Sleep Flashcards
What is sleep?
A state of rest accompanied by altered consciousness and relative inactivity. Restoration of mental and physical function take place.
Narcolepsy
- Chronic neurologic disorder characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep
- caused by the brains inability to regulate sleep-wake cycles
Which hormone regulates the sleep cycle?
Melatonin
Hormones involved in excitation
- Acetylcholine
- Norepinephrine
- Dopamine
- Serotonin
- Histamine
Circadian Rhythm
- Predictable fluctuations in processes that occur in repeated cycles of time, full cycle is 24 hours
- HR, BP, body temp, hormone secretions, metabolism, mood
Non-Rapid Eye Movement sleep (NREM)
- 75-80% of total sleep time
- 4 stages
- parasympathetic nervous system takes over
- ⬇️ HR, RR, BP, body temp, metabolic rate
NREM I
- light sleep
- 5% total sleep time
- transition between wakefulness and sleep
- involuntary muscle jerking (twitching)
- only lasts for a few minutes
NREM II
- light sleep
- 50% total sleep time
- relatively easy arousal
NREM III
- 10% of sleep
- ⬆️ depth of sleep and arousal becomes difficult
NREM IV
- 10% of sleep
- “delta sleep”
- arousal threshold is greatest here
- slow brain waves, relaxed muscles, slow HR, RR, slow metabolism and low body temp
REM
- 20/25% total sleep time
- vivid dreams
- essential to emotional equilibrium, learning, memory, adaptation
- ⬆️ HR, BP, temp, metabolic rate
- small muscle twitching (facial), large muscle immobility, irregular respirations, increased gastric secretions
Sleep in older adults
- 7-9 hours
- less sound, stage IV absent, REM sleep shortens
- difficulty falling asleep
- contributors: polypharmacy, chronic illness, environment
- deprivation leads to delirium
Insufficient sleep
- link between chronic insufficient sleep and obesity (leptin and ghrelin)
- sleep deprivation can cause a reaction time similar to someone intoxicated with alcohol
Insomnia
- most common sleep disorder
- difficulty falling asleep and/or staying asleep
Obstructive Sleep Apnea (OSA)
- throat muscles intermittently relax and block airway during sleep, breathing stops and starts
- excessive daytime sleepiness, insomnia, loud snoring, fatigue, observed apnea, gasping for air during sleep
Short term consequences of Insomnia
- excessive daytime tiredness
- lethargy
- irritability
- depression
Long term consequences of Insomnia
- ⬆️ risk for MI, stroke, HF, HTN, type II DM
Physical effects of insufficient sleep
- HTN
- risk of type II diabetes
- risk of stroke
- renal impairment
- daytime fatigue
Psychological effects of insufficient sleep
- depression
- anxiety
- trigger psychosis/paranoia
- irritability
Treatment of OSA
- Continuous positive airway pressure machine (CPAP) — FIRST CHOICE
- Bilevel positive airway pressure machine (BPAP)
- surgical procedure
OSA risk factors
- age
- obesity
- large neck size
- male
- family hx
Idiopathic Hypersomnia
constant or recurrent episodes of extreme sleepiness during the day
Parasomnias
- episodes or behaviors that occur during arousal from REM that disturb the patient
Restless Leg Syndrome (RLS)
- involuntary movement of the legs when the body is at rest
- unpleasant creeping, crawling, itching, aching, burning, throbbing, tingling
- abnormality in Dopamine levels
Restless leg risk factors
- iron deficiency
- renal disease
- nerve damage
- rheumatoid arthritis
- use of anti-nausea meds/antidepressants
- use of alcohol, nicotine, caffeine
Assessment Techniques
- do you feel rested when you wake up?
- how much sleep do you get each night?
- do you find it difficult to stay awake during the day?
- assess naps, sleep pattern, energy level, sleep environment
Nursing interventions r/t sleep deprivation in older adults
- discourage napping
- encourage pt to engage in physical activity (walking, water aerobics)
- decrease fluids in evening
- review meds for possible sleep effects
- sleep in cool, dark room
- warm bath before bedtime
Sleep hygeine techniques
- avoid caffeine, alcohol, nicotine, physical acitivty late in the day
- avoid napping
- cool and dark room
- warm bath before bedtime
- use of meds and herbal remedies (otc antihistamine, nonbenzodiazepine cns depressant)
- stress relief
How long should older adults sleep for?
7-9 hours
What stage of sleep is typically absent in older adults?
NREM stage IV
Insomnia risk factors
- older adults
- depression
- stress
- female
Somnambulism
sleepwalking
Enuresis
bedwetting
Night terrors
common in children, during deepest stages of sleep
Sleep paralysis
brief state of involuntary immobility occurring on waking
