Test 5 STUDY guide Flashcards
4 Main Regions of the Brain
- cerebrum
- cerebellum
- diencephalon
- Brainstem
Physical Structures of Sleep
- Hypothalamus: located deep in the brain, commands nerve cells that affect sleep and arousal
- SCN: located w/in the hypothalamus, REGULATION OF CIRCADIAN RHYTHM, if damage there is a erratic sleep cycle and cannot regulate circadian rhythm during light/dark cycles
- Brainstem: sends signals to hypothalamus, controls shifts between wake and sleep, multiple structures, pons and medulla, influence on REM sleep, relax muscles which prevents physically acting upon their dreams
- Thalamus: transfers info from the senses to the cerebral cortex, processes data, transfers it from short-term to long-term memory, allow people to block out external distractions, during REM sleep, thalamus transmits images, sounds, and sensations, which influences dreams
- Pineal gland: located in the brains two hemispheres, manufacture melatonin, natural substance the helps prepare body for sleep
Regulation of Sleep
- Circadian Rhythm: Natural internal process that regulates the sleep-wake cycle within a 24-hour period. Regulates a person’s biological clock causing the person to be tired at night and to wake on their own in the morning. Circadian rhythms follow environmental cues (light & temp.), but body can maintain rhythms w/out cues.
- Sleep-wake homeostasis: Helps us sleep when we are suppose to, keep us in a deep sleep. Level of sleep is controlled and will deepen according to the amount of sleep deprivation that the client experiences.
- They are affected by caffeine, stress, lighting, foods, medications, temperature, chocolate,
Promoting Sleep
-Education, lifestyle changes, calm environment, rituals, relaxation, comfort
~Non-pharmacologic Interventions:~
- Avoid stimulants (caffeine, alcohol, nicotine 4-6 hours before bed
- Remove unnecessary light/ noise
- Bedtime routine
- Warm shower/bath before bed
- Dark, quite, comfortable/cool temperature (60-65 degrees) room
-Go to bed when tired, if difficulty falling asleep, go to another room and listen to preferred music
- Keep a consistent sleep-wake cycle, going to bed and waking at the same time, allows the body to fall into a biologic rhythm
- Short naps no more than 30 minutes
- Regular exercise that is completed 3 hours before bed
- No work items or TVs in bedroom, bedroom should be associated with sleep and sexual activity only
- Acupuncture, massage, thermotherapy, guided imagery, mindfulness, meditation, restful breathing, yoga
REM / NREM Sleep
- Non-rapid Eye Movement (NREM): stages of sleep are determined by brainwave functions/amplitudes, eye movement, body movements, and changes in vitals.
- Stage 1= vitals start to lower, lightest stage of sleep, “slowing down”, 1-5 minutes (5% of sleep cycle), electrical brain activity diminish, body and eye movements diminish, may experience muscle twitch, breathing remains regular, muscle tone is present, easily awakened and will feel like they were day dreaming, can progress quickly to next stage if not bugged.
- Stage 2= 50% of our total sleep, deeper sleep & a little more difficult to wake, HR & body temp. decreased, muscles begin to relax, first cycle of stage 2 lasts 25 minutes
- Stage 3= deepest stage of sleep and lasts up tp 40 minutes, muscle, bones, and tissue repair, immune system strengthens, vitals are the lowest, and the hardest to wake up from, can be foggy, short-term hibernation, 15% of sleep -> as we age, shortened amount of stage 3,
-Stage 4/Rapid Eye Movement: “Dream Stage”, on an EEG they look awake. Vital signs increase, inability to move muscles. Still hard to wake up. Increased brain activity associated with REM and muscle atonia. Occurs at the end of each 90 min. sleep cycle and lasts 10 min. to 1 hr., breathing is irregular, rapidly moving eyes, 20-25% of sleep -> increased with age less stage 4 cycles
- EEG is to measure brain waves
Insomnia
- Inability to fall asleep even though given the opportunity
- Cannot stay asleep
-Waking up early and still feeling tired
** Can effect: Lack of motivation, physical/emotional/mental health, no energy, loses concentration, memory disturbances, mood disturbances (anxiety, depression),
** Associated with choric illnesses: heart disease, hypertension, endocrine dysfunction, arthritis
**Treatment: medications, sleep-promoting techniques, lifestyle changes, cognitive-behavioral therapy
Sleep Deprivation
- Affect higher-order cognitive processes
- Impaired judgement
- Decrease response time
~Triggers:~ - Seizure disorders
- Migraines
- Tension headaches
~Increased risk for:~ - Accidents
- Depression
- Stroke
- Mood swings
- Sleep conditions like insomnia
- Immune system is not being strengthened
- Weight gain
- Type 2 diabetes
Types of Sleep Deprivation
Total: Losing a night of sleep or by staying awake for 24 hours or any lengthy time period
Partial: Lessened sleep hours. Can progress into chronic sleep deprivation state. Body is not meeting biological sleep requirement
Selective: purposely strips the client of a cycle of sleep
Acute & Chronic
~Treatment: depends on cause and severity~
- Eliminating caffeine
- Eliminating nicotine
- Eliminate alcohol
- Develop an exercise plan (20-30 min/day)
- Medications and therapy
Sleep Apnea
- Central (CSA): reduction in the brain’s transmission of signals to the respiratory muscles, cessation (ending) of breathing, opioid over dose, heart failure.
