sleep and rest
The nurse is discussing night terrors with a patient. Which statement made by the patient shows proper understanding?
"Fever tends to trigger night terrors." This statement shows proper understanding. While experts do not understand why, they believe that night terrors could be triggered by fever, stress, alcohol, lack of sleep, and stress or conflict.
A female patient with tremors and circadian rhythm disorder complains that she is having difficulty sleeping and is often awakened. She frequently works nights during shift rotation. Which question by the nurse is appropriate?
"Have you considered switching to days permanently?" This question is appropriate, as constant shift changes and working at night causes circadian rhythm disorders. Finding a day job may alleviate the patient's sleep disorder because the patient's circadian clock is set by the light-dark cycle over a 24- hour period. Are you taking any medications that may be causing you to have trouble sleeping?" This question is appropriate, as certain medications may cause circadian rhythm disorders. Have you been tested for Parkinson's disease?" This is an appropriate question, as tremors are a symptom of Parkinson's disease. People with Parkinson's disease have blunted circadian rhythms.
A nurse is teaching a parent with a child diagnosed with nocturnal enuresis about the disorder. Which statement(s) by the parent shows a need for further teaching
"If my daughter does not watch scary movies at night she will not wet the bed." This statement shows a need for further teaching. While stress can cause bedwetting, there is no evidence that states scary movies cause bedwetting. However, scary movies are known to cause night terrors *"My daughter is between ages 3-7, the ages when bedwetting is common." This statement shows a need for further teaching. Night terrors, rather than bedwetting, is common in children ages 3 to 7 years of age. Children generally gain control over their bladder between ages 5-6. *My daughter cannot control her bladder; there must be something wrong with her." This statement shows a need for further education. Acquiring bladder control should be presented as a normal process, so the child will gradually be helped to stop bedwetting. *"My daughter does not need behavioral therapy for her bedwetting problem." This statement shows ineffective teaching. Behavioral therapy is often used for people suffering with nocturnal enuresis.
The nurse is teaching a patient about melatonin. Which statement made by the patient indicates the teaching has been effective?
"Melatonin regulates the circadian phase of sleep." Melatonin regulates the circadian phase of sleep. "Melatonin is a hormone that is made in the pineal gland." The hormone melatonin is synthesized in the pineal gland.
A parent of a 3-year-old is concerned about her child's sleeping habits. The child often shows resistance to going to bed, is sleeping six hours a night in a crib, and takes an hour long nap each day. Which statement by the nurse is appropriate?
"Showing resistance to bedtime is normal for this age group." This statement is appropriate, as children in this age group show resistance to go to bed. "Napping is good for a 3-year-old child as it will restore energy." This statement is appropriate, as toddlers need to take naps to restore their energy. Sleep needs fluctuate with growth spurts." This statement is appropriate, as sleep needs for toddlers fluctuate with growth spurts.
Stages of sleep
1. Lightest Sleep (NREM) 2. Slightly Deeper Sleep (NREM) 3. Deeper Sleep (NREM) 4. Delta Waves are omitted but there is not much difference between this stage and stage 3 (NREM) 5. REM
Sleep apnea is characterized by a lack of air flow through the mouth and nose for at least _______ seconds during sleep
10- Healthy people who do not have sleep apnea may stop breathing for a second or two. However, when an individual stops breathing for 10 seconds or more during sleep, the situation is abnormal. They are experiencing an apneic episode, due to a sleep apnea condition.
Which individual may be at risk for a sleeping disorder?
10-year-old who sleeps 6 hours each night with regular daytime naps This patient may have a sleeping disorder, as naps are rare at this age and school aged children should get at least 8-12 hours of sleep per night.
Which BPM reading is normal for a sleeping newborn with a steady heart rate of 150 bpm while awake? 160 165 140 135 120
140 bpm is within the normal range for a sleeping infant with a normal heart rate of 150 while awake. A decrease in heart rate of 10 bpm is normal in a sleeping infant. 135 bpm is within the normal range for an infant who is napping with a normal heart rate of 150 bpm while awake. Heart rate decreases with sleep. A decrease in an infant's heart rate of 10-15 bpm is normal.
Circadian Rhythms repeat every_______ hours.
24-Circadian rhythms are found in plants, animals, humans, and most all living things. They are physical, psychological, and behavioral changes that respond to light and darkness in the environment. Circadian rhythms repeat approximately every 24 hours.
