Sleep Flashcards
Compare Rest vs. Sleep
Rest: Calmness, Relaxation, freedom from anxiety, inactivity
Sleep: Altered consciousness, decreased perception/reaction to environment
Sleep-wake cycle is regulated by the _____
brain
When the _______________ deactivates, sleep occurs
Reticular Activating System
VS are lowest at _______-_______(am/pm)
4-5am
What is the purpose of sleep?
repair/resoration of mental and physical function
T/F: The older you get, you sleep more heavier and get deep sleep. As you age, you earn more hours of sleep.
False, the older you get, you sleep more lightly and get less deep sleep. As you age, you earn less hours of sleep
T/F: Studies show the amount of sleep needed doesn’t appear to diminish with age
True
The sleep cycle alternates between REM and Non-Rem every ______ minutes. All stages go through (______ -______ cycles in _______hours)
- every 90 minutes
- 4-6 cycles in 8 hours
Describe NREM Sleep
(# of Stages, Stages, Benefits, Vital Sign Observations, MISC)
Number of Stages
- 4 stages
Stages
Light Sleep Stage:
- Stage I
- Stage II
Good/Deep Sleep Stage - Deep Delta Waves
- Stage III
- Stage IV (no muscle movement)
-> DEEPEST SLEEP STAGE
Benefits:
- Body repairs/regenerates tissue
- Build bone/muscle
- Strengthen immune system
Vital Sign Observations
- Decreased vital signs (bc metabolic rate falls)
- Slowed brain waves (on EEG)
- Relaxed muscles
MISC
- 75-80% total sleep time
Describe REM Sleep
(Benefits, Vital Sign Observations, MISC)
Benefits:
Essential to:
- Mental/Emotional Health
- Learning
- Memory
- Adaptation
Vital Sign Observations
- Increased vital signs
- Irregular respirations
MISC
- Dreaming occurs
Stage _____ is the deepest/most restorative sleep stage. The longest stage of NREM sleep is Stage __________
Stage IV
Stage II
Which type of sleep does dreaming occur?
REM Sleep
T/F: Elders have an easier time falling asleep, and sleep through the night
False, elders have a harder time falling asleep and wake up more often
How many hours of sleep do elders need?
6-8 hours
Stage ______ sleep is the stage of NREM sleep that is absent/considerably decreased in older adults
Stage 4
When taking a sleep history, what topics should you touch on during your general assessment?
- Sleep pattern
- Functioning
- Sleep aids
- Sleep disturbances
-> Contributing factors: noise in environment, lighting, routine care measures
What physical signs indicate a person may be affected by sleep disturbances?
- Presence of weakness
- ℅ fatigue, lethargy
- Yawning
- Swollen/reddened/glazed eyes
- Slow speech
Many factors affect sleep. Describe how each of these factors affect sleep:
- Fatigue
- Alcohol/Caffeine/Nicotine
- Medications
- Illness
- Nutrition
- Environment
- Exercise
- Psychological stress
FAMINEE P
Fatigue
- Excessive exercise/exhaustion/overtiredness can make it difficult to fall asleep/stay asleep
Alcohol/Caffeine/Nicotine
- Stimulaants = harder to sleep
Medications
- Pseudoephedrine = stimulant/insomnia side effect
Illness
- Typically ↓sleep quality
Nutrition
- Tryptophan (protien, turkey) + complex carb = promote sleep by causing drowsiness
- Avoid caffeine (stimulant) and large/heavy/spicy mean
Environment
- Either increase/decrease ability to sleep/sleep quality
Exercise
- Do not exercise within 2 hours of sleep
Psycholgical Stress
- May be difficult to obtain amount of sleep needed
↓REM sleep = ↑anxiety/stress
What is the most common sleep disorder?
Insomnia
What are risk factors of insomnia?
- > 60yrs old
- Women after menopause
- Stress
- Jet lag
- Meds: Pseudoepedrine
Compare Acute Insomnia vs Chronic Insomnia
(How many days does it last? Tx for chronic insomnia?)
Acute insomnia
- lasts for few days
Chronic insomnia:
- >4 weeks
- Tx:
-> Stimulus control
–> Restricting ETOH/caffeine/nicotine
-> No naps
-> Short-term sleeping meds
Explain the pathophysiology of Obsructive Sleep Apnea (OSA)
Hypopharynx collapes -> airway cut off -> cessation of breathing 10+ seconds -> activate SANS (bc hypoxic/drop in O2 stat, irregular pulse, increase BP) -> release stress hormones -> person wakes up (x5-30/hour)
What are risk factors and signs of Obsructive Sleep Apnea (OSA)
Risk Factors
- ↑age
- Obseity
Signs of OSA
- Irregular snoring -> silence -> snorting
What is the treatment method for Obstructive Sleep Apnea (OSA)
(What is it? How does it work?)
Continuous Positive Airway Pressure (CPAP)
-
CPAP: is a mask connected to an air pump worn during sleep
-> Delivers positive air pressure -> holds airway open
A nurse is assesing a patient, Mr. Johnson, who has complaints of falling asleep and staying asleep.
The nurse observes Mr. Johnson is constantly yawning and has reddened, glazes eyes. Upon further assessment, he mentions experiencing low mood, lack of motivation, and loss of interest in activities he once enjoyed. He was diagnosed with depression 6 months ago, but does not take any medication to treat it.
