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IM 1 > Sleep and sleep disorders- exam 7 > Flashcards

Sleep and sleep disorders- exam 7 Flashcards

1
Q

Sleep

A
  • physiological process
  • body’s rest cycle
  • lacks conscious awareness but easily awakened
  • essential for health functioning and survival
  • associated with recumbency and immobility
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2
Q

State in which an individual lacks conscious awareness of environmental of environmental surroundings but can be easily aroused

A

sleep

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3
Q

Insufficient sleep

A

obtaining less sleep

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4
Q

fragmented sleep

A

frequent arousals

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5
Q

nonrestorative sleep

A

sleep that is adequate - duration but do not feel refreshed the next day

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6
Q

State of rest accompanied by natural altered consciousness

A

Sleep

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7
Q

interrelated concepts of sleep

A
  • coping
  • comfort
  • safety
  • functional ability
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8
Q

positive consequences in sleep

A
  • ability to focus
  • alert normal reflexes
  • awake and refreshed
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9
Q

negative consequences of sleep

A
  • slowed responds
  • fatigue
  • irritability
  • altered thought
  • psychosis
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10
Q

sleep disturbance

A

conditions of poor sleep quality

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11
Q

sleep disorders

A
  • abnormalities unique to sleep
  • insomnia
  • narcolepsy
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12
Q

sleep- wake cycle controlled by

A
  • controlled by the brain
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13
Q

Wake behavior

A
  • RAS and various neurotransmitters
  • orexin (hypocretin)
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14
Q

(RAS) Reticular Activating System

A
  • sensory stimuli within cerebral cortex
  • regulates sleep-wake cycle
    4 functions
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15
Q

what are the 4 functions of RAS

A
  1. motor
  2. sensory
  3. visceral
  4. consciousness
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16
Q

Circadian Rhythm

A
  • Managed by the suprachiasmatic (SCN) in hypothalamus
  • synchronized through light detectors through light detectors in retina
  • light is the strongest time cue
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17
Q

Sleep latency

A

When you begin to fall asleep

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18
Q

sleep latency

A
  • starts when eyes are closed for sleep
  • ends when NREM sleep is entered
  • time varies (10-40 minutes)
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19
Q

NREM Sleep- what is the percentage of sleep time?

A

75-80%

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20
Q

what are the three stages in NREM sleep?

A
  1. slow eye movements
  2. HR and temperature decrease
  3. deep or sloe wave sleep; delta waves, parasomnias
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21
Q

parasomnias

A
  • unusual and often undesirable behaviors while falling asleep, transitioning between sleep stages, or during arousal from sleep
  • due to CNS activation
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22
Q

examples of parasomnias - 5

A
  1. sleepwalking
  2. sleep terrors
  3. nightmares
  4. sleep paralysis
  5. sleep hallucinations
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23
Q

REM sleep is what % of sleep?

A

20-25% of sleep cycle

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24
Q

REM sleep occurs how many times during the night?

A

3-4 times a night

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25
Q

REM sleep greatly reduces

A

skeletal muscle tone

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26
Q

during what sleep cycle do we have periods of vivid dreaming occurs?

A

REM Sleep

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27
Q

NREM Stage 1

A
  • falling asleep
  • heartbeat and breathing slow down
  • muscles begin to relax
  • lasts a few minutes
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28
Q

NREM Stage N2-

A
  • light sleep
  • heartbeat and breathing slow down further
  • no eye movements
  • body temp drops
  • brain produces “sleep spindles”
  • lasts about 25 min
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29
Q

NREM Stage N3 (7)
- Slow Wave SLeep

A
  • deepest sleep state
  • heart beat and breathing at slowest rate
  • no eye movements
  • body is full relaxed
  • delta brain waves are present
  • tissue repair and growth, and cell regeneration
  • immune system strengthens
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30
Q

REM Stage R

A
  • primary dreaming stage
  • eye movements become rapid
  • breathing and heart rate increases
  • limb muscles become temporarily paralyzed
  • brain activity is marked increased
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31
Q

Middle age Sleep - 4

A
  • more stage shifts- decrease in NREM3 and REM
  • resistant to sleep deprivation
  • increased awakenings
  • changes in sleep efficiency
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32
Q

older adults - sleep

A

phase changes - go to bed earlier and arise earlier

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33
Q

Neurologic - effects of sleep deprivation

A
  • cognitive impairment
  • behavioral changes
    > Irritability
    > moodiness
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34
Q

