ECPI 2020: NUR 164: CHAPTER 34: REST & SLEEP

A nurse caring for patients in a busy hospital environment should implement which recommendation to promote sleep? A) Keep the room light dimmed during the day. B) Keep the room cool. C) Keep the door of the room open. D) Offer a sleep aid medication to patients on a regular basis

B) Keep the room cool.

A nurse is performing a sleep assessment on a patient being treated for a sleep disorder. During the assessment, the patient falls asleep in the middle of a conversation. The nurse would suspect which disorder? A) Circadian rhythm sleep-wake disorder B) Narcolepsy C) Enuresis D) Sleep apnea

B) Narcolepsy

Barbiturates, amphetamines, and antidepressants increase REM sleep. A. True B. False

B. False Barbiturates, amphetamines, and antidepressants decrease REM sleep.

In which stage of NREM sleep does the person fall into a stage of sleep but can be aroused with relative ease? A. Stage I B. Stage II C. Stage III D. Stage IV

B. Stage II In stage II of NREM sleep, the person falls into a stage of sleep but can be aroused with ease. In stage I, the person is in a transitional stage between wakefulness and sleep. In stages III and IV, the depth of sleep increases, and arousal becomes increasing difficult.

Which of the following snacks is an appropriate bedtime snack to promote sleep in a patient? A. Candy B. Toast C. Lunchmeat D. Cheese

B. Toast Because carbohydrates seem to promote sleep, there appears to be justification for offering a snack or beverage high in carbohydrates (such as toast or crackers) before bedtime. Candy, lunchmeat, and cheese do not contain carbohydrates.

Stages Of NRM Sleep: Stage IV:

- The person reaches the greatest depth of sleep, which is called delta sleep. - Arousal from sleep is difficult. Physiologic changes in the body include the following: - Slow brain waves are recorded on an EEG - Pulse and respiratory rates decrease - Blood pressure decreases - Muscles are relaxes - Metabolism slows and the body temperature is low. - This constitutes about 10% of sleep

Information Recorded in a Sleep Diary:

- Time patient retires - Time patient tries to fall asleep - Approximate time patient falls asleep - Time of any awakening during the night and resumption of sleep - Time of awakening in morning - Presence of any stressors affecting sleep - Record of food, drink, or medication affecting sleep - Record of physical and mental activities - Record of activities performed 2 to 3 hours before bedtime - Presence of worries or anxieties affecting sleep

Factors Affecting Sleep: Culture:

- A person's cultural beliefs and practices can influence rest and sleep. A - Although developmental stages are similar, children's bedtime rituals, sleeping position and place, and pattern of sleep may vary based on culture. - Methods to enhance or foster sleep may also be culturally influenced. - A cultural orientation toward privacy and quiet makes sleep difficult in a busy special care unit. - Sensitivity to a patient's culture must be included in the plan of care for preparing the patient for an evening's sleep.

Factors Affecting Sleep: Illness:

- A physiologic as well as a psychological stressor, influences sleep. Certain illnesses are more closely related to sleep disturbances than others. - For example: Gastric secretions increase during REM sleep. Many people with gastroesophageal reflux disease (GERD) awaken at night with heartburn or pain. They find that using antacids to neutralize stomach acidity often relieves discomfort and promotes sleep. - The pain associated with coronary artery disease and myocardial infarction is more likely with REM sleep. - Epilepsy seizures are most likely to occur during NREM sleep and appear to be depressed by REM sleep. - Liver failure and encephalitis tend to cause a reversal in day-night sleeping habits. - Hypothyroidism tends to decrease the amount of NREM sleep, especially stages II and IV, while hyperthyroidism may result in difficulty falling asleep. - End-stage renal disease (ESRD) disrupts nocturnal sleep and leads to excessive daytime sleepiness. - Patients with ESRD who receive dialysis also have a higher incidence of RLS (discussed later in the chapter), which possibly is related to the iron deficiency common in ESRD.

