Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nursing 2100H > Sleep-Wake Disorders > Flashcards

Sleep-Wake Disorders Flashcards

You may prefer our related Brainscape-certified flashcards:
Family Nurse Practitioner (FNP) flashcards NCLEX-PN® flashcards Nursing Management of Care flashcards Nursing Maternity flashcards Nursing Pharmacology flashcards NCLEX-RN® flashcards Nursing Fundamentals flashcards Nursing Adult Health flashcards Nursing Safety & Infection flashcards Nursing Mental Health flashcards
1
Q

Sleep

A

1/3 of your life spent sleeping

US getting less sleep- 6-6 1/2 hours

50 to 80% mental health pts report sleep problems

Disrupted sleep involved in events:

  • Pennsylvania’s 3 Mile Island reactor failure 1979
  • Chernobyl nuclear meltdown, 1986: reactor lid blown off –> built dome to contain it
  • Exxon Valdez oil spill, 1989
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Sleep Needs

A

Newborns: 17-18 hours
Preadolescents: 10 hours
Adolescents: 9 hours
Adults/Elderly: 8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Sleep-wake cycle

A

endogenously generated rhythm close to 24 hours, synchronized with the day/night cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

sleep latency

A

bedtime to the beginning of sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

sleep architecture

A

pattern of non-REM and REM in a 90 to 110 minute cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

sleep efficiency

A

ratio of total sleep time to nocturnal time in bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Biphasic Stage of Sleep

A
  1. Non-rapid eye movement (NREM) harder to awaken
    -90 minutes after falling asleep
    Four stages:
    -stages 1 and 2—person easily aroused
    -stages 3 and 4—slow-wave sleep (deepest state; restorative function)
  2. Rapid eye movement REM
    - Deep sleep; vivid dreaming
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sleep Disorders Summary

A
  • Ongoing disruptions of normal waking and sleeping patterns –> excessive daytime sleepiness, inappropriate naps, chronic fatigue
  • The inability to perform safely or properly at work, school, or home
  • More common in women
  • Prevalence increases w/age
  • Occur independently of other mental disorders
  • -> but also seen in patients with mental disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Circadian Rhythm

A

Internal clock coordinates sleeping, eating, mood

Body temperature (lower in early morning), and female menstrual cycle
--> cortisol levels, hormone levels

Usually cued by sunlight:

  • Internal pacemaker: in HYPOTHALAMUS (called Suprachiasmatic nuclei)
  • External influences are light/dark cycle, mealtime and work patterns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Circadian Rhythm - 24 hour cycle

A

Effect on hormone releases

  • -> ex. body temp lowest early am
  • -> highest levels mid evening: temp, manual dexterity, reaction time, simple recognition, muscle tone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Circadian Rhythm Sleep Disorders

A

Mismatch between circadian rhythm and the timing and duration of sleep causing excessive sleepiness and/or insomnia and distress

  • Synchronized-rhythms: peak at the same time
  • Desynchronized-rhythms: peak at different times (can look like mental illness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Circadian Rhythm: Sleep Disorders

A
  1. Delayed sleep phase type (“night owls”)
  2. Advanced sleep phase type (early risers, can’t stay awake in PM)
  3. Irregular sleep–wake type
  4. Shift work type
    - 20% of US workforce, sleep shorter/poorer
  5. Jet lag type- not in DSM 5 (traveling east = harder to reset to earlier time zone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Circadian Rhythm: Interdisciplinary Treatment

A
  1. Melatonin
  2. Chronotherapy (delaying sleep time each night 3 hrs until target time is reached)
  3. Luminotherapy (more light during day to keep awake)
  4. Chronopharmaco-therapy (using stimulants to keep you awake, short acting, ex. caffeine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Insomnia

A
  • Difficulty falling asleep, maintaining sleep & early awakening (3 x per week for 3 months).
  • Increases relapse risk in mental/medical disorders
  • Daytime fatigue, diff concentration, bad mood w/no indication of another disorder
  • 23.6% of non-institutionalized adults with 10-15% severe insomnia
  • Other poss causes: mental disorders, pain, cardiac, gastrointestinal, pulmonary, Parkinson’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sleep Disorder Assessment

A

Sleep history and diary: better, worse, events naps, bedtime, supplements, meds, caffiene, alcohol, shift work

  • Recent changes in relationships
  • Fatigue and stress
  • Time zone changes: takes 4-6 days to recover

Rule out substance or meds, mental health and non-psychiatric medical conditions, normal sleep variations

Impact on work, relationships, health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Insomnia Nursing Management

A

Polysomnography: records brain patterns during sleep in a sleep lab, confirms sleep disorders, describes sleep architecture and any abnormalities (picture page 632)

