Question | Answer |
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 |