Sleep Flashcards
What is the purpose of sleep?
Provides healing, restoration to maintain health and well being. Rejuvenate the mind so you can function.
Short term sleep loss does what?
- Alters mood
- Decreases ability to concentrate
- Harder to make descisions
- Less participation in daily activity
- More recovery time
What kind of processes is sleep?
Cyclical, physiological and behavioural process
What effects does the complex system of hormone release during sleep do?
Decrease HR
Decrease BP
Decrease RR
Decrease O2 consumption
Decrease Temperature
What are the 3 processes controlling sleep physiology?
- Ultradian process
- Homeostatic process (Process S)
- Circadian process (Process C)
What is the Ultradian process?
occurs within sleep state and determined based on 2 stages:
What are the 2 stages of the ultradian process?
- NREM
- REM
What is Homeostatic process (Process S)?
dependent on sleepâwake cycle
What is Circadian process (process C)?
Maintain a state of wakefulness
What are the physiological purposes of sleep?
-Memory
- Daytime alertness
- Mood, stress level
- Processing of stored information for the day
- Social Functioning
- Decreased muscle tone
- Decreased urination
- Cell and tissue repair
- Brain tissue restoration
- Immune function, renal function
- Metabolism of glucose
- Hormone secretion
What are circadian rhythms?
The biological functions of most living organisms are regulated by circadian rhythms.
-repeats every 24hours
-Biological clock
What are biological responses to circadian rhythm?
Body temperature peaks in afternoonâdrops as the day moves on.
The body temperature drops sharply after individual falls asleep.
What factors affect ones circadian rhythm?
light, temperature, social activities, and work routines
What is the purpose of a circadian rhythm?
Synchronizes sleepâwake cycles (e.g., bedtime)
What does a circadian rhythm do depending on each individual?
Affects individualâs optimal time of day
What regulates sleep?
A sequence of physiological states integrated by central nervous system activity (e.g., hypothalamus, anterior pituitary).
Where is the sleep centre?
Hypothalamus
What does the hypothalamus secrete?
Hypocretins (orexins) -promote wakefulness
What does the anterior pituitary secrete?
Hormones that promote sleep
-e.g; melatonin
What does the RAS do in relation to sleep?
maintains alertness and wakefulness
-affects wake transitions
What region causes sleep?
Bulbar synchronising region
What does Adenosine do?
builds up in the blood when awake -body breaks it down during sleep
-lack of sleep alters adenosine levels
What does Melatonin do?
natural hormone
-Causes person to feel drowsy
What are the stages of NREM?
(Pre sleep period 10-30mins)
Stage 1-Light sleep
Stage 2- Sound sleep
Stage 3- Deepest sleep
What is Stage 1: NREM light sleep?
Lightest level of sleep (2-5% of adults sleep time)
o This stage only lasts a few minutes
o Person is unresponsive but easily aroused by sensory stimuli, such as noise. o Physiological activity begins to decrease, accompanied by a gradual fall in
vital signs and metabolism.
o Muscle tone is present.
o When awakened from this stage, a person feels as though he or she had been
daydreaming.
What is Stage 2: NREM sound sleep?
Sound sleep (can be easily woken) â (45-55% of adult sleep time)
o This stage only lasts 10-25 minutes o Relaxation progresses.
o Body functions continue to slow.
o Muscle tone remains present.
o Eye movements are absent.
o Accounts for the greatest proportion (45% to
55%) of total sleep time in adults.
What is stage 3: NREM Deepest sleep?
Delta sleep or slow wave sleep (SWS) â10% of adult sleep time
o Deepest period of sleep.
o Individuals difficult to arouse.
o Muscles become completely relaxed. o Vital signs significantly lower but still
within normal limits
o Parasomnias may occur (e.g., sleepwalking, enuresis [bedwetting]) o More prominent during the first half of sleep
o Previous missed sleep will result in more time spent in this stage
What occurs after Stage 3 NREM during the sleep cycle?
REM
-rapid eye movement
What is REM?
Period during sleep where dreams occur
Paradoxicalâ
o Rapid eye movements are present.
o Respirations irregular and shallow, variations in HR & BP o Dreaming occurs more frequently and is more complex
than in NREM sleep.
o This stage usually begins about 90 minutes into sleep o Loss of skeletal muscle tone occurs, gastric secretions
increase.
o The person is difficult to arouse.
o The duration of REM sleep increases
with each cycle.
How many cycles does one have during a night?
four to five times
How long does the first cycle last?
90 mins
How long are the cycles after the first one?
100-120 mins
What stage do adults spend the least amount of time in?
Stage 3 NREM deepest sleep
Who spends more time in Stage 3 NREM?
Newborns and children
What is the idea sleep requirement for a neonate?
16 hours a day
What is the idea sleep requirement for infants?
12-14 hours a day
What is the idea sleep requirement for toddlers?
12 to 14 hours a day
What is the idea sleep requirement for preschoolers?
13 hours a night
What is the idea sleep requirement for school-aged kids?
9-10 hours a night
What is the idea sleep requirement for adolescents?
Varies
-Sleep debt accumulated during week, sleep more on weekends
What is the idea sleep requirement for young adults?
6-8 1/2 hours a night
What is the idea sleep requirement for middle aged/older adults?
6-8 hours a night
What population experiences a decline in total hours of sound sleep?
Middle age/older adults
-Nighttime disturbances, more napping
What are some factors affecting sleep?
1) Drugs and Substances 2) Lifestyle
3) Usual Sleep Pattern 4) Emotional Stress
5) Environment
6) Exercise & Fatigue
7) Food & Calorie Intake
What are some sleep disorders?