Nursing Diagnosis:

  • Sleep pattern disturbance
  • Sleep deprivation
  • Insomnia
17
Q

Insomnia Evidence-Based Treatments: Long Term

A

Long term- BEHAVIORAL interventions produce more sustained effects than drugs.
–>they REDUCE sleep onset time, DECREASE awakenings, and INCREASE total sleep time

Stimulus control: use bed only for sleep/sex, white noise, phone off, blacken windows, note on door, enlist support of family and friends, cool temp

Sleep restriction: try to avoid naps and sleep only during regular sleep hours

Relaxation: deep breathing, stretching, meditation, progressive relaxation, visualization

Avoid before sleep: heavy meal, spicy food, caffeine (6 hours), cigarettes (1 hour), stimulants, exercise (3 hours)

Try warm milk, melatonin (1 mg may work better than a larger dose), valerian root supplements

Avoid alcohol, it disrupts sleep later

Cognitive-behavioral therapy to sort out difficult situations, positive self-talk

Sleep log

Music/reading

Bedtime ritual: same routine before sleep, time of day, preparation for sleep, 7-8 hours, arising at the same time each day

18
Q

Insomnia Evidence-Based Treatments: Short Term

A

Sleep Meds for SHORT term only

Diphenhydramine (Benadryl): antihistamine, use intermittently

Benzodiazepine Receptor Agonists (BzRAs): facilitate GABA

  • Benzos are addicting (schedule 4) and can cause confusion in the elderly
  • ->ex. diazepam (valium), chlordiazepoxide (librium), lorazepam, (ativan), flurazepam (dalmane).
  • BzRAs that are not benzos: Zolpidem (ambien), and zaleplon (sonata)
  • Melatonin receptor agonist: Melatonin and Ramelteon (Rozerem)

Sedating antidepressants

19
Q

Hypersomnolence Disorder

A

EXCESSIVE SLEEPINESS at least three times a week for at least 3 months.

Sleep at least 7 hours at night and at least one:

  1. Recurrent periods of sleep in same day
  2. Over 9 hours non-restorative sleep
  3. Difficulty being fully awake after abrupt awakening

Diagnosis: polysomnography followed by a multiple sleep latency test (20 minute measurements of sleep variables every 2 hours 5X a day)

20
Q

How to treat Hypersomnolence Disorder?

A

Assess sleep patterns

Nursing interventions: sleep hygiene, help establish normal sleep patterns, stimulants

  • Methylphenidate (Ritalin, Concerta)
  • Pemoline (Cylert)
  • Adderall (amphetamine and dextroamphetamine)
  • Modafinil (Provigil) promotes wakefulness but pt. can take naps, cost is $1300 per month)

Caffiene- self med-3-5 hour duration

21
Q

Narcolepsy

A

Irresistible URGE TO SLEEP at any time of the day, regardless of the amount of previous sleep (3 x per week for 3 months)

Short sleep episodes (attacks) 2 to 6 X a day- refreshing and at least 1 of the following:

  1. Cataplexy: bilateral loss of muscle tone while awake
    - alert and oriented
    - after strong emotion such as laughter -> lasts a few seconds, eyelids may droop, knees may buckle, slump in chair
    - –> Within 6 months of onset spontaneous grimaces or jaw opening, tongue thrusting or global hypotonia w/o emotional trigger
  2. Hypocretin deficiency in cerebral spinal fluid (causes cataplexy)
  3. Polysomnograpy shows shorter sleep latency

Other symptoms:

  1. Hypnagogic hallucinations: when falling asleep (visual or auditory)
  2. Sleep paralysis: can’t move or talk when falling asleep or waking up, terrifying
22
Q

Nursing Management of Narcolepsy

A

Nursing assessment: sleep patterns

Nursing interventions:

  • Tricyclic antidepressants: treat cataplexy
  • Sodium Oxybate (Xyrem): for cataplexy and sleep, schedule 2
  • CNS stimulants
  • –methylphenidate (ritalin)
  • –dextroamphetamine (dexadrine)
  • –pemoline (cylert)
  • –modafinil (provigil)

Patient education:

  • Sleep deprivation makes cataplexy worse
  • Develop strategies to manage symptoms
  • –Naps
  • –Activities while driving
  • –Eating (sunflower seeds in the shell)
  • –Windows open
  • –Cool in car
  • –Music, books on tape
  • –Talking
23
Q

Obstructive Sleep Apnea-Hypoapnea

A

Polysomnography of at least five obstructive apneas/hypopneas per hour of sleep and one of the following:

  1. Nocturnal breathing disturbances: snoring, snorting/gasping, or breathing pauses.
  2. Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep

Polysomnography of 15+ obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms.

