Sherpath: Sleep

Low estrogen levels in women

can cause daytime fatigue, night sweats, or hot flashes, all of which interfere with sleep.

Anxiety

can cause intrusive thoughts, muscular tension, and increased norepinephrine levels, all of which may interfere with being able to fall sleep and stay asleep.

Shortness of breath and sinus drainage

can lead to difficulty breathing and inability to sleep

Peptic ulcers

cause pain at night which may be related to an increase in gastric secretions during REM sleep.

During NREM sleep,

cell division for skin and bone marrow renewal occurs, and energy is conserved.

Consuming large amounts of alcohol creates

difficulty falling asleep and limits REM sleep. These effects may cause restless sleep, contributing to any "hangover" experienced on waking. Combining alcohol with sleeping pills can cause dangerous side effects.

End stage renal disease

disrupts sleep and leads to daytime sleepiness.

Other meds that affect sleep patterns

include diuretics, antiparkinsonian medications, antihypertensives, steroids, decongestants, and asthma drugs.

Underlying causes of dyssomnias

include excessive napping, depression, anxiety, medication use, high stimulation levels at bedtime, hyperthyroidism, and shift work

The causes of hypersomnia

include medical conditions such as kidney or liver disorders, central nervous system damage, diabetic acidosis, and hypothyroidism.

How are young adults and older adults sleeping patterns similar?

Both young adults and older adults may awaken more at night

Circadian Rhythms

Influence patterns of biologic and behavioral functions.

Examples of actual nursing diagnosis

Sleep Deprivation related to lifestyle factors and sleep apnea as evidenced by poor sleep patterns, daytime sleepiness, and snoring Disturbed Sleep Pattern related to lighting and noise in the hospital as evidenced by reports of being awakened at night and changes in normal sleep pattern Fatigue related to sleep deprivation as evidenced by daytime drowsiness Insomnia related to anxiety as evidenced by difficulty falling asleep Disturbed Thought Processes related to chronic insomnia as evidenced by inability to understand instructions

Who most commonly has sleep terrors?

Sleep terrors primarily occur in children age 3-7 years old and are most prevalent in 5 to 7-year-old boys. Sleep terrors may run in families.

Parasomnias include

Somnambulism Nocturnal Enuresis Sleep Terrors Bruxism

What does Restless leg syndrome lead to? and who does it primarily affect?

The uncomfortable sensations lead to constant leg movement during the day and usually insomnia at night. This disorder is more common in older adults, but can occur at any age and affects as many as 12 million Americans.

somnambulism

sleep walking. Occurs in NREM 4

Normal sleep sequence

4 NREM and 1 REM cycles

Normal sleep patterns

90 min cycles and 3 to 5 cycles a night

Decrease in body temp between 2 and 4 am

A decrease of 0.5 to 1 degree may be noticed in individuals between 2:00 and 4:00 am because core body temperature, which typically is coupled closely with activity rhythm, is at its lowest between during this time

Adolescents

Adolescents need 8 to 10 hours of sleep each night. Sleep patterns may change to awakening later in the morning, with occasional naps. Males may experience nocturnal emissions ("wet dreams"). Adolescents who drink caffeinated beverages and use technology late into the night may experience daytime sleepiness with impaired alertness and functioning Complaints of tiredness or poor school performance may be related to inadequate sleep.

Adult

Adults sleep 6 to 8 hours a night. They tend to continue sleep patterns established when younger. They may begin to have more night awakenings. Teach adults about sleep hygiene and nonpharmacologic measures (especially stress reduction) to enhance sleep patterns. Discourage the long-term use of sleep medications.

Narcolepsy symptoms

Cataplexy, or the sudden loss of voluntary muscle tone Vivid hallucinations during the onset of sleep or upon awakening Brief episodes of paralysis at the beginning or end of sleep

Causes of sleep terrors

Cause is unknown but Sherpath is suspected :) but they may be triggered by lack of sleep, fever, alcohol use, and periods of emotional stress or conflict.

Who is most impacted by parasomnias?

Children and adolescents. Don't try and wake them

Toddler and preschooler

Children in this group sleep 10 to 12 hours a day. The sleep-wake cycle usually is established by the age of 2 to 3 years. Sleep needs fluctuate with growth spurts. A nap during the day can restore energy. Toddlers and preschoolers may exhibit resistance to going to bed. They may be moved out of the crib to a bed at approximately 2 years of age. Bedtime rituals are important. Teach parents to establish a regular bedtime routine and consistently follow it. Address safety needs that arise when children are able to get out of bed. For example, a safety gate across a doorway may be needed to protect a child from stairs or other hazards should the child get up. Educate parents on how to address a child's fear of the dark (by using a nightlight) or nightmares (by soothing the child but allowing the child to return to sleep)

