Sleep Flashcards
Scope of Sleep
- Restorative Sleep
- Intermittent/Situational Poor Sleep
- Chronic Poor Sleep/Sleep Disorder
Stages of Adult Sleep
Non-Rapid Eye Movement (NREM) Sleep:
Stage 1: Transition from wakefulness to sleep
Stage 2: Most of night sleep, HR and Temp decreases
Stage 3: Deep sleep/ Slow Wave
Stage 4: Deep Sleep
Rapid Eye Movement (REM) Sleep:
- Begin approximately 90 minutes after the onset of sleep.
- REM period is short, and may last only 10 minutes.
- Dreaming typically occurs during REM sleep.
Sleep Amount Based on Age
- Infants: 14-16 hours
- Preschool-aged children: 11-12 hours
- School-aged children: 9-11 hours
- Teenagers: 9 hours
- Adults (including older adults): 7-9 hours
Psychological and Emotional Consequences of Poor Sleep
Psychological and emotional consequences:
- Mood changes
- Irritability
- Excessive daytime sleepiness leading to distress
Physiological Consequences of Poor Sleep
Physiological consequences:
- Hypertension
- Heart disease and heart failure
- Stroke
- Obesity
- Developmental disorders such as alterations in growth hormone
- Reproductive disorders due to disruption in hormonal regulation
- Increased mortality
Common Conditions that Affect Sleep
- Alzheimer’s disease
- Anxiety
- Arthritis
- Asthma
- Cancer
- Chronic obstructive pulmonary disease (COPD)
- Chronic kidney disease
- Depression
- Diabetes
- Epilepsy
- Febrile conditions
- Fibromyalgia
- Gastroesophageal reflux disease
- Heart failure
- Hyperthyroidism
- Menopause
- Pain
- Parkinson’s disease
- Stroke
Common Drugs that Impair Sleep
- Antiarrhythmics
- Antihistamines
- Beta-blockers
- Corticosteroids
- Diuretics
- Nicotine products
- Selective serotonin reuptake inhibitors (SSRIs)
- Theophyline
- Thyroid hormone
Primary Prevention for Sleep
- Good sleep hygiene
- Good sleep environment
- Reviewing personal behaviors
- Consistent bedtime and awakening time
- Good dietary habits
- Regular exercise
Define Insomnia
- A common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep
- Experienced by 1 in 3 adults
- Symptoms include difficulty falling asleep, difficulty staying asleep, waking up too early, or complaints of waking up feeling unrefreshed.
- Acute Insomnia: Difficulty falling asleep or remaining asleep for at least 3 nights/wk for less than a month
- Chronic Insomnia: Same symptoms as acute; Daytime symptoms that persist for 1 month or longer
Factors that can Aggravate Insomnia
Aggravated by inadequate sleep hygiene:
- Stimulants
- Medications
- Using alcohol to induce sleep
- Irregular sleep schedules
- Nightmare
- Exercising near bedtime
- Jet lag
Define Chronic Insomnia
- Same symptoms as acute
- Daytime symptoms that persist for 1 month or longer
- Primary (idiopathic): Lifelong difficulty in initiating and maintaining sleep, resulting in poor daytime functioning
- Comorbid: Insomnia due to a psychiatric illness, a medical condition, medications, or substance abuse
Clinical Manifestations of Insomnia
- Difficulty falling asleep (long sleep latency)
- Frequent awakening (fragmented sleep)
- Prolonged nighttime awakenings
- Feeling unrefreshed on awakening (nonrestorative sleep)
Diagnostic Measures for Insomnia
- Self-report
- Actigraphy: An actigraph is worn like a watch on the wrist of your non-dominant hand and measures activity through light and movement. Actigraphy data can be very helpful for assessing circadian rhythm disorders such as advanced or delayed sleep phase disorder and insomnia.
- Polysomnography (PSG): also called a sleep study, is a comprehensive test used to diagnose sleep disorders; records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study
Nursing Interventions for Insomnia
- Education
- Cognitive-behavioral therapy (CBT)
- Sleep hygiene
- Complementary and alternative therapies:
Melatonin – effective related to jet lag and shift work
Valerian – safe but not effective - Drug therapy:
Benzodiazepines
Benzodiazepine-receptor–like agents
Melatonin-receptor agonist
Antidepressants
Antihistamines
Sleep Hygiene/Healthy Sleep Habits
- Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
- Set a bedtime that is early enough for you to get at least 7 hours of sleep.
- Don’t go to bed unless you are sleepy.
- If you don’t fall asleep after 20 minutes, get out of bed.
- Establish a relaxing bedtime routine.
- Use your bed only for sleep and sex.
- Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
- Limit exposure to bright light in the evenings.
- Turn off electronic devices at least 30 minutes before bedtime.
- Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
- Exercise regularly and maintain a healthy diet.
- Avoid consuming caffeine in the late afternoon or evening.
- Avoid consuming alcohol before bedtime.
- Reduce your fluid intake before bedtime.
Define Obstructive Sleep Apnea
- Also called obstructive sleep apnea-hypopnea syndrome (OSAHS)
- Partial or complete upper airway obstruction during sleep
- Apneic period may include hypoxemia and hypercapnia.
A. The patient predisposed to obstructive sleep apnea (OSA) has a small pharyngeal airway.
B. During sleep, the pharyngeal muscles relax, allowing the airway to close. Lack of airflow results in repeated apneic episodes.
C. With CPAP, continuous positive airway pressure splints the airway open, preventing airflow obstruction.
