Sleep and sleep disorders- exam 7 Flashcards
Sleep
- physiological process
- body’s rest cycle
- lacks conscious awareness but easily awakened
- essential for health functioning and survival
- associated with recumbency and immobility
State in which an individual lacks conscious awareness of environmental of environmental surroundings but can be easily aroused
sleep
Insufficient sleep
obtaining less sleep
fragmented sleep
frequent arousals
nonrestorative sleep
sleep that is adequate - duration but do not feel refreshed the next day
State of rest accompanied by natural altered consciousness
Sleep
interrelated concepts of sleep
- coping
- comfort
- safety
- functional ability
positive consequences in sleep
- ability to focus
- alert normal reflexes
- awake and refreshed
negative consequences of sleep
- slowed responds
- fatigue
- irritability
- altered thought
- psychosis
sleep disturbance
conditions of poor sleep quality
sleep disorders
- abnormalities unique to sleep
- insomnia
- narcolepsy
sleep- wake cycle controlled by
- controlled by the brain
Wake behavior
- RAS and various neurotransmitters
- orexin (hypocretin)
(RAS) Reticular Activating System
- sensory stimuli within cerebral cortex
- regulates sleep-wake cycle
4 functions
what are the 4 functions of RAS
- motor
- sensory
- visceral
- consciousness
Circadian Rhythm
- Managed by the suprachiasmatic (SCN) in hypothalamus
- synchronized through light detectors through light detectors in retina
- light is the strongest time cue
Sleep latency
When you begin to fall asleep
sleep latency
- starts when eyes are closed for sleep
- ends when NREM sleep is entered
- time varies (10-40 minutes)
NREM Sleep- what is the percentage of sleep time?
75-80%
what are the three stages in NREM sleep?
- slow eye movements
- HR and temperature decrease
- deep or sloe wave sleep; delta waves, parasomnias
parasomnias
- unusual and often undesirable behaviors while falling asleep, transitioning between sleep stages, or during arousal from sleep
- due to CNS activation
examples of parasomnias - 5
- sleepwalking
- sleep terrors
- nightmares
- sleep paralysis
- sleep hallucinations
REM sleep is what % of sleep?
20-25% of sleep cycle
REM sleep occurs how many times during the night?
3-4 times a night
REM sleep greatly reduces
skeletal muscle tone
during what sleep cycle do we have periods of vivid dreaming occurs?
REM Sleep
NREM Stage 1
- falling asleep
- heartbeat and breathing slow down
- muscles begin to relax
- lasts a few minutes
NREM Stage N2-
- light sleep
- heartbeat and breathing slow down further
- no eye movements
- body temp drops
- brain produces “sleep spindles”
- lasts about 25 min
NREM Stage N3 (7)
- Slow Wave SLeep
- 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
REM Stage R
- primary dreaming stage
- eye movements become rapid
- breathing and heart rate increases
- limb muscles become temporarily paralyzed
- brain activity is marked increased
Middle age Sleep - 4
- more stage shifts- decrease in NREM3 and REM
- resistant to sleep deprivation
- increased awakenings
- changes in sleep efficiency
older adults - sleep
phase changes - go to bed earlier and arise earlier
Neurologic - effects of sleep deprivation
- cognitive impairment
- behavioral changes
> Irritability
> moodiness
Immune- effects of sleep deprivation
impaired function
Respiratory - effects of sleep deprivation
- asthma exacerbated during sleep
Cardiovascular - effects of sleep deprivation
- heart disease
> hypertension - increase BP in people with hypertension
- stroke
Gastrointestinal- Effects of sleep deprivation
- increase risk for obesity
- increased gastroesophageal reflux disease
Endocrine - effects of sleep deprivation
- increased risk for type 2 diabetes
- increased insulin resistance
- decrease growth hormone
Sleep disturbances in the hospital
- hospitalization associated with decreased sleep time
- environmental sleep-disruptive factors
- psychoactive medications
- acute and critical illness
Symptoms of insomnia -4
- difficulty falling asleep
- difficulty staying asleep
- waking up too early
- complaints of waking up feeling unrefreshed
acute insomnia
difficulty falling asleep
3 nights/week for less than a month
Chronic Insomnia
- difficulty falling asleep
- daytime symptoms that persist for one month or longer
insomnia is aggravated by ___ sleep hygiene
inadequate
aggravated by inadequate sleep hygiene-7
- stimulants
- medications
- using alcohol to induce sleep
- irregular sleep schedules
- nightmare
- exercising near bedtime
- jet lag
Etiology - Chronic Insomnia
-often no known cause
- stressful life event
- psychiatric illness or medical condition
- medications or substance abuse
Clinical Manifestations of insomnia -7
- difficulty falling asleep
- frequent awakening
- prolonged nighttime awakenings
- feeling unrefreshed on awakening
- fatigue, trouble with concentration
- forgetfulness, confusion
- anxiety
diagnosis of insomnia
- self report
- actigrahpy
- polysomnography
actigraphy
watch like device worn on the wrist, that can determine sleep and wake over a 14 day period
Insomnia - interprofessional care
- education
- track sleep
- sleep hygiene
- cognitive behavioral therapy for insomnia
- complementary and alterative therapies
- drug therapy
causes of insomnia -7
- psychiatric
- medical illness, medications
- stress
- substances
- exercise
- age, gender
- travel
treatment of insomnia
- begin with least invasive
- cognitive behavior therapy
- therapist~ counseling
Sedative-Hypnotic drugs - insomnia drug therapy
- 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
Benzodiazepines - insomnia (5)
- used to treat anxiety and insomnia
- used to induce general anesthesia
- used to manage seizure disorders
- potential for abuse
- can produce physical dependence
What are the two Benzodiazepines used specifically for sleep?
