sleep evolve Flashcards
1
Q
what happens to HB BP and respiration during sleep
A
heart rate slows down by 10 or 20 per minute and BP and resperations deacrease
2
Q
Rapid eye movement (REM) sleep occurs during
A
deep sleep
3
Q
REM is associated with
A
altered vital signs, muscle relaxation, increased cerebral blood flow, and steroid release
4
Q
During non–rapid eye movement (NREM) sleep
A
physiologic activity is reduced; brain waves, breathing, and heart rate slow; and blood pressure drops
5
Q
sleep is regulated by
A
reticular activating system (RAS) and neurotransmitter interactions
6
Q
The most familiar rhythm is the
A
day-night, 24-hour circadian rhythm
7
Q
diurnal means
A
active during the day
8
Q
nocturnal means
A
most of their activity during the night
9
Q
Humans are normally considered to be
A
diurnal
10
Q
who controls the 24 hour circadian rythms
A
Nerve cells
11
Q
what affect the sleep cycle
A
daily routines, work schedules, social commitments, alarm clocks, noise, light–dark cycle
12
Q
Humans spend approximately ? of their lives asleep
A
one-third
13
Q
Polysomnography is
A
the recording of brain waves and other physiologic variables, such as muscle activity and eye movements, during sleep
14
Q
A normal polysomnograph shows a sleep sequence of ________ NREM stages and ____ REM stage
A
three, one
15
Q
a normal sleep pattern consists of how many cycle of sleep
A
three to five
16
Q
Quality of sleep is affected
A
frequent wakening, pain, and shortened REM stage of sleep
17
Q
The usual sleep sequence for a person
A
rapid progression through NREM stages 1 through 3, back through NREM stage 2, and then into REM sleep
18
Q
REM sleep lasts
A
up to 45 min
19
Q
stage 1NREM characteristics
A
- Lightest level of sleep, between sleep and wakefulness
- Vital signs and metabolism begin to decrease/slow down
- Easy arousal by external stimuli, such as noise
- Feeling of drowsiness
- Lasts a few minutes
- May occur during the day as “resting my eyes”
20
Q
NREM stage 2
A
- Relaxation increases
- Sleep becomes deeper
- Snoring may occur
- Relatively easy arousal
- Physiologic functions continue to slow
- Accompanied by occasional small muscle jerks
- Lasts 10–20 min
21
Q
NREM stage 3
A
- Deepest stage of sleep, called slow-wave or delta-wave sleep for the type of brain waves seen during this type of sleep
- More difficult arousal and rare movement
- Muscles relaxed
- Vital signs decrease, but regular rhythms/patterns maintained
- Restorative processes (such as the release of growth hormone) occur
- Sleep walking, somnambulism, and nocturnal enuresis may occur
- Strong stimuli needed for arousal
- Amount of time spent in slow-wave sleep depends on how long since a person slept
- Lasts approximately 30–60 min
22
Q
last stage REM
A
- Occurrence of vivid, colorful dreaming (less vivid dreaming may occur in other stages)
- Starts approximately 90 min after sleep is initiated
- Autonomous response causes rapid eye movements, fluctuating heart rate and respirations, and increased blood pressure
- Muscle tone decreased
- Gastric secretions increased
- Very difficult arousal
- Duration of REM sleep increases with each sleep cycle and averages 20 min
23
Q
what age group requires the most sleep
A
Newborns
24
Q
what age group requires the least sleep
A
older adults
25
People deprived of REM sleep become
agitated and impulsive
26
deprivation of NREM sleep results in
withdrawal and vague physical complaints
27
Sleep disorders are classified into
dyssomnias
parasomnias
secondary sleep disorders
28
Dyssomnias are
disorders associated with getting to sleep, staying asleep, or being excessively sleepy
29
Decreases in the amount or changes in the timing of sleep result in
daytime sleepiness, poor concentration, and a feeling of not being rested
30
Causes of dyssomnias
too much napping, anxiety, depression, high levels of stimulation at bedtime, medication use, shift work, and hyperthyroidism
31
disruption of the normal circadian sleep pattern occurs when
person cannot sleep when sleep is wanted, needed, or expected
32
consequences of circadian rhythm disturbances include
sexual dysfunction, memory difficulties, high blood pressure, obesity, and an increased risk for accidents
33
organ system problems that hurt sleep cycle