Dyssomnias include:

Circadian Rhythm Sleep Disorders Insomnia Narcolepsy Hypersomnia Sleep Apnea Sleep Deprivation Restless Legs Syndrome

NREM 4 cycle

Deepest stage of sleep Strong stimuli needed for arousal Vital signs decreased much more than during wake time Restorative processes continue Somnambulism and nocturnal enuresis may occur Lasts 15-30 min May be longer if sleep deprivation has occurred

Narcolepsy questions

Do you fall asleep unexpectedly at random times? (Family or coworkers may report such episodes.) Do you have episodes of weakness, causing you to fall to the floor? Do you have vivid dreams when falling asleep?

Sleep apnea questions

Has anyone told you that you snore loudly or stop breathing while you sleep? Do you have headaches when you wake up? Do you have trouble staying awake during the day? Do you feel tired all the time?

Assessment components related to sleep include

Health History Focused Sleep Assessment Sleep Assessment Instruments Physical Assessment Diagnostic Testing

Insomnia questions

How long does it take you to go to sleep? How often do you have trouble falling asleep? Do you have trouble staying asleep? Waking up early and not getting back to sleep? What time do you wake up in the morning? Do you use an alarm clock? What do you do to prepare for sleep?

Infant

Infants sleep 10 to 12 hours at night, with naps during the day. A drop in 10-15 bpm is normal. Half of their sleep is in lighter stages. Sleep patterns are unique for each child. The general pattern consists of sleeping, awakening to eat, and sleeping again. Caution against using blankets, pillows, and bumpers in cribs, to decrease suffocation risk. Teach that eye movements, grimacing, and body movements are normal features of sleep at this age. Encourage parents to have infants sleep in their own cribs. According to the American Academy of Pediatrics 2011 revised guidelines on SIDS, the infant may sleep in the parents' room if the infant sleeps in his or her own crib and not with parents or siblings. Older infants may safely roll to their stomachs during sleep because they have developed good head control.

NREM 3 cycle

Initial stage of deep sleep More difficult arousal and rare movement Muscles relaxed Vital signs decrease, but regular rhythms/patterns are maintained Restorative processes such as the release of growth hormone occur Lasts 15-30 min

Factors that affect sleep

Lifestyle Diet and Exercise Smoking Alcohol Medications Environment Hospitalization and Illness Anxiety and Stress Relationships

NREM 1 cycle

Lightest level of sleep, between sleep and wakefulness Vital signs and metabolism begin to decrease/slow down Easy arousal by external stimuli, such as noises Feeling of drowsiness Lasts a few minutes May occur during the day as "resting my eyes"

What happens when person awakens from sleep terror?

May recall details of the dream and will not be disoriented.

The neurotransmitters serotonin and gamma aminobutyric acid (GABA) affect?

NREM sleep

Newborns

Newborns should sleep in 2- to 4-hour blocks between feedings. Teach parents to position newborns and infants on the back for sleeping to decrease the risk of sudden infant death syndrome (SIDS).

Obstructive sleep apnea

OSA involves collapse of the upper airway despite respiratory effort. OSA affects 12 million to 18 million people in the United States. The affected person continues to try to breathe, as evidenced by chest and abdominal movements with loud snoring or snorting sounds. Diaphragmatic movements become stronger until the obstruction is relieved. OSA results in increased carbon dioxide levels in the blood that accumulate during the apneic episodes, causing the person to awaken. These awakenings can occur multiple times each night.

Risk Factors for Obstructive sleep apnea

Obesity and large neck circumference Alcohol use and smoking Family history of OSA Structural abnormalities Recessed chin Abnormal upper airway structures Deviated septum Nasal polyps Enlarged tonsils Male gender Older age

REM cycle

Occurrence of vivid, colorful dreaming (less vivid dreaming may occur in other stages) Starts approximately 90 min after sleep is initiated Autonomous response causes rapid eye movements, fluctuating heart rate and respirations, and increased blood pressure Muscle tone decreased Gastric secretions increased Very difficult arousal Duration of REM sleep increases with each sleep cycle and averages 20 min

Older adult

Older adults sleep approximately 6 hours a night. Stage 4 sleep is decreased, resulting in less restorative sleep. The first REM stage is longer. Older adults awaken more at night and take longer to go back to sleep. A decline in health or the use of medications may interfere with sleep. Encourage older adults to maintain the usual bedtime and routines as much as possible. Older adults should exercise caution when using sleep medications.

Physical signs that can be assessed

Presence of muscle contractions and jerks that arouse the patient from sleep Snoring Sleep apnea, a sleep disorder characterized by periods in which respiration is absent

The neurotransmitters acetylcholine and norepinephrine influence what?