Circadian Rhythm Sleep-Wake Disorders:

- Characterized by a chronic or recurrent pattern of sleep-wake rhythm disruption primarily caused by an alteration in the internal circadian timing system or misalignment between the internal circadian rhythm and the sleep-wake schedule desired or required; a sleep-wake disturbance (e.g., insomnia or excessive sleepiness); and associated distress or impairment, lasting for a period of at least 3 months (except for jet lag disorder) - Treatment for circadian rhythm sleep-wake disorders varies based on the type of disorder and the degree to which it affects a person. Behavior therapy includes maintaining regular sleep-wake times, avoiding naps, keeping to a regular exercise routine, and avoiding caffeine, nicotine, and stimulating activities within several hours of bedtime - Light therapy helps ease the transition to a new schedule or time zone. It involves exposing the patient's eyes to an artificial bright light that simulates sunlight for a specific and regular amount of time during the time the person should be awake - Chronotherapy requires a commitment on the part of the patient to act over a period of weeks to progressively advance or delay the time of sleep for 1 to 2 hours per day. Over time, this results in a shift of the sleep-wake cycle

Sleep Disorders: Insomnia:

- Characterized by difficulty falling asleep, intermittent sleep or difficulty maintaining sleep, despite adequate opportunity and circumstances to sleep. - As many as 30 to 35 percent of adults in the United States complain of insomnia. - People with a history of depression are more likely to experience insomnia. - Many cases of insomnia are related to disruptions in circadian rhythms. - Insomnia may be short-term or chronic in nature.

Central disorders of hypersomnolence: Idiopathic hypersomnia:

- Characterized by excessive sleep, particularly during the day. - A person may fall asleep for intervals during work, while eating, or even during conversations. - These naps do not usually relieve their symptoms. - When they awake, they are often disoriented, irritated, restless, and have slower speech and thinking processes. - Some people may have a genetic predisposition to hypersomnia. - It appears most often in adolescents and young adults. - Although not usually life threatening, hypersomnia can have some serious consequences, such as motor vehicle accidents that occur because of drowsiness or falling asleep while driving. These attacks may occur indefinitely

Characteristics of Circadian Rhythm Sleep -Wake Disorders:

- Chronic or recurrent pattern of sleep-wake rhythm disruption Primary causes: - An alteration in the internal circadian timing system or misalignment between the internal circadian rhythm and the sleep-wake schedule desired or required - A sleep-wake disturbance (e.g., insomnia or excessive sleepiness) - Associated distress or impairment, lasting for a period of at least 3 months (except for jet lag disorder).

Stages Of Sleep: Non-rapid eye movement (NREM):

- Comprises about 75% of total sleep time, consists of four stages. Stages I and II, consuming about 5% and 50% of a person's sleep time - Are light-sleep states. - During these stages, the person can be aroused with relative ease. - Stages III and IV, each representing about 10% of total sleep time, are deep-sleep states, termed delta sleep or slow-wave sleep. - The arousal threshold (intensity of stimulus required to awaken) is usually greatest in stage 4 NREM. Throughout the stages of NREM sleep, the parasympathetic nervous system dominates, and decreases in pulse, respiratory rate, blood pressure, metabolic rate, and body temperature are observed.

Key Findings of Physical Assessment:

- Energy level - Facial characteristics - Behavioral characteristics - Physical data suggestive of sleep problems

REM Sleep Characteristics:

- Eyes dart back and forth quickly. - Small muscle twitching, such as on the face - Large muscle immobility, resembling paralysis - Respirations irregular; sometimes interspersed with apnea - Rapid or irregular pulse - Blood pressure increases or fluctuates - Increase in gastric secretions - Metabolism increases; body temperature increases - Encephalogram tracings active - REM sleep enters from stage II of NREM sleep and reenters NREM sleep at stage II: arousal from sleep difficult

Factors Affecting Sleep: Medications:

- Health care practitioners must also take into account the effect that drugs used to treat medical or psychological disorders have on sleep. - Drugs that decrease REM sleep include barbiturates, amphetamines, and antidepressants. - Diuretics, antiparkinsonian drugs, some antidepressants and antihypertensives, steroids, decongestants, caffeine, and asthma medications are seen as additional common causes of sleep problems. - Chronotherapeutics is a growing field of study that involves the strategic use of time in the administration of medicine. Researchers have determined that certain treatments for disease are more effective when circadian rhythms are taken into account. - For example, a larger midafternoon dose of asthma medication may be more effective in preventing attacks that commonly occur at night during sleep. - The timing of antihypertensive medication administration may need to be adjusted to provide peak protection during early-morning hours, when heart attacks are more common. - Cancer chemotherapy appears to be less toxic when administered at certain times of the day. - Paying attention to biologic rhythms may influence drug tolerance and medication effectiveness, and reduce adverse effects, including those related to rest and sleep.

