Sleep Flashcards
Circadian rhythms
Affected by.
light, temperature, social activities, and work routines
Hospitals and extended care facilities usually do not
adapt care to an individual’s sleep-wake cycle preferences.
The biological rhythm of sleep frequently becomes
synchronized with other body functions
common symptoms of sleep cycle disturbances.
Anxiety, restlessness, irritability, and impaired judgment
Physiology of Sleep: Sleep Regulation RAS and BSR:
Integrated by central nervous system (CNS) activity:
- Hypothalamus
- Reticular activating system (RAS)
- Bulbar synchronizing region (BSR)
Purpose of sleep:
Remains unclear
Physiological and psychological restoration
NREM – body tissue restoration
REM – brain tissue & cognitive restoration
Loss of REM – confusion & suspicion
Dreams:
Occur during NREM & REM
REM sleep – vivid & elaborate
Important for learning, memory, and adaptation to stress
Physical illness can cause
pain, physical discomfort, anxiety, depression, and sleep disturbances
Physical illness include:
Hypertension Respiratory disorders Nocturia Pain Restless leg syndrome (RLS)
Hypersomnolence =
Excessive sleepiness
A polysomnogram involves
the use of electroencephalography (EEG), electromyography (EMG), and electro-oculography (EOG) to monitor stages of sleep and wakefulness during nighttime sleep.
Sleep hygiene =
Practices that a patient associates with sleep
Cataplexy is
sudden muscle weakness during intense emotions such as anger, sadness, or laughter; it can occur at any time during the day.
Sleep paralysis is
the feeling of being unable to move or talk just before waking or falling asleep.
Insomnia
Adjustment sleep disorder (acute insomnia), Inadequate sleep hygiene, Behavioral insomnia of childhood, Insomnia caused by medical condition
Sleep apnea
Primary central sleep apnea, Central sleep apnea caused by medical condition, Obstructive sleep apnea syndromes, Excessive daytime sleepiness
-lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep
Narcolepsy
Cataplexy, Sleep paralysis
Dysfunction of regulating sleep and wake states - excessive sleepiness is the most common complaint
Sleep deprivation
Causes by Emotional stress, Medications, Environmental disturbances
Symptoms: fever, difficulty breathing, pain
Parasomnias
More common in children
Somnambulism (sleepwalking), Night terrors, Nightmares, Nocturnal enuresis (bed-wetting), Body rocking, Bruxism
Physical illness
Hypertension, respiratory, musculoskeletal, chronic illness, GI, nausea
Drugs and substances
Hypnotics, diuretics, narcotics, antidepressants, alcohol, caffeine, beta-blockers, anticonvulsants
Lifestyle
Work schedule, social activities, routines
Usual sleep patterns
May be disrupted by social activity or work schedule
Emotional stress
Worries, physical health, death, losses
Environment
Noise, routines
Exercise and fatigue
Moderate exercise and fatigue cause a restful sleep
Food and calorie intake
Time of day, caffeine, nicotine, alcohol
Sleep assessment
Sources for sleep assessment = Patient, family
Tools for sleep assessment = Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index
Sleep history:
Description of sleeping problems usual sleep pattern current life events physical and psychological illness emotional and mental status bedtime routines, bedtime environment behaviors of sleep deprivation
Goal:
The patient will control environmental sources disrupting sleep within 1 month
Outcomes:
Patient will identify factors in the immediate home environment that disrupt sleep in 2 weeks.
Patient will report having a discussion with family members about environmental barriers to sleep in 2 weeks.
Patient will report changes made in the bedroom to promote sleep within 4 weeks.
Patient will report having fewer than two awakenings per night within 4 weeks.
Health promotion:
Environmental controls Promoting bedtime routines Promoting safety Promoting comfort Establishing periods of rest and sleep Stress reduction Bedtime snacks Pharmacological approaches
Acute care:
Environmental controls Promoting comfort Establishing periods of rest and sleep Promoting safety Stress reduction
Restorative or continuing care
Promoting comfort
Controlling physiological disturbances
Pharmacological approaches
Determine whether expected outcomes have been met.
Are you able to fall asleep within 20 minutes of getting into bed?
Describe how well you sleep when you exercise.
Does the use of quiet music at bedtime help you to relax?
Do you feel rested when you wake up?