REM sleep

Health promotion diagnosis

Readiness for Enhanced Sleep

NREM 2 cycle

Relaxation increases Sleep becomes deeper Snoring may occur Relatively easy arousal Physiologic functions continue to slow Accompanied by occasional small muscle jerks Lasts 10-20 min

Risk diagnosis related to stress

Risk for Injury (related to sleep walking, for example)

School-aged children

School-age children sleep 8 to 12 hours a night. Naps are rare. The occurrence of nightmares decreases with age. The stress of starting school may disrupt the sleep pattern. Less sleep is needed by the age of 11 to 12 years, so bedtime may be extended. The bedtime routine is still important.

Actual nursing diagnosis related to sleep

Sleep Deprivation Disturbed Sleep Pattern Fatigue Insomnia Disturbed Thought Processes

Apnea-Hypopnea Index

The apnea-hypopnea index details the number of episodes of absent breathing (apnea) or shallow breathing (hypopnea) a sleeping patient experiences per hour. The apnea-hypopnea index and the patient's oxygen saturation levels are considered when determining the severity of obstructive sleep apnea (OSA). Normal number of episodes for an adult is fewer than 5 per hour. Mild OSA ranges from 5 to 15 episodes per hour. Moderate OSA ranges from 15 to 30 episodes per hour. Severe OSA is more than 30 episodes per hour.

Multiple sleep latency test

The multiple sleep latency test monitors a patient's brain waves, heartbeat, and eye movements during several 20-minute naps during the day. This test is used for patients suspected of having narcolepsy, and it shows whether they enter REM sleep shortly after falling asleep.

Focused assessments related to sleep should include investigation into:

The type of problem Any potential causes Identified signs and symptoms When the disturbance started The effect on daily roles and activities How the patient copes with the problem The ability of the nurse to treat the problem or the need for a referral to another professional

Describe sensations of restless leg syndrome

The uncomfortable sensations are described as crawling, tingling, and pulling feelings which delay the onset of sleep.

Sleep disorder questions

Why do you think you are having sleep problems? Does anything make your sleep problem worse? Better? Have you recently had any changes at home or at work? Have you started any new medications? Do you drink caffeinated beverages or take any other stimulants? Is there anyone else at home who does not sleep well? What have you tried to improve your sleep? Can you describe your bedtime routine?

Sleep hygiene index

a 13-item self-reported assessment that examines sleep hygiene behaviors

Pittsburgh sleep quality index

a self-reported 19-item instrument that assesses sleep quality and sleep disturbances over a 1-month period.

Epworth sleepiness scale

a self-reported 8-item questionnaire that can differentiate between sleep disorders and sleep deprivation.

Parasomnias

are disorders associated with abnormal sleep behaviors, rather than disorders of sleep itself.

Parasomnia definition

are disorders associated with abnormal sleep behaviors, rather than disorders of sleep itself. The behaviors come from autonomic nervous system, motor system, or cognitive processes during sleep or during the transitions between sleep and wakefulness.

Dyssomnias

are disorders associated with getting to sleep, staying asleep, or being excessively sleepy

Sleep Terrors

are night terrors in which a person quickly awakens from sleep in a terrified state. Sleep terrors occur during deep sleep and usually happen during the first third of the night.

Secondary sleep disorders

are symptoms of underlying situational, mental health, or medical conditions that interfere with sleep.

Treatment of nocturnal enuresis

behavioral therapy and the use of a bed alarm. The bed alarm sounds when moisture is present, which in turn wakes the person. Behavioral therapy may be used alone or in conjunction with a bed alarm. Bed alarms have been shown to be effective in treating nocturnal enuresis

Causes of nocturnal enuresis

behavioral, psychological, or medical issues, including a small bladder, urinary tract infections, stress, or developmental delays that interfere with toilet training.

Polysomnography records

eye movements, muscle movement and activity, heart and respiratory rates, oxygen levels, airflow, and brain activity while the patient sleeps.

What negative health effects can develop from sleep deprivation?

hallucinations, disorientation, increased blood pressure, glucose metabolism, hormone regulation, and increased seizure activity for those that have preexisting seizure disorders.

Key physical assessment signs include

inadequate energy levels for tasks, physical weakness, fatigue, lethargy, decreased affect, and behavioral findings such as yawning or slow speech.

Insomnia info

increases in occurrence with age affects more women than men (National Institute of Neurological Disorders and Stroke [NINDS], 2014a) can be traced to acute stress or lifestyle changes (short-term insomnia) can lead to symptoms of sleep deprivation and daytime fatigue can cause impairment in work and social life

Narcolepsy

is a chronic neurologic disorder caused by the brain's inability to regulate the sleep-wake cycle normally, resulting in an uncontrollable desire to sleep. At various times throughout the day, people with narcolepsy experience overwhelming sleepiness and fall asleep for periods lasting from seconds to several minutes, even after getting adequate nighttime sleep.