Rapid eye movement (REM):

- It is more difficult to arouse a person during this - consumes 20% to 25% of a person's nightly sleep time - People who are awakened during the REM state almost always report that they have been dreaming. They can usually vividly recall their dreams even if they were absurd or have no sensible meaning for them. Everyone dreams. - the pulse, respiratory rate, blood pressure, metabolic rate, and body temperature increase, whereas general skeletal muscle tone and deep tendon reflexes are depressed. REM sleep is believed to be essential to mental and emotional equilibrium and to play a role in learning, memory, and adaptation. - Person who is deprived of REM sleep for several nights generally will spend more time in REM sleep on successive nights

Factors Affecting Sleep: Environmental factors:

- Most people sleep best in their usual home environments. - Sleeping in a strange or new environment tends to influence both REM and NREM sleep. - People accustomed to sleeping in a noisy environment, such as a busy large city, actually have a hard time falling asleep in an area that is extremely quiet. - By turning on a radio or other noise, the person may actually be able to rest in the new environment. Likewise, if a patient is accustomed to sleeping in a quiet environment, a room next to a high-traffic area, such as the nurse's desk, may not be the best place for this patient to rest.

Obtaining a Sleep History:

- Nature of problem - Cause of problem - Related signs and symptoms - When the problem began and how often it occurs - How the problem affects everyday living - Severity of the problem and how it can be treated - How the patient is coping with the problem and success of treatments attempted

Factors Affecting Sleep: Lifestyle and habits:

- People working a shift other than the day shift must reorganize their priorities, or sleep difficulties may occur. - Based on the circadian cycle, the body prepares for sleep at night by decreasing the body temperature and releasing melatonin (a natural chemical produced at night that decreases wakefulness and promotes sleep). - Working the night shift disrupts this natural process and can result in loss of sleep and other adverse effects. - Developing a sleep pattern is especially difficult if the work shift changes periodically. - Nurses and others who work long hours and varying shifts have difficulty finding time to exercise, which can promote weight gain. - The duration and quality of sleep can be affected by watching some types of television shows, participating in stimulating outside activities, and taking part in activity or exercise within 3 hours of the person's normal bedtime. - A person's ability to relax from work-related pressures and to put aside home stresses are also important factors in the ability to fall asleep.

Common Etiologies for Nursing Diagnoses:

- Physical or emotional discomfort or pain - Changes in bedtime rituals or sleep environment - Disruption of circadian rhythm - Exercise and diet before sleep - Drug dependency and withdrawal - Symptoms of physical illness

Nursing Interventions to Promote Sleep:

- Prepare a restful environment. - Promote bedtime rituals. - Offer appropriate bedtime snacks and beverages. - Promote relaxation and comfort. - Respect normal sleep-wake patterns. - Schedule nursing care to avoid disturbances. - Use medications to produce sleep. - Teach about rest and sleep.

Functions of Rest and Sleep:

- Rest refers to a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed. - Sleep is a state of rest accompanied by altered consciousness and relative inactivity. - Sleep is part of what is called the sleep-wake cycle. Wakefulness is a time of mental activity and energy expenditure. - Sleep is a period of inactivity and restoration of mental and physical function.

Sleep Related Movement Disorders: Restless Legs Syndrome (RLS):

- Restless legs syndrome (RLS), also known as Willis- Ekbom disease (WED), is a common sleep-related movement disorder that affects up to 15% of the population, most often middle-aged and older adults. - People with restless legs syndrome (RLS) cannot lie still and report unpleasant creeping, crawling, or tingling sensations in the legs. - Nonpharmacologic treatments

Sleep Characteristics To Assess:

- Restlessness - Sleep postures - Sleep activities - Snoring - Leg jerking

Stages Of NRM Sleep: Stage III:

- The depth of sleep increases, and arousal becomes increasingly difficult. - This stage composes about 10% of sleep.

Stages Of NRM Sleep: Stage II:

- The person falls into a stage of sleep. - The person can be aroused with relative ease. - This stage constitutes 50% to 55% of sleep.

Stages Of NRM Sleep: Stage I:

- The person is in a transitional stage between wakefulness and sleep. - The person is in a relaxed state but still somewhat aware of the surroundings. - Involuntary muscle jerking may occur and waken the person. - The stage normally lasts only minutes. - The person can be aroused easily. - This stage constitutes only about 5% of total sleep.

