Sleep and Wake Disorders

Question 1

1. Circadian Rhythm:

The term “circadian” is derived from the Latin words “circa” (meaning “around”) and “diem” (meaning “day”). Circa (circulo)-dian (dia)

Answer 1

• The circadian rhythm is a natural, internal process that regulates the sleep-wake cycle and repeats roughly every 24 hours.
  
  • It is influenced by external factors such as light and darkness, and it plays a crucial role in regulating various physiological and behavioral processes.

Question 2

2. Stages of Sleep:

Answer 2

• Sleep is generally divided into two main types: REM (Rapid Eye Movement) and non-REM (NREM) sleep.
  
  • Non-REM in turn sleep has three stages:
    
    • Stage 1: Light sleep, transition from wakefulness to sleep. It is a brief stage.
    • Stage 2: Slightly deeper sleep, characterized by a decrease in heart rate and body temperature.
    • Stage 3: Deep sleep, AKA slow-wave sleep (SWS). It is essential for physical restoration and growth.

Question 3

3. REM (Rapid Eye Movement) Sleep:

Answer 3

• REM sleep is characterized by rapid eye movements, increased brain activity, and vivid dreaming.
  
  • It plays a crucial role in cognitive functions, learning, and memory consolidation.

Question 4

4. Etiology of sleep-related issues:

Answer 4

• Include factors such as genetic predisposition, lifestyle, environmental influences, and medical conditions that contribute to sleep-related issues.

Question 5

5. DSM-5 Sleep Disorders:

Answer 5

• Hypersomnolence Disorder: Excessive sleepiness despite getting enough sleep.
• Narcolepsy/Hypocretin Deficiency: Characterized by sudden and uncontrollable episodes of falling asleep. (Neuropeptides produced by neurons in the hypothalamus. (Hypocretin deficiency is most notably associated with a sleep disorder called narcolepsy)
• Breathing-Related Sleep Disorders::
• Obstructive Sleep Apnea Hypopnea Syndrome (OSAHA): Breathing pauses during sleep due to airway obstruction.
• Central (CNS) Sleep Apnea: Lack of respiratory effort during sleep.
• Circadian Rhythm Sleep Disorder:
• Shift Work Type: Sleep difficulties due to working non-traditional hours.
• Advanced Sleep Phase Type: A tendency to fall asleep and wake up earlier than desired.
• Delayed Sleep Phase Type: A tendency to fall asleep and wake up later than desired.

Question 6

1. Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders:

This is the initial phase of sleep, constituting about 75-80% of a sleep cycle.

(The cycle is : 90- to 120-minutes )

Answer 6

• Sleepwalking (Somnambulism): Involves walking or other complex behaviors during sleep, typically during the first third of the night. (Ex: if you sleep 9h it would be during the first 3h)
  Somnambulism, commonly known as sleepwalking, typically occurs during Non-Rapid Eye Movement (NREM) sleep. Sleepwalking episodes often happen during the deeper stages of NREM sleep, specifically during the slow-wave sleep (SWS) phases.
• Sleep Terrors [During NREM sleep] (Night Terrors): Episodes of intense fear and panic during sleep, often accompanied by screaming and physical movements. Not the same as a nightmare but yes somehow

Question 7

2. Nightmare Disorder:

Answer 7

• Involves repeated, disturbing dreams that lead to awakenings and a recall of vivid, disturbing imagery.

Question 8

3. REM Sleep Behavior Disorder:

Answer 8

• Characterized by the absence of normal muscle paralysis during REM sleep, leading to acting out dreams physically.

Question 9

4. Restless Leg Syndrome (RLS):

Answer 9

• A neurological disorder characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations.

Question 10

5. Substance-Induced Sleep Disorder:

Answer 10

• Sleep disturbances caused by substance use (e.g., drugs, medications, or withdrawal from substances).

Question 11

6. Insomnia Disorder:

Answer 11

• Persistent difficulty falling asleep, staying asleep, or achieving restorative sleep, leading to impaired daytime functioning.

Question 12

Nursing Process: 1. Assessment (pg. 363-365):

Answer 12

• Comprehensive assessment of the patient's sleep patterns, habits, and any sleep-related disturbances.
  
  • Consideration of the patient’s medical history, medications, lifestyle, and environmental factors affecting sleep.
  • Identification of any signs and symptoms of sleep disorders, such as difficulty falling or staying asleep, snoring, daytime sleepiness, etc.

Question 13

Nursing Process: 2. Diagnosis (NANDAs - North American Nursing Diagnosis Association):

Answer 13

• Sleep Deprivation:
  
  • Related to insufficient quantity or quality of sleep.
  • Evidenced by complaints of fatigue, irritability, difficulty concentrating, and impaired functioning.
• Insomnia:
  
  • Related to difficulty falling asleep, staying asleep, or achieving restorative sleep.
  • Evidenced by self-report of sleep difficulties and impaired daytime functioning.
• Readiness for Enhanced Sleep:
  
  • Related to expressed desire to improve sleep patterns.
  • Evidenced by the patient’s willingness to engage in sleep-promoting activities.
• Disturbed Sleep Pattern:
  
  • Related to factors such as irregular sleep-wake cycles, environmental disruptions, or medical conditions.
  • Evidenced by reports of disrupted sleep patterns and observable disturbances.