Sleep Apnea

is a condition in which a person experiences the absence of breathing (apnea) or diminished breathing (hypopnea) during sleep between snoring intervals. It is characterized by a lack of airflow through the mouth and nose for at least 10 seconds, lasting up to 2 minutes, during sleep. The most common type is obstructive sleep apnea (OSA).

Restless leg syndrome

is a genetic sleep disorder in which people experience abnormal, intense, and uncomfortable sensations in the lower extremities.

Sleep

is a naturally occurring altered state of consciousness regulated by the central nervous system.

A way that REM and NREM differ?

is associated with memory, learning, increased cerebral blood flow, and epinephrine release.

Hypersomnia

is excessive sleepiness that lasts at least one month and disrupts a person's work or social life. The person still experiences trouble awakening in the morning even after 8 to 12 hours of sleep at night.

Pain related to coronary artery disease

is more likely to occur during REM sleep.

Bruxism

is the clenching or grinding of teeth from side to side. This most often occurs during sleep and may be related to stress. People can develop pain if the clenching occurs over an extended period of time or if it is tight

Polysomnography

is the recording of brain waves and other physiologic variables, such as muscle activity and eye movements, during sleep

Hyperthyroidism

makes it hard for a person to fall asleep.

Pain associated with an illness, or injury

may cause inability to fall asleep or may wake a person from sleep.

Diagnosis of Narcolepsy

narcolepsy results from disease processes affecting brain mechanisms that regulate REM sleep. Normally, sleep starts with NREM sleep and transitions to REM sleep. However, people with narcolepsy enter REM sleep within a few minutes of falling asleep. Narcolepsy diagnosis is confirmed by sleep diagnostic tests such as polysomnography and the multiple sleep latency test.

How do night terrors differ from nightmares?

nightmares are more common in the early morning and tend to occur after the person has a strong emotional experience or watches a frightening movie or television program.

Acute and intensive care units in hospitals can put patients at risk for sleep deprivation due to?

noise, constant light, medical care from staff, and patient's poor physical state

Epileptic seizures

occur more often in NREM sleep stages

Sleep deprivation

occurs from prolonged lack of sleep of good quality and adequate quantity. Sleep deprivation can result from drug and substance abuse, hospitalization, medications, stress, environmental factors such as noise or light, and disruption of normal sleep patterns

Somnambulism

or "sleepwalking," is one of the leading causes of self-injury and sleep-related violence. Sleepwalking may lead to injury to others and even homicide. Sleepwalkers may sit up with glassy eyes, get up, and walk around. They usually will avoid anyone who attempts to talk to them.

Nocturnal enuresis

or bedwetting at night, is a socially disruptive and stressful condition that commonly occurs in childhood.

reticular activating system (RAS)

receives sensory impulses from the spinal cord and relays motor impulses to the thalamus and all parts of the cerebral cortex.

Melatonin

regulates the circadian rhythm of sleep and is closely related to light conditions. The sleep-wake circadian rhythm is further affected by the light-dark cycle of the natural environment as input of surroundings is received by the retina of the eyes

Betablockers

reported to cause nightmares and insomnia

Rapid eye movement (REM)

sleep occurs during deep sleep and is manifested by quick scanning movements of the eyes that are associated with dreaming. REM sleep is associated with memory storage, learning, increased cerebral blood flow, and epinephrine release

The four non-rapid Eye Movement (NREM)

stages are characterized by sleep which progresses from lighter to deeper at each stage. During non-rapid eye movement sleep stages, growth hormone is released to repair epithelial and brain cells, cell division for skin and bone marrow renewal occurs, and energy is conserved

Medications that can decrease REM sleep

such as barbiturates, amphetamines, and some antidepressants

Narcotics

suppress REM sleep, cause frequent awakening, and may cause excessive daytime sleepiness.

Hypothyroidism

tends to decrease the amount of NREM sleep

Nerve cells within the hypothalamus control?

the 24-hour circadian rhythms which affect body temperature, endocrine function, blood pressure, sleep, and other functions. Factors such as daily routines, work schedules, social commitments, alarm clocks, and noises affect the circadian rhythm and sleep-wake cycle.

Insomnia

the most common dyssomnia, is characterized by difficulty in falling asleep or staying asleep, sleep that is too light, or early morning awakenings.

Cataplexy

the sudden loss of voluntary muscle tone

Hypertension

usually causes early morning awakening and fatigue.

The diagnosis of OSA is confirmed

with polysomnography to measure respirations, heart rate, and muscle movements.