Sleep Cycle Stages:

- The person passes consecutively through four stages of NREM sleep. - The pattern is then reversed. - Return from stage IV to III to II - Enter REM sleep instead of re-entering stage I - The person re-enters NREM sleep at stage II and moves on to III and IV.

Factors Affecting Sleep: Developmental Considerations:

- Variations in sleep patterns are related to age - Routine assessment of sleepiness or short sleep patterns in children is a first step in identifying the existence of a sleep problem and factors interfering with a child's sleep. - With a growing body of evidence linking inadequate sleep with obesity and other health concerns in children, health care practitioners must ask about patterns of sleep and sleep habits in children and discuss these issues with parents. - A majority of people ages 65 and older report difficulty falling asleep, early awakening or waking frequently during the night, napping, or not feeling rested after a night's sleep. - Older adults often need more time to fall asleep and are less able to cope with changes in their usual sleep patterns compared to younger people. - Many older adults nap during the day, which often results in sleeping fewer hours at night. - Chronic illnesses in older adults may also affect their sleep patterns. - For instance, many older men have enlargement of the prostate gland, which may cause them to awaken throughout the night to use the bathroom.

A nurse is assessing patients in a skilled nursing facility for sleep deficits. Which patients would be considered at a higher risk for having sleep disturbances? Select all that apply. A) A patient who has uncontrolled hypothyroidism. B) A patient with coronary artery disease. C) A patient who has GERD. D) A patient who is HIV positive. E) A patient who is taking corticosteroids for arthritis. F) A patient with a urinary tract infection.

A) A patient who has uncontrolled hypothyroidism. B) A patient with coronary artery disease. C) A patient who has GERD.

A nurse is caring for an older adult who is having trouble getting to sleep at night and formulates the nursing diagnosis Disturbed sleep pattern: Initiation of sleep. Which nursing interventions would the nurse perform related to this diagnosis? Select all that apply. A) Arrange for assessment for depression and treatment. B) Discourage napping during the day. C) Decrease fluids during the evening. D) Administer diuretics in the morning. E) Encourage patient to engage in some type of physical activity. F) Assess medication for side effects of sleep pattern disturbances.

A) Arrange for assessment for depression and treatment. B) Discourage napping during the day. E) Encourage patient to engage in some type of physical activity. F) Assess medication for side effects of sleep pattern disturbances.

A nurse is teaching a patient with a sleep disorder how to keep a sleep diary. Which data would the nurse have the patient document? Select all that apply. A) Daily mental activities B) Daily physical activities C) Morning and evening body temperature D) Daily measurement of fluid intake and output E) Presence of anxiety or worries affecting sleep F) Morning and evening blood pressure readings

A) Daily mental activities B) Daily physical activities E) Presence of anxiety or worries affecting sleep

To promote sleep in a patient, a nurse suggests what intervention? A) Follow the usual bedtime routine if possible. B) Drink two or three glasses of water at bedtime. C) Have a large snack at bedtime. D) Take a sedative-hypnotic every night at bedtime.

A) Follow the usual bedtime routine if possible.

A nurse caring for patients in a long-term care facility is implementing interventions to help promote sleep in older adults. Which action is recommended for these patients? A) Increase physical activities during the day. B) Encourage short periods of napping during the day. C) Increase fluids during the evening. D) Dispense diuretics during the afternoon hours.

A) Increase physical activities during the day.

A nurse observes involuntary muscle jerking in a sleeping patient. What would be the nurse's next action? A) No action is necessary as this is a normal finding during sleep. B) Call the primary care provider to report possible neurologic deficit. C) Lower the temperature in the patient's room. D) Awaken the patient as this is an indication of night terrors.

A) No action is necessary as this is a normal finding during sleep.

Somnambulism is a parasomnia in which the person walks in his or her sleep. A. True B. False

A. True Somnambulism is a parasomnia in which the person walks in his or her sleep.

Factors Affecting Sleep: Motivation:

A desire to be wakeful and alert helps overcome sleepiness and sleep. - For example, a tired person may be wakeful and alert when at a party or when attending an interesting play or concert. - The opposite is also true: When there is minimal motivation to be awake, sleep generally follows. - For example, a student who is bored and disinterested in a lecture or class may doze during the lecture.

