Sleep & Fatigue Flashcards
5 Stages of Sleep Cycle
- Awake
- NREM 1 ( falling asleep )
- NREM 2 ( light )
- NREM 3,4 ( deep sleep )
- REM ( rapid eye movement )
How many sleep cycles do we complete a night?
4-5
Most/ Least amount of time
50% of sleep in N2
25% in REM
Sleep Cycles throughout the night
Deep sleep is longer at the start of the sleep period
What happens during a sleep cycle?
- Regulation of appetite hormones
- Growth hormone secretion
- Memory consolidation
- Altered state
- Tissue growth and repair
- Brain growth
- Muscle relaxing
- Brain regrouping
N1
- Heart and breathing slow down
- Muscles relax
- Mins
N2
- No eye movements
- Body temp drops
- 25 mins
N3
- Deepest sleep
- Slowest HR
- Fully relaxed
REM
- Dreaming stage
- Eye movements become rapid
- Rem is where restoration of brain tissue and cognitive function
- Waking in deep sleep will cause confusion
Circadian Rhythm
Regulates:
- When you go to sleep
- When you wake up
- BP
- Temp
- Hormone secretion
Cortisol is highest when?
In morning
Melatonin is lowest/ highest when?
Melatonin is lowest in morning and highest at night
Sleep Across Lifespan: Newborns
- Sleep an average of 16 hours a day
- Don’t have a circadian rhythm for first four weeks
- Enter REM immediately after falling asleep
Sleep Across Lifespan: Infants
- 15 hours a day of sleep
- 1/3 is in REM
Sleep Across Lifespan: Toddlers
- Sleep an average of 11-13 hours
- Night-time fears
- Need consistent bedtime routine
Sleep Across Lifespan: School age
- Sleep for 10-11 hours
- Sacrifices sleep for other things
Sleep Across Lifespan: Teens
- 9-10 hours
- Sleeping in, waking up later
Sleep Across Lifespan: Adults
- 7-9 hours a night
Older Adults and Sleep
- 7-9 hours a night
- Awake earlier, go to bed earlier
- Sleep latency ( can’t fall asleep )
- Awakening in night ( polyuria )
- Less deep sleep
Types of Sleep Disturbances
- Insomnia
- Hypersomnia ( randomly falling asleep )
- Sleep apnea ( breathing starts/stops )
- Restless leg syndrome
- Parasomnias
- Circadian rhythm disorders
Primary sleep disorders…
Are those that exist as an independent condition
Secondary Sleep Disorders
Occur as the result of some other situation and correcting that situation with sleep
- Caused by medical conditions, mental health
- Conditions that impair sleep: Alzheimers, GERD
- Meds that impair sleep: Beta blockers, corticosteroids, diuretics
Insufficient Sleep –>
Day-Time Sleepiness
Who is at risk for sleep disturbances?
- Adolescents
- Poor Sleep
- Pregnant people
- Older adults
- Shift workers
- Chronic conditions
Risk factor for lack of sleep ( Huge )
HOSPITLIZATION
BEARS
Sleep assessment:
- B: Bedtime problems
- E: Excessive daytime sleepiness
- A: Awakenings during night
- R: Regularity/ Duration of sleep
- S: Sleep disorders breathinh
Sleep Assessment
- Self Report ( Sleep Diary )
- Report from parent
- Symtoms: Insomnia, irratability
How to modify environment to promote sleep in a Hospital?
- Turn off lights
- Do Not Disturb sign
- Close door
- Comfy position
Is napping all day healthy?
No, messes with circadian rhythm
Promoting good sleep hygiene
- Regular bedtime / wake up
- Relaxing before bed
- No electronics
- Avoid naps
Obstructive Sleep Apnea
Patient stops breathing while they sleep!
- Soft palate or tongue obstruction
- Risks: High BP, Stroke, Weight, Diabetes, Pulm Disease, Cardio Disease, smoking, edema in throat
OSA Risk Factors
- Obesity
- Large Uvula
- Smoking
- Short neck
- Large tonsils
- Edema
OSA Complications
Cardiovascular function: Increased risk for stroke
Metabolic: T2 Diabetes risk, weight gain
Neural functioning
Sleep Fatigue
Higher in men, over 65+
Assessment for Sleepiness ( Sleep Apnea )
- Daytime sleepiness
- Snoring
- GERD
- Height, weight, BMI
- Assess oral cavity
- High BP
Diagnostic Assessment
STOP-Bang
Sleep study
STOP Bang Questionnaire for Sleep Apnea
S: Snoring?
T: Tired
O: Observed
P: Pressure
B: BMI
A: Age
N: Neck size
G: Gender - Male
- Yes to 3+ questions= High risk
- Commonly treated with CPAP
CPAP ( Continuous Positive Airway Pressure )
Nasal Pillow, Full face, Nasal
Other interventions for improving sleep OSA:
- Reduce obstruction
Fatigue
Decrease in body’s reserves that affect basic body functions
- Examples: Overexertion of muscles –> weakens capacity
Fatigue ( Affects )
- Nutrition
- Pain
- Sleep
- Perfusion
- Mobility
- Sickness
Types of Fatigue
Physiologic
Secondary
Physiologic Fatigue
- Protein calorie malnutrition
- Overexercising
- Sleep deprivation
- Pregnancy
- Caffeine use
Secondary Fatigue
- Due to Acute Conditions
- Acute renal failure
- Influenza
- Pneumonia
- Traumatic injury
Types of Fatigue
Secondary ( Due to Chronic Disease )
- Anemia
- Cancer
- COPD
- Diabetes
- Heart failure
- Depression
Treatment related fatigue
- Chemotherapy
- Radiation therapy
- Surgery
- Medication side effects
Medications that have the effect of Fatigue include
- Beta blockers
- Sedatives
- Antihistamines
Consequences of Fatigue
- Neg impacts on quality of life
- Limits functional ability
- Change to routine
- Depression
Assessing Fatigue
- Tiredness
- Lack of motivation
- Impaired function
- Mental exhaustion
- Lethargy
- Muscle weakness
- Loss of appetite
- Palpitations / Dizziness
EBP Interventions for Fatigue
- Correct modifiable causes
- Mild physical activity
- Energy conservation
- Balanced diet
- Sleep hygiene
- Therapies
- Cognitive behavioral therapy
