Sleep And Sleep Orders Flashcards
Sleep
A physiological process
The body’s rest cycle
Associated with recumbency and immobility
Lacks conscious awareness but easily awakened
Esssential for healthy functioning and survival
Actually definition of sleep
State in which an individual lacks conscious awareness of environmental surroundings but can be easily aroused
Insufficient sleep
Obtaining less than the recommended hour of sleep most adults require 7-8 hours in a 24 hour period
Fragmented sleep
Frequent arousal or actual awakening that interrupt sleep
Recumbency
To be laying down
Non restorative sleep
Sleep that is an adequate duration but does not result in the individual feeling fresh and alert the next day
What causes a person to have poor sleep quality?
Insomnia
Narcolepsy
Sleep apnea
Abnormalities unique to sleep
What is the sleep wake cycle controlled by?
The brain
What is our wake behavior controlled by
RAS - reticular activation system
What helps keep people awake?
Orexin
A person who has low levels of orexin tend to have narcolepsy
Activation of RAS causes
Alertness and attention
When RAS is activated what does it effect?
Motor sensory visceral consciousness
What does visceral mean ?
Normal Organ function like our heart beating
Rest is essential to what?
RAS
Circadian rhythm **
The biologic rhythm of behavior and physiology within a 24 hour period
What is strongly linked to circadian rhythm?
Light!!!! Day light is a huge factor in our circadian rhythm
Our body is built to be awake when it is light and asleep when it is dark
T/f
What can help a pt’s circadian rhythm if you are a nurse who works night shift to keep it normal
Quiet time, turn off the TV, dark curtains
ICU Psychosis
Patient not being able to distinguish day from night
REM
Rapid eye movement
Sleep latency
The time it takes for a person to fall asleep
Starts when eyes are closed for sleep and ends when NON-rem sleep is entered and can take 10-40 min
NREM
Non rapid eye movement 3 stages
75%to 80% of sleep time divided into three stages
Three stages of NREM
Stage 1 slow eye movement
Stage 2
HR and temp decrease
Stage 3 deep or slow wave sleep
SWS: delta waves. Parasomnias
Stage one of REM
A person can be easily awakened
Slow eye movements
Stage 2
HR and tempature decreases and this is where we spend most of our sleep
Stage 3
Deep or slow wave sleep
Difficult to awaken may have parasomnias
The older we get
The less deep or slow wave sleep we have
Parasomnias
Unusual and often undesirable behaviors while falling asleep, transitioning between sleep stages or during arousal from sleep due to CNS activation
Example of parasomnias
Nightmares
Sleep walking
Sleep terrors
Sleep paralysis
Sleep hallucinations
REM sleep
Brain is very active but mentally restful
Greatly reduced skeletal muscle tone
Period when most vivid dreaming occurs
Middle age
More shifts in their stages in sleep
Resistant to sleep deprivation
Increased awakenings
Changes in sleep efficiency
Older adults
Phase changes go to bed earlier and arise earlier
What are things that sleep deprivation can do to our bodies? Neurological
Cognitive impairment
Behavioral changes
What are things sleep deprivation can do to the body (immune)
Impaired function
What are things that sleep deprivation can affect the body (respiratory wise)
Asthma exacerbated during sleep
Cardiovascular what are things that can happen in the body because of sleep deprivation?
Heart diseases like hypertension dysrythmias)
BP in people with hyper tension
Stroke
Gastrointestinal what are some risk that can happen because of sleep deprivation?
Risk of obesity
Gastroesophageal reflux (GERD) disease
What are things that can happen because of sleep deprivation endocrine
Risk for type 2 diabetes
Insulin resistance
Growth hormones
What are some examples of sleep disturbances in the hospital?
Enviromental sleep-disruptive factors like beeping
Psychoactive medications
Acute and critical illness
Acute insomnia
Difficulty falling asleep or remaining asleep for at least 3 nights a week for less than a month
Chronic insomia
Same symptoms as acute
Daytime symptoms that persist for 1 month or longer
What can cause insomnia?
Stimulus like caffeine
Medication
Using alcohol to induce sleep
Irregular sleep schedules
Nightmare
Excercising near bed time
Jet lag
Why should you never use alcohol to induce sleep?