Immune- effects of sleep deprivation

A

impaired function

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35
Q

Respiratory - effects of sleep deprivation

A
  • asthma exacerbated during sleep
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36
Q

Cardiovascular - effects of sleep deprivation

A
  • heart disease
    > hypertension
  • increase BP in people with hypertension
  • stroke
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37
Q

Gastrointestinal- Effects of sleep deprivation

A
  • increase risk for obesity
  • increased gastroesophageal reflux disease
38
Q

Endocrine - effects of sleep deprivation

A
  • increased risk for type 2 diabetes
  • increased insulin resistance
  • decrease growth hormone
39
Q

Sleep disturbances in the hospital

A
  • hospitalization associated with decreased sleep time
  • environmental sleep-disruptive factors
  • psychoactive medications
  • acute and critical illness
40
Q

Symptoms of insomnia -4

A
  • difficulty falling asleep
  • difficulty staying asleep
  • waking up too early
  • complaints of waking up feeling unrefreshed
41
Q

acute insomnia

A

difficulty falling asleep
3 nights/week for less than a month

42
Q

Chronic Insomnia

A
  • difficulty falling asleep
  • daytime symptoms that persist for one month or longer
43
Q

insomnia is aggravated by ___ sleep hygiene

A

inadequate

44
Q

aggravated by inadequate sleep hygiene-7

A
  • stimulants
  • medications
  • using alcohol to induce sleep
  • irregular sleep schedules
  • nightmare
  • exercising near bedtime
  • jet lag
45
Q

Etiology - Chronic Insomnia

A

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

46
Q

Clinical Manifestations of insomnia -7

A
  • difficulty falling asleep
  • frequent awakening
  • prolonged nighttime awakenings
  • feeling unrefreshed on awakening
  • fatigue, trouble with concentration
  • forgetfulness, confusion
  • anxiety
47
Q

diagnosis of insomnia

A
  • self report
  • actigrahpy
  • polysomnography
48
Q

actigraphy

A

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

49
Q

Insomnia - interprofessional care

A
  • education
  • track sleep
  • sleep hygiene
  • cognitive behavioral therapy for insomnia
  • complementary and alterative therapies
  • drug therapy
50
Q

causes of insomnia -7

A
  • psychiatric
  • medical illness, medications
  • stress
  • substances
  • exercise
  • age, gender
  • travel
51
Q

treatment of insomnia

A
  • begin with least invasive
  • cognitive behavior therapy
  • therapist~ counseling
52
Q

Sedative-Hypnotic drugs - insomnia drug therapy

A
  • drugs that depress CNS function
  • primarily used to treat anxiety and insomnia
  • antianxiety agents or anxiolytics
  • distinction between antianxiety effects and hypnotic effects depends on dosage
53
Q

Benzodiazepines - insomnia (5)

A
  • used to treat anxiety and insomnia
  • used to induce general anesthesia
  • used to manage seizure disorders
  • potential for abuse
  • can produce physical dependence
54
Q

What are the two Benzodiazepines used specifically for sleep?

A
  1. temazepam (restoril)
  2. Triazolam (Halcion)
55
Q

Common Benzodiazepines

A
  1. diazepam
  2. lorazepam
  3. alprazolam
56
Q

Pharmacologic effects - Benodizepines

A
  • CNS reduce anxiety and promote sleep
  • Cardiovascular system: Oral vs. Intravenous
  • respiratory system: weak respiratory depressants
57
Q

Therapeutic uses of benzodiazepines

A
  • anxiety
  • insomnia
  • seizure disorders, muscle spasm
  • ETOH withdrawal, perioperative applications
58
Q

Adverse effects of Benzodiazepines -6

A
  • CNS depression
  • amnesia
  • sleep driving
  • paradoxical effects
  • respiratory depression
  • abuse
59
Q

oral overdose

A

drowsiness, lethargy, and confusion

60
Q

Intravenous toxicity

A

life threatening reactions, profound hypotension, respiratory arrest, and cardiac arrest

