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Psych Exam 2 > Sleep > Flashcards

Sleep Flashcards

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1
Q

Consequences of sleep loss

A

excessive sleepiness
sleep deprivation
mental and physical problems
psychomotor impairment
increased risk for errors
*sleepiness slows reaction times just as if patient was using a substance or alcohol

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2
Q

common side effects of sleep deprivation

A

weight gain/DM
decreased hand-eye coordination similar to intoxication
memory problems
depression and negative affect in other psych illnesses
weakening of immune system
increase in pain perception
cardiac disease
kidney disease
increased risk of injury in adults, teens, and children
human errors linked to tragic accidents

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3
Q

sleep deprivation

A

not getting the sleep you need

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4
Q

what makes you sleep

A

internal body clock
adenosine: increasing levels signals a shift towards sleep
light and darkness
melatonin is released in the dark which helps you feel drowsy
sun rises, cortisol prepares body to wake

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5
Q

factors that can affect sleep

A

physical
mental
psychiatric
environmental
night shift
genetics
medications
aging

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6
Q

REM sleep

A

is regulated by brain stem
rejuvenates the brain
REM and NREM are both necessary for optimal health

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7
Q

NREM

A

regulated from higher brain centers
rejuvenates the body
has 3 stages

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8
Q

stage 1 NREM

A

transition between awake and sleep
light stage of sleep
high amplitude theta waves
very slow brain waves
lasts only 5-10 min

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9
Q

stage 2 NREM

A

reduced heart rate and respiration
body temp drops
breathing and heart rate become more regular
lasts 20 minutes
sleep spindles

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10
Q

stage 3 NREM

A

further reduction in heart rate, RR, BP and response to external stimuli
restorative sleep
deepest sleep occurs
delta waves

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11
Q

REM sleep

A

brain becomes more active
body relaxed and immobilized
dreams
rapid eye movement
increased RR
20% of total adult sleep time

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12
Q

sequence of sleep states

A

sleep begins at stage 1 and progresses to 2 and 3
after 3, stage 2 is repeated before entering REM
once REM is over, stage 2 is repeated
cycle at least 4-5 times per night
REM stage approximately 90 min after falling asleep
1st REM cycle might only last a short time, but each cycle gets longer lasting up to 1 hour
sleep is not passive
brain in very active during different stages of sleep

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13
Q

homeostatic process

A

sleep drive
promotes sleep
accumulation of sleep-inducing substances in the brain
operates like a timer
need to sleep
longer you have been awake the stronger your desire for sleep becomes

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14
Q

circadian process/drive

A

promotes wakefulness
regulation of internal clock
controls timing of sleep
coordinates light-dark cycle
regulates sleep patterns, feeding patterns, core body temperature, brain wave activity, and hormone production over a 24 hour period

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15
Q

sleep latency

A

the time it takes to fall asleep
associated with stage 1 NREM

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16
Q

sleep architecture

A

structural organization of NREM and REM sleep

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17
Q

hypnogram

A

graphic display of sleep architecture

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18
Q

sleep community

A

distribution of sleep and wakefulness across the sleep period

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19
Q

sleep fragmentation

A

disruption of sleep stages

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20
Q

sleep efficiency

A

ratio of sleep duration to time spent in bed

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21
Q

zeitgebers

A

helps set external clock to a 24 hour cycle

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22
Q

master biological clock

A

SCN in hypothalamus that regulates a host of functions

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23
Q

basal sleep requirement

A

amount of sleep necessary to feel fully awake and sustain normal levels of performance

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24
Q

sleep requirements by age

A

infants-12 months - 16-18 hours
pre-school age- 11-12 hours
school age- at least 10 hours
teens- 9-10 hours
adults- 7-8 hours

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25
Q

assessing sleep disorders

A

inquire into chief complaint
assess impact on patients life
ask about caffeine intake, alcohol and nicotine use, use of illicit drugs
any family history of sleep disorders
complete 2 week sleep log
complete sleep scales: stanford sleepiness scale/ epworth sleepiness scale

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26
Q

polysomnography (PSG)

A

lab sleep study
evaluates oxygen levels, body movements, brain waves
diagnose sleep apnea

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27
Q

electroencephalogram (EEG)

A

assess electrical activity
detects any potential problems
part of polysomnography

28
Q

multiple sleep latency test (MSLT)

A

day time nap study
used in conjunction with PSG at night to diagnose narcolepsy

29
Q

treatments for sleeping disorders

A

sleep meds and melatonin
CBT
allergy or cold meds
meds for underlying health issues
assistive breathing or surgery (CPAP, BiPAP)
dental guard
lifestyle changes
increasing vegetables and fish in diet and reducing sugar
exercise
establishing regular sleep schedule
drinking less water before bed
limiting caffeine late afternoon or evening
cutting back on tobacco and alcohol use
eat smaller, low carb meals before bed

