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Sleep-Wake Disorders Flashcards

1
Q

What is the recommended hours on avg an adult should get?

A

7-9 hrs

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2
Q

What is the major consequence of acute or chronic sleep curtailment?

A

excessive sleepiness

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3
Q

Is excessive sleepiness obj or subj?

A

Subj, the pt reports the difficulty of staying awake

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4
Q

Define sleep deprivation

A

a discrepancy between hrs of sleep and hr required for optimal sleep fxning

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5
Q

What do the neurocognitive Sx of chronic sleep deprivation mimic?

A

psychiatric Sxs

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6
Q

What are you at risk for when you sleep less than 6 hrs or greater than 8 hrs/night?

A
  • obesity
  • diabetes
  • HTN
  • CVD
  • stroke
  • depression
  • substance use
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7
Q

Which 2 hormones are affected when experiencing sleep deprivation?

A

ghrelin and leptin

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8
Q

What are the 2 distinct physiological states of sleep?

A
  1. NREM

2. REM

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9
Q

How many stages are in NREM?

A

3 stages

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10
Q

What is the term related to the time it takes to fall asleep?

A

sleep latency

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11
Q

Describe N1

A

brief transition between wakefulness and sleep; compromises between 2-5% of total sleep time

  • Slow eye rolling movements are common
  • lost awareness of the env but generally easily aroused
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12
Q

Describe N2

A

HR and RR decline

- 45-55% of total sleep

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13
Q

Describe N3

A

further reduction of HR, RR, BP, and response to external stimuli
- reduced sympathetic activity

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14
Q

What is another name for NE?

A

Delta sleep or slow wave

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15
Q

What type sleep do you receive from N3?

A

Restorative sleep

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16
Q

How is REM characterized?

A
  1. absence of skeletal muscle tone (muscle atonia)
  2. bursts of rapid eye movement
  3. myoclonic twitches of the facial and limb muscles
  4. reports of dreaming
  5. ANS variability
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17
Q

An avg adult experience NREM or REM 1st upon sleep?

A

NREM

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18
Q

Typically how many cycles occur over the 90-130 intervals across the sleep period?

A

4-6 cycles

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19
Q

What is sleep architecture?

A

the structural organization of NREM and REM sleep

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20
Q

Sleep fragmentation

A

disruption of sleep stages as indicated by excessive amounts of stage 1 sleep, multiple brief arousal, and frequent shifts in sleep staging

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21
Q

What are the 2 interactions that regulate sleep and wakefulness?

A
  1. sleep drive- sleep

2. circadian drive- wakefulness

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22
Q

Which 2 factors affect the circadian drives?

A
  1. exogenous

2. endogenous

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23
Q

Describe exogenous factors

A

various clues from the env (zeitebers) that help set our internal clock to a 24-hr cycle

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24
Q

What are the strongest external cue for wakefulness?

