeping trends?
Duration – 7-9hrs
Latency?
Average 10 mins
Less than 5 = sleep deprivation
30 or more = insomnia
How many nocturnal awakenings?
Nocturnal awakenings: 1-2 per night
What is circadian rhythm
body hormones (cortisol, melatonin) function on a 24 hr clock, signal body to sleep at night Night shift messes this up
Newborn, Infant sleep info
circadian rhythm develops around 2-3 months, 6-9 months they sleep through the night, sleep 13hrs/ day
Toddler/ preschool
largest amount of REM sleep (30%), sleep time decreases
School age/ adolescent
School age: average 9 hrs
Adolescent: REM reaches adult average, still need 9 hrs but rarely do (screen time, hormone changes, school start times)
Adult
7 hrs average, more nocturnal awakenings
older adult
increased sleep latency, increased time in bed, sleep problems related to medical issues
Environment impact on sleep
Noise
Light — melatonin decreases
Temp – avoid hot or cold
Relationships – infants, family with cognitive conditions, break ups, healthcare providers coming in and out
Nutrition/ elimination impact on sleep
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
Medication impact on sleep
- 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
Insomnia
increased sleep latency —> decreased sleep time overall
contributes: stimulants, med side effects, hospital environment
treatments: CBT-1, medications
Obstructive sleep apnea
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
Narcolepsy
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
restless leg syndrome + periodic limb movement disorder
make sure to maintain iron levels**
RLS – urge to move leg
PLMD – the actual movement of your leg during sleep
BEARS approach sleep evaluation tool
Bedtime Excessive fatigue Awakenings Regularity of sleep duration Snoring
Recommendations
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
