Sleep Disorders, Chapter 22

Sleepwalking

Also known as somnambulism; the repeated action after the onset of sleep of rising from bed and ambulating.

Breathing-related sleep disorders

Obstructed sleep apnea: CPAP, Central sleep apnea: try to breathe but no response Sleep related hypoventilation: elevated CO2

Sleep terror disorder

Parasomnias involving incomplete arousal from deep sleep and characterized by screaming and physical activity, unresponsiveness to others, and *amnesia for the event.*

Nightmare

Parasomnias involving intense, frightening dreams that *can be recalled* by the sleeper and may involve partial arousals from sleep.

Trazodone (Desyrel), a medication used for insomnia, is highly efficacious but tolerance builds quickly. A. TRUE B. FALSE

Trazodone (Desyrel), a medication used for insomnia, is highly efficacious but tolerance builds quickly. B. FALSE

Parasomnia

Sleep disorders involving abnormal physiologic and behavioral events related to sleep characterized by dysfunctions with sleep, sleep stages, or partial arousals and *associated with disturbing physiologic and behavioral events.*

Sleep guidelines

-Sleep only as long as you have to. Restrict time in bed to help deepen sleep. -Get up same time every day. -Exercise daily- helps you get into deep sleep more readily, where cellular regeneration occurs -Free from light and noise -Don't go to bed hungry; no greasy or heavy food -Avoid excessive liquids; includes alcohol -Don't go to bed angry -Train body to associate bed with sleep

All of the following structures of the brain are important for wakefulness, except A. reticular system B. hypothalamus C. cortex D. amygdala

All of the following structures of the brain are important for wakefulness, except D. amygdala

Circadian Rhythm Sleep-Wake disorders

6 categories -Delayed sleep phase type: -Advanced sleep phase type -Irregular sleep wake type -Non 24 hours sleep wake type -Shift work type: about 10% of night shift workers have this; half of all of them have some time of complaint. Higher risk of GI disorders, cancer, cardiac disease, diabetes. Takes 8 years off your life if you work nights more than 5 years. Need 2 days off during rotation, and move around a lot during shift, have to protect sleep area from light and noise (if you aren't in total darkness, you don't make melatonin*) -Unspecified

Insomnia disorders

6-10% of American adults Younger people have harder time falling asleep; older have more fragmented sleep Age alone does not interfere with sleep onset ½ of teens get less than 7 hours. Sedentary lifestyle, frequent, windowless rooms all day

Periodic limb movements (PLM)

A disorder that involves twitching and/or uncontrolled movements of the limbs that occur at times of rest or sleep or both.

Hypersomnia

A dysomnia characterized by prolonged or excessive sleep at night or during the day; can be related to depression or central nervous system dysfunction.

Insomnia

A dyssomnia characterized by abnormal wakefulness such as an inability to fall or remain asleep and impaired daytime performance.

Narcolepsy

A dyssomnia that involves uncontrollable, recurrent, brief episodes of sleep.

Restless leg syndrome (RLS)

A movement disorder that involves uncomfortable pulling or crawling sensations of the lower limbs that occur at times of rest or sleep.

Polysomnography

A series of tests, often including an EEG, to measure sleep stages, usually done in a sleep lab.

Cataplexy

A temporary, sudden loss of muscle tone often associated with narcolepsy.

Multiple sleep latency test (MSLT)

A test of a client's daytime sleepiness; it measures sleep latency (the time it takes to fall asleep) and the amount of REM sleep.

All of the following are examples of parasomnias, except A. nightmare disorder B. sleep terror disorder C. breathing-related sleep disorder D. sleepwalking disorder

All of the following are examples of parasomnias, except C. breathing-related sleep disorder

Nursing Interventions for Clients with Sleep Disorders (22-2)

Assess for medical disorders that may interfere with sleep Assess for pain/discomfort Assess meds and drug interactions Assess client for use of caffeine-containing substances Assess client for use of alcohol or substances of abuse Prepare environment for sleep (ambient temp, comfortable bed, reduce background noise) Decrease environmental stimuli Establish routine and prep for sleeping that has been found to promote sleep for client Assess for concomitant mental disorders (think depression) Teach self-mastery and relaxation techniques Encourage client to verbalize concerns and feelings to relieve anxiety Assess and evaluate use of sleep meds Evaluate for fall precautions (with sleep meds, at higher risk) Discourage excessive napping

Dyssomnia

Disorders of initiating or maintaining sleep involving impaired amount, quality, and timing of sleep.