A
  1. light
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25
What is the strongest external cue for sleep
darkness
26
What are the wakefulness neurotransmitters?
1. dopamine 2. NE 3. SE 4. Ach 5. His 6. Glu 7. hypocretin
27
What are the sleep-promoting neurotransmitters?
1. Adenosine 2. GABA 3. Glanin
28
How many hrs do short sleepers receive? Long sleepers?
Short sleepers: requiring less than 5 hrs/ night | Long sleepers: 10+ hrs/night
29
Basal sleep requirement
the amt of sleep necessary to feel fully awake and able to sustain normal level of performance
30
What is the most common sleep test and is used to Dx and evaluate pts w/ sleep-related breathing disorders?
polysomnography
31
What is the purpose of the maintenance of wakefulness test MWT?
evaluates a pt's ability to remain awake in a situation conducive to sleep
32
Which sleep disorder is characterized by dissatisfaction w/ quantity or quality of sleep?
Insomnia disorder
33
Which 3 factors contribute to insomnia?
1. Predisposing 2. Precipitating 3. Perpetuating
34
Describe the predisposing factor in inosmonia
"built into us" - individual factors that create a vulnerability to insomnia such as hx of poor- quality sleep, depression and anxiety or state of hyperarousal
35
Describe the precipitating factors in insomonia
"things in life" | - external factors that trigger insomnia such as personal and work difficulties and grief
36
Describe the perpetuating factors in insomnia
" behaviors that help maintain" | - sleep practices and attributes that maintain the sleep complaint such as caffeine or ETHOL use
37
What is hypersomnolence disorder?
excessive daytime sleepiness that occurs for 3 mos+
38
What would you see in a pt w/ hypersomnolence?
1. periods of sleep or unintended lapses into sleep 2. frequent napping 3. prolonged main sleep period 9hrs+ 4. nonrefreshing nonrestortative sleep regardless of sleep amt 5. difficulty w/ full alertness during the awake period
39
How is hypersomnolence treated? (Non-pharmacological and pharmacological)
Non- pharmacological maintaining a regular sleep-wake schedule Pharmacological- long-acting amphetamines (methylphenidate) and nonamphetamine-based (Provigil)
40
Describe Narcolepsy
uncontrollable urge to sleep
41
What can occur w/ narcolepsy?
1. cataplexy 2. sleep paralysis 3. hypnagogic hallucinations
42
What is cataplexy?
brief episodes of bilateral loss of muscle tone while maintain consciousness triggered by anger, frustration, or laughter
43
What is the difference between narcolepsy and other sleep disorders?
people typically feel refreshed after any amount of sleep from narcolepsy while other disorders still do not refreshed no matter the hrs of sleep
44
How is Narcolepsy treated?
- Provigil - Nuvigil - Methylphenidate - Amphetamine - Xyrem
45
How is cataplexy treated?
TCAs and SSRIs
46
What is the most common disorder of breathing and sleeping?
obs. sleep apnea hypopnea syn.
47
What medical condition is obs. sleep apnea associated w/?
obesity
48
Which breathing disorder is the cessation of respiration during sleep due to the instability of the resp. control system?
central sleep apnea
49
Which breathing disorder is associated w/ sustained O2 desat. during sleep in the absence of apnea or resp. events?
sleep hypoventilation
50
Which main category of sleep disorders occurs when there is a misalignment between the timing of the individual's normal wakefulness and external factors affecting the timing or duration of sleep?
circadian rhythm sleep
51
Which sleepwalking and sleep terrors are categorized?
NREM Movement Sleep Arousal Disorders
52
What are sleep terrors?
sudden terrifies near-awakenings
53
If a pt has a sleep terror do they remember their dream?
no, they do not remember their dream content
54
At what age is a person more vulnerable to experience a sleep terror?
4-12 yrs/old
55
How are sleep terrors treated?
exploring areas of stress and rarely benzos
56
Define Sleepwalking
consists of a sequence of complex behaviors that began in the 1st 3rd of the night during NREM sleep
57
What age is most at risk for sleepwalking?
4-8 yrs/old
58
How is sleepwalking treated?
instructing the pt and fam regarding safety measures as alarms or locks on windows and doors - meds= benzos when the risk for injury or accident is likely
59
At which time of life can nightmare disorders begin?
preschool
60
At which stage of sleep do nightmare occur?
during REM sleep and usually long after a long REM period late in the night
61
What are some RFs for nightmare disorder?
- past adverse events - sleep problems - genetics
62
What is REM sleep behavior disorder characterized by?
elaborate motor activity associated w/ dreaming
63
How REM sleep behavior disorder treated?
pt and sleep partner safety
64
Which disorder is characterized by an uncomfortable sensation in the legs?
Restless Leg Syndrome
65
What can worsen the Sx of RLS?
- period of inactivity - evening time - SSRIs and SNRIs
66
What 3 substances can lead to substance-induced sleep disorder?
1. ETHOL 2. Caffeine 3. Nicotine
67
What effect does Nicotine have on sleep?
pts may wake in response to mild w/drawal Sxs
68
What effect does ETHOL have on sleep?
decreases deep sleep and REM sleep
69
What effect does caffeine have on sleep?
blocks adenosine to increase latency and reduces slow wave sleep
70
Sleep disturbance is common in which pts?
1. alcoholism | 2. insomnia
71
What are helpful in identifying sleep patterns and behaviors that may be contributing to the sleep complaint?
sleep diaries
72
List some sleep-wake disorder nursing Dxs?
1. insomnia 2. sleep deprivation 3. Disturbed sleep pattern 4. Readiness for enhanced sleep

Mental Health (16 decks)

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