Which individual requires the least amount of sleep? 2 year old 9 year old 16 year old 70 year old
70 year old would require the least amount of sleep; older adults sleep approximately 6 hours/night
polysomnography recordings of sleep show recurring patterns of sleep lasting approximately ______ minutes
90 minutes -Polysomnography is the recording of brain waves and other physiologic variables, such as muscle activity and eye movements, during sleep. A normal polysomnograph shows a sleep sequence of four NREM stages and one REM stage. NREM sleep alternates with REM sleep in time intervals of approximately 90 minutes, and a normal sleep pattern consists of three to five cycles of sleep each night.
Narcolepsy
A sleep disorder characterized by uncontrollable sleep attacks.
Which neurotransmitters primarily influence REM sleep? A. Acetylcholine B. Norepinephrine C. Serotonin D. GABA E. Growth hormone-releasing hormone
Acetylcholine has primary influence on REM sleep; it helps to promote rapid eye movement and is involved in the system that results in inhibitory actions. Norepinephrine is important to the sleep-wake cycle. It increases blood pressure and cardiac output, and is primarily involved in arousal from sleep; at high levels, it decreases REM sleep.
Adolescent Sleep patterns
Adolescents need 8 to 10 hours of sleep each night. Sleep patterns may change to awakening later in the morning, with occasional naps. Males may experience nocturnal emissions ("wet dreams"). Adolescents who drink caffeinated beverages and use technology late into the night may experience daytime sleepiness with impaired alertness and functioning Complaints of tiredness or poor school performance may be related to inadequate sleep.
Adult sleep patterns
Adults sleep 6 to 8 hours a night. They tend to continue sleep patterns established when younger. They may begin to have more night awakenings. Teach adults about sleep hygiene and nonpharmacologic measures (especially stress reduction) to enhance sleep patterns. Discourage the long-term use of sleep medications.
Which is true about newborns and infants regarding sleep? (SATA) 1. An infant's sleep patterns consist of sleeping, awakening to eat, and sleeping again. 2. Infants sleep 10-12 hours a night with naps during the day. 3. Grimacing is an abnormal feature of sleep for an infant. 4. Newborns should sleep in 1- to 2-hour blocks between feedings. 5. Older infants may safely roll to their stomachs during sleep.
An infant's sleep patterns consist of sleeping, awakening to eat, and sleeping again. A newborn's sleep patterns consist of sleeping, awakening to eat, and sleeping again. Infants sleep 10-12 hours a night with naps during the day. Infants sleep 10-12 hours at night with naps during the day. Older infants may safely roll to their stomachs during sleep. Older infants may safely roll to their stomachs during sleep because they have developed good head control.
Which sleep pattern would be common for an older adult woman?
Awaken at 6:00 am and go to bed at 11:00 pm Awakening early and sleeping 6-8 hours is a normal sleeping pattern for older adults.
A nurse is teaching a patient about the effects of medication on sleep. Which statement shows a need for further teaching?
Barbiturates increase REM sleep." This statement shows a need for further teaching. Barbiturates decrease, rather than increase, REM sleep
How are sleep deprivation and narcolepsy similar?
Both Disorders can cause hallucinations
How are toddler and infant sleeping patterns similar?
Both toddlers and infants sleep around 10-12 hours per day. Both toddlers and infants take naps during the day.
Toddler and preschooler sleep pattern
Children in this group sleep 10 to 12 hours a day. The sleep-wake cycle usually is established by the age of 2 to 3 years. Sleep needs fluctuate with growth spurts. A nap during the day can restore energy. Toddlers and preschoolers may exhibit resistance to going to bed. They may be moved out of the crib to a bed at approximately 2 years of age. Bedtime rituals are important. Teach parents to establish a regular bedtime routine and consistently follow it. Address safety needs that arise when children are able to get out of bed. For example, a safety gate across a doorway may be needed to protect a child from stairs or other hazards should the child get up. Educate parents on how to address a child's fear of the dark (by using a nightlight) or nightmares (by soothing the child but allowing the child to return to sleep)
Which factors can affect the sleep wake cycle? (SATA) Daily Routines Social commitments alarm clocks light-dark cycles colorful dreams
Daily routines are factors affecting the circadian rhythm and sleep-wake cycle. For example, people with a daily routine of exercise tend to sleep better during the night. Social commitments are factors affecting the circadian rhythm and sleep-wake cycle, as individual's may tend to stay up later and awaken early, getting an inadequate amount of sleep. Alarm clocks The noise from alarm clocks is a factor that affects the circadian rhythm and sleep-wake cycle, as it will awaken the individual from sleep. Light-dark cycles are factors that affect the circadian rhythm and sleep-wake cycle, as the body's level of melatonin normally increases after darkness falls, making people feel drowsy.
