Sleep

Question 1

What is sleep?

Answer 1

A state of rest accompanied by altered consciousness and relative inactivity. Restoration of mental and physical function take place.

Question 2

Narcolepsy

Answer 2

• Chronic neurologic disorder characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep
• caused by the brains inability to regulate sleep-wake cycles

Question 3

Which hormone regulates the sleep cycle?

Answer 3

Melatonin

Question 4

Hormones involved in excitation

Answer 4

• Acetylcholine
• Norepinephrine
• Dopamine
• Serotonin
• Histamine

Question 5

Circadian Rhythm

Answer 5

• Predictable fluctuations in processes that occur in repeated cycles of time, full cycle is 24 hours
• HR, BP, body temp, hormone secretions, metabolism, mood

Question 6

Non-Rapid Eye Movement sleep (NREM)

Answer 6

• 75-80% of total sleep time
• 4 stages
• parasympathetic nervous system takes over
• ⬇️ HR, RR, BP, body temp, metabolic rate

Question 7

NREM I

Answer 7

• light sleep
• 5% total sleep time
• transition between wakefulness and sleep
• involuntary muscle jerking (twitching)
• only lasts for a few minutes

Question 8

NREM II

Answer 8

• light sleep
• 50% total sleep time
• relatively easy arousal

Question 9

NREM III

Answer 9

• 10% of sleep
• ⬆️ depth of sleep and arousal becomes difficult

Question 10

NREM IV

Answer 10

• 10% of sleep
• “delta sleep”
• arousal threshold is greatest here
• slow brain waves, relaxed muscles, slow HR, RR, slow metabolism and low body temp

Question 11

REM

Answer 11

• 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

Question 12

Sleep in older adults

Answer 12

• 7-9 hours
• less sound, stage IV absent, REM sleep shortens
• difficulty falling asleep
• contributors: polypharmacy, chronic illness, environment
• deprivation leads to delirium

Question 13

Insufficient sleep

Answer 13

• link between chronic insufficient sleep and obesity (leptin and ghrelin)
• sleep deprivation can cause a reaction time similar to someone intoxicated with alcohol

Question 14

Insomnia

Answer 14

• most common sleep disorder
• difficulty falling asleep and/or staying asleep

Question 15

Obstructive Sleep Apnea (OSA)

Answer 15

• 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

Question 16

Short term consequences of Insomnia

Answer 16

• excessive daytime tiredness
• lethargy
• irritability
• depression

Question 17

Long term consequences of Insomnia

Answer 17

• ⬆️ risk for MI, stroke, HF, HTN, type II DM

Question 18

Physical effects of insufficient sleep

Answer 18

• HTN
• risk of type II diabetes
• risk of stroke
• renal impairment
• daytime fatigue

Question 19

Psychological effects of insufficient sleep

Answer 19

• depression
• anxiety
• trigger psychosis/paranoia
• irritability

Question 20

Treatment of OSA

Answer 20

• Continuous positive airway pressure machine (CPAP) — FIRST CHOICE
• Bilevel positive airway pressure machine (BPAP)
• surgical procedure

Question 21

OSA risk factors

Answer 21

• age
• obesity
• large neck size
• male
• family hx

Question 22

Idiopathic Hypersomnia

Answer 22

constant or recurrent episodes of extreme sleepiness during the day

Question 23

Parasomnias

Answer 23

• episodes or behaviors that occur during arousal from REM that disturb the patient

Question 24

Restless Leg Syndrome (RLS)

Answer 24

• involuntary movement of the legs when the body is at rest
• unpleasant creeping, crawling, itching, aching, burning, throbbing, tingling
• abnormality in Dopamine levels

Question 25

Restless leg risk factors

Answer 25

• iron deficiency
• renal disease
• nerve damage
• rheumatoid arthritis
• use of anti-nausea meds/antidepressants
• use of alcohol, nicotine, caffeine

Question 26

Assessment Techniques

Answer 26

• 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

Question 27

Nursing interventions r/t sleep deprivation in older adults

Answer 27

• 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

Question 28

Sleep hygeine techniques

Answer 28

• 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

Question 29

How long should older adults sleep for?

Answer 29

7-9 hours

Question 30

What stage of sleep is typically absent in older adults?

Answer 30

NREM stage IV

Question 31

Insomnia risk factors

Answer 31

• older adults
• depression
• stress
• female

Question 32

Somnambulism

Answer 32

sleepwalking

Question 33

Enuresis

Answer 33

bedwetting

Question 34

Night terrors

Answer 34

common in children, during deepest stages of sleep

Question 35

Sleep paralysis

Answer 35

brief state of involuntary immobility occurring on waking