Alcohol reduces your rem sleep
It’s not good to excercise two hours before bed
T/f
Chronic insomnia
Often no known cause
Highly linked to stressful life event
Psychiatric illness or medical condition
Medications or substance abuse
Clinical manifestations of insomia
Difficult falling asleep (long sleep latency )
Frequent awakening (fragment sleep )
Prolonged nighttime awakenings
Feeling unrefreshed on awakenings (non restorative sleep)
Fatigue trouble with concentration
Forgetfulness confusion
Anxiety
How do we diagnose insomnia?
Self report
Actigraphy
Polysomnography (PSG)
Actigraphy
Watch like device, worn on the wrist that can determine sleep and wake over a 14 day period
What is the first thing you are going to do when a person thinks they have insomnia?
Tell them to keep a sleep log
Write down what time they went to bed
What time they woke up
Did they get up during the night
Did they feel refreshed when they woke up
What is the next step after a sleep log?
Actigraphy
What is the third thing we can do when a patient reports insomnia
Polysomnography
Polysomnography
EEG
EOG/ECG
Thoracic movement
Abdominal movement
Breathing patterns
Heart rate
Sleep wake cycle
Inter-professional care of insomnia
Education (teach what will help sleep)
Track sleep (keep log for two weeks)
Sleep hygiene
Cognitive-behavioral therapy for insomia (CBT-I)
Comple,emtatu and alternative therapies
Drug therapy
What is the first line of treatment for insomnia
Cognitive-behavioral therapy for insomnia(CPT-I)
What are the next things we can do for insomnia
Complementary and alternative therapies (aroma therapy melatonin)
Drug therapy
What are two things that will help you sleep?
Fat and protien
What are some things that you can include during education about sleep?
What will help you sleep
Insomnia causes
Psychiatric
Medical illness, medications
Stress:Sundance’s employment school life
Substances caffeine alcohol nicotine
Excercise
Age gender
Other factors :travel
Insomnia
Began with least invasive
Cognitive behavior therapy
Therapist
Counseling
Melatonin
Hormone that helps reduce sleep designed for short term use. If patients use it for longer than a month it will no longer work
Sedative hypnotic drug
A drug for sleep
Designed to decrease the CNS function
Can be used for anxiety and help with insomnia
What is another name for antianxiety drugs?
Anxiolytics
Benzodiazepines
Can be used for anxiety and insomnia, during general anesthesia
Used to manage sizer disorders, muscles spasms, panic disorder and alcohol withdrawal. Watch patients very carefully can get addicted
What are some common benzodiazepines?
Diazepam (Valium)
Lorazepam (Ativan)
alprazolam (xanax)
What are the common benzodiazepines used for?
Can cause sleepiness but not commonly used for sleep
What are the benzodiazepines that are only used for sleep
Temazepam (restoril)
Triazolam (halcion)
What can benzodiazepines will cause
Slow respiratory- breathing it slows down respiratory
Adverse effects
CNS depression
Amnesia
Sleep driving
Paradoxical effect
Respiratory depression
Abuse
Oral overdose of benzodiazepines
Drowsiness lethargy (super sleepy) and confusion
If a person gets too much benzodiazepines
Gastric lovage
Activated charcoal
Dialysis
Goal is to get it out of their system
Gastric lavage
We wash out their GI tract
Activated charcoal
Make them throw up
Flumazenil (Romazicon)
Reverses sedative effects if benzodiazepines but may not reverse respiratory depression
Monitor for seizures when benzodiazepine stopped monitor!!!!
Benzodiazepine receptor like agents
Zolpidem (ambien)
Zaleplon ( sonata)
eszopiclone (lunesta)
Zolipidem (ambien)
Sedative-hypnotic
Short term management of insomnia
Side effects :day time drowsiness and dizziness
People have been known to do crazy stuff like (sleep driving, doing things unknowingly)
Only for short term use
Zaleplon (sonata)
Short term management of insomnia
Less bizarre side effects
Eszopiclone (lunesta)
Approved for treating insomnia
Less side effects
No limitation on how long to use
Well tolerated
Low potential for abuse
Antidepressants
Trazodone (oleptro)
Doxepin and amitriptyline
Amitriptyline
Common antidepressant that can be used to help them sleep
Antihistamines
Diphenhydramine (Benadryl)
Doxylamine (unisom)
Unisom (doxlamine)
Can be used without prescription been around forever can only be used for 1-2 weeks
Can develop a tolerance
Alternatives medicines
Melatonin
Valerian root, chamomile, Passion flower, lemon balm, lavender
White noise and relaxation strategies
Epworth sleepiness scale
Give it to the patient to rate their sleepiness
Sleep apnea
Absence of breath while sleeping
What should you do when a pt is having trouble breathing?
