chapter 43 - sleep and rest

REM sleep enters at stage ___ of NREM sleep and reenters NREM at stage___ (same stage)

2

____ stages of NREM sleep

4

sleep occurs in recurring cycles of ______ to ______ minutes.

90 to 100

true/false its ok to have a pillow, blanket and stuffed animal in the crib with the infant while sleeping.

FALSE

needed for the consolidation of explicit memories -these memories require conscious thought (recalling who came to dinner last night)

NREM sleep

-transitional stage (aware you're falling asleep) -*decreased* physical activity begins w/ gradual fall in vital signs and metabolism -relaxed state -*involuntary* muscle jerking -usually 10-30 min -sensory stimuli such as noise *easily* arouse person -when awakened person feels as if *daydreaming* has occurred

NREM stage 1

-last 10-20 min -period of sound sleep -relaxation progresses -body function begins to *slow* -arousal remains relatively *easy*

NREM stage 2

-lasts 15-30 min -involves initial stages of deep sleep -muscles are *completely* relaxed -vital signs decline but remain regular -individual is *difficult* to arouse and rarely moves

NREM stage 3

characterized by: -general decrease in body temp., bp, breathing rate, and other bodily functions -brain never decreases activity

normal sleep

disorders associated w/ abnormal sleep behaviors, rather than disorders of sleep itself -more common in children (in adults the indicate serious problems) somnambulism (sleep walking), sleep talking, bruxism (grinding of teeth), nocturnal enuresis (bedwetting), nocturia, night terrors

parasomnias

factor influencing sleep physical illness, pain/discomfort, resp disorders (copd, emphysema, allergies, asthma), nocturia

physiological factors

a sleep lab study to monitor the stage of sleep and wakefulness; used to diagnose sleep disorders involves: -EEG to measure and record brain wave activity -EMG to record muscle and presence of REM sleep -EOG to record eye movement -EKG to record heart rate and rhythm

polysomnogram

imbalanced circadian rhythm after several weeks, the biological clock usually does adjust

shift work

without proper ___________ our ability to concentrate, make judgements, and participate in daily activities decreases.

sleep

a person experiences the absence of breathing or diminished breathing during sleep between snoring intervals most common type is obstructive sleep apnea (OSA) -lack of airflow through the mouth and nose for at least 10 sec and up to 2 min during sleep

sleep apnea

treatment: therapy for underlying cardiac/resp complications & emotional prob. -recommend lifestyle changes (smoking cessation, alcohol moderation, weight loss, use a side/prone sleep position) -CPAP device -oral appliances -surgical procedures

sleep apnea

NREM stage 1 --> NREM stage 2 --> NREM stage 3 --> NREM stage 4 --> NREM stage 3 --> NREM stage 2 --> REM --> NREM stage 2 --> cont.

sleep cycle

leads to: -chronic tiredness -mood changes -frustration -difficulty controlling emotions -inability to think abstractly -absenteeism

sleep deprivation

result of a decrease in the amount, quality and consistency of sleep can be caused by phone, tablet, tv, studying, illness and hospitalization this is worse than intoxication - it causes work and auto accidents, as well as poor work and school performance

sleep deprivation

s/s: -daytime drowsiness -impaired cognitive function -restlessness -perceptual disorders -slowed reaction time -irritability -somatic (body) complaints (hand tremors) -general feeling of malaise if prolonged you may see: delusion, paranoia, and other psychotic behavior may occur

sleep deprivation

these are conditions that prevent a restful night of sleep -8 main categories

sleep disorders

the nurse should promote these to help insomnias: -limit daytime naps to 30 min -avoid stimulants such as caffeine/nicotine close to bedtime -exercise (walking or cycling) to promote good quality sleep -steer clear of any food that could be disruptive right before sleeping -ensure adequate exposure to natural light -establish a regular relaxing bedtime routine -ensure pleasant sleep environment

sleep hygiene measure

symptom of narcolepsy occurs during the transition from being asleep to waking up

sleep paralysis

these physiological changes occur in what phase of NREM sleep? -slow brain waves are recored on ECG -pulse and resp rate decrease -muscles are relaxed -metabolism slows -low body temp

stage 4

true/false promoting sleep is an important nursing intervention.

true

true/false sleep deprivation significantly contributes to medical errors in such a way that sleep deprived professionals commit 36% more serious errors than usual (31% are causing fatality)

true

true/false sleep is essential for physical, mental, and spiritual well-being and for the regulation of emotions. it helps maintain memory and learning.

