Sleep Disorders

Question 1

Manifestations of Insomnia?

Answer 1

• Difficulty falling asleep (long sleep latency)
• Difficulty maintaining sleep (prolonged nighttime awakenings or awakening too early and not being able to fall back to sleep)
• Awakening earlier than desired
• Avoidance or resistance to scheduled bedtime
• Inability to sleep without intervention

Question 2

How to assess for insomnia?

Answer 2

• Diagnostic studies
• Self-Report
  
  • Subjective information
  • 1-2 week sleep diary
    → Number and times of naps
    → Times of going to bed, awakening, getting up
    → Number of awakenings
    → Overall sleep quality ratings
• Comprehensive sleep history
• Actigraphy

Question 3

Drug therapy for insomnia?

Answer 3

• Benzodiazepine-receptor agonists (zolpidem, eszopiclone)
  
  • Recommended for intermittent, not daily
  • Stop drug immediately if they experience sleepwalking, sleep driving
• Melatonin receptor agonists (ramelteon)
  
  • Rapid onset medication for insomnia; not for waking during the night
• Antidepressants (trazodone, amitriptyline, mirtazapine)
  
  • Some antidepressants have sedation side effects
• Benzodiazepine Hypnotics (temazepam)
  
  • Can cause dangerous sedation with alcohol or other CNS depressants
  • Recommended for 2-3 weeks duration only
• Antihistamines (diphenhydramine, hydroxyzine)
• Antipsychotics (quetiapine, olanzapine)

Question 4

Implementations for insomnia?

Answer 4

• Patient education on sleep hygiene may be helpful but is inadequate for chronic insomnia
• CBT-I for chronic insomnia
• Decrease caffeine intake
• Reduce light and noise; avoid looking at the clock; keep bedroom temperatures cooler
• Teach safe use of sleep medications/aids

Question 5

Manifestations of narcolepsy?

Answer 5

Cataplexy

• Brief and sudden loss of skeletal muscle tone
• Can manifest as a brief episode of muscle weakness or complete postural collapse and falling

Question 6

What is OSA (Obstructive Sleep Apnea)?

Answer 6

Partial or complete upper airway obstruction during sleep:

• Usually occur during REM cycle (airway muscle tone is lowest)
• Occur repeatedly throughout the night

Apnea:

• > 90% cessation of respiratory airflow lasting >10 seconds

Hypopnea:

• 30-90% decrease in airflow

Question 7

Manifestations of Obstructive Sleep Apnea (OSA)?

Answer 7

• Frequent arousals during sleep
• Insomnia
• Excessive daytime sleepiness
• Witnessed apneic episodes
• Snoring
• Morning headache
• Irritability
• Personality changes

Question 8

Seizure precautions at bedside?

Answer 8

• Suction in case of aspiration
• Ambu bag and oxygen in case of oxygen deprivation
• Padded bed frame in case of uncontrollable body movement
• Bed frame positioned closer to the floor in case of fall

Question 9

Seizure precautions at unit?

Answer 9

Crash cart/Emergency cart

Question 10

Recognizing Tonic-Clonic Seizures?

Answer 10

• Characterized by loss of consciousness and falling to the ground
• Body stiffens (tonic) with subsequent jerking of extremities (clonic)
• Dilated pupils, hyperventilation, then apnea
• Cyanosis, excessive salivation, and tongue or cheek biting, incontinence

Question 11

How to keep patient safe during a seizure?

Answer 11

• Maintain suction at client’s bedside
• Have oxygen available
• Safety measures
• Maintain IV access
• Document specifics of seizure
• Open and maintain patent airway, support head, turn to side, loosen constrictive clothing, ease to floor
• Do not restrain patient or place any objects in their mouth
• May require positioning, suctioning, or oxygen after seizure

Question 12

Absence seizures?

Answer 12

• Most often occurs in children and rarely beyond adolescence
• Occurs more often in girls
• May stop as child matures, or may evolve into another type of seizure
• Typical absence seizure
  
  • Sudden onset brief staring spell, lasts less than 10 to 20 seconds

Question 13

Atypical absence seizures?

Answer 13

• Characterized by staring spell with other manifestations
  
  • Eye blinking
  • Jerking movements of the lips
  • Repetitive finger movements
• Lasts as much as 30 seconds
• Usually continue into adulthood

Question 14

Focal awareness seizures?

Answer 14

• Client remain conscious and alert
• Have unusual feelings or sensations
  
  • Sudden and unexplainable feelings of joy, anger, sadness, or nausea
  • May hear, smell, taste, see, or feel things that are not real
  • Localized twitching

Question 15

Focal impaired awareness seizures?

Answer 15

• Clients have loss of consciousness or a change in awareness
• Eyes are open but abnormal response
  
  • May do things that can be dangerous or embarrassing
  • After seizure, no memory of activities

Question 16

Caring for a patient experiencing a seizure in bed?

Answer 16

• Turn your client to the side to reduce the risk of choking; head should be flexed forward
• Loosen clothing from the neck, chest, or abdominal areas
• Remove the pillow and raise padded side rails
• Provide supplemental oxygen if the client is struggling to breathe
• Never restrain the limbs
• Administer drug therapy (usually benzodiazepines) to control seizures

Question 17

Caring for a patient experiencing a seizure not in bed?

Answer 17

• Lower client to the floor, if possible
• Protect head from injury
• Move furniture that may injure the client