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Chapter 42: sleep

24-hour day-night cycle Circadian Rhythm
Major Sleep Center Hypothalmus
Awake and Alertness RAS- Reticular Activating System
Induces sleep BSR- Bulbar synchronizing region
Stages of Adult sleep Stage2 (NREM), Stage3 (NREM), stage4 (NREM), Stage3 (NREM), Stage2 (NREM), REM
Purpose of sleep remains unclear,provides healing&restoration, Physiologicl restoration,Maintenance of biological functions, Neccessary for brain tissue restoration
Purpose of physiological restoration Conserves energy- preserves cardiac function (HR>60), decrease respirations and BP/relax muscle tone
Normal sleep requirements:Neonate 16hrs/day
Normal sleep requirements: Infants 8-10hrs a night- total 15hrs/day
Normal sleep requirements: Toddlers 12hrs/day plus naps
Normal sleep requirements: Preschooler 12hrs/night
Normal sleep requirements:School Age 9-12hrs
Normal sleep requirements: Adolescents 7 1/2hrs
Normal sleep requirements: Young Adults 6-8 1/2 hrs
Normal sleep requirements:Middle/older adults Total hours decline
Factors affecting sleep Physical illness, drugs/substances, lifestyle, usual sleep pattern, emotional stress, environment, excersise/fatigue, food&calorie intake
Physical Illness- examples pain, chronic illness, nausea, physical discomfort, mood issues, respiratory disease, nocturia, RLS, peptic ulcer disease
Drugs/Substances- examples Hypnotics, diuretics, antidepressants/stimulants, Beta blockers, Benzodiazepines, Alcohol, caffeine, narcotics, anticonvulsants
Lifestyle- examples daily routines, work schedules, unaccustomes heavy work, social activities, changing evening time meal
Emotional stress- examples "worries",physical health, death, losses
Environment- examples Disruptive bed partner (snoring, restless), extraneous noises, different environment, time of day
Exercise/Fatigue- examples Moderate excercise and fatigue causes a restful sleep (2 or more hours before bedtime), work that is stressful
Food and Caloric intake- Examples Watch caffeine, good eating habits promote sleep, weight gain/overweight (OSA), nicotine, alcohol, milk allergy (infants)
Excessive sleepiness Hypersomnolence
Chronic difficult falling asleep or frequent wakening from sleep and/or short sleep Insomnia
Situational stress Transient Insomnia
Result of dyssomnia sleep deprivation
What is chronic sleep deprivation associated with Cardiac diseae, weight gain, DMII, poor memory, depression and digestive problems
Symptoms of sleep deprivation blurred vision, clumsiness,decrease reflexes, slowed reaction time, decreased reasoning and judgement, confused and disoriented, irritable/agitated, decreased motivation
Dysfunction of mechanisms that regulate sleep and wake states Narcolepsy
Sudden muscle weakness during intense emotion Cataplexy
SIDS, Somnambulism(sleep walking), Night terrors, Nocturnal enuresis (bed wetting), body rocking, Bruxism (teeth grinding) Parasomnia
Lack of airflow through nose and mouth >10sec or longer Sleep Apnea
3 types of sleep Apnea Central, OSA, Mixed
OSA- how does it occur? Muscles of oral cavity relax during sleep, results in a blocked or partially blocked airway, diminishes nasal airflow or stops compltetly for as long as 30 secs-SNoring
2 major risk factors OSA Obesity and hypertension
What increases risk for OSA Smoking, heart failure, DM II, alcohol use, family history
Structural abnormalities- predisposed to OSA Deviated septum, nasal polyps, larger neck circumference, enlarged tonsils
OSA causes decline in arterial Oxygen saturation which puts the person at risk for.. cardiac dysrhythmias, right sided heart failure, pulmonary HTN, angina, stroke and HTN
Patient might complain of.. excessive daytime sleepiness, fatigue, morning headaches, irritabilty, depression, difficulty concentrating, decreased sex drive
Treatment of OSA: treatment for underlying cardiac and respiratory complications and emotional problems that may occur because of disorder
Dysfunction in the respiratory control center of the brain, impluse to breath fail temporarily, common in pt with brainstem injury, MD and encephalitis Central Sleep Apnea (CSA)
Induce sleep Hypnotics
Calming/soothing effects Sedatives
long-term use of hypnotics/sedatives may distrupt sleep and lead to more serious issues; tolerance, withdraw, rebound insomnia
Treatment of choice: Nonbenzodiazepines
Example of Nonbenzodiazepines: Ambien
Ambien: short-term use (2-3 weeks), cause fewer problems with abuse, dependence & rebound insomnia
Cause relaxation, antianxiety and hypnotic affects by suppressing the response stimuli Benzodiazepines
Cautions with Benzodiazepines do not take more than prescribed, caution with older adults because it stays in the body longer, can cause respiratory depression, amnesia, rebound insomnia & impaired motor function(falls)
Pharmacological approaches: nursing consideratios Caution with glaucoma, COPD, renal or hepatic failure, avoid use with other CNS depressants, watch older adults for changes in continence, ambulation and alertness
Pharmacological approaches: contraindicated pregnancy/lactation, severe resp disorder, severe liver/kidney disorder, hypersensitivity, alcohol/drug abuse, other CNS depressants
Created by: aeponton