1
Q
What is sleep?
A
A state of rest accompanied by altered consciousness and relative inactivity. Restoration of mental and physical function take place.
2
Q
Narcolepsy
A
- Chronic neurologic disorder characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep
- caused by the brains inability to regulate sleep-wake cycles
3
Q
Which hormone regulates the sleep cycle?
A
Melatonin
4
Q
Hormones involved in excitation
A
- Acetylcholine
- Norepinephrine
- Dopamine
- Serotonin
- Histamine
5
Q
Circadian Rhythm
A
- Predictable fluctuations in processes that occur in repeated cycles of time, full cycle is 24 hours
- HR, BP, body temp, hormone secretions, metabolism, mood
6
Q
Non-Rapid Eye Movement sleep (NREM)
A
- 75-80% of total sleep time
- 4 stages
- parasympathetic nervous system takes over
- ⬇️ HR, RR, BP, body temp, metabolic rate
7
Q
NREM I
A
- light sleep
- 5% total sleep time
- transition between wakefulness and sleep
- involuntary muscle jerking (twitching)
- only lasts for a few minutes
8
Q
NREM II
A
- light sleep
- 50% total sleep time
- relatively easy arousal
9
Q
NREM III
A
- 10% of sleep
- ⬆️ depth of sleep and arousal becomes difficult
10
Q
NREM IV
A
- 10% of sleep
- “delta sleep”
- arousal threshold is greatest here
- slow brain waves, relaxed muscles, slow HR, RR, slow metabolism and low body temp
11
Q
REM
A
- 20/25% total sleep time
- vivid dreams
- essential to emotional equilibrium, learning, memory, adaptation
- ⬆️ HR, BP, temp, metabolic rate
- small muscle twitching (facial), large muscle immobility, irregular respirations, increased gastric secretions
12
Q
Sleep in older adults
A
- 7-9 hours
- less sound, stage IV absent, REM sleep shortens
- difficulty falling asleep
- contributors: polypharmacy, chronic illness, environment
- deprivation leads to delirium
13
Q
Insufficient sleep
A
- link between chronic insufficient sleep and obesity (leptin and ghrelin)
- sleep deprivation can cause a reaction time similar to someone intoxicated with alcohol
14
Q
Insomnia
A
- most common sleep disorder
- difficulty falling asleep and/or staying asleep
15
Q
Obstructive Sleep Apnea (OSA)
A
- throat muscles intermittently relax and block airway during sleep, breathing stops and starts
- excessive daytime sleepiness, insomnia, loud snoring, fatigue, observed apnea, gasping for air during sleep
16
Q
Short term consequences of Insomnia
A
- excessive daytime tiredness
- lethargy
- irritability
- depression
17
Q
Long term consequences of Insomnia
A
- ⬆️ risk for MI, stroke, HF, HTN, type II DM
18
Q
Physical effects of insufficient sleep
A
- HTN
- risk of type II diabetes
- risk of stroke
- renal impairment
- daytime fatigue
19
Q
Psychological effects of insufficient sleep
A
- depression
- anxiety
- trigger psychosis/paranoia
- irritability
20
Q
Treatment of OSA
A
- Continuous positive airway pressure machine (CPAP) — FIRST CHOICE
- Bilevel positive airway pressure machine (BPAP)
- surgical procedure
21
Q
OSA risk factors
A
- age
- obesity
- large neck size
- male
- family hx
22
Q
Idiopathic Hypersomnia
A
constant or recurrent episodes of extreme sleepiness during the day
23
Q
Parasomnias
A
- episodes or behaviors that occur during arousal from REM that disturb the patient
24
Q
Restless Leg Syndrome (RLS)
A
- involuntary movement of the legs when the body is at rest
- unpleasant creeping, crawling, itching, aching, burning, throbbing, tingling
- abnormality in Dopamine levels
25
Restless leg risk factors
- iron deficiency
- renal disease
- nerve damage
- rheumatoid arthritis
- use of anti-nausea meds/antidepressants
- use of alcohol, nicotine, caffeine
26
Assessment Techniques
- do you feel rested when you wake up?
- how much sleep do you get each night?
- do you find it difficult to stay awake during the day?
- assess naps, sleep pattern, energy level, sleep environment
27
Nursing interventions r/t sleep deprivation in older adults
- discourage napping
- encourage pt to engage in physical activity (walking, water aerobics)
- decrease fluids in evening
- review meds for possible sleep effects
- sleep in cool, dark room
- warm bath before bedtime
28
Sleep hygeine techniques
- avoid caffeine, alcohol, nicotine, physical acitivty late in the day
- avoid napping
- cool and dark room
- warm bath before bedtime
- use of meds and herbal remedies (otc antihistamine, nonbenzodiazepine cns depressant)
- stress relief
29
How long should older adults sleep for?
7-9 hours
30
What stage of sleep is typically absent in older adults?
NREM stage IV
31
Insomnia risk factors
- older adults
- depression
- stress
- female
32
Somnambulism
sleepwalking
33
Enuresis
bedwetting
34
Night terrors
common in children, during deepest stages of sleep
35
Sleep paralysis
brief state of involuntary immobility occurring on waking
Fundamentals Exam 2
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