Sleep Disorders Flashcards
sleep
- a physiological process
- the body’s rest cycle
- associated with recumbency and immobility
- lacks conscious awareness but easily awakened
- essential for healthy functioning and survival
sleep
- state in which an individual lacks conscious awareness of environmental surroundings but can be easily aroused
- insufficient sleep: obtaining less than the recommended amount of sleep, most adults require 7-8 hrs of sleep in a 24 hr period
- fragmented sleep: frequent arousals or actual awakenings that interrupt sleep
- nonrestorative sleep: sleep that is of adequate duration but does not result in the individual feeling refreshed and alert the next day
sleep disturbances and disorders
- sleep disturbance: conditions of poor sleep quality
- sleep disorders: abnormalities unique to sleep
– insomnia
– narcolepsy
sleep-wake cycle
- controlled by the brain
- wake behavior
– RAS and various neurotransmitters: reticular activating system helps control sleep-wake cycle
– orexin (hypocretin): helps regulate sleep-wake cycle, helps keep people awake, low level of orexin = prone to narcolepsy
reticular activating system (RAS)
- sensory stimuli within cerebral cortex
- regulates sleep-wake cycle
- 4 functions:
– motor
– sensory
– visceral: normal functioning of the organs, like breathing
– consciousness
(activation of RAS causes alertness and attention, when RAS is activated it affects the 4 functions)
circadian rhythm
- managed by the suprachiasmatic nucleus (SCN) in hypothalamus
- synchronized through light detectors in retina
- light is the strongest time cue
(circadian rhythm: biologic rhythms of behavior and physiology within a 24 hr period, strongly linked to light,
time cue: body meant to be awake when it is light, and asleep when it is dark,
ICU psychosis: pt not being able to distinguish day and night (bc almost never dark and lots of noise in ICU)
stages of sleep - chart
- NREM stage 1: 5%
- NREM stage 2: 50% (most)
- NREM stage 3: 15%
- REM: 25%
- wake after sleep onset: 5%
(majority of time in non REM sleep)
phases of sleep
- sleep latency: time it takes for a person to fall asleep
- NREM (non-rapid eye movement): 3 stages
- REM (rapid eye movement)
sleep latency
- starts when eyes are closed for sleep
- ends when non-REM sleep is entered
- time varies: usually 10-40 minutes
NREM sleep
- 75% to 80% of sleep time
- divided into 3 stages
– stage 1: slow eye movement (person can be easily awakened)
– stage 2: HR and temperature decrease (spend most of our night’s sleep)
– stage 3: deep or slow wave sleep (SWS); delta waves, parasomnias (difficult to awaken, decreases with age - older we get, less deep sleep we get)
parasomnias
- unusual and often undesirable behaviors while falling asleep, transitioning between sleep stages, or during arousal from sleep
- due to CNS activation
- examples:
– sleepwalking
– sleep terrors
– nightmares
– sleep paralysis
– sleep hallucinations
(common in stage 3 - slow wave sleep)
REM sleep
- 20-25% of sleep cycle
- occurs 3-4 times a night (cycle through sleep cycle 3-4 times a night)
- greatly reduced skeletal muscle tone
- period when most vivid dreaming occurs
(brain is very active but mentally restful)
stages of sleep - chart (she didn’t talk about)
- NREM stage N1: falling asleep
– heartbeat and breathing slow down
– muscles begin to relax
– lasts: a few min. - NREM stage N2: light sleep
– heartbeat and breathing slow down further
– no eye movements
– body temperature drops
– brain produces “sleep spindles”
– lasts: about 25 min. - NREM stage N3: slow wave sleep
– deepest sleep state
– heartbeat and breathing are at their slowest rate
– no eye movements
– body is fully 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 markedly increased
aging and sleep
- middle age:
– more stage shifts: down in NREM3 and REM
– resistant to sleep deprivation: can function on lower amount of sleep fairly well whereas younger person needs more sleep to focus
– increased awakenings
– changes in sleep efficiency - older adults:
– phase changes: go to bed earlier and arise earlier
which statement is true regarding REM sleep? select all that apply.
a. muscle tone is greatly reduced
b. it occurs only once at night
c. it is separated by distinct physiologic stages
d. the most vivid dreaming occurs at this phase
a. muscle tone is greatly reduced
d. the most vivid dreaming occurs at this phase
what is the best description for sleep?
a. quiet state in which there is little brain activity
b. loosely organized state similar to coma
c. state in which pain sensitivity decreases
d. state in which the individuals lack conscious awareness of the environment
d. state in which the individual lacks conscious awareness of the environment
effects of sleep deprivation and sleep disorders - picture
- neurologic:
– cognitive impairment
– behavioral changes (e.g., irritability, moodiness) - immune:
– impaired function - respiratory:
– asthmas exacerbated during sleep - cardiovascular:
– heart disease (hypertension, dysrhythmias)
– increased BP in people with hypertension
– stroke - gastrointestinal:
– increased risk for obesity
– increased gastroesophageal reflux disease (GERD) - endocrine:
– increased risk for type 2 diabetes
– increased insulin resistance
– decreased growth hormone
sleep disturbances in the hospital
- hospitalization associated with decreased sleep time
– environmental sleep-disruptive factors
– psychoactive medications
– acute and critical illness
(want to have quiet time, turn TV off, turn off lights so that pt has better sleep time)
insomnia
symptoms include:
- difficulty falling asleep
- difficulty staying asleep
- waking up too early
- complaints of waking up feeling unrefreshed
insomnia
acute insomnia:
- difficulty falling asleep or remaining asleep for at least 3 nights/week for less than a month
chronic insomnia:
- same symptoms as acute
- daytime symptoms that persist for 1 month or longer
insomnia
aggravated by inadequate sleep hygiene
- stimulants
- medications
- using alcohol to induce sleep (reduces REM sleep, more insufficient sleep)
- irregular sleep schedule
- nightmare
- exercising near bedtime (not good within 6 hrs of bedtime)
- jet lag
chronic insomnia
etiology:
- often no known cause
- stressful life event
- psychiatric illness or medical condition
- medications or substance abuse
insomnia
clinical manifestations:
- difficulty falling asleep (long sleep latency)
- frequent awakening (fragmented sleep)
- prolonged nighttime awakenings
- feeling unrefreshed on awakening (nonrestorative sleep)
- fatigue, trouble with concentration
- forgetfulness, confusion
- anxiety
insomnia
diagnosis:
- self-report
- actigraphy
- polysomnography (PSG): sleep study
– at home sleep study: thing on forehead and nasal cannula type thing
– traditional sleep study: done in office with the full stuff (EEG, EOG/ECG, oronasal air flow, chin EMG, position sensor, pulse ox, thoracic and abdominal movements, control unit)
(most common to self-report,
1st thing when might have insomnia is to keep a sleep log (time went to bed, time woke up, did they wake up during the night, did they feel refreshed?) keep sleep log for 2 weeks)
actigraphy
watch like device, worn on wrist, that can determine sleep and wake over a 14 day period
insomnia
interprofessional care
- education
- track sleep
- sleep hygiene (table 7-3)
- cognitive-behavioral therapy for insomnia
- complementary and alternative therapies (alt ex: aromatherapy)
- drug therapy
(since insomnia can be bc of stress and mental health, therapy is 1st line of treatment (bc it is least invasive and may solve problem without using meds)
patient teaching - chart
yes, no???? _________slide 32
