Stress & Sleep Flashcards
General Adaptation Syndrome (GAS)
Three Stage reaction to stress
- Alarm Stage - Fight or flight response
- Resistance - body stabilizes and response opposite to alarm reaction —-> recovery
- Exhaustion - Body not able to resist the effects of the stressor —–> death
In response to stress, the hypothalamus sends a signal to the SNS. In response, the SNS stimulates the _______ to release epinephrine and norepinephrine (catecholamines) which prepare the body for the “flight and fight response”
Adrenal Medulla
In response to stress, the hypothalamus releases corticotropin releasing hormone (CRH) which stimulates the anterior pituitary gland to produce beta-endorphin (analgesic effect) and adrenocorticotropic hormone (ACTH). ACTH stimulates the release of corticosteroids (glucocorticoid - glucose and aldosterone - sodium)
Adrenal Cortex
Alarm Reaction in Other Bodily Systems
Heart - Increase heart rate & stroke volume; increase cardiac output —> increased BP, redistribution of blood to vital organs
Blood Vessels - peripheral vasoconstriction
Lungs - increased respirator rate; shallow breathing
Liver - glycogenolysis; increase blood glucose
GI system - decreased secretions and peristalsis; decrease digestion
Muscle - increase blood flow to muscle
Resistance Stage
GAS
Stabilization
Hormonal levels return to normal
Parasympathetic nervous system activity
Adaptation to stressors
Exhaustion State
GAS
Increase physiological response as noted in the alarm reaction
Decreased energy level
Decreased physiological adaption
Reticular Activating System (RAS)
Region in the brainstem that controls sleep cycle
Diffuse network of nerve pathways in the brainstem connecting the spinal cord, cerebrum, and cerebellum, and mediating the overall level of consciousness
Bulbar Synchronizing Region
Region in the brainstem that controls the sleep cycle
Area in the brainstem that releases serotonin from specialized cells in the raphe nuclei sleep system of the pons and medulla causing sleep
Other regions in the brain as well as hormones and neurotransmitters involved with sleep
Hypothalamus
Norepinephrine, serotonin, dopamine, Acetylcholine, histamine, GABA
Melatonin
NREM (non-REM) Sleep
Stages of Sleep
Accounts for 75%-80% of sleep
Subdivided into 4 stages
Stage I & II: light sleep states, easily arousable
Stage III & IV: deep sleep states, termed slow or delta waves
Decrease in vital signs and metabolic rate with continuous low level muscle movements
REM (rapid eye movement) Sleep
Accounts for 20%-25% of sleep follows NREM sleep Brain waves resemble wakefulness Most vivid dreams occur Increase in vital signs Body loses muscle tone called REM atonia Important in mental and emotional equilibrium and learning
Factors Affecting Sleep
Developmental Considerations Motivation Culture Lifestyle & Habits Environmental Factors Psychological Stress Illness Medications
benefits of nap and sleep room for night-shifters
A 20 minute nap (restorative sleep) has potential to boost performance and accuracy, reduce fatigue, improve moods and better address patient’s needs
What are the differences in the NREM and REM Cycles during sleep for young and older adults? Similarities? Explain significance to nursing practice
Young adults: Sleep is affected by many factors - health, occupation, exercise. Lifestyle demands may interfere with sleep patterns. REM sleep averages about 20% of sleep; important to reinforce developing good sleeping habits
Older Adults: Sleep is less sound and stage IV sleep is absent or considerably decreased. Periods of REM sleep shorten; comprehensive nursing assessment and individualized interventions may be effective in long-term care of this age group. Use sedatives with extreme caution because of declining physiologic function and concerns about polypharmacy
Insomnia
Assessment: History taking, finding the cause of the disorder and note clinical manifestations (includes difficulty of falling asleep, long sleep latency, frequent awakenings, fragmented sleep; prolonged nighttime awakenings or awakening too early and not able to fall back to sleep; awakening feeling unrefreshed (nonrestorative sleep)
Interventions: Cognitive behavioral therapy; drug therapy
Obstructive Sleep Apnea
Sleep-disordered breathing characterized by partial or complete upper airway obstruction during sleep
Assessment: narrowing of air passages with relaxation of muscle tone during sleep or the tongue and soft palate fall backward and partially or completely obstruct the pharynx; loud snoring and brief cessation of breathing lasting from 10-90 seconds usually reported by bed partner; brief arousal described as startle response
Intervention: sleep on side (side lying/lateral) rather than supine, elevate head (fowlers); oral appliance; CPAP
Central Disorders of Hypersomnolence
Narcolepsy and Hypersomnia are characterized by excessive daytime sleepiness. One significant difference is people with narcolepsy experience sudden onset of sleepiness while hypersomnia experience increasing sleepiness over time
Circadian Rhythm Sleep-Wake Disorders
Shift workers and jet lag disorder
Parasomnias
Somnambulism (Sleepwalking)
Sleep Terrors
Nightmares
Sleep- Related movement disorders
Restless leg syndrome
Effects of Sleep Deprivation
Neurologic: cognitive impairment, behavior changes
Endocrine: Increased risk for Type II Diabetes; increased insulin resistance; sleep duration and quality are predictors of HgA1C; decreased growth hormone
Immune: Impaired function
Cardiovascular: increased blood pressure in people with HTN
GI: increased risk for obesity
Pain: Poor sleep can intensify pain
