NUR 302 Chapter 43 Sleep

Sleep history

Description of sleeping problems, usual sleep pattern, current life events, physical and psychological illness, emotional and mental status, bedtime routines, bedtime environment, behaviors of sleep deprivation

Circadian rhythms

The most familiar rhythm is the 24-hour, day-night cycle known as the diurnal or _____. Affected by light, temperature, social activities, and work routines. The biological rhythm of sleep frequently becomes synchronized with other body functions. ___ influence the pattern of major biological and behavioral functions. The predictable changing of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood depend on the maintenance of the 24-hour ___.

presleep

The normal sleep pattern for an adult begins with a ____ period during which the person is aware only of a gradually developing sleepiness. This period normally lasts 10 to 30 minutes; however, if a person has difficulty falling asleep, it lasts an hour or more.

Rest

does not imply inactivity. When ____, people experience feelings of rejuvenation, feeling refreshed, and able to carry out of activities of daily living. Illness and unfamiliar health care routines affect the usual ___ and sleep patterns of hospitalized patients. It will be important to allow patients periods of ___.

nocturnal angina

Connections between heart disease, sleep, and sleep disorders exist. Sleep-related breathing disorders are linked to increased incidence of ____ (chest pain), increased heart rate, electrocardiogram changes, high blood pressure, and risk of heart diseases and stroke.

Nursing interventions

designed to improve the quality of a person's rest and sleep are largely focused on health promotion. Patients need adequate sleep and rest to maintain active and productive lifestyles. During times of illness, rest and sleep promotion are important for recovery.

polysomnogram, Multiple Sleep Latency Test (MSLT)

A ____ involves the use of EEG, EMG, and EOG to monitor stages of sleep and wakefulness during nighttime sleep. The ____ provides objective information about sleepiness and selected aspects of sleep structure by measuring eye movements, muscle-tone changes, and brain electrical activity during at least four napping opportunities spread throughout the day.

REM, NREM

A person usually reaches ___ sleep about 90 minutes into the sleep cycle. Seventy-five to 80% of sleep time is spent in ___ sleep.

biological clocks

All persons have ____ that synchronize their sleep cycles. This explains why some people fall asleep at 8 p.m., whereas others go to bed at midnight or early in the morning. Different people also function best at different times of the day.

REM

Although dreams occur during both NREM and REM sleep, the dreams of ___ sleep are more vivid and elaborate; and some believe that they are functionally important to learning, memory processing, and adaptation to stress. The ability to describe a dream and interpret its significance sometimes helps resolve personal concerns or fears. Another theory suggests that dreams erase certain fantasies or nonsensical memories.

middle age

In ____, the amount of stage 4 sleep begins to fall—a decline that continues with advancing age.

adolescents

In _____, shortened sleep time often results in excessive daytime sleepiness, which frequently leads to reduced performance in school, vulnerability to accidents, behavior and mood problems, and increased use of alcohol. Get ~7½ hours

critical thinking

In the case of sleep, integrate knowledge from nursing and disciplines such as pharmacology and psychology. Use personal experience Professional standards

hypersomnolence

Many adults in the United States have significant sleep problems from inadequacies in either the quantity or quality of their nighttime sleep and experience ___ on a daily basis. ____ are sleep disturbances that result in daytime sleepiness and are not caused by disturbed sleep or alterations in circadian rhythms.

hypnotics, Sedatives

Medications that induce sleep are called ___. ___are medications that produce a calming or soothing effect. Benzodiazepines and benzodiazepine-like drugs are common classifications of drugs used to treat sleep problems. Regular use of any sleep medication often leads to tolerance and withdrawal.

Sleep disorders

are conditions that, if untreated, generally cause disturbed nighttime sleep that results in one of three problems: insomnia, abnormal movements or sensation during sleep or when awakening at night, or excessive daytime sleepiness.

Neonates, Infants, Toddlers, Preschoolers, School Age, Young Adults

Normal Sleep Requirements and Patterns, ____ 16 hours a day, ____ 8 to 10 hours at night for a total of 15 hours per day, ___ Total 12 hours a day, ___ 12 hours a night, ____ 9 to 10 hours, ___ Get 6 to 8½ hours

bed rest

Nurses frequently care for patients who are on ___ to reduce physical and psychological demands on the body in a variety of health care settings. However, these people do not necessarily feel rested. Some still have emotional worries that prevent complete relaxation

nonrapid eye movement (NREM), rapid eye movement (REM)

Once asleep, the person usually passes through four or five complete sleep cycles per night, each consisting of four stages of ____ sleep and a period of ____ sleep.

continuous positive airway pressure (CPAP)

One of the most effective therapies is use of a nasal ___ device at night, which requires a patient to wear a mask over the nose. A mask delivers room air at a high pressure.

acute care

Patients in ___ settings have their normal rest and sleep routine disrupted, which generally leads to sleep problems. In this setting, nursing interventions focus on controlling factors in the environment that disrupt sleep, relieving physiological or psychological disruptions to sleep, and providing for uninterrupted rest and sleep periods for the patient

reticular activating system (RAS)

Researchers believe that the ascending ____ located in the upper brainstem contains special cells that maintain alertness and wakefulness. The _____ receives visual, auditory, pain, and tactile sensory stimuli. Activity from the cerebral cortex (e.g., emotions or thought processes) also stimulates the ____. Arousal, wakefulness, and maintenance of consciousness result from neurons in the ____ releasing catecholamines such as norepinephrine.

