Sleep Flashcards
Natural, necessary, involves a shift in physiologic & neurologic activity, & is intended to be restorative. Sleep is not a period of inactivity. A lack of sleep can cause people to develop chronic conditions such as diabetes, obesity, & depression. It can also impair daily mental & physical functions.
Sleep
The scope of sleep ranges from restorative sleep, which results in an individual feeling resting, impaired sleep, which leaves the individual not feeling rested or refreshed. Impaired sleep can be intermittent or chronic with chronic sleep being associated with physical, cognitive, & social challenges. * Figure 9.1 (Concept book)
Scope of Sleep
-Non Rapid Eye Movement (NREM) Sleep (4 stages)-Light sleep & awakened easily, Movement must be through all four stages before reaching the REM Sleep. Each stage last from 5-15 minutes. This stage plus REM Sleep takes between 90-110 minutes
Non Rapid Eye Movement
The phase of sleep in which most dreams occur. During rapid eye movement sleep, a person’s brain activity, breathing, heart rate, and blood pressure increase, and the eyes move rapidly while closed. The muscles in the arms and legs become temporarily unable to move.
-Rapid Eye Movement (REM) Sleep
Helps with tissue regeneration, muscle & bone development, & immune enhancement. Regulation of body metabolism & fat deposition are also affected by the duration of deep sleep, & there are hormones that are associated with sleep that are essential for our health(cortisol, human growth hormones, & leptin & ghrelin(hormones that regulate appetite & body fat deposition.)
Restorative Processes of Sleep
-Amount of sleep typically needed by people in each age group is as follows:
-Newborns: 14-17 hours per 24 hours (Night-time sleep plus naps)
-Infants: 12-15 hours per 24 hours
-Toddlers: 11-14 hours per 24 hours (including naps)
-Preschoolers: 10-13 hours per 24 hours
-School-aged children: 9-11hours
-Teenagers: 8-10 hours
-Adults: 7-9 hours
-Older adults: 7-8 hours
Age Related Differences
-Problems with sleep become a disorder when it is reoccurring or chronic.
Sleep Disorders
Primary sleep disorders are those that exist as independent condition
-Insomnia, Sleep related breathing disorders-Obstructive or Central Sleep Apnea, Sleep related movement disorders-Restless leg Syndrome, Parasomnias Sleep walking, Sleep Terrors, Night terrors
Primary Sleep Disorder
Secondary sleep disorders are often caused by medical conditions, mental health conditions, & side effects of medical treatments(such as medications) *Box 9.1 (Common Conditions that Affect Sleep-Anxiety, Asthma, Cancer, COPD)
Secondary Sleep Disorder
- Commonly occurring physiological consequences of poor sleep include:
-HTN
-Heart Disease/Heart failure
-Stroke
-Obesity
-Developmental disorders such as alterations in growth hormone
-Reproductive disorders due to disruption in hormonal regulation
-Increased mortality
*Untreated Obstructive Sleep Apnea can (Impaired cognition, HTN, cardiovascular disease, diabetes, decrease in the quality of life, & increased mortality.
Consequences of Sleep
*Every human is at risk for sleep problems.
* Populations at risk:
-Middle aged & older adult
-Women (Insomnia & Restless Leg Syndrome)
-Pregnant & perimenopausal women (Sleep disturbances due to hormone fluctuations that can disrupt sleep (Night sweat/pregnant woman body can lead to discomfort due to body changes & difficulty breathing & put pressure on bladder-leading to frequent awakenings in the night)
-Men have highest risk for OSA than women up until menopause women are at equal risk for OSA
-Obesity-Common risk factor for OSA/OSA is also diagnosed in individuals who aren’t obese
Populations at Risk
When a sleep problem presents, questions about how the person feels upon awakening are important. (Ideally the person wakes feeling rested & refreshed. Anything other than that could indicate problem-They might not feel rested or refreshed, they might lack energy & not feel productive at work, complaints of weakness, malaise, lack of appetite & so on.)
-A thorough review of systems to identify underlying sleep problems such as pens & needles feelings in legs, pain, or nocturnal urination. These things can disrupt their pattern of sleep. Headache, respiratory problems, dry mouth, or sore throat, heartburn, or acid reflux, heart beating really fast or irregularly, or pain anywhere in the body.
-Family history & social history are helpful. Most sleep disorders are due to genetics.
History Assessment
-Few physical findings directly indicate sleep disorders like thicker tongue, smaller upper airway. Some helpful assessments include:
-Neck circumference-16 or greater in women/17 or greater in men with OSA
-Weight/BMI-People with higher BMI (30 or greater) likely to be indication of OSA
-Respiratory & cardiac function-These conditions are associated with sleep disorders due to result or by raising problems with circulation & oxygenation that can interfere with their sleep. Cardiac function, skin, & mucus membranes in color can indicate oxygenation status & can alert the nurse to sleep problems as well.
-Neurological changes tend to have an effect on sleep quality as well.
Physical Examination
*Definitive tests for sleep problems measure activity & events related to sleep wakefulness.
*Polysomnography (PSG) -Sleep Study
-EEG type of electrodes on the pt. to monitor sleep patterns & stages. Stretching belts to measure Respiratory efforts, leads to monitor muscle activity (on limbs, chin, & jaw & can measure eye movement. Nasal/oral airflow, & pulse oximetry.
*Sleep journals-May be helpful for recording their daily activities dietary intake, bedtime, & discussion of what happened during the night & what time they woke up at. Subjective assessment on awakening as if they feel refreshed and restored can also be important.
Diagnostic Tests
- Primary prevention focuses on:
-Good sleep hygiene (Critical link in healthy sleep & avoiding or managing sleep problems)
-Good sleep environment (Should be comfortable, well ventilated, quiet, & dark as possible. Optimal temp for sleep is cool. Too warm or too cool can interfere with sleep. Bed should only be used for sleep & sexual activity. Bedding & blanket should be evaluated as distracting from the quality of sleep.)
-Reviewing personal behaviors (Widespread causes of sleep problems-A lack of time spent sleeping often contributes to daytime sleepiness. A large number of sleep complaints/problems stem from not having enough sleep or not making sleep a priority.
-Consistent bedtime & awakening time- Napping is generally discouraged except when napping is short like for 30 minutes & individual has no problem falling asleep at bedtime.)
-Good dietary habits-Alcohol & stimulants should be avoided as bedtime approaches. Generally, 4-6 hours before bedtime. Alcohol, stimulants, & eating a heavy meal, spicy foods, or sugary foods should be avoided 4-6 hours before bedtime.
-Regular Exercise-Very conducive to sleep. Teach pts. Not to exercise close to bedtime. OTC meds can interfere with sleep. Individuals start to depend on those sleep aids.
Clinical Management: Primary Prevention