30
Q

sleep hygiene

A

have a fixed wake up time
prioritize sleep
make gradual adjustments
don’t overdo it with naps
keep routine consistent
budget 30 min for winding down
dim lights
unplug from electronics
test methods of relaxation
dont toss and turn

31
Q

insomnia

A

dissatisfaction with quality of sleep
most common sleep disorder
females more frequently affected
difficulty initiating sleep, maintaining sleep, frequent awakenings, early morning awakening and inability to return to sleep
non refreshing/restorative sleep
at least 3 nights per week present for at least 3 months

32
Q

3P model of insomnia

A

predisposing factors - prior hx of quality sleep ( depression and anxiety)
precipitating factors- external events ( divorce, role change, retirement, grief)
perpetuating factors - Sleep practices that maintain sleep complaints (excessive naps, caffeine)

33
Q

treatment for insomnia

A

effectively treated without meds with CBT, sleep restriction, stimulus control, and attention to sleep hygiene
long term meds still are not required

34
Q

hype somnolence disorders

A

excessive sleepiness despite a main sleep period of 7 hours with one of the following
recurrent periods of sleep or lapses into sleep within same day, a prolonged main sleep episode of more than 9 hours that is nonrestorative, difficulty being fully awake after abrupt awakening
occurs at least 3 times in the last 3 months
hyper somnolence is accompanied by significant distress or impairment in cognitive, social, occupational, or other areas of functioning

35
Q

treatment of hyper somnolence

A

maintaining a regular sleep wake cycle
allow for an extended sleep opportunity of 10 hours o more
treated with long acting amphetamine based stimulants such as methylphenidate and nonamphetamine based stimulants such as modafinil (provigil)

36
Q

narcolepsy

A

uncontrollable urge to sleep
relatively rare
frequent in men
begins young adulthood and persist throughout lifespan
hypnagogic hallucinations- false auditory, visual and tactile hallucinations that occur at transition from wakefulness to sleep
sleep paralysis- inability to move or speak during transition from sleep to wakefulness
disturbed nighttime sleep with middle of the night awakenings and memory lapses
feel refreshed upon awaking and feel sleepy within 2-3 hours later

37
Q

cataplexy

A

brief episodes of bilateral loss of muscle tone while maintaining consciousness
triggered by strong emotions
may last seconds to several minutes, recovery is generally immediate
occurs with half the population of narcolepsy
some have 1-2 episodes in lifetime, others have up to 20 per day
treat with sodium oxybate (xyrem) may take up to 8 weeks to see effect

38
Q

treatment of narcolepsy

A

lifestyle modifications (naps, exercise, and balanced diet)
modafinil (provigil)
armodafinil (nuvigil)
methylphenidate
amphetamine
sodium oxybate (xyrem)

39
Q

Obstructive sleep apnea hypopnea

A

men
associated with obesity
repeated episodes of upper airway collapse and obstruction resulting in fragmented sleep
unable to sleep and breathe at same time
loud disruptive snoring, apnea episodes, excessive daytime sleepiness
diagnosed by clinical evaluation and polysomnography
treated with CPAP

40
Q

central sleep apnea

A

cessation of respirations during sleep
instability of the respiratory control system
seen in older adults, advanced cardiac or pulmonary diseases, or other neurological disorders
treatment: treat existing conditions, using a device to assist breathing or use supplemental oxygen.

41
Q

sleep related hypoventilation

A

too slow or shallow
hypoventilation, carbon dioxide levels rise in body while blood oxygen level lower
disrupts quality of sleep, leading to feelings of tiredness during day
NO apnea or respiratory events
associated with morbid obesity, lung parenchymal disease, or pulmonary vascular pathology
treatment with CPAP or BiPAP

42
Q

circadian rhythm sleep-wake disorder

A

misalignment between the patients sleep pattern and the sleep pattern that is desired or regarded as the societal norm
characterized by irregular sleep/wake cycle AED insomnia and hypersomnia
causes significant distress in at least one area of functioning
treatment: bright light therapy, sleep hygiene, medications, behavioral therapy and lifestyle changes

43
Q

goals of treating sleep-wake disorders

A

reduce circadian misalignment
improve sleep
improve alertness
short naps
frequent sleep
avoid working multiple days in a row
sufficient time off between shifts
dark room/dark glasses to aid in sleep
a short modification of 2-4 hours in the cycle can make a big difference

44
Q

shift work sleep disorder

A

have an increased risk of accidents at work, work related errors, irritability, mood problems, poor coping skills, impaired social functioning, health related complaints (GI, cardiac) drug and ETOH dependency

45
Q

how to deal with shift sleep disorder

A

get at least 7-8 hours of sleep
make sleep priority
minimize exposure to light on the way home
follow bedtime rituals
create a quiet, dark and peaceful setting during sleep
ask family members to wear headphones to listen to music or watch TV
avoid vacuuming, dish washer, or other noisy activities while you sleep