Valerian, Kava, Chamomile

Several other herbal products assist in sleep. ____ is effective in mild insomnia and RLS. It effects the release of neurotransmitters and produces very mild sedation. ___ helps promote sleep in patients with anxiety. It should be used cautiously because of its potential toxic effects on the liver. ____, an herbal tea, has a mild sedative effect that may be beneficial in promoting sleep.

aging

Sleep becomes more fragmented with ____, and a person spends more time in lighter stages.

electroencephalogram (EEG), electromyogram (EMG), electrooculogram (EOG)

Specific physiological responses and patterns of brain activity identify each sequence. Instruments such as the ____, which measures electrical activity in the cerebral cortex; the ____, which measures muscle tone; and the ____, which measures eye movements provide information about some structural physiological aspects of sleep.

homeostatic process, circadian rhythms

The ____ (Process S), which primarily regulates the length and depth of sleep; and the _____ (Process C: "biological time clocks"), which influence the internal organization of sleep, timing and duration of sleep-wake cycles, operate simultaneously to regulate sleep and wakefulness (Daroff et al, 2012). Time of wake up is defined by the intersection of Process S and Process C.

parasomnias

The ____ are undesirable behaviors that occur usually during sleep. Somnambulism (sleepwalking), Night terrors, Nightmares, Nocturnal enuresis (bed-wetting), Body rocking, Bruxism

suprachiasmatic nucleus (SCN)

The ____ nerve cells in the hypothalamus control the rhythm of the sleep-wake cycle and coordinate this cycle with other circadian rhythms.

NREM stage 4

The body needs sleep to routinely restore biological processes. During deep slow-wave (_____) sleep, the body releases human growth hormone for the repair and renewal of epithelial and specialized cells such as brain cells. Protein synthesis and cell division for renewal of tissues such as the skin, bone marrow, gastric mucosa, or brain occur during rest and sleep. NREM sleep is especially important in children, who experience more ____ sleep.

hypothalamus

The major sleep center in the body is the _____. It secretes hypocreatins (orexins) that promote wakefulness and rapid eye movement sleep. Prostaglandin D2, L-tryptophan, and growth factors control sleep.

Obstructive sleep apnea (OSA)

The two major risk factors for ___ are obesity and hypertension.___ occurs when muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing nasal airflow (hypopnea) or stopping it (apnea) for as long as 30 seconds. Excessive daytime sleepiness is the most common complaint. Feelings of sleepiness are usually most intense on awakening, right before going to sleep, and about 12 hours after the midsleep period. Causes a serious decline in arterial oxygen saturation level.

REM

With each successive cycle stages 3 and 4 shorten, and the period of ___ lengthens. ___ sleep lasts up to 60 minutes during the last sleep cycle. Not all people progress consistently through the stages of sleep. ____ sleep is necessary for brain tissue restoration and appears to be important for cognitive restoration and memory. A loss of ____ sleep leads to feelings of confusion and suspicion.

NREM

___ sleep contributes to body tissue restoration. During sleep the heart rate falls to 60 beats/min or less, which benefits cardiac function. Other biological functions decreased during sleep are respirations, blood pressure, and muscle tone

Pregnancy

____ increases the need for sleep and rest. However, a majority of ____ women describe variations in sleep habits. Estrogen has been shown to decrease REM sleep.

Sleepwalkers

are unaware of their surroundings and are slow to react, increasing the risk of falls. Do not startle ___ but instead gently awaken them and lead them back to bed.

Restless leg syndrome (RLS)

can occur before sleep onset. ____ symptoms include recurrent, rhythmical movements of the feet and legs. Patients feel an itching sensation deep in the muscles. Relief comes only from moving the legs, which prevents relaxation and subsequent sleep.

Cataplexy,

involved with narcolepsy, or sudden muscle weakness during intense emotions such as anger, sadness, or laughter, occurs at any time during the day.

Central sleep apnea (CSA)

involves dysfunction in the respiratory control center of the brain. The impulse to breathe fails temporarily, and nasal airflow and chest wall movement cease. The oxygen saturation of the blood falls. The condition is common in patients with brainstem injury, muscular dystrophy, and encephalitis. Less than 10% of sleep apnea is predominantly central in origin. People with ____ tend to awaken during sleep and therefore complain of insomnia and excessive daytime sleepiness (EDS). Mild and intermittent snoring is also present.

Sleep apnea

is a disorder characterized by lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep. Three types of ____ are known: central, obstructive, and mixed. The most common form is obstructive.

Narcolepsy

is a dysfunction of mechanisms that regulate the sleep and waking states. During the day a person suddenly feels an overwhelming wave of sleepiness and falls asleep; REM sleep occurs within 15 minutes of falling asleep. Cataplexy, or sudden muscle weakness during intense emotions such as anger, sadness, or laughter, occurs at any time during the day. Sleep paralysis is another symptom.

Melatonin

is a neurohormone produced in the brain that helps control circadian rhythms and promote sleep. It is a popular nutritional supplement that is found to be helpful in improving sleep efficiency and decreasing nighttime awakenings. The recommended dose is 0.3 to 1 mg taken 2 hours before bedtime.

Sleep deprivation

is a problem many patients experience as a result of dyssomnia. Causes include fever, difficulty breathing, pain, emotional stress, medications, and disturbances in the health care setting. Owing to long work schedules and rotations, health care providers are prone to _____. Hospitalization makes patients prone to sleep deprivation caused by environmental noises and interruptions for care.

Insomnia,

the most common sleep disorder, is a symptom patients experience when they chronically have difficulty falling asleep. Adjustment sleep disorder (acute ____), Inadequate sleep hygiene, Behavioral ___ of childhood, ___ caused by medical condition