A nurse is providing discharge teaching for patients regarding their medications. For which patients would the nurse recommend actions to promote sleep? Select all that apply. A) A patient who is taking iron supplements for anemia. B) A patient with Parkinson's disease who is taking dopamine. C) An older adult taking diuretics for congestive heart failure. D) A patient who is taking antibiotics for an ear infection. E) A patient who is prescribed antidepressants. F) A patient who is taking low-dose aspirin prophylactically.

B) A patient with Parkinson's disease who is taking dopamine. C) An older adult taking diuretics for congestive heart failure. E) A patient who is prescribed antidepressants.

A nurse on a maternity ward is teaching new mothers about the sleep patterns of infants and how to keep them safe during this stage. What comment from a parent alerts the nurse that further teaching is required? A) "I can expect my newborn to sleep an average of 16 to 24 hours a day." B) "If I see eye movements or groaning during my baby's sleep I will call the pediatrician." C) "I will place my infant on his back to sleep." D) "I will not place pillows or blankets in the crib to prevent suffocation."

B) "If I see eye movements or groaning during my baby's sleep I will call the pediatrician."

A nurse working the night shift in a pediatric unit observes a 10-year-old patient who is snoring and appears to have labored breathing during sleep. Upon reporting the findings to the primary care provider, what nursing action might the nurse expect to perform? A) Preparing the family for a diagnosis of insomnia and related treatments. B) Preparing the family for a diagnosis of narcolepsy and related treatments. C) Anticipating the scheduling of polysomnography to confirm OSA. D) No action would be taken, as this is a normal finding for hospitalized children.

C) Anticipating the scheduling of polysomnography to confirm OSA.

A nurse is caring for a patient who states he has had trouble sleeping ever since his job at a factory changed from the day shift to the night shift. For what recommended treatment might the nurse prepare this patient? A) The use of a central nervous system stimulant B) Continuous positive airway pressure machine (CPAP) C) Chronotherapy D) The application of heat or cold therapy to promote sleep

C) Chronotherapy

A nurse is discussing with an older adult patient measures to take to induce sleep. What teaching point might the nurse include? A) Drinking a cup of regular tea at night induces sleep. B) Using alcohol moderately promotes a deep sleep. C) Having a small bedtime snack high in tryptophan and carbohydrates improves sleep. D) Exercising right before bedtime can hinder sleep.

C) Having a small bedtime snack high in tryptophan and carbohydrates improves sleep.

A nurse observes a slight increase in a patient's vital signs while he is sleeping during the night. According to the patient's stage of sleep, the nurse expects what conditions to be true? Select all that apply. A) He is aware of his surroundings at this point. B) He is in delta sleep at this time. C) It would be most difficult to awaken him at this time. D) This is most likely an NREM stage. E) This stage constitutes around 20% to 25% of total sleep. F) The muscles are relaxed in this stage.

C) It would be most difficult to awaken him at this time. E) This stage constitutes around 20% to 25% of total sleep.

In which of the following sleep disorders does the patient have an uncontrollable desire to sleep? A. Insomnia B. Sleep apnea C. Narcolepsy D. Restless leg syndrome

C. Narcolepsy In narcolepsy, a person can literally fall asleep while performing ADLs. Insomnia is characterized by difficulty falling asleep. Sleep apnea is a condition in which a person experiences the absence of breathing during sleep between snores. Restless leg syndrome is a crawling or tingling sensation in the legs.

Central Disorders of Hypersomnolence: Narcolepsy:

Characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep - Up to 70% of people with narcolepsy also experience cataplexy, the sudden, involuntary loss of skeletal muscle tone lasting from seconds to one or two minutes.

Central Disorders of Hypersomnolence: Idiopathic hypersomnia:

Characterized by excessive sleep, particularly during the day.

Sleep-Related Breathing Disorder: Obstructive Sleep Apnea (OSA):

Characterized by five or more predominantly obstructive respiratory events: - The absence of breathing [apnea] - Diminished breathing efforts [hypopnea] - Respiratory effort-related arousals during sleep, accompanied by sleepiness, fatigue, insomnia, snoring - Subjective nocturnal respiratory disturbance - Observed apnea and associated health disorders

A nurse working in a sleep lab observes the developmental factors that may affect sleep. Which statements accurately describe these variations? Select all that apply. A) REM sleep constitutes much of the sleep cycle of a preschool child. B) By the age of 8 years, most children no longer take naps. C) Sleep needs usually decrease when physical growth peaks. D) Many adolescents do not get enough sleep. E) Total sleep decreases in adults with a decrease in stage IV sleep. F) Sleep is less sound in older adults and stage IV sleep may be absent.

