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Module 1 (Intro To Basics) > Sleep/Sleep Disorders > Flashcards

Sleep/Sleep Disorders Flashcards

1
Q

Recumbency

A

laying down

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2
Q

Sleep general descriptions

A

-physiological process
- body’s rest cycle
- associated with recumbency and immobility
- lacks conscious awareness but is easily awakened
- essential for healthy functioning and survival

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3
Q

Insufficient sleep def

A

is obtaining less than 7-8 hours of sleep in 24 hour period

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4
Q

Fragmented def

A

-frequent arousals or awakening that interrupt sleep

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5
Q

Nonrestorative Sleep def

A

sleep that is adequate duration but does not result in the individual feeling refreshed and alert the next day

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6
Q

Sleep def

A

state in which an individual lacks conscious awareness of environmental surroundings but can be easily aroused

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7
Q

Sleep disturbance

A

conditions of poor sleep quality

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8
Q

Sleep disorders

A

abnormalities unique to sleep
- insomnia
- nacrolepsy

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9
Q

Sleep-Wake Cycle

A

controlled by the brain
wake behavior
- RAS and various neurotransmitters
- Orexin (hypocretin

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10
Q

RAS stands for

A

Reticular Activating System

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11
Q

RAS controls

A

sensory stimuli within the cerebral cortex
- regulates the sleep-wake cycle
- motor, sensory, visceral, consciousness

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12
Q

Orexin

A

neuro peptide comes out of the hypothalamus by helping keep people awake

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13
Q

Pt has low levels of orexin are prone to have

A

narcolepsy

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14
Q

Activation of RAS

A

causes alertness and attention

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15
Q

Circadian Rhythm is managed by

A

suprachiasmatic nucleus (SCN) in hypothalamus

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16
Q

Circadian Rhythm is synchronized through

A

light detectors in the retina

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17
Q

What is the strongest time cue for circadian rhythm?

A

light

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18
Q

Phases of Sleep

A
  • sleep latency 5%
  • NREM Stages 1-3
    = Stage 1 5%
    = Stage 2 50%
    = Stage 3 15%
  • REM (25%)
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19
Q

Sleep Latency

A
  • Time it takes for a person to fall asleep
  • starts when eyes are closed for sleep
  • ends when NREM is entered
  • time varies usually 10-40 mins
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20
Q

ICU Sycosis

A

caused by not being able to distinguish between day and night

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21
Q

Majority of sleep phase is in

A

NREM 75%
REM 25%

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22
Q

T/F: Sleep latency is technically not a phase.

A

True

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23
Q

NREM (Non-rapid eye movement) is what percentage of sleep time overall?

A

75-80 % of sleep time

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24
Q

NREM: Stage 1

A
  • slow eye movements
  • person can be easily awaken
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25
Q

NREM: Stage 2

A

HR and temp decrease

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26
Q

NREM: Stage 3

A
  • a person is difficult to awaken and may have parasomnias, which decreases with age
  • deep or slow wave sleep (SWS) delta waves, parasomnias
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27
Q

Parasomnias

A

-Unusual and often undesirable behaviors while falling asleep, transitioning between sleep stages, or during arousal from sleep
-Due to CNS activation

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28
Q

Examples of Parasomnias

A
  • sleep walking
  • sleep terrors
  • nightmares
  • sleep paralysis
  • sleep hallucinations
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29
Q

REM Sleep

A

20-25% of the sleep cycle
- occurs 3 to 4 times a night
- greatly reduced skeletal muscle tone
- period when most vivid dreaming occurs

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30
Q

What phase of sleeping of the brain is very active but mentally restful?

A

REM

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31
Q

Middle Age Changes in sleep

A

-More stage shifts - ↓ in NREM3 and REM
-Resistant to sleep deprivation
-Increased awakenings
-Changes in sleep efficiency

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32
Q

Older Age Changes in sleep

A
  • Phase changes – go to bed earlier and arise earlier
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33
Q

Which statement is true regarding REM sleep? Select all that apply.
a. Muscle tone is greatly reduced
b. It occurs only once in the night
c. It is separated by distinct physiologic stages
d. The most vivid dreaming occurs at this phase

A

a. Muscle tone is greatly reduced
d. The most vivid dreaming occurs at this phase

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34
Q

What is the best description for sleep?
a. Quiet state in which there is little brain
activity
b. Loosely organized state similar to a coma
c. State in which pain sensitivity decreases
d. State in which the individual lacks
conscious awareness of the environment

A

d. State in which the individual lacks conscious awareness of the environment

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35
Q

Neurologic changes with lack of sleep

A
  • cognitive impairment
  • behavior changes ( irritability and moodiness)
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36
Q

Immunity changes with lack of sleep

A
  • impaired condition
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37
Q

Respiratory changes with lack of sleep

A
  • asthma exacerbated during sleep
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38
Q

