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Exam 7 > Sleep and Sleep Disorders > Flashcards

Sleep and Sleep Disorders Flashcards

1
Q

Sleep is

  • a physiological process
  • the body’s rest cycle
  • associated with recumbent & immobility
  • lacks conscious awareness but easily awakened
  • essential for healthy functioning and survival
A

Physiological process
The body’s rest cycle
Associated with recumbency (laying down) & immobility
Lacks conscious awareness but easily awakened
Essential for healthy functioning and survival
(Influences mood, behavior, and etc.)

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2
Q

Sleep

State in which an individual lacks conscious awareness of environmental surroundings but can be easily aroused
- insufficient sleep
- fragmented sleep
- nonrestorative sleep

A

Insufficient sleep (less sleep than recommended)
Fragmented sleep (waking up frequently)
Nonrestorative sleep (not feeling refreshed next day)

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3
Q

Sleep disturbances and disorders

Sleep disturbance
- conditions of poor sleep quality
Sleep disorders
- abnormalities unique to sleep ( insomnia and narcolepsy )

A

Sleep disturbance
- conditions of poor sleep quality (less than 6 hrs of sleep)

Sleep disorders
- abnormalities unique to sleep
— insomnia
— narcolepsy
Untreated sleep disorder -> can cause horrible events

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4
Q

Sleep-wake cycle

  • controlled by the brain
  • wake behavior
    — RAS & various neurotransmitters
    — orexin (hypocretin)
A

Controlled by the brain
Wake behavior (process of waking up)
- RAS ( activation & arousal for the body to work ) & various neurotransmitters (helps ppl stay awake)
- Orexin, lack of -> narcolepsy, (hypocretin)

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5
Q

Reticular Activating System (RAS)

  • sensory stimuli within cerebral cortex
  • regulates sleep wake cycle
  • 4 functions
A

Sensory stimuli within cerebral cortex
Regulates sleep wake cycle
4 functions
- motor
- sensory (low, can’t feel anything)
- visceral (BP, Breathing)
- consciousness

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6
Q

Circadian Rhythm

  • managed by the suprachiasmatic nucleus (SCN) in hypothalamus
  • synchronized through light detectors in retina
  • light is the strongest time cue
A

Managed by the suprachiasmatic nucleus (SCN) in hypothalamus (master clock of the body)
Synchronized through light detectors in retina
Light is the strongest time cue

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7
Q

Stages of sleep

NREM Stage 1: 5%
NREM Stage 2: 50%
NREM Stage 3: 15%
REM 25%
Wake after sleep onset 5%

A

NREM Stage 1: 5%
NREM Stage 2: 50%
NREM Stage 3: 15%
REM 25%
Wake after sleep onset 5%

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8
Q

Phases of sleep

  • sleep latency
  • NREM
  • REM
A

Sleep latency
NREM (non-rapid eye movement): 3 stages 75%
REM (rapid eye movement) 25% deepest sleep

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9
Q

Sleep latency

  • starts when eyes are closed for sleep
  • ends when non-REM sleep is entered
  • time varies - usually 10 - 40 minutes
A

Starts when eyes are closed for sleep
Ends when non-REM sleep is entered
Time varies - usually 10 - 40 minutes

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10
Q

NREM Sleep
75% - 80% of sleep time
Divided into 3 stages

A

75% - 80% of sleep time
Divided into 3 stages
- stage 1: slow eye movements
- stage 2: HR and temp decrease
- stage 3: deep or slow wave sleep (SWS); delta waves, parasomnias

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11
Q

Pararsomnia’s

  • unusual and often undesirable behaviors while falling asleep, transitioning between sleep stages, or during arousal from sleep
  • due to CNS activation
A

Unusual and often undesirable behaviors while falling asleep, transitioning between sleep stages, or during arousal from sleep ( sleep talking and walking )
Due to CNS activation ( person is usually unaware )

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12
Q

Parasomnias include

  • sleepwalking
  • sleep terrors
  • nightmares
  • sleep paralysis
  • sleep hallucinations
A