Breathing-related sleep disorders

Dyssomnias involving disruption of sleep as a result of ventilation abnormalities and neurologic or cardiac problems that can involve upper-airway structural abnormalities, periods of nonventilation, and obstructed respirations.

Primary Sleep Disorder

Dyssomnias- include insomnia and hypersomnia (example: narcolepsy) Parasomnias- include disorder associated with sleep and sleep-wake cycles (example: sleepwalking)

Episodes of cataplexy are increased in persons experiencing hypersomnia. A. TRUE B. FALSE

Episodes of cataplexy are increased in persons experiencing hypersomnia. B. FALSE

Insomnia is characterized by decreased arousal at night and impaired daytime performance. A. TRUE B. FALSE

Insomnia is characterized by decreased arousal at night and impaired daytime performance. B. FALSE

Common sleep medications

Long-term use: -Rozerem -Lunesta High efficacy, low risk tolerance -Ambien Moderate efficacy, low risk tolerance -Trazodone Short-term use, tolerance -Restoril -Dalmane -Xanax Can also use many antidepressants (especially SSRIs), antihistamines (sedative, Benadryl, Vistaril), antianxiety (for sleep), antipsychotics (for sedation), and rarely used barbiturates (high dependency risk, -bital)

Many sleep disorders are caused by environmental problems and poor sleep hygiene. A. TRUE B. FALSE

Many sleep disorders are caused by environmental problems and poor sleep hygiene. A. TRUE

REM Sleep Behavior Disorder and RLS- Neurological disorders

Narcolepsy: hypopretin deficiency, autoimmune disorder caused by a strep infection Hypersolmnolence

Types of sleep disorders

Primary Sleep Disorder Sleep Disorders related to another Mental Disorder Sleep Disorders caused by a General Medical Condition Substance-Induced Sleep Disorder

Nonrapid eye movement (NREM)

Slow-wave sleep that involves the three deepest and least active stages of sleep involving light sleep, sleep, and deep slow wave or delta sleep. It is measured by the relative absence of rapid eye movement and neuron activity.

Side notes for medications

Some medications (such as Rozerem) can be affected by grapefruit juice. One of the most commonly used medications for insomnia is zolpidem tartrate (Ambien), taken 30 minutes before bed.

Rapid eye movement (REM)

The lightest and most active stage of sleep measured by neuron activity and rapid eye movements and characterized by dreaming.

Sleep architecture

The patterns or five stages of REM (rapid eye movement) and NREM (nonrapid eye movement) representing the structure, continuity, and underlying physiologic mechanisms of sleep.

Circadian rhythm

The underlying biologic rhythms involved in sleep/wake cycles.

Which of the following environmental factors is important in sleep hygiene? A. Presence of a television to lull a person to sleep B. A high carbohydrate snack beside the bed in case of hunger C. Dimmed lighting in the bedroom D. Turn up the heat to help relaxation

Which of the following environmental factors is important in sleep hygiene? C. Dimmed lighting in the bedroom

Which of the following statements is true about sleep terror? A. Low degree of autonomic arousal during the episode B. Responsive to others during the episode C. Clear dream recall D. Amnesia for the episode

Which of the following statements is true about sleep terror? D. Amnesia for the episode

Which of the following statements is true about the stages of normal sleep? A. Non-REM sleep predominates the first one third of the sleep cycle. B. Non-REM sleep predominates the last one third of the sleep cycle. C. Non-REM sleep predominates the middle one third of the sleep cycle. D. Non-REM and REM sleep predominate the middle and last one third of the sleep cycle.

Which of the following statements is true about the stages of normal sleep? D. Non-REM and REM sleep predominate the middle and last one third of the sleep cycle.