Cardiovascular changes with lack of sleep

A

heart disease ( hypertension, dysrhythmia)
increase in BP with hypertension
stroke

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39
Q

Gastrointestinal changes with lack of sleep

A

increase risk for obesity and GERD

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40
Q

Endocrine changes with lack of sleep

A
  • increase risk for type 2 diabetes
  • increase insulin resistance
  • decrease in growth hormones
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41
Q

Sleep disturbances in the hospital and factors

A

hospitalization associated with decreased sleep time
- environmental sleep-disruptive factors
- psychoactive medications
- acute and critical illness

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42
Q

Insomnia symptoms

A

difficulty falling asleep (long sleep latency)
frequent awakening (fragmented sleep)
prolonged nighttime awakening
waking up too early
c/o feeling unrefreshed on awakening (nonrestorative sleep)
fatigue, trouble with concentration
forgetfulness, confusion
anxiety

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43
Q

Acute insomnia

A

diffculty falling asleep or remaining asleep for at least 3 night/week for less than a month

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44
Q

Chronic insomnia

A
  • same symptoms as acute
  • daytime symptoms that persist for 1 month or longer
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45
Q

Insomnia causes are aggravated by

A
  • inadequate sleep hygiene
    ~ stimulants
    ~ medications
    ~ using alcohol to induce sleep
    ~ irregular sleep schedule
  • nightmare
  • exercising near bedtime
  • jet lag
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46
Q

Alcohol reduces/increases REM sleep

A

reduces

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47
Q

Avoid strenuous exercise __ hours before bed

A

6

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48
Q

Melatonin

A

-hormone help induce sleep
-can be suitable for patients but designed for short-term use (if used for more than 2 weeks to a month: lessen the effect)
- side effect: cause prolonged QT syndrome

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49
Q

Etiology of Chronic Insomnia

A

often NKA
- stressful life event
- psychiatric illness or medical condition
- medications or substance abuse

50
Q

Insomnia Diagnosis

A

self-report (sleep log for 2 weeks)
actigraphy
polysomnography (PSG)

51
Q

Actigraphy

A

noninvasive technique that measures the physical activity levels of a subject by means of a wristwatch-like motion-sensing device that can be worn for 14 days

52
Q

Polysomnography

A

sleep study
records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study

53
Q

Insomnia Interprofessional Care

A

education
track sleep
sleep hygiene
cognitive-behavioral therapy for insomnia
complementary and alternative therapies
drug therapy

54
Q

Sleep Hygiene (Table 7.3)

A
  • Do not go to bed unless sleepy
  • If not asleep after 20 mins, do a non-stimulating activity and return when sleepy
  • Regular sleep pattern
  • Rituals
  • Full Night’s sleep
  • Environment is quiet, dark, and a little bit cold
  • do not read, or be on the phone in bed
  • avoid caffeine, nicotine, and alcohol 4-6 hours before bed
  • don’t go to bed hungry but no big meal before
  • avoid exercising within 6 hours of bedtime
  • avoid sleeping pills and use them cautiously
  • practice relaxation techniques to cope with stress
55
Q

Insomnia causes

A

psychiatric
medical illness, medications
stress: finances, employment, school, life
substances: caffeine, alcohol, nicotine
exercise
age, gender
travel

56
Q

Insomnia Treatment

A

begin with least invasive
cognitive behavior therapy
therapist: counseling

57
Q

Insomnia: Drug Therapy

A

Benzodiazepines
Benzodiazepines-receptor-like agents
Melatonin-receptor agonist
Antidepressants
Antihistamines
Sedative-Hypnotic drugs
Alternative therapies

58
Q

Sedative-Hypnotic Drugs

A

depress CNS function
primarily used to treat anxiety and insomnia
antianxiety agents or anxiolytics
distinction between antianxiety effects and hypnotic effects depends on dosage

59
Q

Benzodiazepines

A

Used to treat anxiety and insomnia
Used to induce general anesthesia
Used to manage seizure disorders, muscle spasms, panic disorder, and alcohol withdrawal
Potential for abuse (watch pt. very carefully)
Can produce physical dependence

60
Q

If taking benzodiazepines, then you have to see your healthcare provider every?