Sleep walking
Sleep terrors
Nightmares
Sleep paralysis
Sleep hallucinations

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13
Q

REM sleep

  • 20 - 25% of sleep cycle
  • occurs 3 to 4 times a night
  • greatly reduced skeletal muscle tone
  • period when most vivid dreaming occurs
A

20 to 25% of sleep cycle
Occurs 3 to 4 times a night
Greatly reduced skeletal muscle tone
Period when most vivid dreaming occurs

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14
Q

Aging and sleep:

Middle age

  • more stage shifts - low in NREM3 & REM
  • resistant to sleep deprivation
  • increased awakenings
  • changes in sleep efficiency

Older adults

  • phase changes - go to bed earlier and arise earlier
A

Middle age

  • more stage shifts - decreased in NREM3 & REM
  • resistant to sleep deprivation
  • increased awakenings
  • changes in sleep efficiency

Older adults
- phase changes - go to bed earlier and arise earlier

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15
Q

Effects of sleep deprivation & sleep disorders

Neurologic
Immune
Respiratory
Cardiovascular
Gastrointestinal
Endocrine

A

N: cognitive impairment, behavioral changes ( irritability, moodiness )

I: Impaired function

R: Asthma exacerbated during sleep

C: Heart disease ( hypertension, dysrhythmias), increase BP in ppl w/ hypertension, stroke

G: Increase risk for obesity, increase gastroesophageal reflux disease (GERD)

E: Increase risk for type 2 diabetes, increase insulin resistance, decrease growth hormone

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16
Q

Sleep disturbances in the hospital

  • hospitalization associated with decreased sleep time
    — environmental sleep-disruptive factors
    — psychoactive medications
    — acute & critical illness
A

Hospitalization associated w/ decreased sleep time
- environmental sleep-disruptive factors
- psychoactive medications
- acute & critical illness

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17
Q

Insomnia Symptoms Include

  • difficulty falling asleep
  • difficulty staying asleep
  • waking up too early
  • complaints of waking up feeling unrefreshed
A

Difficulty falling asleep
Difficulty staying asleep
Waking up too early
Complaints of waking up feeling unrefreshed

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18
Q

Acute insomnia

  • difficulty falling asleep or remaining asleep for at least 3 nights/ week for less than a month
A

Difficulty falling asleep or remaining asleep for at least 3 nights/ week for less than a month

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19
Q

Chronic Insomnia

  • same symptoms as acute
  • daytime symptoms that persist for 1 month or longer
A

Same symptoms as acute
Daytime symptoms that persist for 1 month or longer

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20
Q

Insomnia

Aggravated by inadequate sleep hygiene
- stimulants
- meds
- using alcohol to induce sleep
- irregular sleep schedules
- nightmare
- exercise near bedtime
- jet lag

A

Stimulants
Medications
Using alcohol to induce sleep
Irregular sleep schedules
Nightmare
Exercise near bedtime
Jet lag

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21
Q

Chronic Insomnia: Etiology ( causes )

  • often no known cause
  • stressful life event
  • psychiatric illness or medical condition
  • medications or substance abuse
A

Often no known cause
Stressful life event
Psychiatric illness or medical condition
Medications or substance abuse

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22
Q

Insomnia

Clinical manifestations
- difficulty falling asleep
- frequent awakening
- prolonged nighttime awakenings
- feeling unrefreshed on awakening
- fatigue, trouble with concentration
- forgetfulness, confusion
- anxiety

A

Difficulty falling asleep
Frequent awakening
Prolonged nighttime awakenings
Feeling unrefreshed on awakening
Fatigue, trouble with concentration
Forgetfulness, confusion
Anxiety

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23
Q

Insomnia diagnosis

  • self report
  • actigraphy
  • polysomnography (PSG)
A

Self report
Actigraphy
Polysomnography (PSG)

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24
Q

Actigraphy

  • watch like device worn on the wrist, that can determine sleep and wake over a 14 day period
A

Watch like device worn on the wrist, that can determine sleep and wake over a 14 day period

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25
Q

Insomnia Interprofessional care

  • education
  • track sleep
  • sleep hygiene
  • cognitive behavioral therapy for insomnia (CBT-I)
  • complementary & alternative therapies
  • drug therapies
A