The nurse asks Mr. Johnson what he does for work. He is a construction worker. He works from 6am - 6pm. On his lunch break, he naps in his car for 30 minutes. He attempts to fall asleep immedialty when he arrives home from work, but states that even though he is extremly exhausted, he is just unable to fall asleep.
What nursing interventions/teaching should the nurse mention to Mr. Johnson? (What areas of Mr. Johnsons life should be addressed?)
- Treat Mr. Johnsons depression
-> Can help improve sleep - Refrain from physical activities/exercise within 2 hours of sleep
-> Exhaustion/overtiredness can make it difficult to fall asleep and stay asleep - Refrain from daytime napping
Ms. Karen, a 65 y/o women, comes into the hospital complaining the inability to fall asleep and stay asleep.
The nurse looks at Karens chart and finds out Karen has takes pseudoephedrine prn for nasal congestion. Karen also has a history of HTN and takes diuretics.
The nurse asks about Karens sleep schedule, and finds out she sleeps at 10pm and wakes up around 6am.
The nurse further assesses Karen and finds out that Karen constantly takes psuedoepinephrine, even if she shes is not congested. The nurse asks what time Karen takes her diuretics and she says around 5pm, after she has dinner. Karen elaborates and says that her diuretics make her thirsty, so she continuously drinks fluids up until bedtime. She also mentions that she likes to read a book and eat spicy Buldak ramen 30 minutes before she falls asleep.
Based on this information, what nursing interventions/teaching should the nurse implement for Karen?
Warn about med side effects
- Pseudoephedrine is a stimulant and side effects include insomnia. Karen should NOT take this medication daily if she is not congested; only PRN
Educate Karen when she should take Diuretics
- Karen should take diuretics in the early day/morning because they will cause Karen to urinate frequently. This will impede with her ability to fall/stay asleep if she constantly feels the need to pee.
Educate about Fluid intake
- Fluid intake should stop at 6pm (for the same reason above^)
Encourage small snack consisting of complex carb and protein (with tryptophan) 1 hour before bed
- Large/Heavy/Spicy foods can make it harder to fall asleep
- Examples of good snacks to have 1 hour before bed: peanut butter on toast; crackers and cheese
Mr. Vasquez is admitted into the hospital for pain that radiates throughout his whole body.
He is located in busy hospital and reports having troubles falling asleep. Mr. Vasquez is located in Room #1 right next to the nurses station, where alarms usually go off.
Upon inspection of Mr. Vasquez’s room by the nurse, she finds that his bed constantly full of crumbs from dinner. The room temperature is set to 40°F.
What are ways the nursing staff can help Mr. Vasquez fall asleep before bedtime?
What are other general ways nurses can help any patient fall asleep?
Mr. Vasquez’s needs:
- Address pain issue before hours of sleep
- Keep area quiet
- Clean sheets + provide warmth (increase room temp/provide extra blankets)
Other ways to help patients fall asleep:
- PM care
-> Massage
-> Use bathroom - Address pt need for PRN sleeping medication
What are Sedative-Hyponotics?
(What are they used for? Limitations? Examples?)
Use
- Induce Sleep
Limitations
- NOT EFFECTIVE AFTER 1-2 WEEKS OF STEADY USE
-> Will end up disturbing normal REM/non-REM sleep
Examples
- Benzodiazepines
- Ativan
- Restoril
Hypersomnia
Excessive daytime sleepiness
Parasomnias
waking activities done while sleeping (sleep walking, bed betwetting)
Insomnia
- difficulty falling asleep/mainitaing sleep
*most common sleep disorder
Narcolepsy
- chronic neurologic disorder characterized by excessive daytime sleepiness/frequent urges to sleep or inadvertent daytime lapses into sleep
Obstructive Sleep Apnea (OSA)
repeated episodes of breathing cessation
Sleep Deprivation
- cumulative effect of a person not having sufficient sleep, reflecting a decrease in the amount, consistency, or quality of sleep
-> Underlying sleep disorders (insomnia, sleep apnea, RLS)
-> Poor sleep habits
-> Insufficient total sleep time
Bruxism
- grinding of teeth when asleep
Circadian rhythm sleep-wake disorders
- conditions that disrupt body’s natural sleep-wake cycle, leading to abnormal sleep patterns and daytime fatigue
-> Shift-work disorder
-> Jet-lag disorder
Shift-work disorder
result of working on a schedule outside traditional 9am-5pm workday, which goes against the bodys natural circadian rhythm
Jet-lag disorder
- results from conflict between pattern of sleep/wakefullness between the internal biological clock and that of a new timezone
Polysomnogram (Sleep study)
(What does it use?)
Uses a:
- electroencephalograph (EEG, electrical current from brain)
- electrooculogram (EOG, eye mvt)
- electromyograph (EMG, muscle tone)
Nocturnal polysomnography (Overnight sleep study)
(What does it use?)
Uses a:
- Video recording of sleep awakening/mvt.
- Cardiopulmonary monitoring of O2 stat
- Electrocardiogram (ECG, detect any cardiac arrhythmias)
Sleep Diary
- Pt logs total hours of sleep/number of undisturbed sleep/# of awakenings
- Pvd specific data on the patient’s sleep–wakefulness patterns
Sleep Screening Tools
(Incude 4 examples)
Questionnaire screening tool:
- Epworth Sleepiness Scale
- Pittsburgh Sleep Quality Index (PSQI)
- STOP-Bang Questionnaire (OSA)
- Stanford Sleepiness Scale