46
Q

Sleep walking

A

rising from bed, walking about
awakened with great difficulty
runs in families
rare in adults, common in children age 4-8
high risk for injury
amnesia
treatment: Safety measures, stress reduction, and benzo’s
benzo’s are habit forming so used only briefly, low doses and monitored closely

47
Q

sleep terrors

A

sudden terrified near-awakenings, sitting up in bed followed by panicked scream
abruptly exhibit behaviors of fear, panic, confusion
no response to soothing from others
not fully awake, often returns to normal sleep without ever fully waking up
amnesia
treatment: exploring stress, sleep hygiene, medication is rarely used, but benzo’s can be used

48
Q

nightmare disorder

A

generally occur in second half of major sleep episode
rapidly become oriented and alert
significant distress or impairment
cannot be explained by the effects of a drug abuse or medication
nightmares cannot be attributed to another mental health disorder or medical condition
can be triggered by stress or anxiety, trauma, sleep deprivation, medications, substance misuse, scary books and movies
treatment for nightmares isn’t usually necessary

49
Q

restless leg syndrome

A

voluntary response and urge/need to move legs to stop sensations of creeping, crawling, aching, pulling, searing, tingling, bubbling, pain, cramping or itching
symptoms increase with rest
middle age older adults
pregnant women
stress makes it worse
familial link
results in insomnia

50
Q

treatment of restless leg

A

muscle relaxation, stress reduction, understand etiology
no test or cure
various meds may treat
movement helps to relieve symptoms

51
Q

alcohol induced sleep disorder

A

decreases deep sleep and REM sleep
responsible for middle of the night awakenings with difficulty returning to sleep

52
Q

nicotine induced sleep disorder

A

CNS stimulant, increasing heart rate, blood pressure, and respirations
individuals wake in response to mild withdraw

53
Q

caffeine induced sleep disorder

A

blocks adenosine promoting wakefulness

54
Q

comorbidities to sleep disorders

A

less than 6 hours of sleep per night increases risk to cardiovascular, endocrine, immune, and neurological function
short sleep duration less than 7 hours
lack of sleep causes obesity, cardiovascular disease, HTN, impaired glucose tolerance, DM, and mood disturbance
increased risk of HTN, DM, cardiovascular disease and stroke

55
Q

sleep disorders and psych disorders

A

sleep problems are common in patients with depression, bipolar disorder, and anxiety
increased risk of developing mental illness
treating sleep disorder may help alleviate the symptoms of the mental health problem

56
Q

mood disorders and sleep

A

insomnia and hypersomnia are part of the diagnostic criteria for depression
symptoms include difficulty falling asleep, frequent nighttime awakenings, early morning awakenings, and non-restorative sleep
some MDD suffer from obstructive sleep disorder
depressed patients with insomnia are less likely to respond to treatment for MDD than those with sleep problems

57
Q

bipolar and sleep disorders

A

insomnia or report less need for sleep during manic episode or hypersomnia, insomnia or restless sleep
insomnia worsens before manic episode
lack of sleep triggers episode
adversely affects mood and contributes to relapse

58
Q

Generalized anxiety disorder and sleep

A

GAD have prolonged sleep latency and frequent nighttime awakenings, worry, anxiety, thinking about problems, stressors, have difficulty initiating and falling asleep
sleep panic attacks are possible

59
Q

OCD and sleep

A

initiation and maintenance sleep problems

60
Q

PTSD and sleep

A

nightmares; almost a universal finding

61
Q

Does insomnia occur more frequently with medical diagnosis or psychiatric diagnosis
a- medical
b- psychiatric

A

B

62
Q

which of the following involves episodes of upper airway collapse and obstruction?
a- obstructive sleep apnea hypopnea syndrome (OSHA)
b- CPAP
c- RSBD
d- NREM

A

A

63
Q

which is the minimum amount of sleep a nurse on shift work should get in 24 hour period?
a- 4 to 5
b- 5 to 6
c- 6 to 7
d- 7 to 8

A

D

64
Q

which s the most likely indication that a client might really have insomnia?
a- difficulty occurs at least once a week
b- the difficulty occurs at least 2 nights a week
c- the difficulty occurs at least 3 nights a week
d- the difficulty occurs at least once per month

A

C

65
Q

which of the following may be precipitating factor for insomnia
a- never goes to bed at the same time
b- has a history of depression and anxiety
c- recently got divorced and moved to a new city
d- drinks quite a bit of alcohol in the evenings

A

C

66
Q

You ask your client how long it usually takes her to fall asleep at night. You are asking her about her?
a- sleep latency
b- sleep efficiency
c- sleep continuity
d- sleep architecture

A

A

Psych Exam 2 (9 decks)

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