Lewis Chapter 7 Sleep and Sleep Disorders

REM

Brain waves resemble wakefulness 20% to 25% of sleep

75% to 80% of adults spend this much time in this sleep cycle?

NREM

sleepwalking and sleep terrors are arousal parasomnias that occur during which sleep?

NREM sleep

These drugs are effective and safe for use from 6 months to a year

Non-benzodiazepine hypnotics

NREM stage 1

Person is easily awakened Slow eye movements

List the manifestations of insomnia

1. difficulty falling asleep 2. frequent awakenings 3. prolonged nighttime awakenings or awakening too early and not being able to fall back to sleep 4. awakening feeling unrefreshed

Cognitive behavioral therapy includes what components?

1. limit the amount of time an individual can stay in bed 2. maintain a scheduled time to get up in the morning 3. go to bed only when feeling sleepy 4. get out of bed when unable to sleep

Risk factors for obstructive sleep apnea

smoker, obese (>30kg/m2), older than 65, neck circumference greater than 17inches, craniofacial abnormalities

What strategies could decrease the distress of rotating shifts for nurses Select ALL that applies a. Take a brief onsite nap b. Use sleep hygiene practices c. Sleep just before going to work d. Maintain consistent sleep/wake schedules even on days off if possible d. Negotiate to control work schedule rather than having someone else impose the schedule

ALL OF THEM

What is not recommended for first-line treatment of insomnia?

Benzodiazepine Hypnotics

NREM stage 2

Associated with specific EEG waveforms Most of the night of sleep Slowed heart rate, decreased body temperature

NREM stage 3

Deepest sleep Associated with specific EEG waveforms Decreased occurrence in older adults

What sleep cycle causes the most vivid dreams and individuals cannot initiate muscle movement?

REM

nightmares occur during which sleep?

REM sleep during the final third of sleep

What is used to screen for obstructive sleep apnea?

STOP-BANG questionnaire

Which medication is a nonamphetamine wake-promotion drug that may be used for narcolepsy? a. Modafinil (Provigil) b. Suvorexant (Belsomra) c. Protriptyline (Vivactil) d. Desipramine (Norpramin)

a. Modafinil (Provigil)

A nurse caring for a patient in the ICU implements strategies to create an environment conductive to sleep. Which strategy would be most effective? a. Turning off the lights in the room during the night b. Having the television on at all times for background noise c. Silencing the alarms on the bedside monitor and infusion pumps d. Administering ordered analgesics around the clock, even if the patient denies pain

a. Turning off the lights in the room during the night

Refers to the difficulties falling or remaining asleep at least 3 nights per week for less than a month

acute insomnia

Define nonrestorative sleep

sleep that is of adequate duration but does not result in the individual feeling refreshed and alert the next day

The nurse knows that a patient taught sleep hygiene practices needs further instructions when he says a. "Once I go to bed, I should get up if I am not asleep in 20 minutes b. "It's okay to have my usual two glasses of wine in the evening before bed" c. "A couple of crackers with cheese and a glass of milk may help to relax before bed" d. "I should go to the gym earlier in the day so that I'm done at least 6 hours before bedtime"

b. "It's okay to have my usual two glasses of wine in the evening before bed"

What is the best therapy to try first for insomnia? a. Complementary therapies such as melatonin b. Cognitive-behavioral therapies such as relaxation therapy c. Benzodiazepine-receptor agents (zolpidem) d. Over the counter medications such as diphenhydramine

b. Cognitive-behavioral therapies such as relaxation therapy

What are clinical manifestations of insomnia (select all that apply) a. Narcolepsy b. Fragmented sleep c. Long sleep latency d. Morning headache e. Daytime sleepiness f. Difficulty concentrating

b...c...e...f

Which statement about sleep is accurate? a. Lack of sleep causes medical and psychiatric disorders b. Adults generally require at least 5 hours of sleep every 24 hours c. During sleep an individual is not consciously aware of his or her environment d. Less that 10% of adults report at least one sleep problem, such as difficulty falling asleep

c. During sleep an individual is not consciously aware of his or her environment

The health care provider has ordered continuous positive airway pressure (CPAP) for a patient with serious obstructive sleep apnea. How will CPAP help the patient? a. Prevent airway occlusion by bringing the tongue forward b. Be easily tolerated by both the patient and patient's bed partner c. Provide enough positive pressure in the airway to prevent airway collapse d. Deliver a high inspiratory pressure and a low expiratory pressure to prevent airway collapse.

c. Provide enough positive pressure in the airway to prevent airway collapse

What controls the cyclic changes between waking and sleep? a. Fluctuating levels of melatonin b. The environmental light-dark cycles c. Suprachiasmatic nucleus in hypothalamus d. A variety of neurotransmitters released from the nervous system

c. Suprachiasmatic nucleus in hypothalamus

a brief and sudden loss of skeletal muscle tone. it can manifest as a brief episode of muscle weakness or complete postural collapse and falling. laughter, anger, or surprise often triggers episodes

cataplexy

Refers to the difficulties falling or remaining asleep that persist for 3 months or longer

chronic insomnia

The patient is complaining of insomnia and daytime fatigue. Which beverage would be the best option for this patient with an afternoon snack? a. Diet Coke b. Dr. Pepper c. Decaffeinated coffee d. A & W root beer float

d. A & W root beer float

While caring for a patient following an uvulopalatopharyngoplasty (UPP) the nurse monitors the patient for which complications in the immediate postoperative period? a. Snoring and foul-smelling breath b. Infection and electrolyte imbalance c. Loss of voice and severe sore throat d. Airway obstruction and hemorrhage

d. Airway obstruction and hemorrhage

What is a typical parasomnia? a. Cataplexy b. Hypopnea c. Sleep apnea d. Sleep terrors

d. Sleep terrors

An older patient ask the nurse why she has so much trouble sleeping. What is the most appropriate response from the nurse? a. Disturbed sleep is a normal result of aging b. Have you tried over-the-counter medications to help you sleep c. Don't worry, You don't need as much sleep as you did when you were younger d. Tell me more about the trouble you are having. There may be some things we can do to help

d. Tell me more about the trouble you are having. There may be some things we can do to help

True or False: Narcolepsy can be cured

false

Define fragmented sleep

frequent arousals or actual awakenings that interrupt sleep continuity

herb that is associated with liver toxicity

kava

What is the strongest cue for the sleep/wake rhythm?

light

What is linked to the environmental light-dark cycle?

melatonin

What disorder is characterized by going directly into REM from wakefulness

narcolepsy

are unusual and often undesirable behaviors that occur while falling asleep, transitioning between sleep stages or arousing from sleep

parasomnias

What is first tried with mild sleep apnea?

positional therapy (elevating head, sleeping on one's side)

What is the diagnosis of insomnia based on?

self-report. An evaluation is competed by the patient in the form of a 1-2 week sleep diary