Education
Track sleep
Sleep hygiene
Cognitive behavioral therapy for insomnia (CBT-I)
Complementary & alternative therapies (essential oils)
Drug therapies

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26
Q

Insomnia treatment

  • begin with least invasive
  • cognitive behavioral therapy
  • therapist: counseling
A

Begin with least invasive
Cognitive behavioral therapy
Therapist: counseling

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27
Q

Insomnia: drug therapy

  • benzodiazepines
  • benzodiazepine - receptor like agents
  • melatonin receptor agonist
  • antidepressants
  • antihistamines
  • alternative therapies
A

Benzodiazepines
Benzodiazepine - receptor like agents
Melatonin receptor agonist
Antidepressants
Antihistamines
Alternative therapies

28
Q

Sedative hypnotic drugs

  • drugs that depress CNS function
  • PRIMARILY USED TO TREAT ANXIETY & INSOMNIA
  • anti anxiety agents or anxiolytics
  • distinction between anti anxiety effects & hypnotic effects depends on dosage
A

Drugs that depress CNS function
Primarily used to treat anxiety & insomnia
Anti anxiety agents or anxiolytics
Distinction between anti anxiety effects & hypnotic effects depends on dosage

29
Q

Benzodiazepines

  • used to treat anxiety and insomnia
  • used to induce general anesthesia
  • used to manage seizure disorders, muscle spasms, panic disorder, and alcohol withdrawal
  • potential for abuse
  • can produce physical dependence
A

Used to treat anxiety and insomnia
Used to induce general anesthesia
Used to manage seizure disorders, muscle spasms, panic disorder, and alcohol withdrawal
Potential for abuse
Can produce physical dependence

30
Q

Benzodiazepines used specifically for sleep
- temazapam ( Restoril )
- triazolam ( Halcion )
Common benzodiazepines
- diazepam ( Valium )
- lorazepam ( Ativan )
- alprazolam ( Xanax )

A

Benzodiazepines used specifically for sleep
- temazapam ( Restoril )
- triazolam ( Halcion )
Common benzodiazepines
- diazepam ( Valium )
- lorazepam ( Ativan )
- alprazolam ( Xanax )

31
Q

Benzodiazepines pharmacological effects
- CNS: reduce anxiety & promote sleep
- cardiovascular system: oral vs IV
- respiratory system: weak resp depressants

Therapeutic uses
- anxiety
- insomnia
- seizure disorders, muscle spasm
- ETOH withdrawal, perioperative applications

A

Benzodiazepines pharmacological effects
- CNS: reduce anxiety & promote sleep
- cardiovascular system: oral vs IV
- respiratory system: weak resp depressants

Therapeutic uses
- anxiety
- insomnia
- seizure disorders, muscle spasm
- ETOH withdrawal, perioperative applications

32
Q

Benzodiazepines adverse effects

  • CNS depression
  • amnesia
  • sleep driving
  • paradoxical effects
  • respiratory depression
  • abuse
A

CNS depression
Amnesia
Sleep driving
Paradoxical effects
Respiratory depression
Abuse

33
Q

Benzodiazepines

  • acute toxicity
  • oral overdose
  • IV toxicity
A

Acute toxic
Oral overdose
- drowsiness, lethargy, and confusion
IV toxic
- life threatening reactions, profound hypotension, resp arrest & cardiac rest

34
Q

Benzodiazepines receptor like agents

Zolpidem ( ambien )
- sedative hypnotic
- short term management of insomnia
- side effects: daytime drowsiness and dizziness

A

Zolpidem ( ambien )
- sedative hypnotic
- short term management of insomnia
- side effects: daytime drowsiness and dizziness

35
Q

Benzodiazepines rec

Zeleplon (Sonota)
- approved for short term management of insomnia
- most common side effects; headache nausea drowsiness dizziness myalgia and abd pain

A

Zeleplon (Sonota)
- approved for short term management of insomnia
- most common side effects; headache nausea drowsiness dizziness myalgia and abd pain