  • Apnea, not breathing for 10 seconds to minutes
  • Hypoapnea is excessively slow or shallow breathing
  • Up to 20% US adults, 2/3 are obese
  • 2-3 times more car wrecks
24
Q

Patient Education for Obstructive Sleep Apnea

A
  • Continuous positive airway pressure (CPAP)
  • Weight loss strategies
  • Changing to lateral sleeping position
  • Oral appliance
25
Q

What is the surgical treatment for Obstructive Sleep Apnea?

A

uvulopalatopharyngoplasty

–> CPAP machine

26
Q

Central Sleep Apnea

A

Brain is not sending proper signals to the muscles that control breathing

No evidence of airway obstruction

  • 5 or more episodes of apnea per hour
  • Shortness of breath relieved by sitting up
  • Insomnia or hypersomnia
  • Difficulty concentrating
  • Mood changes
  • Morning headaches
  • Snoring
27
Q

Nursing Management of Central Sleep Apnea

A
  • C-PAP
  • Reduce opioid medications
  • Treat medical conditions like heart failure which can cause it
  • Oxygen
28
Q

Restless Leg Disorder (RLD)

A
  • –>intense desire to move legs accompanied by sensations of creeping, crawling, tingling, burning, or itching
  • 3 X per week for 3 months
  • Some antidepressants and anti-nausea drugs may worsen symptoms
  • Not a side effect like akasthisia
  • Treat if iron deficient
  • Treat with Parkinson’s drugs (L-dopa), muscle relaxants, benzodiazepines, opioids
29
Q

Patient Education for RLD

A
  • Take pain relievers.
  • Try baths and massages.
  • Apply warm or cool packs.
  • Try relaxation techniques, such as meditation or yoga.
  • Establish good sleep hygiene.
  • Exercise.
  • Cut back on alcohol and tobacco.
30
Q

Non-REM Sleep Arousal Disorder

A
  • -> Recurrent episodes of incomplete awakening from sleep

- usually occurring during the first 1/3 of the major sleep episode accompanied by either sleep terrors or sleep walking

31
Q

Interdisciplinary Treatment for sleepwalking

A
  • Instruct to take precautions regarding possible sleepwalking episodes
  • Benzodiazepines if potential for harm
  • Hypnosis supplemented by psychotherapy
32
Q

Sleep Walking

A

repeatedly walking about during sleep with a blank stare, minimally responsive to others and hard to awaken

33
Q

Sleep Terrors

A

Recurrent abrupt terrified arousals from sleep usually with a panicky scream.

  • intense fear and autonomic arousal such as mydriasis, tachycardia, rapid breathing, sweating.
  • inconsolable.

Amnesia for the episodes

Little or no recall of terrorizing dream

34
Q

Interdisciplinary Treatment for sleep terrors

A
  • Cognitive and behavioral interventions: visualize different ending, stuffed animal, bedtime story
  • Desensitization and relaxation techniques
  • For PTSD use prazosin (Minipress)
35
Q

Nightmare Disorder

A

Repeated occurrence of frightening dreams that fully awaken an individual occurring almost exclusively during REM sleep
-Cause unknown

36
Q

Interdisciplinary treatment for nightmare disorder

A
  • Psychotherapy aimed at conflict resolution
  • Cognitive and behavioral interventions
  • –> Imagery rehearsal therapy
  • Prazosin (minipress)
37
Q

Sleep Disorder Etiology

A
  • Circadian rhythm disturbances
  • The reticular activating system (RAS) in the brain maintains wakefulness. As the RAS cycle decreases, neurotranmitters that promote sleep take over.
  • Histamine and Dopamine neurotransmitters-promote wakefulness
  • Hypocretin: a neurotransmitter that regulates arousal, wakefulness. Cataplexy is caused by a lack of it.
  • Adenosine and Gamma Aminobutyric Acid GABA- inhibitory neurotransmitters –> promote sleep
  • Melatonin hormone derived from serotonin produced in response to darkness induces sleep
  • Cortisol: stress hormone secreted by adrenal glands, levels vary throughout day lowest at night
  • ->too high or too low at night messes up sleep
38
Q

True or False: Obstructive sleep apnea is characterized by excessive sleepiness either during the day or for extended periods at night.

A

False.

  • Obstructive sleep apnea involves snoring during sleep and episodes of sleep apnea that disrupt sleep and contribute to daytime sleepiness.
  • -> Primary hypersomnia is characterized by excessive sleepiness either by daytime sleep episodes or sleeping extended periods at night.

Nursing 2100H (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions