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Nursing 2100H > Sleep-Wake Disorders > Flashcards

Sleep-Wake Disorders Flashcards

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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
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2
Q

Sleep Needs

A

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

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3
Q

Sleep-wake cycle

A

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

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4
Q

sleep latency

A

bedtime to the beginning of sleep

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5
Q

sleep architecture

A

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

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6
Q

sleep efficiency

A

ratio of total sleep time to nocturnal time in bed

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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
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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
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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
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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
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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)
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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)
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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)
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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
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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

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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)

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