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Physiology & Pharmacology > Sleep > Flashcards

Sleep Flashcards

1
Q

sleep is …………..

A 
altered state of consciousness 
characterized by decreased response to external stimuli 
changes in physiologic processes 
minimal physical activity 
variable levels of consciousness
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2
Q

REM sleep occurs ………

A

every 90 minutes beginning 1-2 hours after you fall asleep

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3
Q

Newborns sleep …………

A

16-17 hours per day
53% of that time is spent in REM sleep
their sleep cycle begins in REM sleep
infant sleep cycle is about 50-60 minutes

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4
Q

Aging and sleep

A

Total sleep time is decreased…. older adults take longer to fall asleep and awaken more frequently during the night

Amount of time in stage IV sleep decreases

Potential Causes include:
Physical ailments
Lack of daily routine
Circadian rhythm changes
Medications
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5
Q

Narcolepsy is not characterized by

A

frequent cataplexy

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6
Q

Somnoambulism is a disorder primarily of childhood and appears to resolve within a few years.

True or false.

A

True.

Somnoambulism is sleepwalking

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7
Q

Somnambulism in adults is often associated with

A

disordered breathing

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8
Q

Difference between parasomnia and dyssomnias

A

Parasomnia refers to behavior while asleep

Dyssomnia refers to disorders of sleep/wake cycle

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9
Q

Cognitive behavior therapy is _________________ than drug therapy for both short term and long term care management of chronic insomnia in older adults.

A

more effective

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10
Q

How many stages of sleep are there ?

A

4 non REM main stages and 1 REM stage that occur during 90 minute cycles

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11
Q

Non rapid eye movement consists of

A

N1, N2 and N3

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12
Q

N1 is also called the

A

hypnogogic state.
may experience hallacinations, common feeling of falling (hypnic jerks)
This is the stage between wakefulness and sleep - it is the first and lightest stage of sleep

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13
Q

What is an EEG ?

A

An electroencephalogram documents normal sleep patterns

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14
Q

How many cycles of REM and Non REM sleep occur each night in an adult approximately?

A

Four to Six cycles

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15
Q

The hypothalamus is a major ____________ center

A

sleep

The hypothalamus secretes certain neuropeptides that promote wakefulness

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16
Q

REM occurs for what percentage of sleep time ?

A

20-25%

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17
Q

Non REM accounts for what percentage of sleep time

A

75-80%

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18
Q

What physiological changes happen to the body during REM sleep?

A

altered heart rate, blood pressure and respiration, muscle relaxation, loss of temperature regulation, increased parasympathetic activity and sympathetic activity associated with rapid eye movement,

penile erection in men and clitoral engorgement in women, release of steroids and many memorable dreams
Cerebral blood flow increases
Respiratory control appears largely independent of metabolic requirements and oxygen variation
increased levels of acetylcholine and dopamine

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19
Q

What physiological changes happen to the body during non REM sleep?

A

There is a state of reduced activity as sympathetic tone is decreased and parasympathetic activity is increased

BMR decreases by 10-15 %
Temperature decreases 0.5-1.0 C
heart rate, blood pressure, respirations, muscle tone decrease
pupils are constricted 
knee jerk reflexes are absent 
decrease cerebral blood flow
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20
Q

Non REM sleep is initiated when ……..

A

the hypothalamus releases inhibitory signals

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21
Q

REM sleep is initiated by

A

REM-on and REM-off neurons in the pons and mesencephalon

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22
Q

N2

A

second stage of Non REM sleep -
sleep spindles- rapid bursts of rhythmic brain activity
K Complex

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23
Q

N3 and N4

A

very difficult to wake up during this stage. If you walk and talk during sleep, this would be the stage

delta waves
deepest stages of sleep
essential for restoring energy and releasing growth hormones

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24
Q

REM sleep is also sometimes called

A

paradoxical sleep because your brain is very active and equal to you being awake but your body is prohibited from moving- muscles are rather paralyzed

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25
Q

Sleep cycle progression

A

N1 - N2 - N3 - N2 - REM - N1

26
Q

Lack of sleep effects

A 
Profound fatigue
Irritability
Apathy, depression
Confusion, hallucinations
Impaired memory
Paranoia 
Low pain tolerance
Immunosuppression
Slowed tissue repair
Susceptibility to infection
27
Q

What does sleep do for us ?

A

Sleep is restorative

Restores normal levels of activity
Restores normal balance among parts of the nervous system
Psychological well-being
Necessary for protein synthesis

28
Q

Sleep wake cycles are coordinated with ……….

A

the circadian rhythm (24 hour rhythm cycles/biological clock)

29
Q

What is the RAS ?

A

Reticular Activating System - this is an area of the brain stem that influences sleep cycles
it facilitates reflex and voluntary movements
it controls cortical activities related to state of alertness

30
Q

human growth hormone is released during which stages of sleep for kids and young adults ?

A

Stages III and IV

31
Q

Insomnia

A

trouble falling asleep or staying asleep. Can be acute or chronic.
- one feels fatigued while awake - can be mild, moderate or severe

Acute insomnia - jet lag, acute stres
Chronic Insomnia - drug and alcohol abuse, chronic pain disorders, aging, chronic depression, use of certain drugs, genetics and environmental factors that result in hyperarousal

32
Q

What is the most common diagnosed sleep disorder ?

A

OSAS
Obstructive Sleep Apnea Syndrome

results from partial or total upper airway collapse with obstruction to airflow recurring during sleep - causes excessive snoring, gasping and multiple apneic episodes

The periodic breathing eventually produces arousal which interrupts the sleep cycle, reducing total sleep time and producing sleep and REM deprivation

leads to hypercapnia and low oxygen saturation, which can lead to polycythemia, pulmonary hypertension,, systemic hypertension, stroke, right sided CHF, dysrhythmias, liver congestion, cyanosis and peripheral edema

Associated with Hypersomnia (excessive daytime sleepiness)

33
Q

What is a polysomnography ?