breast, prostate, and colorectal cancer; depression; coronary artery disease; impaired glucose tolerance; and decreased fertility
34
Dyssomnias underlying cause
* Insomnia
* Obstructive sleep apnea (OSA)
* Shift-work sleep disorder
* Time zone change (jet lag)
* Hypersomnia
* Restless legs syndrome
* Narcolepsy
* Sleep deprivation
35
Parasomnias
Specific Disorder/Underlying Cause
* Nocturnal enuresis
* Somnambulism
* Sleep terrors
* Bruxism
36
Secondary sleep disorders
Specific Disorder/Underlying Cause
* Physiologic effect of medical conditions: heart failure, chronic obstructive pulmonary disease, pain, or gastroesophageal reflux disease
* Hospitalization with a serious illness
* Mental health disorders:
* Depression
* Anxiety
* Fear
37
Insomnia is the most common
dyssomnia
38
Insomnia is characterized by
difficulty in falling asleep or staying asleep, sleep that is too light, or early-morning awakenings
39
insomnia consern
not getting enough sleep
40
The occurrence of insomnia increases with
age
41
Short-term insomnia usually can be traced to
acute stress or lifestyle changes
42
insomnia is more common in
women
43
Insomnia can lead to symptoms of
sleep deprivation and daytime fatigue, which can cause impairment in work, social, and other areas of functioning
44
Narcolepsy is
chronic neurologic disorder caused by the brain’s inability to regulate the sleep-wake cycle normally, resulting in an uncontrollable onset of sleep or loss of awareness
45
people with narcolepsy experience
overwhelming sleepiness and fall asleep for periods of seconds to several minutes
46
three other major symptoms frequently characterize narcolepsy
cataplexy
vivid hallucinations
brief episodes of total paralysis
47
cataplexy is
sudden loss of voluntary muscle tone
48
Scientists now believe that narcolepsy results from
disease processes affecting brain mechanisms that regulate REM sleep
49
people with narcolepsy enter rem sleep within
few minute of falling asleep
50
The diagnosis of narcolepsy is confirmed by
sleep diagnostic tests, including the polysomnogram and the multiple sleep latency test.
51
newborns should sleep ___ to ___ hours a day
14- to 17
52
Infants sleep __ to __ hours a day
12 to 15
53
toddler sleep
11 to 14 hours a day
54
School-age children sleep
9 to 11 hours a day
55
adolescent sleep
8 to 10 hours a day
56
adults sleep
7 to 9 hours a day
57
older adults sleep
7 to 8 hours a day
58
Hypersomnia is
excessive daytime sleepiness lasting at least 1 month that causes impairment in the ability to function in occupational or other areas of the affected person’s life
59
Hypersomnia can be caused by
kidney or liver disorders, diabetic acidosis, central nervous system damage, or hypothyroidism.
60
Sleep apnea is
condition in which the person experiences the absence of breathing (apnea) or diminished breathing during sleep between snoring intervals
61
Sleep apnea is characterized by
lack of airflow through the mouth and nose for at least 10 seconds, lasting up to 2 minutes, during sleep
62
most common type of sleep apnea is
OSA obstructive sleep apnea
63
OSA involves collapse of
the upper air way
64
Prolonged sleep apnea can cause
daytime sleepiness and an increase in blood pressure, leading to cardiac arrest
65
Risk factors for OSA include
being male,
overweight or obese
large neck circumference
smoking
alcohol use
middle-aged or older
family history of OSA
Structural abnormalities
66
Sleep deprivation occurs from
prolonged lack of sleep of good quality and adequate quantity
67
Disturbances of sleep leading to deprivation can be associated with
aging
hospitalization
drugs and substance abuse
stress
medications
environmental factors
disruptions of normal sleep pattern
68
Sleep deprivation symptoms
fatigue
headache
nausea
increased sensitivity to pain
decreased neuromuscular coordination
irritability
difficulty concentrating
69
Sleep deprivation could cause
hypertension
weight gain
inflammation
altered glucose metabolism and hormone regulation,
increased frequency of seizures in patients with seizure disorders
70
what promotes sleep and rest
appropriate noise
hygiene
light
comfort
socialization
hope
nutrition
conservation of patient energy
71
ICU could cause
sleep deprivation
72
Restless legs syndrome is also called
Willis-Ekbom disease
73
Restless legs syndrome is
familial sleep disorder
74