Given the normal human circadian rhythm for body temperature, which pattern of body temperature might be noticed in patients between 2:00 and 4:00 am
Decrease of 0.5 to 1 degree A decrease of 0.5 to 1 degree may be noticed in individuals between 2:00 and 4:00 am because core body temperature, which typically is coupled closely with activity rhythm, is at its lowest between during this time.
Which Characteristics will a sleep deprived person experience? (SATA). hyperactivity violent behavior decreased concentration difficulty making decisions emotionally irritable
Decreased concentration People with sleep deprivation have decreased concentration, because mental functioning is decreased. Difficulty making decisions Decreased mental functioning occurs with sleep deprivation, making it more difficult for these individual's to make decisions. Emotionally irritable People with sleep deprivation may become emotionally irritable, as lack of sleep lessens a person's ability to cope with stress.
Which question asked by a nurse relate to a sleep assessment>
Do you eat a snack before going to bed? How many hours a night do you sleep? Do you feel rested in the morning? What is your bedroom like?
which question should a nurse ask a patient who describes symptoms of insomnia?
Do you have trouble staying asleep, patients with insomnia wake up frequently during the night.
What factors cause sleep disturbances in older adults? Recurrent nightmares Frequent awakenings Nocturnal emissions Half of sleep in lighter stages
Frequent awakenings Older adults experience more frequent awakenings. It takes them around 1.5-2 hours to go back to sleep because they are in the REM stage for longer periods.
which events affect the quality of sleep? (SATA) Frequent wakening Pain Shortened REM stage Shortened NREM stage Obstructive sleep apnea
Frequent wakening, Pain, shortened REM stage, obstructive sleep apnea
A Patient with a liver disorder has been unable to function at work for the past few months due to excessive daytime sleepiness. The Patient sleeps nine hours each night, but still has trouble getting up for work. What condition does the nurse suspect for this patient?
Hypersomnia The nurse suspects that this patient has hypersomnia, or daytime sleepiness lasting a month or longer. People with this disorder feel tired even after 8-12 hours of sleep. The condition is generally caused by medical conditions, such as liver and kidney disease along with other ailments.
Infant sleep patterns
Infants sleep 10 to 12 hours at night, with naps during the day. Half of their sleep is in lighter stages. Sleep patterns are unique for each child. The general pattern consists of sleeping, awakening to eat, and sleeping again. Caution against using blankets, pillows, and bumpers in cribs, to decrease suffocation risk. Teach that eye movements, grimacing, and body movements are normal features of sleep at this age. Encourage parents to have infants sleep in their own cribs. According to the American Academy of Pediatrics 2011 revised guidelines on SIDS, the infant may sleep in the parents' room if the infant sleeps in his or her own crib and not with parents or siblings. Older infants may safely roll to their stomachs during sleep because they have developed good head control.
Which disorder is the most common type of dyssomnia? Insomnia narcolepsy hypersomnia restless leg syndrome
Insomnia is the most common dyssomnia, and is characterized by difficulty in falling asleep or staying asleep, sleep that is too light, or early morning awakenings.
which disorders are possible causes of hypersomnia? (SATA) Kidney disorders diabetic acidosis heart disease central nervous system damage hyperthyroidism
Kidney disease, diabetic acidosis, central nervous system damage
Which long-term medication(s) should be prescribed for a patient who has a history of insomnia?
Lunesta Lunesta is the best medication for this patient, as it is for long-term use and has been approved by the FDA.
Which reading increases prior to night time sleet?
Melatonin levels increase in response to darkness and induce sleep.
A patient displaying small muscle jerks is in which stage of sleep?
NREM 2 In the NREM 2 stage, a transition from wakefulness to sleep occurs; therefore, a person may experience small muscle spasms or jerks.
During which sleep state can sleepwalking occur? NREM 1 NREM 2 NREM 3 NREM 4
NREM 4 -Sleepwalking, also known as somnambulism, would most likely occur during the NREM 4, as it is the deepest stage of sleep.
A patient with no known medical conditions is complaining that she is tired all the time and unable to stay awake. She is falling asleep while at work, has vivid hallucinations upon awakening, and brief episodes of paralysis at the beginning of sleep. The nurse suspects that this patient is suffering from which condition?
