Sleep
Polysomnography
records eye movements, muscle movement and activity, heart and respiratory rates, oxygen levels, airflow, and brain activity while the patient sleeps.
The nurse is consulting with a 44-year-old patient who suffers from insomnia. Which lifestyle factors would the nurse inform the patient might affect sleep patterns?
A good sleep pattern depends on many lifestyle factors. Working a rotating shift disrupts the sleep-wake cycle and results in poor sleep. Performing unaccustomed, heavy work may cause excessive fatigue and interfere with sleep. Late night social activities may interfere with sleep by providing too many stimuli. Changing the evening mealtime may interfere with sleep. A heavy meal eaten before bedtime may cause indigestion and sleep irregularities.
Which substances may produce insomnia if consumed in the evening?
Alcohol Nicotine Caffeine Consumption of alcohol, nicotine, and caffeine in the evening produces insomnia. Nicotine and caffeine act as stimulants and produce sleeplessness. Alcohol interferes with the quality of sleep. A light meal and a protein-rich diet do not cause insomnia.
What is the similarity between obstructive sleep apnea (OSA) and central sleep apnea (CSA)?
Both decrease the oxygen saturation level. Both obstructive sleep apnea (OSA) and central sleep apnea (CSA) decrease the oxygen saturation level. OSA causes loud snoring; CSA causes mild and intermittent snoring. CSA ceases the movement of the chest wall; patients with OSA show chest wall movement. OSA occurs when muscles of the throat relax during sleep; CSA involves a dysfunction in the respiratory control center of the brain. p. 996
How is stage 1 of nonrapid eye movement (NREM) sleep similar to stage 2 of NREM sleep?
Stage 1 lasts for a few minutes; stage 2 lasts 10 to 20 minutes. Muscles are completely relaxed in stage 3 of NREM sleep. Stage 1 is the lightest level of sleep; stage 2 is a period of sound sleep.
Parasomnias
disorders associated with abnormal sleep behaviors, rather than disorders of sleep itself. Somnambulism Nocturnal Enuresis Sleep Terrors Bruxism
Assessment components related to sleep include:
Health History Focused Sleep Assessment Sleep Assessment Instruments Physical Assessment Diagnostic Testing
A patient has hypothyroidism. Which stage of the sleep cycle is decreased in the patient?
Stage 4 of nonrapid eye movement Hypothyroidism affects the sleep cycle. Hypothyroidism decreases stage 4 of nonrapid eye movement (NREM) sleep. Stage 4 of NREM sleep lasts approximately 15 to 30 minutes and is the deepest stage of sleep. Hypothyroidism doesn't affect stage 1, stage 2, or stage 3 of NREM sleep. Stage 1 NREM sleep lasts a few minutes and includes the lightest level of sleep. Stage 2 of NREM sleep is 10 to 20 minutes and is a period of sound sleep. Stage 3 of NREM sleep lasts 15 to 30 minutes and involves initial stages of deep sleep. p. 995
Which sleep-related side effect is seen with the use of antidepressants and anticonvulsants?
Suppressed rapid eye movement (REM) sleep
Health Assessment Questions Related To Sleep
How have you been sleeping? Do you have any bedtime routines? What time do you usually go to bed? What time do you usually awaken? Do you feel rested when you awaken? How long does it take for you to go to sleep? Do you awaken during the night? How often? What do you do? Do you have enough energy to complete your tasks during the day? Do you take naps during the day? For how long? What is your normal eating pattern? Do you drink beverages with caffeine, such as colas, coffee, or tea? Does your sleep partner comment about your sleep? Snoring? Pauses in breathing? What do you do to help yourself sleep? Do you use over-the-counter medications? Prescription medications?
Some conditions cause specific disturbances in sleep:
Hyperthyroidism makes it hard for a person to fall asleep. Low estrogen levels in women can cause daytime fatigue, night sweats, or hot flashes, all of which interfere with sleep. End-stage renal disease disrupts sleep and leads to daytime sleepiness. Shortness of breath and sinus drainage can lead to difficulty breathing and inability to sleep. Pain associated with an illness or injury may cause inability to fall asleep or may wake a person from sleep. Peptic ulcers cause pain at night which may be related to an increase in gastric secretions during REM sleep. Pain related to coronary artery disease is more likely to occur during REM sleep. Hypertension usually causes early morning awakening and fatigue. Epileptic seizures occur more often in NREM sleep stages. Hypothyroidism tends to decrease the amount of NREM sleep.
Dyssomnias
disorders associated with getting to sleep, staying asleep, or being excessively sleepy. Circadian Rhythm Sleep Disorders Insomnia Narcolepsy Hypersomnia Sleep Apnea Sleep Deprivation Restless Legs Syndrome
Hypersomnia
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. The causes of hypersomnia include medical conditions such as kidney or liver disorders, central nervous system damage, diabetic acidosis, and hypothyroidism.
In a patient with narcolepsy, rapid eye movement (REM) sleep occurs within how many minutes of falling asleep? Record your answer using a whole number.