D) Many adolescents do not get enough sleep. E) Total sleep decreases in adults with a decrease in stage IV sleep. F) Sleep is less sound in older adults and stage IV sleep may be absent.

Illnesses Associated With Sleep Disturbances: Gastroesophageal reflux:

Gastric secretions increase during REM sleep. Many people with gastroesophageal reflux disease (GERD) awaken at night with heartburn or pain. - They find that using antacids to neutralize stomach acidity often relieves discomfort and promotes sleep.

Obstructive Sleep Apnea (OSA):

In adults, five or more predominantly obstructive respiratory events (the absence of breathing [apnea] or diminished breathing efforts [hypopnea] or respiratory effort-related arousals) during sleep, accompanied by sleepiness, fatigue, insomnia, snoring, subjective nocturnal respiratory disturbance, or observed apnea and associated health disorders (hypertension, coronary artery disease, atrial fibrillation, congestive heart failure, stroke, diabetes, cognitive dysfunction, or mood disorder)

Treatment for Dyssomnias:

Pharmacologic therapy: - Sedatives - Hypnotics Nonpharmacologic therapy • Cognitive Behavioral Therapy (CBT) - Progressive muscle relaxation measures - Stimulus control - Sleep restriction; sleep hygiene measures - Biofeedback and relaxation therapy

Factors Affecting Sleep: Psychological Stress:

Psychological stress, such as from illness and various life situations, tends to disturb sleep. - In general, psychological stress affects sleep in two ways: (1) the person experiencing stress may find it difficult to obtain the amount of sleep needed; (2) REM sleep decreases in amount, which tends to add to anxiety and stress.

Rest & Sleep: Factors To Assess: Usual sleep-wakefulness pattern: Recent changes / Usual sleeping and waking times

Questions & Approaches: - Do you set an alarm and hit "snooze" before getting up? - How many hours of sleep do you usually get in a day? - Do you wake up earlier in the morning than you would like and find it difficult to fall back asleep? - Have there been any recent changes in your usual sleep-wake patterns? If yes, describe them and tell me if they are causing any problems for you. - Do you usually go to bed and wake up about the same time each day?

Rest & Sleep: Factors To Assess: Number and duration of naps:

Questions & Approaches: - Do you take naps throughout the day?

Rest & Sleep: Factors To Assess: Number of hours of undisturbed sleep:

Questions & Approaches: - How have you been sleeping? - Do you have any difficulty falling asleep? - Do you wake up frequently during the night? - Do you dream at night? - Are your dreams frightening?

Rest & Sleep: Factors To Assess: Quality of sleep:

Questions & Approaches: - How much sleep do you think you need to feel rested?

Rest & Sleep: Factors To Assess: Effect of sleep pattern on everyday functioning / Energy level (ability to perform activities of daily living):

Questions & Approaches: - In what way does the sleep you get each day affect your everyday living? - Has this sleep disturbance caused any change in your sex life? - Do you feel rested and ready to start the day when you wake up? - Are there times during the day or certain activities when you feel especially tired? - What happens when you don't get enough sleep? - Are you having difficulty concentrating?

Rest & Sleep: Factors To Assess: Sleep disturbances and contributing factors Nature of the sleep disturbance Onset of disturbance Causes (physical, psychosocial, medicine related) Severity Symptoms Interventions attempted and results

Questions & Approaches: - Tell me about your sleep problem. - How often does it occur? - Are you doing anything differently now that might be causing the problem? - Do you wake up gasping for air? - Do you snore? - Do you recall changing your position frequently during the night? - What have you been doing to deal with the problem? - How effective were these measures?

Rest & Sleep: Factors To Assess: Sleep aids Means of relaxing before bedtime Bedtime rituals Sleep environment Pharmacologic aids

Questions & Approaches: - What do you do to relax before you get ready for bed? - Describe what you usually do to help yourself fall asleep. - Tell me how you like your room (lights, noises, ventilation, position of door, temperature) and bed (mattress, pillows, blankets) when you are sleeping. - Do you take any medications to help you sleep? - Are you taking any medicine at all?