A

3 months

61
Q

Benzodiazepines used specifically for sleep

A

temazepam (Restoril)
triazolam (Halcion)

62
Q

Common Benzodiazepines

A

diazepam (Valium)
lorazepam (Ativan)
alprazolam (Xanax)

  • commonly used for anxiety and panic attacks but causes sleepiness
63
Q

Pharmacologic effects Benzodiazepines

A

CNS: reduce anxiety and promote sleep
Cardiovascular system: Oral vs. intravenous
Respiratory system: Weak respiratory depressants

64
Q

Therapeutic effects Benzodiazepines

A

Anxiety
Insomnia
Seizure disorders, muscle spasm
EtOH withdrawal, perioperative applications

65
Q

Adverse effects Benzodiazepines

A

CNS depression
Amnesia
Sleep driving
Paradoxical effects
Respiratory depression
Abuse

66
Q

Benzodiazepines Overdose effects

A

Acute toxicity
oral overdose = drowsiness, lethargy, and confusion
IV toxicity = life-threatening reactions, profound hypotension, respiratory arrest, and cardiac arrest

67
Q

Benzodiazepines general treatment measures
Oral

A

gastric lavage
activated charcoal
dialysis

68
Q

Benzodiazepines treatment with flumazenil (Romazicon)

A
  • competitive benzodiazepine receptor agonist
    - reverses sedative effects for benzodiazepines but may not reverse respiratory depression
  • monitor for seizures when benzo. is stopped
  • effects fade an hour after administration: monitor for sedation
69
Q

Benzodiazepine-Receptor-Like agents

A

Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)

70
Q

Zolpidem (Ambien)

A

Sedative-hypnotic
Short-term management of insomnia
Side effects: daytime drowsiness and dizziness

71
Q

Zaleplon (Sonata)

A

Approved for short-term management of insomnia
Most common side effects: headache, nausea, drowsiness, dizziness, myalgia, and abdominal pain

72
Q

Eszopiclone (Lunesta)

A

Approved for treating insomnia
No limitation on how long it can be used
Generally well tolerated
Adverse effect: bitter aftertaste, headache, somnolence, dizziness, and dry mouth
Low potential for abuse

73
Q

Antidepressants

A

Trazodone (Oleptro)
Doxepin and Amitriptyline

74
Q

Trazodone (Oleptro)

A

Atypical antidepressant with strong sedative actions
Can decrease sleep latency and prolong sleep duration
Does not cause tolerance or physical dependence

75
Q

Doxepin and Amitriptyline

A

Old tricyclic antidepressant with strong sedative actions
Used to treat patients who have trouble staying asleep

76
Q

Antihistamines

A

Diphenhydramine (Benadryl)
Doxylamine (Unisom)

77
Q

Diphenhydramine (Benadryl)

A

May be added to nighttime cold/pain preparations

78
Q

Doxylamine (Unisom)

A

Can be purchased without prescription
Less effective
Tolerance develops quickly (1 to 2 weeks)
Adverse effects: daytime drowsiness and anticholinergic effects
Not intended for long-term use

79
Q

Alternative Medicine

A

Melatonin: effectively related to jetlag and shift work
Valerian root, chamomile, passionflower, lemon balm, and lavender: have very mild sedative effects, proof of benefits for insomnia is lacking
White noise and relaxation strategies

80
Q

Insomnia: nursing management

A

sleep hx
asses diet, caffeine, and alcohol intake
ask about sleep aids
sleep diary for 2 weeks
medical hx: factors that affect sleep

81
Q

Insomnia: Diagnosis

A

sleep deprivation
disturbed sleep pattern
readiness for enhanced sleep

82
Q

Insomnia: nursing implementation

A

Assume primary role in teaching sleep hygiene
-Decrease caffeine intake
-Bedtime routine
-Decreased blue light before bedtime
-Reduce light and noise
Teach patient about sleep medications

83
Q

What is a way to measure your sleepiness?

A

Epworth Sleepiness Scale

84
Q

OSA

A

Obstructive Sleep Apnea
- airway closes when asleep by tongue

85
Q

Respiratory and Sleep Problems

A

Sleep apnea
Snoring and hypoventilation
Obesity hypoventilation syndrome
Reduced chest wall compliance
↑ work of breathing
↓ total lung capacity and functional residual capacity
Also called obstructive sleep apnea-hypopnea syndrome (OSAHS)
Partial or complete upper airway obstruction during sleep
Apneic period may include hypoxemia and hypercapnia.

86
Q

Respiratory and Sleep Problems: Complications result in

A

Hypertension
Cardiac changes
Poor concentration/memory
Impotence
Depression

87
Q

Apnea is the

A

cessation of spontaneous respirations for longer than 30 seconds
- each obstruction may last 10-90 secs.

88
Q

How many cycles of apnea and arousal occur repeatedly during 6-8 hours of sleep?

A

200-400 times

89
Q

S/S Apnea

A

Frequent arousal during sleep
Insomnia
Excessive daytime sleepiness
Witnessed apneic episodes
Loud snoring
Morning headache
Irritability

90
Q

Sleep apnea although underreported occurs in what percentage of Americans?

A

2-10

91
Q

Risk Factors of Sleep Apnea

A

obesity (body mass index >28 kg/m2)

age >65 years

neck circumference >17 inches

craniofacial abnormalities that affect the upper airway, and acromegaly.

Smokers are more likely to have OSA.