Narcolepsy The patient most likely has narcolepsy. She is displaying several symptoms of narcolepsy, including inability to stay awake, vivid hallucinations, and paralysis at the beginning or end of sleep.
Newborn sleep patterns
Newborns should sleep in 2- to 4-hour blocks between feedings. Teach parents to position newborns and infants on the back for sleeping to decrease the risk of sudden infant death syndrome (SIDS).
Older adult sleep patterns
Older adults sleep approximately 6 hours a night. Stage 4 sleep is decreased, resulting in less restorative sleep. The first REM stage is longer. Older adults awaken more at night and take longer to go back to sleep. A decline in health or the use of medications may interfere with sleep. Encourage older adults to maintain the usual bedtime and routines as much as possible. Older adults should exercise caution when using sleep medications.
School age child sleep patterns
School-age children sleep 8 to 12 hours a night. Naps are rare. The occurrence of nightmares decreases with age. The stress of starting school may disrupt the sleep pattern. Less sleep is needed by the age of 11 to 12 years, so bedtime may be extended. The bedtime routine is still important.
The nurse is teaching a patient about secondary sleep disorders. Which statement by the patient shows effective teaching?
Sinus drainage may cause difficulty breathing." This statement shows effective teaching as sinus drainage may cause difficulty breathing as people breathe through their noses. A blockage or drainage will cause a decrease in breathing, which will make it more difficult to sleep. *"Shortness of breath impairs the ability to sleep." This statement shows teaching has been effective, as shortness of breath impairs the ability to sleep. When the muscles in a person's airway narrows or closes during breathing, oxygen levels in the blood decrease. The brain senses the inability to breath and rouses a person awake to reopen the airway. *End-stage renal disease leads to daytime sleepiness." This statement shows effective teaching. End-stage renal disease leads to daytime sleepiness. The effects of renal disease on breathing lead to sleep disorders. These disturbances can lead to insomnia at night and sleepiness during the day.
Which dyssomnia is characterized by a prolonged lack of sleep of good quality and inadequate quantity?
Sleep deprivation occurs from prolonged lack of sleep of good quality and adequate quantity. When a person is deprived of sleep, the brain is unable to function properly, affecting emotional state and cognitive abilities. Sleep deprivation can damage the body and lead to chronic health problems.
What may occur during NREM 2 sleep? Snoring bedwetting increase in blood pressure release of growth hormone
Snoring - may occur during NREM 2 sleep, because at this stage of sleep, the physiologic functions continue to slow and muscles become relaxed. Snoring occurs when the muscles that keep airways open become too relaxed.
sleep apnea
a condition in which a person experiences the absence of breathing (apnea) or diminished breathing (hypopnea) during sleep between snoring intervals. It is characterized by a lack of airflow through the mouth and nose for at least 10 seconds, lasting up to 2 minutes, during sleep. The most common type is obstructive sleep apnea (OSA).
circadian rhythm
affects body temperature, endocrine function, blood pressure, sleep and other functions
REM sleep deprivation causes...
agitation, and impulsive behavior
Parasomnias
are disorders associated with abnormal sleep behaviors rather than disorders of sleep itself. they come from autonomic nervous system, motor system, or cognitive processes during sleep or during the transitions between sleep and wakefulness
Nocturnal enuresis
bedwetting
bruxism
clenching or grinding teeth
Hypothalamus
controls the 24 hour circadian rhythms.
Factors that affect the circadian rhythm and sleep wake cycle
daily routines, work schedules, social commitments, alarm clocks and noises
Parasomnias
disorders associated with abnormal sleep behaviors, rather than disorders of sleep itself
Dyssomnias
disorders associated with getting to sleep, staying asleep, or being excessively sleepy, Underlying causes of dyssomnias include excessive napping, depression, anxiety, medication use, high stimulation levels at bedtime, hyperthyroidism, and shift work
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 and even after 8-12 hours of sleep at nigth. caused by medical conditions such as kidney or liver disorders, CNS damage, diabetic acidosis and hypothyroidism.
Insomnia
recurring problems in falling or staying asleep, sleep that is too light, or early morning awakenings.
Melatonin
regulates the circadian rhythm of sleep and is closly related to light conditions
Somnambulism
sleepwalking
Cataplexy
sudden loss of voluntary muscle tone
Secondary sleep disorders
symptoms of underlying situational, mental health, or medical conditions that interfere with sleep.
NREM sleep deprivation causes...
withdrawal and vague physical complaints