true

-this is the greatest depth of sleep termed *delta sleep* -arousal from sleep is *difficult* -*if sleep loss has occurred,* individual spends a considerable part of the night in this stage -vital signs are considerably *lower* than in waking hours -usually 15-30 min -sleep walking and bed wetting occur in this stage

NREM stage 4

patient complaints: -excessive loud snore and snorting sounds -excessive daytime sleepiness -patients w/ OSA often wake with a h/a -evaluate the risk/improvements with a spouse or SA

OSA

-usually about 90 min after sleep begun -*increases* with each cycle; usually averages 20 min -vivid, full color dreaming occurs -eyes dart back and forth -small muscle twitching (ex. face) -large muscle immobility -resp. *irregular*; sometimes interspersed w/ apnea -*rapid or irregular* pulse -bp *increases or fluctuates* -*increase* in GI secretions -*increase* in metabolism -body temp *increases*

REM sleep

needed for the consolidation of implicit memories -the long term memories we can do w/o consciously thinking

REM sleep

infants need to sleep on their backs (prone) to decrease the risk for __________.

SIDS (sudden infant death syndrome)

symptom of narcolepsy the *sudden* loss of muscle tone and stability --> causes drop attacks

cataplexy

-non-rapid eye movement sleep (NREM) -rapid eye movement sleep (REM)

categories of sleep

the biological clock regular bodily rhythms that occur on a 24-hour cycle failure to maintain this negatively influences overall health

circadian rhythm

_______________ represents one of the most sleep deprived segments of our population.

college students

factor influencing sleep any change in lifestyle, occupation, retirement

current life events

factor influencing sleep mealtime schedule, time of day, food/calorie intake, caffeine

diet (poor eating)

factor influencing sleep room temp, lighting, noises (esp unfamiliar), routines, poor ventilation, size, firmness of bed and pillows

environment

s/s: -trouble waking in the morning -feeling excessively sleepy or having a general lack of energy during the day -needing or taking frequent naps throughout the day -dozing off during inappropriate times such as during meals, in the middle of conversations, or even while driving -naps *don't* relieve symptoms -feelings of irritability or anxiety -difficulty concentrating -lapses in attention -loss of appetite *constant feeling of tiredness*

excessive daytime sleepiness

symptom for narcolepsy

excessive daytime sleepiness

factor influencing sleep moderate exercise aids in a restful sleep

exercise

a health problem tired people become inefficient and more likely to make mistakes

fatigue

the quality of sleep and getting enough sleep is just as essential to survival as __________ and __________.

food and water

-conservation of energy -restoration of tissues and growth -thermoregulation -regulation of emotions -neural maturation -memory and learning -10 hr/night is ideal for best performance

functions of sleep

symptom of narcolepsy may occur just before falling asleep or right after waking up and are associated w/ an episode of REM sleep

hallucinations

causes: -adjustment sleep disorder (acute) -inadequate sleep hygiene -medical condition -substance abuse -shift work

insomnias

most common sleep-related disorder -trouble falling asleep or staying asleep through the night the last *for at least one month* -*common in:* older adults, with stress, and medical/mental problems -this leads to fatigue; problems with attention, concentration or memory; poor performance; moodiness or irritability; daytime sleepiness; impulsiveness or aggression; errors or accidents

insomnias

treatment: -underlying cause -improve sleep hygiene measures -relaxation techniques

insomnias

if we get tired enough then we will doze off for a few seconds at a time and this can cause problems when at work, driving, etc.

involuntary sleep

long-term effects: -part of the brain that controls language memory, planning, and sense of time is severely affected -functioning at a level equivalent to a BAC of 0.05% (2 glasses of wine) -stroke risk *quadruples* -cancer, heart disease, and diabetes risk increases -sperm count decreases -death risk increases

lack of sleep

short-term effects: -grumpiness -grogginess -irritability -forgetfulness -difficulty concentrating -attention span shortens -more hungry (eating more) -not looking your best or most approachable -losing brain tissue and memory problems

lack of sleep

*sudden* and severe onset of sleep during waking hours characterized by recurrent 'sleep attacks' that the patient cannot fight -the person goes *directly* from wake to REM sleep -sleep attacks last approx 10-20 min -pt feels refreshed by sleep but feels sleepy again several hours later 40% of people have or have had another mental disorder

narcolepsy

-take responsibility to get a min. 6 hr of sleep -maintain regular sleep schedule when not working -include a 4 hr anchor sleep time where sleep is scheduled whether on/off work -wear dark glasses that block light when driving home from night shift -seek exposure to bright light asap when waking -before first night shift, power nap for 30-90 min before leaving

ways to help your biological clock