36
Q

Benzodiazepines rec like

Eszopicplone ( lunesta )
- approved for treating insomnia
- no limit Italian on how long it can be used
- generally well tolerated
- adverse effect: bitter aftertaste, headache somnolence dizziness and dry mouth
- low potential for abuse

A

Eszopicplone ( lunesta )
- approved for treating insomnia
- no limit Italian on how long it can be used
- generally well tolerated
- adverse effect: bitter aftertaste, headache somnolence dizziness and dry mouth
- low potential for abuse

37
Q

Antidepressants

Trazodone ( oleptro )
- atypical antidepressant w/ strong sedative actions
- can decrease sleep latency & prolonged sleep duration
- doesn’t cause tolerance or physical dependence

Doxepin & Amitriptyline
- old tricyclic antidepressant w/ strong sedative actions
- used to treat pt who have trouble staying asleep

A

Trazodone ( oleptro )
- atypical antidepressant w/ strong sedative actions
- can decrease sleep latency & prolonged sleep duration
- doesn’t cause tolerance or physical dependence

Doxepin & Amitriptyline
- old tricyclic antidepressant w/ strong sedative actions
- used to treat pt who have trouble staying asleep

38
Q

Antihistamines

Diphenhydramine ( Benadryl )
- may be added to nighttime cold/ pain preparations

Doxylamine ( Unisom )
- can be purchased w/out prescription
- less effective
- tolerance develops quickly 1 to 2 weeks
- ADR: daytime drowsiness and anticholinergic effects
- not intended for long term use

A

Diphenhydramine ( Benadryl )
- may be added to nighttime cold/ pain preparations

Doxylamine ( Unisom )
- can be purchased w/out prescription
- less effective
- tolerance develops quickly 1 to 2 weeks
- ADR: daytime drowsiness and anticholinergic effects
- not intended for long term use

39
Q

Alternative medicines

  • complementary & alt therapies
  • melatonin: effective related to jet lag & shift work
  • valerian root, chamomile, passionflower, lemon balm, lavender: have very mild sedative effects, proof of benefits in insomnia is lacking
  • white noise & relaxation strategies
A

Complementary & alt therapies
Melatonin: effective related to jet lag & shift work
Valerian root, chamomile, passionflower, lemon balm, lavender: have very mild sedative effects, proof of benefits in insomnia is lacking
White noise & relaxation strategies

40
Q

Insomnia: nursing assessment includes

  • sleep history
  • assess diet, caffeine and alcohol intake
  • ask about sleep aids
  • sleep diary for 2 weeks
  • medical history: factors that affect sleep
A

Sleep history
Assess diet, caffeine and alcohol intake
Ask about sleep aids
Sleep diary for 2 weeks
Medical history: factors that affect sleep

41
Q

Nursing diagnosis insomnia

  • sleep deprivation
  • disturbed sleep pattern
  • readiness for enhanced sleep
A

Sleep deprivation
Disturbed sleep pattern
Readiness for enhanced sleep

42
Q

Insomnia nursing implementation

Assume primary role in teaching sleep hygiene
- decrease caffeine intake
- bedtime routine
- decreased blue light before bedtime
- reduce light and noise
Teach pt about sleep medications

A

Assume primary role in teaching sleep hygiene
- decrease caffeine intake
- bedtime routine
- decreased blue light before bedtime
- reduce light and noise
Teach pt about sleep medications

43
Q

Respiratory & sleep problems

  • sleep apnea
  • snoring and hypoventilation
  • obesity hypoventilation syndrome
  • reduced chest wall compliance
  • increased work of breathing
  • deceased total lung capacity and functional residual capacity
  • also called obstructive sleep apnea hypopnea syndrome ( OSAHS )
  • partial/ complete upper airways obstruction during sleep
  • apneic period may include hypoxemia & hypercapnia
A

Sleep apnea
Snoring and hypoventilation
Obesity hypoventilation syndrome
Reduced chest wall compliance
Increased work of breathing
Deceased total lung capacity and functional residual capacity
Also called obstructive sleep apnea hypopnea syndrome ( OSAHS )
Partial/ complete upper airways obstruction during sleep
Apneic period may include hypoxemia & hypercapnia