15 In a patient who has narcolepsy, rapid eye movement (REM) sleep occurs within 15 minutes of falling asleep.
Sleep apnea is classified by how many types?
3 central apnea, obstructive apnea, and mixed apnea
The nurse is gathering a sleep history from a patient who is being evaluated for obstructive sleep apnea. Which common symptoms does the patient most likely report? Select all that apply.
Common symptoms for obstructive sleep apnea include headache, snoring, and excessive daytime sleepiness caused by poor sleep during the night. p. 996
While monitoring a patient's vital signs, the nurse finds that the patient's pulse and respiration during sleep are significantly lower than during waking hours. The nurse also recalls that during this stage of sleep the body releases human growth hormone. The patient is in which nonrapid eye movement (NREM) stage of sleep?
During stage 4 of NREM sleep, a patient's vital signs are significantly lower than during waking hours. This is a deep, slow-wave sleep stage during which the body releases human growth hormone. Stage 1 NREM sleep is the lightest level of sleep and lasts for just a few minutes. Stage 2 NREM sleep is a period of sound sleep that lasts for 10 to 20 minutes. Stage 3 NREM sleep involves the initial stages of deep sleep lasting for 15 to 20 minutes.
A sleeper's random eye movement (REM) sleep is around 30% of the sleep time. The sleeper belongs to which age group?
Infants In infants, around 30% of the sleep time is random eye movement (REM) sleep. In neonates, around 50% of the sleep time is REM sleep. In young adults and preschoolers, around 20% of the sleep time is REM sleep.
Medication
Many over-the-counter medications and prescriptions can affect the quality of sleep, causing restlessness, sleepiness, or insomnia. Some medications decrease REM sleep, such as barbiturates, amphetamines, and some antidepressants. Other medications that affect sleep patterns include diuretics, antiparkinsonian medications, antihypertensives, steroids, decongestants, and asthma drugs. Beta blockers have been reported to cause nightmares and insomnia. Narcotics suppress REM sleep, cause frequent awakening, and may cause excessive daytime sleepiness.
For what does an electromyogram (EMG) monitor in a patient diagnosed with a sleep disorder?
Muscle tone Various instruments are used to measure a patient's sleep pattern. An EMG measures muscle tone. An electrooculogram (EOG) measures eye movements. An electrocardiogram (ECG) measures the electrical activity of the heart. An electroencephalogram (EEG) measures electrical activity in the cerebral cortex.
A patient reports to the nurse, "I feel like I'm unable to move or talk just before waking or falling asleep." Which sleep disorder does the nurse suspect?
Narcolepsy Sleep paralysis is a symptom associated with narcolepsy. It occurs when patients feel like they are unable to move or talk just before waking or falling asleep. Sleep paralysis is not associated with cataplexy, mixed sleep apnea, or central sleep apnea. Cataplexy is sudden muscle weakness while experiencing intense emotions such as anger, sadness, or laughter. It may occur any time during the day. Mixed sleep apnea is associated with both central sleep apnea (CSA) and obstructive sleep apnea (OSA). CSA involves dysfunction in the respiratory control center of the brain.
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
The nurse is assessing a patient who complains of sleep deprivation. Which physiological symptoms should the nurse expect to find in the patient?
Ptosis or blurred vision Cardiac arrhythmias Diminished reflexes Decreased hearing Sleep deprivation may slow down all the body systems. This slowing may result in ptosis or blurred vision, cardiac arrhythmias, diminished reflexes, and decreased hearing. Sleep deprivation would not increase the response time to questions asked or to any activity, because responses have slowed.
A patient with anemia who is 24 weeks pregnant complains to the nurse of recurrent, rhythmical movements of her feet and legs before the onset of sleep. What could be the reason for her condition?
Renal failure Gender Pregnancy Her gestational age Lower level of iron The symptoms in the patient indicate that she is suffering from a condition called restless legs syndrome (RLS). This condition is more common in women, pregnant females, and those with low iron levels. Though renal failure is associated with RLS, the patient does not show any other signs of renal failure. Gestational age does not play a role in RLS.
The nurse is teaching a group of student nurses about the stages of sleep. Which event does the nurse discuss while explaining rapid eye movement (REM) sleep?
Skeletal muscle paralysis
Which phase of nonrapid eye movement (NREM) sleep involves the initial stages of deep sleep?
Stage 3 Stage 3 of the nonrapid eye movement (NREM) sleep involves the initial stages of deep sleep. Stage 1 includes the lightest level of sleep. Stage 2 is a period of sound sleep. Stage 4 is the deepest stage of sleep.
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.
Secondary sleep disorders
symptoms of underlying situational, mental health, or medical conditions that interfere with sleep. Situational conditions such as stress related to work or other responsibilities, anxiety about a chronic illness, or fear for one's safety can significantly impact sleep. Medical conditions such as heart failure, chronic obstructive pulmonary disease, pain, and gastric reflux disease all may have symptoms that affect a patient's ability to sleep. Mental health disorders cause changes in sleep-wake regulation. Up to 90% of patients with depression report disturbed sleep.