- temazepam (restoril)
- Triazolam (Halcion)
Common Benzodiazepines
- diazepam
- lorazepam
- alprazolam
Pharmacologic effects - Benodizepines
- CNS reduce anxiety and promote sleep
- Cardiovascular system: Oral vs. Intravenous
- respiratory system: weak respiratory depressants
Therapeutic uses of benzodiazepines
- anxiety
- insomnia
- seizure disorders, muscle spasm
- ETOH withdrawal, perioperative applications
Adverse effects of Benzodiazepines -6
- CNS depression
- amnesia
- sleep driving
- paradoxical effects
- respiratory depression
- abuse
oral overdose
drowsiness, lethargy, and confusion
Intravenous toxicity
life threatening reactions, profound hypotension, respiratory arrest, and cardiac arrest
alternative medicine
-complementary and alternative therapies
- white noise and relaxation strategies
melatonin
effective related to jetlag and shift work
insomnia nursing assessment
- sleep history
- assess diet,caffeine, and alcohol intake
- ask about sleep aids
- sleep diary for 2 weeks
- medical history- factors that affect sleep
insomnia nursing diagnosis
- sleep deprivation
- disturbed sleep pattern
- readiness for enhanced sleep
nursing implementation- insomnia
- assume primary role in teaching sleep hygiene
- teach patient about sleep medications
What four things can you do to help with sleep hygiene
- decrease caffeine intake
- bedtime routine
- decreased blue light before bedtime
- reduce light and noise
symptoms of sleep apnea
- loud snoring
- excessive day time sleepiness
- morning headache
- unrefreshing sleep
- increased irritability
treatments of non-surgical sleep apnea
- change sleep position
- decrease weight
- CPAP
- Drug therapy for underlying cause
Surgical treatment sleep apnea
- adenoidectomy
- Uvulectomy
- Remodeling posterior oropharynx
- bariatric surgery to reduce weight
complications in respiratory and sleep problems
- hypertension
- cardiac changes
- poor concentration/memory
- impotence
- depression
S/S of sleep apnea
- frequent arousal during sleep
- insomnia
- excessive daytime sleepiness
- witnessed apneic episodes
- loud snoring
- morning headache
- irritability
apnea
cessation of spontaneous respirations for longer than 10 seconds
sleep apnea obstruction may last from – to – seconds
10-90 seconds
risk factors of sleep apnea
- obesity
- age >65 years
- neck circumference >17inches
- craniofacial abnormalities that affect the upper airway
- ## smokers are more likely to have OSA
testing for sleep apnea
sleep study
treatment of mild sleep apnea
- sleeping on ones side
- elevating HOB
- avoiding sedatives and alcohol 3-4 hrs before
- weight loss
- oral appliance
treatment of severe sleep apnea
-CPAP
- BiPAP
- Surgery
patient teaching on CPAP and BiPAP
- benefit of loosing weight
- benefit of sleeping on side
- avoid sedatives
- stress reduction
- stress importance of exercise
- avoid smoking
- self image disturbance
discharge planning
- case manger- need for equipment
-nutritional consult - spiritual consult
nursing diagnosis for sleep apnea
- anxiety
- insomnia
- imbalanced nutrition
- knowledge deficit
Narcolepsy
- brain unable to regulate sleep-wake cycles
- causes uncontrollable urges to sleep, often fo directly into REM sleep
two types of Narcolepsy
type 1: with cataplexy
type 2: without cataplexy
symptoms of narcolepsy
- sleep paralysis
- cataplexy
- fragmented nighttime sleep
Nursing - narcolepsy
- teach about sleep and sleep hygiene
- take naps
- avoid heavy meals and alcohol
- ensure patient safety
- lifestyle changes
what are the two wake promotion drugs for narcolepsy?
- modafinil
- armodafinil
Older age is associated with
- overall shorter total sleep time
- decreased sleep efficiency
- more awakenings
- insomnia symptoms
Gerontologic - sleep
- awakenings during the night increases risk for falls
- medications used by older adults, cause sleep problems
- avoid long-acting benzodiazepines
nurse fatigue
- inadequate sleep
- extended work hours
- increased risk for errors
who is at risk for fatigue?
- nurse compassion fatigue
- patients
- nurse
being awake for 17 hours equals
blood alcohol level 0.05%
being awake more then 24 hours
equivalent to blood alcohol level 0.10%