44
Q

Respiratory & sleep problems:
complications can result in

  • hypertension
  • cardiac changes
  • poor concentration/ memory
  • impotence
  • depression
A

Hypertension
Cardiac changes
Poor concentration/ memory
Impotence
Depression

45
Q

Clinical signs and symptoms

  • apnea is cessation of spontaneous respirations for longer than 10 s
  • each obstruction may last from 10 to 90 s
  • apnea and arousal cycles occur repeatedly, as many as 200 to 400 x during 6 to 8 hrs of sleep
A

Frequent arousal during sleep
Insomnia
Excessive daytime sleepiness
Witnessed apneic episodes
Loud snoring
Morning headache
Irritability

46
Q

Risk factors

Sleep apnea occurs in 2 to 10% of Americans but us considered to be underreported

  • obesity
  • age >65 yo
  • neck circumference >17 inches
  • craniofacial abnormalities that affect the upper airway and acromegaly
  • smokers are more likely to have OSA
  • OSA is more common in men than in woman until after menopause, when the prevalence of the disorder is the same in both genders. Women with OSA have higher mortality rates
A
  • obesity (bmi >28 kg/m2)
  • age >65 yo
  • neck circumference >17 inches
  • craniofacial abnormalities that affect the upper airway and acromegaly
  • smokers are more likely to have OSA
  • OSA is more common in men than in woman until after menopause, when the prevalence of the disorder is the same in both genders. Women with OSA have higher mortality rates

OSA IS SLEEP APNEA

47
Q

Lab & diagnostic testing

  • may take one or two nights for complete diagnosis depends
  • polysomnography AKA SLEEP STUDY
A

May take one or 2 nights for complete diagnosis depends
Polysomnography aka sleep study

48
Q

Mild sleep apnea treatment

  • sleeping on one’s side
  • elevating HOB
  • avoiding sedatives & alcohol 3 - 4 hrs before sleep
  • weight loss
  • oral appliance
A

Sleeping on one’s side
Elevating HOB
Avoiding sedatives & alcohol 3 - 4 hrs before sleep
Weight loss
Oral appliance

49
Q

Sleep apnea treatment

Severe ( >15 apnea/ hypopnea events/ hr)
- CPAP
- BiPAP
- Surgery

A

CPAP
- possible compliance issues

Surgery
- UPPP or UP3
- Genioglossal advancement & hyoid myotonic (GAHM)

50
Q

Pt teaching

If pt on CPAP BiPAP remind them to always take with them if overnight trips planned

A

Explain benefit of losing weight
Explain benefit of sleeping on side
Explain the need to avoid sedatives or alcohol 3-4 hrs before bedtime
Stress reduction
Stress importance of exercise
Avoid smoking
Self imagine disturbance

51
Q

Discharge planning

  • case manger need for equipment
  • nutritional consult
  • spiritual consult
A

Case manger need for equipment
Nutritional consult
Spiritual consult

52
Q

Nursing diagnosis

  • anxiety
  • insomnia
  • imbalanced nutrition more than body requires
  • knowledge deficit
A

Anxiety
Insomnia
Imbalanced nutrition more than body requires
Knowledge deficit

53
Q

Narcolepsy

  • brain unable to regulate sleep wake cycles normally
  • causes uncontrollable urges to sleep, often fo directly into REM sleep
  • unknown cause
A

Unknown cause
- associated with destruction of neurons that produce orexin
- orexin - neuropeptide that regulates sleep/ wake cycles
- low lvls of orexin lead to difficulty staying awake

54
Q

Narcolepsy

2 types:
- type 1: with cataplexy
- type 2: without cataplexy

Symptoms
- sleep paralysis
- cataplexy
- fragmented nighttime sleep

A

Narcolepsy = immediate deep sleep, diagnosed based sleep study

2 types:
- type 1: with cataplexy
- type 2: without cataplexy ( no muscle weakness )

Symptoms
- sleep paralysis
- cataplexy ( muscle weakness )
- fragmented nighttime sleep ( can last longer than an hr )