Physiology of Sleep:

Reticular activating system (RAS): - Facilitates reflex and voluntary movements - Controls cortical activities related to state of alertness Bulbar synchronizing region: Two systems in the brainstem, the reticular activating system (RAS) and the bulbar synchronizing region, are believed to work together to control the cyclic nature of sleep Hypothalamus: control center for sleeping and waking

Illnesses Associated With Sleep Disturbances: Coronary artery diseases:

The pain associated with coronary artery disease and myocardial infarction is more likely with REM sleep.

Restless Leg Syndrome (RLS):

a condition in which patients are unable to lie still and report experiencing unpleasant creeping, crawling, or tingling sensations in the legs

Sleep Deprivation:

a decrease in the amount, consistency, and quality of sleep; results from decreased REM or NREM sleep

Melatonin:

a natural chemical produced at night that decreases wakefulness and promotes sleep

Sleep Terrors:

are more common in children and occur during the deepest stages of sleep. - Typical behavior involves waking up screaming and sitting up in bed. They may appear to be awake and reasonable but are unable to communicate when they awaken from a sleep terror.

Sleep-related Eating Disorder:

occurs when a person eats while sleeping but has no recollection of eating in the morning. It can occur during sleepwalking and those affected can gain weight and experience injury either from cooking in their sleep or eating potentially dangerous raw food. They may also exhibit signs of sleep disruption during waking hours.

Sleep Cycle:

passage through the four stages of NREM sleep (I, II, III, IV), then reversal (IV, III, II), and finally, instead of reentering stage I and awakening, entering REM sleep and returning to stage II

Parasomnias:

patterns of waking behavior that appear during sleep (e.g., sleep walking, sleep talking, nocturnal erections)

Rem Sleep Behavior Disorder: (RBD)

characterized by "acting out" dreams while asleep. While experiencing the dream episode, the sleeper can moan and thrash around in the bed, possibly causing harm to a bed partner or oneself

Central disorders of hypersomnolence:

characterized by excessive daytime sleepiness (hypersomnolence) that is not attributable to another sleep disorder, specifically those that result in disturbed sleep (e.g., sleep-related breathing disorders) or abnormalities of circadian rhythm

Narcolepsy:

condition characterized by an uncontrolled desire to sleep

Hypersomnia:

condition characterized by excessive sleeping, especially daytime sleeping

Rest:

condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed

Circadian Rhythm:

rhythm that completes a full cycle every 24 hours; synonym for diurnal rhythm

Illnesses Associated With Sleep Disturbances: Epilepsy:

seizures are most likely to occur during NREM sleep and appear to be depressed by REM sleep.

Somnambulism:

sleepwalking

Rapid Eye Movement Sleep (REM):

stage that constitutes 20% to 25% of a person's nightly sleep; person is difficult to arouse during this stage

Sleep:

state of altered consciousness throughout which varying degrees of stimuli preclude wakefulness

Illnesses Associated With Sleep Disturbances: Liver failure and encephalitis:

tend to cause a reversal in day-night sleeping habits.

Illnesses Associated With Sleep Disturbances: Hypothyroidism:

tends to decrease the amount of NREM sleep, especially stages II and IV, while hyperthyroidism may result in difficulty falling asleep.

Insominia:

difficulty in falling asleep, intermittent sleep, or early awakening from sleep

Illnesses Associated With Sleep Disturbances: End-stage renal disease:

disrupts nocturnal sleep and leads to excessive daytime sleepiness. Patients with ESRD who receive dialysis also have a higher incidence of RLS (discussed later in the chapter), which possibly is related to the iron deficiency common in ESRD.

Enuresis:

involuntary urination; most often used to refer to a child who involuntarily urinates during the night involuntary urination; most often used to refer to a child who involuntarily urinates during the night

Nightmares:

involves frightening dreams that are vivid and disturbing. They occur more frequently in children and represent a normal developmental process.

Sleep Enuresis:

is urinating during sleep or bedwetting. It occurs most commonly in males who are over 3 years of age.

Non-Rapid Eye Movement (NREM):

non-rapid eye movement that characterizes four stages of sleep

Sleep Hygiene:

nonpharmacologic recommendations like reviewing and changing lifestyles and environment that help an individual get a better night's sleep

Screening Tools to Assess Sleep Disturbances:

• The Epworth Sleepiness Scale • The Pittsburgh Sleep Quality Index (PSQI) • Sleep Disturbance Questionnaire