A

A sleep study. This is needed for those with sleep apnea along with a physical exam

34
Q

Treatment of sleep apnea

A

Removal of obstruction (e.g. tonsils) (tonsillectomy)
CPAP
Weight loss
Change sleep position

35
Q

What effect does smoking have on sleep

A

reduces REM sleep

Wake in 3-4 hours d/t withdrawal from nicotine

36
Q

What effect does alcohol have on sleep?

A

Induces sleep but can cause later wakefulness and poor sleep quality

37
Q

what effect does depression have on sleep ?

A
  • Insomnia is a risk factor for depression, but it is also a symptom of it
38
Q

Sleep deprivation is associated with an increased risk of …………….

A 
HTN
depression
DM
MI
Obesity 
CVA
39
Q

Incidence of OSAS increases after what age ?

A

65 or older

40
Q

Major risk factors of OSA?

A

male gender, older age, obesity and postmenopausal status (not on hormone therapy) in women

41
Q

Narcolepsy

A 
primary hypersomnia (excessive daytime sleepiness)
characterized by hallacinations, sleep paralysis, and rarely (brief spells of muscle weakness)
42
Q

Our sleep wake cycle is driven by _____________

A

circadian rhythms.

43
Q

Circadian rhythm sleep disorders

A

another sleep disorder caused by changing our circadian rhythms so that our sleep wake times are affected

44
Q

parasomnias

A

behavior that may interfere with or occur during sleep

They occur during NREM stage 3 sleep

45
Q

Somnambulism

A

sleepwalking - a disorder associated primarily with childhood

46
Q

Night Terrors

A

Sudden apparent arousals in which the child expresses intense fear or emotion. however child is not awake and can be difficult to arouse. once awakened child has no memory of event
adults can experience it with corresponding daytime anxiety

47
Q

Bruxism

A

Bruxism is a condition in which you grind, gnash or clench your teeth. If you have bruxism, you may unconsciously clench your teeth when you’re awake (awake bruxism) or clench or grind them during sleep (sleep bruxism) It usually occurs during stage 2 of sleep

48
Q

Enuresis

A

bed wetting -

49
Q

Restless Leg syndrome

A

common sensorimotor disorder associated with unpleasant sensations (prickling, tingling, crawling) and nonvolitional periodic leg movements that occurs at rest and is worse in the evening or at night. there is a compelling urge to move the legs for relief with a significant effect on sleep and quality of life
more common in women, during pregnancy, the elderly and individuals with iron deficiency

50
Q

Shift work sleep disorder

A

circadian rhythm sleep disorder that affects many shift workers who rotate or swing long shifts particularly between the hours of 10 PM and 6 AM.

51
Q

What is sundown syndrome in elders ?

A

Late day confusion, restlessness, and mood swings in elderly hospitalized patients. Associated with dementia.

52
Q

First treatment method and Second Treatment method

for adults with chronic insomnia

A

Cognitive Behavioral Therapy

Short Term Pharmacological treatment - determined through shared decision making between provider and patient

53
Q

CBT for insomnia involves

A 
sleep diary 
sleep restrictions (no naps, stay up later)

Stimulus control instructions (pinpointing actions that may be preventing sleep such as time in bed awake)
Sleep hygiene education (cool, dark room, no caffeine, etc.)

Relapse prevention:
Don’t compensate for sleep loss
Start stimulus control procedures immediately
Re-engage sleep restriction should the insomnia persist beyond a few days

Drawback is that CBT-I is slow.
First week or two pt may feel worse
Takes 5-6 weeks to improve sleep quality

54
Q

What is Zolpidem (Ambien)

A

Generic name Zolpidem is a medication for short term management of insomnia
- it is a sedative hypnotic drug - specifically a benzodiazepine-like drug
Mechanism of Action: acts as an agonist at the benzodiazepine receptor site on the GABA receptor - chloride channel complex

  • reduces the amount of time it takes to fall asleep (sleep latency) and awakenings and can prolong sleep duration
  • there is a rapid onset upon oral intake - plasma levels peak at 2 hours. Drug is widely distributed although levels in the brain remain low.
    Low dependence risk, withdrawal symptoms are minimal or absent
    Side effects could possibly include daytime drowsiness and dizziness
55
Q

Sedative hypnotic drugs depress_________________

They are used commonly for __________ and ___________

A

CNS function; anxiety; insomnia

56
Q

Common Side effects of Zolpidem

A

daytime drowsiness, weakness, feeling “drugged” or light-headed; ataxia; stuffy nose, xerostomia, nose or throat; nausea, constipation, diarrhea; or headache, muscle pain.

57
Q

Severe Side effects of Zolpidem

A

Anaphylaxis (hives; difficulty breathing; swelling of face, lips, tongue, or throat)

58
Q

Nursing interventions that promote normal sleep

A

Reduce environmental distractions
Promote bedtime rituals
Provide comfort measures
Engender a feeling of safety
Clustering care
Teach stress reduction, relaxation techniques and good sleep hygiene
Administer sleep medications, if appropriate
Make a referral to sleep specialist for investigation of sleep complaints

59
Q

What are secondary sleep disorders ?

A 
Alterations in the quality and/or quantity of sleep caused by primary diseases
Depression
Pain
Sleep apnea syndromes
Alterations in thyroid hormone secretion
60
Q

What are sleep provoked disorders?

A

Sleep stage alterations produced in certain disease states

Physiology & Pharmacology (13 decks)

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