Question 14

Nursing Process: 3. Expected Outcomes:

Answer 14

• Sleep Deprivation:
  
  • Patient will report feeling more rested and alert.
  • Patient will demonstrate improved concentration and cognitive function.
• Insomnia:
  
  • Patient will achieve improved sleep quality and duration.
  • Patient will report decreased daytime sleepiness and improved daytime functioning.
• Readiness for Enhanced Sleep:
  
  • Patient will adopt and maintain sleep-promoting behaviors.
  • Patient will demonstrate an understanding of factors contributing to improved sleep.
• Disturbed Sleep Pattern:
  
  • Patient will establish a regular sleep-wake cycle.
  • Patient will report fewer disruptions to sleep and improved sleep continuity.

Question 15

Nursing Process: ### Interventions: Non-Pharmacologic

Answer 15

Non-Pharmacologic/Sleep Hygiene (Box 19.2):
1. Maintain a Consistent Sleep Schedule:
- Go to bed and wake up at the same time every day, even on weekends.
- This helps regulate the body’s internal clock.

2. Create a Relaxing Bedtime Routine:
   
   • Develop calming activities before bedtime, such as reading a book or taking a warm bath.
3. Optimize Sleep Environment:
   
   • Keep the bedroom dark, quiet, and cool.
   • Use comfortable bedding and consider blackout curtains or an eye mask.
4. Limit Exposure to Screens Before Bed:
   
   • Reduce exposure to screens (phones, computers, TVs) at least an hour before bedtime.
   • The blue light emitted by screens can interfere with melatonin production.
5. Limit Stimulants and Alcohol:
   
   • Avoid caffeine and nicotine close to bedtime.
   • Limit alcohol intake, as it can disrupt sleep patterns.
6. Exercise Regularly:
   
   • Engage in regular physical activity, but avoid vigorous exercise close to bedtime.
7. Manage Stress:
   
   • Practice relaxation techniques such as deep breathing, meditation, or progressive muscle relaxation.

Question 16

Pharmacologic Interventions

Answer 16

1. Benzodiazepines:
   
   • Examples include Klonopin (clonazepam), Restoril (temazepam), Halcion (triazolam).
   • Used for their sedative and anxiolytic properties.
   • Generally prescribed for short-term use due to the risk of dependence.
2. Non-benzodiazepine Hypnotics:
   
   • Examples include Lunesta (eszopiclone), Sonata (zaleplon), Ambien (zolpidem).
   • Act on the same receptors as benzodiazepines but with a different chemical structure.
   • Prescribed for short-term treatment of insomnia.
3. Other Soporifics (somníferos):
   
   • Trazodone: An antidepressant with sedative properties often used off-label for insomnia.
   • Melatonin: A hormone that regulates the sleep-wake cycle; used for jet lag and sleep disorders.
   • Diphenhydramine: An antihistamine with sedative effects; found in some over-the-counter sleep aids.
4. Psychostimulants for Narcolepsy:
   
   • Modafinil (class of drugs known as eugeroics) or Methylphenidate: Stimulant medications that promote wakefulness and are used in the treatment of narcolepsy.

Question 17

The terms “Rapid Eye Movement” (REM) and “Non-Rapid Eye Movement” (NREM) refer to different phases of sleep based on the movement of the eyes:

1. Rapid Eye Movement (REM):
   
   • Explanation: During REM sleep, your eyes move quickly in various directions.
   • Characteristics: This stage is associated with vivid dreams and increased brain activity, similar to when you’re awake.
   • Eye Movement: Rapid and noticeable eye movements.
2. Non-Rapid Eye Movement (NREM):
   
   • Explanation: In NREM sleep, your eyes don’t move rapidly; they remain relatively still.
   • Characteristics: NREM sleep has different stages, including lighter and deeper sleep phases. It’s typically dreamless, and the body is in a more relaxed state.
   • Eye Movement: Minimal or non-rapid eye movement.

So, the terms simply describe whether your eyes are moving quickly (REM) or not moving rapidly (NREM) during different stages of sleep.

Question 18

The deepest stage of sleep occurs during Non-Rapid Eye Movement (NREM) sleep, specifically in the stages known as slow-wave sleep (SWS).

The entire sleep cycle repeats multiple times throughout the night, with NREM and REM sleep occurring in roughly 90- to 110-minute cycles. The initial sleep cycles of the night tend to have longer periods of deep NREM sleep, while REM sleep becomes more prominent in the later cycles. However, the exact timing and duration of each stage can vary between individuals.