55
Q

Narcolepsy

Nursing & interprofessional management

  • teach abt sleep & sleep hygiene
  • take naps
  • avoid heavy meals and alcohol
  • ensure pt safety
  • lifestyle changes
A

Teach abt sleep & sleep hygiene
Take naps
Avoid heavy meals and alcohol
Ensure pt safety
Lifestyle changes

56
Q

Narcolepsy: drug therapy

  • Modafinil (Provigil)
  • Armodafinil (Nuvigil)
  • Both are wake promotion drugs (NO AMPHETAMINE)
A

Modafinil (Provigil)
Armodafinil (Nuvigil)
Both are wake promotion drugs (NO AMPHETAMINE)

57
Q

Parasomnias

  • unusual & often undesirable behaviors while falling asleep b/w sleep stages, or during arousal from sleep
  • Due to CNS activation
  • symptoms
A

Unusual & often undesirable behaviors while falling asleep b/w sleep stages, or during arousal from sleep
Due to CNS activation
Symptoms
- sleepwalking
- sleep terrors
- nightmares

58
Q

Gerontological Considerations

  • older age is associated with
    — overall shorter total sleep time
    — decreased sleep efficiency
    — more awakenings
    — insomnia symptoms
A

Older age is associated with
- overall shorter total sleep time
- more awakenings
- insomnias symptoms

59
Q

Gerontological considerations

Sleep
- awakenings during the night increases risk for falls
- medications used by older adults can contribute to sleep problems
- avoid long acting benzodiazepines

A

Awakenings during the night increases risk for falls
Medications used by older adults can contribute to sleep problems
Avoid long acting benzodiazepines

60
Q

Nurse fatigue: Facts

  • inadequate sleep
  • extended work hours
  • increased risk for errors
A

Inadequate sleep
Extended work hours
Increased risk for errors

61
Q

Who is at risk?

  • nurse compassion fatigue
  • pts
  • nurse
    — awake for 17 hrs
    — awake for more than 24 hrs
A

Nurse
- Awake for 17 hrs
— equals same cognition as blood alcohol lvl 0.05%
- Awake for more than 24 hrs
— equivalent to blood alcohol lvl 0.10%

62
Q

National academy of medicine

  • Formerly institute of medicine
    — nonprofit organization devoted to safety and evidence based practice in healthcare
  • recommendations
    — no more than 12 hrs in 24 hr period
    — limit to 60 hrs in one week
A

Formerly institute of medicine
- nonprofit organization devoted to safety & evidence based practice in healthcare
Recommendations
- no more than 12 hrs in 24 hr period
- limit to 60 hrs in one week

63
Q

Nurse fatigue: management

Do’s
Don’ts

A

Do’s
- take at least 1 break in addition to lunch break
- use caffeine therapeutically as a stimulant to stay awake
- nutrition: complex cards and protein
- exercise

Don’ts
- DO NOT DRINK ALCOHOL ( DEPRESSANT )

64
Q

Shift work sleep disorder

Characterized by
- insomnia
- excessive sleepiness

A

Insomnia
Excessive sleepiness

65
Q

Shift work sleep disorder symptoms include

  • fatigue or malaise
  • difficulty paying attention or concentrating
  • memory impairment
  • mood disturbance or irritability
  • excessive daytime sleepiness
  • hyperactivity impulsivity aggression and other behavioral problems
  • reduced motivation energy or initiative
  • feeling of sleep dissatisfaction
A

Fatigue or malaise
Difficulty paying attention or concentrating
Memory impairment
Mood disturbance or irritability
Excessive daytime sleepiness
Hyperactivity impulsivity aggression and other behavioral problems
Reduced motivation energy or initiative
Feeling of sleep dissatisfaction

66
Q

Special sleep needs of nurses

  • nurses on permanent night or rapidly rotating shifts are at increased risk of experiencing shift work sleep disorder
  • use strategies to help reduce distress associated with shift work
    — onsite napping
    — consistent sleep wake schedule
A

Nurses on permanent night or rapidly rotating shifts are at increased risk for experiencing shift work sleep disorder
Use strategies to help reduce distress associated with shift work
- onsite napping
- consistent sleep wake schedule

Exam 7 (2 decks)

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