Restless legs syndrome characterized by
uncontrollable urge to move the legs resulting from intense, abnormal, lower-extremity sensations of crawling or tingling
75
Restless legs syndrome can occur at any age but is more common in
elderly
76
Parasomnias are
disorders associated with abnormal sleep behaviors, rather than disorders of sleep itself
77
Parasomnias behaviors comes from
activation of the autonomic nervous system, motor system, or cognitive processes during sleep or during the transitions between sleep and wakefulness
78
parasomnia is more common in
children and adolescents
79
attempting to wake a person up from parasomnia should be
ENCOURAGED
DISCOURAGED
DISCOURAGED
80
Somnambulism is
sleep walking
81
Nocturnal enuresis is
bedwetting at night
82
Nocturnal enuresis is a
socially disruptive and stressful condition that is common, but underreported, in childhood
83
what helps with nocturnal enuresis
Bed alarms
medications
behavioral therapy
84
sleep terrors are considered
parasomnia
85
sleep terrors are triggered by
fever, lack of sleep, use of alcohol, or periods of emotional stress or conflict
86
Bruxism is
the clenching of teeth or the grinding of teeth from side to side
87
bruxism is due to
stress
88
Secondary sleep disorders can be
disabling symptoms of underlying medical or psychiatric disorders
89
Lifestyle
work schedule that does not match the person’s biologic rhythms (such as night shift rotations or assignments) frequently interferes with sleep
90
fast-paced life with multiple demands can prevent a person from
relaxing and falling asleep easily
91
Diet and Exercise
type and amount of food and liquid consumed are recognized to affect sleep
92
caffeinated substances can cause
sleep distubance
93
nicotine can
affect sleep because it has a stimulating effect
94
what food promote sleep
snacks that contain complex carbohydrates
95
alchohol can
help fall asleep but increase wakefulness in last half of night
96
Medications that decrease REM sleep include
barbiturates
amphetamines
antidepressants
97
medications that affect sleep patterns include
diuretics
antiparkinson medications
antihypertensives
steroids
decongestants,
bronchodilator
98
what medication causes nightmares and insomnia
Beta blockers
99
Narcotics affect on sleep
suppress REM sleep
cause frequent awakening
may cause excessive daytime sleepiness
100
what medications help sleep (short term)
zaleplon
zolpidem
101
(long term) medications that improve sleep
Eszopiclone
102
Sleeping in new environments may
alter both NREM and REM sleep stages
103
hospitalization factors that affect sleep include
unfamiliar surroundings
sounds, and smells
proximity to other patients
lack of privacy
increased light levels
medical technology
underlying medical illnesses.
104
Psychological stress decreases
REM sleep
105
Anxiety—including stress associated with work, finances, illness, and family—can cause
intrusive thoughts
106
muscular tension, and increased norepinephrine levels may interfere with
being able to go to sleep and stay asleep
107
Relationships: new parents
New parents often report sleep disturbance as they adjust to the parenting role and associated frequent nightly awakenings
108
Poor Sleep Hygiene
Lack of good sleep habits may prevent adequate sleep
109
Focused Health Assessment Questions: sleep disorder
* Why do you think you are having sleep problems?
* Have you recently had any changes at home or at work?
* Have you started any new medications?
* Is there anyone else at home who does not sleep well?
110
Focused Health Assessment Questions: Insomnia
* How long does it take you to go to sleep?
* How often do you have trouble falling asleep?
* Do you have trouble staying asleep? Waking up early and not getting back to sleep?
* What time do you wake up in the morning? Do you use an alarm clock?
* What do you do to prepare for sleep?
* What have you tried to improve your sleep?
111
Focused Health Assessment Questions: Sleep Apnea
* Has anyone told you that you snore loudly or stop breathing while you sleep?
* Do you have headaches when you wake up?
* Do you have trouble staying awake during the day?
* Do you feel tired all the time?
112
Focused Health Assessment Questions:
* Do you fall asleep unexpectedly at random times? (Family or co-workers may report such episodes.)