You should raise the head of the bed
OSA / sleep apnea
Obstructive sleep apnea
Why does sleep apnea get closed?
Our airway gets closed
Our tongue may shifts back as well as the epiglottis
Symptoms of sleep apnea
Loud snoring
Excessive day time sleepiness
Frequent episodes of obstructed breathing during sleep
Morning headache
Unrefreshing sleep
Increased irritability
Non surgical Treatments of sleep apnea
Raise HOB
Decrease weight
CPAP
Drug therapy for underlying cause
Surgical therapy
Adenoldectomy
Uvulectomy
Remodeling posterior oropharynx
Bariatric surgery to decrease weight
Respiratory and sleep problems
Sleep apnea
Snoring and hypoventilation
Obesity hypoventilation syndrome
Reduced chest wall compliance
Increase work breathing
Decreased total lung capacity and functional residual capacity
OSA
Partial or complete upper airway obstruction during sleep
Apneic period may include hypoxemia and hypercapnia
Complications of respiratory and sleep problems can be
Hypertension
Cardiac changes
Poor concentration/ memory
Impotence
Depression
Polysomnography aka
Sleep study
Mild sleep apnea treatments
Sleep on one side
Elevating the head of the bed
Avoid sedatives and alcohol 3 to 4 hours before sleep
Weight loss
Oral appliance
Sleep apnea treatment severe > 15 apnea/hypopnea events/hr
CPAP
BiPAP
surgery
Uvulopalatopharyngoplasty (UPPP or UP3)
Genioglossal advancement and hyoid myotomy
Narcolepsy
Brain unable to regulate sleep wake cycles normally
Causes uncontrollable urges to sleep often go directly into REM sleep
Unknown causes
Low levels of orexin lead to difficulty staying awake
What are two types of narcolepsy
Type 1: with cataplexy
Type 2 : without cataplexy
BiPAP
Is for sicker patients
One pressure on inspiration and one pressure on expiration
Try to give patient a BiPAP before they incubate them in the hospital
If patient is on CPAP or BiPAP and they go on over night trips
Recommend that they take the CPAP and BiPAP with them due to shortages
Cataplexy
Is a brief and sudden loss of skeletal muscle tone that can manifest as an episode of muscle weakness or complete collapse and falling
What are some symptoms of narcolepsy
Sleep paralysis
Cataplexy
Fragmented nighttime sleep
Nursing and inter professional management
Of narcolepsy
Teach about sleep and sleep hygiene
Take naps
Avoid heavy melas and alcohol
Ensure patient safety
Lifestyle changes
How many naps a day should someone with narcolepsy nap
3 or more short naps for 15 minutes through out the day
Avoid large meals and alcohol
Drug therapy for narcolepsy
Modafinil (provigil)
Armodafinil (nuvigi)
Both are wake promotion drugs
What happens as people age?
They get less sleep
Sleep paralysis
Mentally alert of body but body is not awake
Why would older people get up a lot at night
May use the restroom
Be in pain
Medication
Need a drink of water due to dry mouth
Respiratory issues
Symptoms of insomnia
What does more awakenings during the night for older people increase
The risk of falls
Why should we avoid long acting benzodiazepines in geriatric patients
It can cause day time sleepiness
Nurse fatigue
Inadequate sleep
Extended work hours
Increased risk for errors
When a nurse is awake for 17 hours it is the same as
Blood alcohol level being at 0.05%
If nurses are awake for more than 24 hours
Equivalent to blood alcohol level .10%
What it is recommended for a nurse to work
No more than 12 hours in a 24 hour period
Limit to 60 hours 7 days period
Dos of nurse fatigue
Take at least one break addition to lunch break
We caffeine therapeutically as a stimulant to stay awake
Nutrition
Complex carbs and proteins
Excercise
DO NOT
Drink alcohol (depressant)