OSA is more common in men than in women until after menopause, when the prevalence of the disorder is the same in both genders. Women with OSA have higher mortality rates

92
Q

Apnea Lab and Diagnostic Testing

A

1-2 nights for complete diagnosis depends
Polysomnography aka sleep study

93
Q

Mild sleep Apnea Tx

A

Sleeping on one’s side
Elevating HOB
Avoiding sedatives and alcohol 3 to 4 hours before sleep
Weight loss
Oral appliance

94
Q

Severe sleep apnea Tx

A

CPAP
-Possible compliance issues
BiPAP (one pressure on inspiration and one pressure expiration with full face mask)
-For sicker patients and before the ventilator
Surgery
-Uvulopalatopharyngoplasty (UPPP or UP3)
-Genioglossal advancement and hyoid myotomy (GAHM)

95
Q

What is considered severe sleep apnea?

A

more than 15 apnea/hypopnea events/hour

96
Q

If patients on CPAP or BiPAP remind them

A

to always take with them if overnight trips are planned.

97
Q

Patient teaching on Apnea

A

Explain benefit of losing weight
Explain benefit of sleeping on side
Explain the need to avoid sedatives or alcohol 3-4 hours prior to bedtime
Stress reduction
Stress importance of exercise
Avoid smoking
Self imagine disturbance

98
Q

Discharge Planning

A

Case manger- need for equipment
Nutritional consult
Spiritual consult

99
Q

Narcolepsy

A

Brain unable to regulate sleep-wake cycles normally
Causes uncontrollable urges to sleep, often going directly into REM sleep

100
Q

Causes of Narcolepsy

A

Unknown cause
=Associated with the destruction of neurons that produce orexin
=Orexin – neuropeptide that regulates sleep/wake cycles
Low levels of orexin lead to difficulty staying awake

101
Q

Typical diagnosis age of narcolepsy

A

adolescent to 30s

102
Q

Different types of narcolepsy

A

Type 1: with cataplexy
Type 2: w/o cataplexy

103
Q

Cataplexy

A

brief and sudden loss of skeletal muscle tone that can manifest as muscle weakness or complete postural collapse and falling

104
Q

S/S Narcolepsy

A

sleep paralysis
cataplexy
fragmented nighttime sleep

105
Q

Narcolepsy Nursing Management

A

Teach about sleep and sleep hygiene
Take naps (3 15 min naps throughout the day)
Avoid heavy meals and alcohol
Ensure patient safety
Lifestyle changes

106
Q

Narcolepsy: drug therapy

A

Modafinil (Provigil)
Armodafinil (Nuvigil)

107
Q

Modafinil (Provigil) and Armodafinil (Nuvigil) are what type of drugs?

A

wake-promotion drugs

108
Q

Older age is associated with

A

Overall shorter total sleep time
Decreased sleep efficiency
More awakenings
Insomnia symptoms

109
Q

Sleep Gerontologic Considerations

A

Awakenings during the night increases risk for falls
Medications used by older adults can contribute to sleep problems
Avoid long-acting benzodiazepines

110
Q

Nurse Fatigue

A

inadequate sleep
extended work hours
increased risk for errors

111
Q

Who is at risk when a nurse is fatigued?

A

Patients and nurses

112
Q

A nurse awake for 17 hours has the same cognition as BAC of

A

0.05%

113
Q

A nurse awake for more than 24 hours has the same cognition as BAC of

A

0.1%

114
Q

National Academy of Medicine (Institute of Medicine)

A

Nonprofit organization devoted to safety and evidence-based practice in healthcare
Recommendations
No more than 12 hours in 24 hour period
Limit to 60 hours in 7 day period

115
Q

Nurse Fatigue Management Do’s

A

Take at least one break in addition to lunch break
Use caffeine therapeutically as a stimulant to stay awake
Nutrition: complex carbs and protein
Exercise

116
Q

Nurse Fatigue Management Don’ts

A

DO NOT drink alcohol (depressant)

117
Q

Shift Work Sleep Disorder is characterized by:

A

insomnia
excessive sleepiness

118
Q

Shift Work Sleep Disorder S/S

A

Fatigue or malaise
Difficulty paying attention or concentrating
Memory impairment
Mood disturbance or irritability
Excessive daytime sleepiness
Hyperactivity, impulsivity, aggression, and other behavioral problems
Reduced motivation, energy, or initiative
Higher risk of errors or accidents
Feelings of sleep dissatisfaction

119
Q

Nurses on _______ _________ shifts are at increased risk of experiencing shift work sleep disorder

A

rapidly rotating

120
Q

What strategies for nurses help reduce the distress associated with shift work?

A

On-site napping
consistent sleep-wake schedule

121
Q

How many times can you enter REM sleep in a single night?

A

3-4

Module 1 (Intro To Basics) (32 decks)

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