Sleep Flashcards
sleep is …………..
altered state of consciousness characterized by decreased response to external stimuli changes in physiologic processes minimal physical activity variable levels of consciousness
REM sleep occurs ………
every 90 minutes beginning 1-2 hours after you fall asleep
Newborns sleep …………
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
Aging and sleep
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
Narcolepsy is not characterized by
frequent cataplexy
Somnoambulism is a disorder primarily of childhood and appears to resolve within a few years.
True or false.
True.
Somnoambulism is sleepwalking
Somnambulism in adults is often associated with
disordered breathing
Difference between parasomnia and dyssomnias
Parasomnia refers to behavior while asleep
Dyssomnia refers to disorders of sleep/wake cycle
Cognitive behavior therapy is _________________ than drug therapy for both short term and long term care management of chronic insomnia in older adults.
more effective
How many stages of sleep are there ?
4 non REM main stages and 1 REM stage that occur during 90 minute cycles
Non rapid eye movement consists of
N1, N2 and N3
N1 is also called the
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
What is an EEG ?
An electroencephalogram documents normal sleep patterns
How many cycles of REM and Non REM sleep occur each night in an adult approximately?
Four to Six cycles
The hypothalamus is a major ____________ center
sleep
The hypothalamus secretes certain neuropeptides that promote wakefulness
REM occurs for what percentage of sleep time ?
20-25%
Non REM accounts for what percentage of sleep time
75-80%
What physiological changes happen to the body during REM sleep?
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
What physiological changes happen to the body during non REM sleep?
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
Non REM sleep is initiated when ……..
the hypothalamus releases inhibitory signals
REM sleep is initiated by
REM-on and REM-off neurons in the pons and mesencephalon
N2
second stage of Non REM sleep -
sleep spindles- rapid bursts of rhythmic brain activity
K Complex
N3 and N4
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
REM sleep is also sometimes called
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
Sleep cycle progression
N1 - N2 - N3 - N2 - REM - N1
Lack of sleep effects
Profound fatigue Irritability Apathy, depression Confusion, hallucinations Impaired memory Paranoia Low pain tolerance Immunosuppression Slowed tissue repair Susceptibility to infection
What does sleep do for us ?
Sleep is restorative
Restores normal levels of activity
Restores normal balance among parts of the nervous system
Psychological well-being
Necessary for protein synthesis
Sleep wake cycles are coordinated with ……….
the circadian rhythm (24 hour rhythm cycles/biological clock)
What is the RAS ?
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
human growth hormone is released during which stages of sleep for kids and young adults ?
Stages III and IV
Insomnia
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
What is the most common diagnosed sleep disorder ?
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)
What is a polysomnography ?
A sleep study. This is needed for those with sleep apnea along with a physical exam
Treatment of sleep apnea
Removal of obstruction (e.g. tonsils) (tonsillectomy)
CPAP
Weight loss
Change sleep position
What effect does smoking have on sleep
reduces REM sleep
Wake in 3-4 hours d/t withdrawal from nicotine
What effect does alcohol have on sleep?
Induces sleep but can cause later wakefulness and poor sleep quality
what effect does depression have on sleep ?
- Insomnia is a risk factor for depression, but it is also a symptom of it
Sleep deprivation is associated with an increased risk of …………….
HTN depression DM MI Obesity CVA
Incidence of OSAS increases after what age ?
65 or older
Major risk factors of OSA?
male gender, older age, obesity and postmenopausal status (not on hormone therapy) in women
Narcolepsy
primary hypersomnia (excessive daytime sleepiness) characterized by hallacinations, sleep paralysis, and rarely (brief spells of muscle weakness)
Our sleep wake cycle is driven by _____________
circadian rhythms.
Circadian rhythm sleep disorders
another sleep disorder caused by changing our circadian rhythms so that our sleep wake times are affected
parasomnias
behavior that may interfere with or occur during sleep
They occur during NREM stage 3 sleep
Somnambulism
sleepwalking - a disorder associated primarily with childhood
Night Terrors
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
Bruxism
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
Enuresis
bed wetting -
Restless Leg syndrome
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
Shift work sleep disorder
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.
What is sundown syndrome in elders ?
Late day confusion, restlessness, and mood swings in elderly hospitalized patients. Associated with dementia.
First treatment method and Second Treatment method
for adults with chronic insomnia
Cognitive Behavioral Therapy
Short Term Pharmacological treatment - determined through shared decision making between provider and patient
CBT for insomnia involves
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
What is Zolpidem (Ambien)
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
Sedative hypnotic drugs depress_________________
They are used commonly for __________ and ___________
CNS function; anxiety; insomnia
Common Side effects of Zolpidem
daytime drowsiness, weakness, feeling “drugged” or light-headed; ataxia; stuffy nose, xerostomia, nose or throat; nausea, constipation, diarrhea; or headache, muscle pain.
Severe Side effects of Zolpidem
Anaphylaxis (hives; difficulty breathing; swelling of face, lips, tongue, or throat)
Nursing interventions that promote normal sleep
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
What are secondary sleep disorders ?
Alterations in the quality and/or quantity of sleep caused by primary diseases Depression Pain Sleep apnea syndromes Alterations in thyroid hormone secretion
What are sleep provoked disorders?
Sleep stage alterations produced in certain disease states