- Sleep deprivation
- Insomnia
3.Hypersomnolence - Hypersomnia
- Narcolepsy
- Sleep apnea
- Parasomnias
- Shift work sleep disorder
What is sleep deprivation?
insufficient sleep during a specific time period
What is a common cause of sleep deprivation?
Lifestyle/work
What are consequences of sleep deprivation?
Behavioural disorders
Mood disturbances
Decreased alertness
Lowered cognitive performance Decreased memory
Slowed thought processes Increased irritability Decreased job performance
Impaired emotional control
Health risks associated with sleep deprivation?
- changed in metabolism (obesity)
- ^increase heart rate, skin lesions, decrease body temperature
- Pain, physical discomfort (e.g. conditions like arthritis)
- Mood disorders (anxiety, depression)
- Illness & need to sleep in uncomfortable positions
- Respiratory disease
- Cardiac disorders
- Nocturia ââurination during the nightâ
- Increase physiological risks for: strokes, cancer, chronic illness, cardiac
- disorders, obesity, hypertension, diabetes
What is insomnia?
Troubles falling asleep, staying asleep or waking up early -Second most common complaint in clinical
-May indicate underlying physical or psychological disorder
What is transient insomnia?
Intermittent insomnia is periodic episodes of insomnia
What is a cause of transient insomnia?
schedule changes (shift, work, travel,
medication, situational crisis, intake of drugs or alcohol)
What are potential causes of Insomnia?
*Poor sleep hygiene
* Depression
* Stress
* Feeling overwhelmed
* Breathing conditions
* Stomach upset
* Cardiac disorders
* Hot flashes
* Arthritis
* Frequent urination
* Stroke
* Parkinsonâs
* Dementia
What is Hypersomnolence?
is a condition where a person experiences significant episode of
sleepiness, even after having 7 hours or more of quality sleep
What is Hypersomnia?
Excessive prolonged sleepiness or difficulty waking
What can Hypersomnia be related to?
narcolepsy, sleep apnea, pain and mood disorders
What is Narcolepsy?
neurological disorderâno cure for itâcauses people to fall asleep at any given time of the day, even when they want to be awake.
-Has serious effects on quality of life.
What is sleep apnea?
disorder where people stop breathing for a period of at least 10 seconds while asleep
What are the two types of sleep apnea?
- Central
- Obstructive
What is central sleep apnea?
loss of inspiratory effort due to an underlying pathological condition
What is OSA?
stop breathing for a period of at least 10 seconds while asleep due to an obstruction of the upper airway
What is one of the most common sleep disorders?
Obstructive sleep apnea
What are some obstructions leading to OSA?
Caused by relaxation of soft palate, tongue muscles, tonsils
What is almost always present with OSA?
Snoring
What makes someone more at risk for OSA?
Obesity
Smoking
Alcohol consumption Positive family history Ethnicity (Asian)
Who does sleep apnea more likely to affect?
Middle-age men (+ obesity) Post-menopausal women Younger women
Children
What are sleep apnea treatments?
Lose weight, exercise, stop smoking, avoid sedatives Behavioral treatment (sleep positioning)
Dental devices to keep jaw open
Sleep apnea dental device
Implanted nerve stimulator
Inspire nerve stimulator
Surgical removal of the tissue blocking the airway
What is a CPAP?
Continuous Positive Airway Pressure
* A machine that has a tube and mask that covers the nose or nose & mouth
* Provides a constant high-pressure flow of air
* Keeps airway constantly open
* When person initiates a breath, the high-pressure flow of air
rushes into the lungs
What is parasomnias?
undesirable sleep problems that occur while falling asleep, between phases or during transitions from sleep to wakefulness.
Examples of parasomnias?
Ex. Sleep walking Talking in sleep Night terrors Bed wetting
What is Shift work sleep disorder?
effects those who work outside the 9-5 work-day. This disorder is from opposing the bodyâs internal clock.
Those with Shift work sleep disorder are more at risk for what?
Cardiovascular disease
How can you manage shift work?
Sleep as much between shifts as possible Avoid other sleep inhibitors if possible Understand your own needs
Stay hydrated and nourished
Maintain healthy sleep hygiene
What are some sources for sleep assessment data?
Patient, bed partner or parents
What are some tools for sleep assessment?
- Sleep scale: 0 / 10 to 10 / 10
- Assess sleep quantity and quality
- Visual analog scale used repeatedly over time
How do you take someones sleep history?
Description of sleeping problems Usual sleep pattern
Physical and psychological illness Current life events
Bedtime routines
Bedtime environment
Behaviors associated with sleep deprivation
Factors that affect sleep?
Drugs and substances
* Hypnotics, diuretics, antidepressants, alcohol, caffeine, narcotics, ïą- blockers, benzodiazepines, anticonvulsants, anti-parkinsonians
* Cocaine, methamphetamines, heroine (marijuana research is inconclusive) Lifestyle
* Work schedule (shift work), social activities, routines Usual sleep pattern
* Disruption by social activity or work schedule, travel (e.g., jetlag) Emotional stress
* Worries, physical health, death, losses Environment
* Noise, routines Supporting sleep in the hospital environment Exercise and fatigue
* Restful sleep enabled by moderate exercise and fatigue Food and caloric intake
* Time of day, caffeine, nicotine, alcohol
* What kinds of foods/drinks contain caffeine?
What are some nursing diagnoses for patients w/ sleep problems?
Anxiety
Ineffective breathing pattern Compromised family coping Ineffective coping
Ineffective health maintenance Fatigue
Insomnia
Sleep deprivation
Examples of nursing diagnosis for sleep problems?
Anxiety related to upcoming final exams as evidenced by disruption of regular sleep patterns
Insomnia related to respiratory illness as evidenced by patientâs statement of inability to sleep at night with blocked nasal passages
