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Mental Health > Sleep-Wake Disorders > Flashcards

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
Q

What is the strongest external cue for sleep

A

darkness

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26
Q

What are the wakefulness neurotransmitters?

A
  1. dopamine
  2. NE
  3. SE
  4. Ach
  5. His
  6. Glu
  7. hypocretin
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27
Q

What are the sleep-promoting neurotransmitters?

A
  1. Adenosine
  2. GABA
  3. Glanin
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28
Q

How many hrs do short sleepers receive? Long sleepers?

A

Short sleepers: requiring less than 5 hrs/ night

Long sleepers: 10+ hrs/night

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29
Q

Basal sleep requirement

A

the amt of sleep necessary to feel fully awake and able to sustain normal level of performance

30
Q

What is the most common sleep test and is used to Dx and evaluate pts w/ sleep-related breathing disorders?

A

polysomnography

31
Q

What is the purpose of the maintenance of wakefulness test MWT?

A

evaluates a pt’s ability to remain awake in a situation conducive to sleep

32
Q

Which sleep disorder is characterized by dissatisfaction w/ quantity or quality of sleep?

A

Insomnia disorder

33
Q

Which 3 factors contribute to insomnia?

A
  1. Predisposing
  2. Precipitating
  3. Perpetuating
34
Q

Describe the predisposing factor in inosmonia

A

“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
Q

Describe the precipitating factors in insomonia

A

“things in life”

- external factors that trigger insomnia such as personal and work difficulties and grief

36
Q

Describe the perpetuating factors in insomnia

A

” behaviors that help maintain”

- sleep practices and attributes that maintain the sleep complaint such as caffeine or ETHOL use

37
Q

What is hypersomnolence disorder?

A

excessive daytime sleepiness that occurs for 3 mos+

38
Q

What would you see in a pt w/ hypersomnolence?

A
  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
Q

How is hypersomnolence treated? (Non-pharmacological and pharmacological)

A

Non- pharmacological maintaining a regular sleep-wake schedule
Pharmacological- long-acting amphetamines (methylphenidate) and nonamphetamine-based (Provigil)

40
Q

Describe Narcolepsy

A

uncontrollable urge to sleep

41
Q

What can occur w/ narcolepsy?

A
  1. cataplexy
  2. sleep paralysis
  3. hypnagogic hallucinations
42
Q

What is cataplexy?

A

brief episodes of bilateral loss of muscle tone while maintain consciousness triggered by anger, frustration, or laughter

43
Q

What is the difference between narcolepsy and other sleep disorders?

A

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
Q

How is Narcolepsy treated?

A
  • Provigil
  • Nuvigil
  • Methylphenidate
  • Amphetamine
  • Xyrem
45
Q

How is cataplexy treated?

A

TCAs and SSRIs

46
Q

What is the most common disorder of breathing and sleeping?

A

obs. sleep apnea hypopnea syn.

47
Q

What medical condition is obs. sleep apnea associated w/?

A

obesity

48
Q

Which breathing disorder is the cessation of respiration during sleep due to the instability of the resp. control system?

A

central sleep apnea

49
Q

Which breathing disorder is associated w/ sustained O2 desat. during sleep in the absence of apnea or resp. events?

A

sleep hypoventilation

50
Q

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?

A

circadian rhythm sleep

51
Q

Which sleepwalking and sleep terrors are categorized?

A

NREM Movement Sleep Arousal Disorders

52
Q

What are sleep terrors?

A

sudden terrifies near-awakenings

53
Q

If a pt has a sleep terror do they remember their dream?

A

no, they do not remember their dream content

54
Q

At what age is a person more vulnerable to experience a sleep terror?

A

4-12 yrs/old

55
Q

How are sleep terrors treated?

A

exploring areas of stress and rarely benzos

56
Q

Define Sleepwalking

A

consists of a sequence of complex behaviors that began in the 1st 3rd of the night during NREM sleep

57
Q

What age is most at risk for sleepwalking?

A

4-8 yrs/old

58
Q

How is sleepwalking treated?

A

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
Q

At which time of life can nightmare disorders begin?

A

preschool

60
Q

At which stage of sleep do nightmare occur?

A

during REM sleep and usually long after a long REM period late in the night

61
Q

What are some RFs for nightmare disorder?

A
  • past adverse events
  • sleep problems
  • genetics
62
Q

What is REM sleep behavior disorder characterized by?

A

elaborate motor activity associated w/ dreaming

63
Q

How REM sleep behavior disorder treated?

A

pt and sleep partner safety

64
Q

Which disorder is characterized by an uncomfortable sensation in the legs?

A

Restless Leg Syndrome

65
Q

What can worsen the Sx of RLS?

A
  • period of inactivity
  • evening time
  • SSRIs and SNRIs
66
Q

What 3 substances can lead to substance-induced sleep disorder?

A
  1. ETHOL
  2. Caffeine
  3. Nicotine
67
Q

What effect does Nicotine have on sleep?

A

pts may wake in response to mild w/drawal Sxs

68
Q

What effect does ETHOL have on sleep?

A

decreases deep sleep and REM sleep

69
Q

What effect does caffeine have on sleep?

A

blocks adenosine to increase latency and reduces slow wave sleep

70
Q

Sleep disturbance is common in which pts?

A
  1. alcoholism

2. insomnia

71
Q

What are helpful in identifying sleep patterns and behaviors that may be contributing to the sleep complaint?

A

sleep diaries

72
Q

List some sleep-wake disorder nursing Dxs?

A
  1. insomnia
  2. sleep deprivation
  3. Disturbed sleep pattern
  4. Readiness for enhanced sleep

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