- Obstructive (OSA): recurrent episodes of upper airway collapse and obstruction while sleeping combined with waking from sleep, snoring is a common symptom, o2 may decrease, excessive daytime sleepiness, low energy, lack of motivation
-Treatment:
~continuous positive air pressure (CPAP) most common. Worn on the nose or mouth & nose while asleep. Air pressure is delivered to keep airway open
~Lifestyle changes
~Avoid: sleeping on back, smoking, alcohol consumption, obesity
Narcolepsy
- Chronic disorder
- Sudden sleepiness, sudden periods of sleep, difficulties staying awake, falls asleep randomly during the day
- Nocturnal hallucinations
- Paralysis while asleep
- Vivid dreams
- Cataplexy
- Brief loss of voluntary muscle tone triggered by an emotional stimulus such as laughter
Hyper-somnolence
- Excessive day time fatigue that does not improve with more sleep
- Not associated with poor nighttime sleep or a disturbed circadian rhythm
- Cause is unknown -> dysfunctional autonomic nervous system, trauma to the central nervous system, possibly genetic factors
-Results in: poor memory, depression, short attention span, irritability
Restless Legs Syndrome (RLS) aka Willis- Ekbom disease
- Cause is unknown
- Neurological sensorimotor disorder, a condition with abnormal/ uncomfortable sensations in the legs
- Uncontrollable urge to move legs
~Manifestations:
-worse in evening/ at bedtime
- causes sleep disturbances (cant sleep or stay asleep)
~Associated with:
- iron or vitamin deficiencies
- Multiple sclerosis
- Run in families -> inherited syndrome
~Treatment: avoid caffeine, nicotine, and alcohol
Pharmacologic Interventions for Sleep
- GABA agonists: benzodiazepines (Valium), alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan)
~reduces activity of the arousal centers
~Results in: drowsiness, relaxed muscles, less anxiety, retrograde amnesia
~use cautiously in older adults because of decreased liver/kidney function
~Physical dependance, not recommended for long-term use - Non-benzodiazepine hypnotics: zolpidem (Ambian), zaleplon (Sonata), eszopiclone (Lunesta)
~ Most common prescribed sleep medications
~Adverse effects: gastric discomfort, hallucinations, memory loss, higher doses can induce stimulation and euphoria, potential for abuse - Controlled-release melatonin
~Fist-line med, cost-effective, non-habit forming, few adverse effects - Antihistamines (OTC Sleep Aids) doxylamine succinate (Unisom), diphenhydramine (Benadryl)
~Risks: daytime drowsiness, dry mouth, visual disturbance, difficulty urinating, constipation
*Patients should discuss their options with their provider before using meds.
Digestion Process
-Mouth
-Saliva
-Peristalsis
-Esophagus
-Stomach
-Liver
-Gallbladder
-Pancreas
-Small intestine
-Large intestine
-Rectum
-Anus
“MY PLATE” Diet
-Maintain a balanced diet
-Watching caloric intake
-Consuming the necessary amounts of nutrients
-Provides body with nutrients needed to function properly
*Calories: energy that is stored in food and used for processes of the body such as walking, breathing, and running
-Low-fat/fat-free dairy = 3 cups
-Fruits = 2 cups
-Veggies = 2.5 cups
-Whole Grains = 6 oz
-Nutrient dense foods
~Avoid/Limit:~ unhealthy foods, added sugar/salt, trans fats
~Weight Loss: 1-2 lb/week, increase fiber intake to control hunger, lifestyle and diet changes
*unintentional weight loss should be explored and determine if its an undiagnosed health problem
~Weight gain to correct weight loss related to an illness, increase muscle mass, nutrient rich foods