* Do you have episodes of weakness, causing you to fall to the floor?
* Do you have vivid dreams when falling asleep?
113
physical assessment for sleep
inadequate energy level for tasks
physical weakness
fatigue
lethargy
decreased affect
behavioral signs, such as yawning or slow speech
114
Physical signs that may indicate potential sleep problems
obesity,
thick neck,
nasal polyps
deviated septum
shortness of breath.
115
Other signs sleep problems
muscle contractions and jerks that arouse the patient from sleep
snoring
sleep apnea
or the irregular periods of silence followed by an abrupt snort indicative of OSA
116
STOP-Bang tool assess for
OSA
117
STOP-Bang tool questions
Snoring
Tiredness and sleepiness during the day
Observed cessation of breathing during sleep
Blood Pressure abnormalities
118
STOP-Bang tool assessment data
Body mass index (BMI)
Age
Neck circumference
Gender
119
Polysomnography records
eye movements
muscle movement and activity
heart and respiratory rates
oxygen levels
airflow
brain activity while the patient sleeps
120
The results of polysomnography include
apnea-hypopnea index, or the number of apneic or hypopneic episodes per hour
121
hypopneic is
shallow or slow breathing
122
normal number of OSA (hypopneic)
fewer than 5 per hour
123
mild number of OSA (hypopneic)
5 to 15
124
moderate number of OSA (hypopneic)
15 to 30
125
severe OSA is more than (hypopneic)
30
126
sleep latency test monitor ? during several 20-minute naps during the day
brain waves
heartbeat
eye movement
127
sleep latency test is used for patients suspected of
having narcolepsy
128
sleep latency test shows weather the patient
enter REM sleep shortly after falling asleep
129
strategies to improve sleep
Addressing the sleep environment
supporting sleep routines
providing light snacks if allowed
instituting relaxation measures
carefully using medications
130
Treatment for insomnia should include
stimulus control
sleep restriction
sleep hygiene
cognitive therapy
131
Treatment for hypersomnia is aimed at
correcting any underlying conditions contributing to the hypersomnia
132
Treatment for narcolepsy
regular exercise routine
a regular sleep routine
daytime naps if possible
light meals high in protein to maintain alertness
vitamins
133
narcolepsy patient should avoid
alcohol
heavy meals
long-distance driving
long periods of sitting
134
Medications for narcolepsy
central nervous system stimulants
modafinil
tricyclic antidepressants
selective serotonin reuptake inhibitor antidepressants
sodium oxybate
135
Lifestyle changes for good sleep practices recommended in the treatment of sleep apnea
weight loss and avoiding alcohol
136
treatment of sleep apnea
surgical procedures to correct abnormalities of the soft tissue or bone structure that is obstructing the patient’s airway
use of an oral appliance while sleeping to keep the airway open
continuous positive airway pressure (CPAP)
137
Treatment for restless legs syndrome
decreased caffeine
alcohol
tobacco use
routine exercise
maintaining a regular sleep pattern
138
medications that help restless legs syndrome
dopaminergic agents
ropinirole
pramipexole
gabapentin enacarbil
rotigotine
Benzodiazepines and opioid medication (only if monitored by physician)
139
Bedtime Routines That Promote Sleep
Take a warm bath.
Eat a light snack that contains carbohydrates.
Drink warm milk.
Avoid caffeine, tobacco, and excessive alcohol.
Get a back massage.
Relax using aromatherapy and music therapy.
Adjust the environment for temperature, noise, and light.
Elevate the head of the bed for patients diagnosed with gastroesophageal reflux disease (GERD).
Avoid large meals and certain medications in the evening.
140
Antihistamines affect on sleep
sedative effects that can promote sleep
141
Tricyclic antidepressants affect on sleep
alleviate depression for their beneficial effect on sleep patterns
142
Sedative-hypnotics induce sleep but are associated with
disturbances in REM and NREM sleep patterns
143
Information to be recorded daily in the sleep diary includes:
* Activities and food within 2 hours of going to bed
* Time of retiring
* Time of awakening
* Required time to fall asleep
* Number of times aroused during the night
* Length of time awake if aroused during the night
* Degree of restfulness in the morning
* Use or nonuse of an alarm
* General comments regarding sleep