61
Q

alternative medicine

A

-complementary and alternative therapies
- white noise and relaxation strategies

62
Q

melatonin

A

effective related to jetlag and shift work

63
Q

insomnia nursing assessment

A
  • sleep history
  • assess diet,caffeine, and alcohol intake
  • ask about sleep aids
  • sleep diary for 2 weeks
  • medical history- factors that affect sleep
64
Q

insomnia nursing diagnosis

A
  • sleep deprivation
  • disturbed sleep pattern
  • readiness for enhanced sleep
65
Q

nursing implementation- insomnia

A
  • assume primary role in teaching sleep hygiene
  • teach patient about sleep medications
66
Q

What four things can you do to help with sleep hygiene

A
  1. decrease caffeine intake
  2. bedtime routine
  3. decreased blue light before bedtime
  4. reduce light and noise
67
Q

symptoms of sleep apnea

A
  • loud snoring
  • excessive day time sleepiness
  • morning headache
  • unrefreshing sleep
  • increased irritability
68
Q

treatments of non-surgical sleep apnea

A
  • change sleep position
  • decrease weight
  • CPAP
  • Drug therapy for underlying cause
69
Q

Surgical treatment sleep apnea

A
  • adenoidectomy
  • Uvulectomy
  • Remodeling posterior oropharynx
  • bariatric surgery to reduce weight
70
Q

complications in respiratory and sleep problems

A
  • hypertension
  • cardiac changes
  • poor concentration/memory
  • impotence
  • depression
71
Q

S/S of sleep apnea

A
  • frequent arousal during sleep
  • insomnia
  • excessive daytime sleepiness
  • witnessed apneic episodes
  • loud snoring
  • morning headache
  • irritability
72
Q

apnea

A

cessation of spontaneous respirations for longer than 10 seconds

73
Q

sleep apnea obstruction may last from – to – seconds

A

10-90 seconds

74
Q

risk factors of sleep apnea

A
  • obesity
  • age >65 years
  • neck circumference >17inches
  • craniofacial abnormalities that affect the upper airway
  • ## smokers are more likely to have OSA
75
Q

testing for sleep apnea

A

sleep study

76
Q

treatment of mild sleep apnea

A
  • sleeping on ones side
  • elevating HOB
  • avoiding sedatives and alcohol 3-4 hrs before
  • weight loss
  • oral appliance
77
Q

treatment of severe sleep apnea

A

-CPAP
- BiPAP
- Surgery

78
Q

patient teaching on CPAP and BiPAP

A
  • benefit of loosing weight
  • benefit of sleeping on side
  • avoid sedatives
  • stress reduction
  • stress importance of exercise
  • avoid smoking
  • self image disturbance
79
Q

discharge planning

A
  • case manger- need for equipment
    -nutritional consult
  • spiritual consult
80
Q

nursing diagnosis for sleep apnea

A
  • anxiety
  • insomnia
  • imbalanced nutrition
  • knowledge deficit
81
Q

Narcolepsy

A
  • brain unable to regulate sleep-wake cycles
  • causes uncontrollable urges to sleep, often fo directly into REM sleep
82
Q

two types of Narcolepsy

A

type 1: with cataplexy
type 2: without cataplexy

83
Q

symptoms of narcolepsy

A
  • sleep paralysis
  • cataplexy
  • fragmented nighttime sleep
84
Q

Nursing - narcolepsy

A
  • teach about sleep and sleep hygiene
  • take naps
  • avoid heavy meals and alcohol
  • ensure patient safety
  • lifestyle changes
85
Q

what are the two wake promotion drugs for narcolepsy?

A
  • modafinil
  • armodafinil
86
Q

Older age is associated with

A
  • overall shorter total sleep time
  • decreased sleep efficiency
  • more awakenings
  • insomnia symptoms
87
Q

Gerontologic - sleep

A
  • awakenings during the night increases risk for falls
  • medications used by older adults, cause sleep problems
  • avoid long-acting benzodiazepines
88
Q

nurse fatigue

A
  • inadequate sleep
  • extended work hours
  • increased risk for errors
89
Q

who is at risk for fatigue?

A
  • nurse compassion fatigue
  • patients
  • nurse
90
Q

being awake for 17 hours equals

A

blood alcohol level 0.05%

91
Q

being awake more then 24 hours

A

equivalent to blood alcohol level 0.10%

IM 1 (34 decks)

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