Sleep

Front 1

Sleep is part of a --- hour sleep wake cycle

Back 1

24

Front 2

sleep

Back 2

Sleep is a reversible behavioral state of perceptual disengagement from and unresponsiveness to the environment

Front 3

functions of sleep?

Back 3

- rest & physical restoration
- memory consolidation
- hormone secretion (i.e. growth hormone)
- dreaming

Front 4

Non-REM stages 3 & 4 sleep?

Back 4

Deep sleep, when totally disengaged to environment.
-- Slow wave sleep
-- Stage of growth hormone secretions
-- hard to be awaken

Front 5

What pattern is REM similar to?

Back 5

When being awake & brain is active

Front 6

age-related sleep changes?

Back 6

Children -- need > 9 hrs, large amounts of slow wave sleep

Adults
-- 7-9 needed, many are sleep deprived
-- around middle age: SWS decrease, stages 1 & 2 increase, REM stays the same
-- Women - sleep changes r/t pregnancy, menstruation, menopause

Older adults
-- maintain changes that occur in midlife
-- very little SWS
-- easy to awaken, but still need 7-9 hours

Front 7

objective ways to measure sleep?

Back 7

-- Polysomnography (electrodes)
-- Actigraphy - movement sensor. inactive = sleep

Front 8

subjective ways to measure sleep?

Back 8

-- Sleep diaries
-- sleep questionaire

Front 9

Cognitive effects of sleep deprivation?

Back 9

impairment of:
-- decision making & judgment
-- learning & memory
-- psychomotor & cognitive speed
-- vigilance & attention

there may be genetic influences on vulnerability to cognitive effects of sleep loss

Front 10

Physical effects of sleep deprivation?

Back 10

-- increase evening cortisol (stress hormone)
-- increase insulin level/resistance (diabetes risk)
-- increase blood glucose
-- inflammation
-- appetite dysregulation (obesity)

Front 11

Who is at risk for sleeping & driving?

Back 11

< 24 y/o, shift worker

Front 12

What to do if sleep?

Back 12

-- take a break
-- take a nap
-- drink coffee
-- cool air, radio & conversation

Front 13

What is BEARS?

Back 13

To ask PT

B = bedtime/wake time routines
E = excessive daytime sleepiness
A = awakenings
R = regularity of sleep schedule
S = snoring

Front 14

Primary sleep disorders?

Back 14

-- Insomnia
-- obstructive sleep apnea
-- restless legs syndrome
-- periodic limb movement disorder
-- circadian rhythm disorders
-- parasomnias

Front 15

Paradoxical insomnia is when...

Back 15

person does sleep but thinks he/she didn't

Front 16

insomnia criteria

Back 16

-- one or more:
------ difficulty initiating sleep
------ difficulty maintaining sleep
------ early morning awakening

-- occurs despite adequate opportunity to sleep (i.e. it is not sleep deprivation)
-- daytime impairment

Front 17

characteristic of chronic insomnia?

Back 17

1/3 perpetuating factors, 1/3 precipitating factors, & 1/3 predisposing

-- goal is stop the problem behaviors

Front 18

characteristic of acute insomnia?

Back 18

more precipitating factors, no perpetuating factors yet

Front 19

characteristic of early insomnia?

Back 19

excessive time in bed (thinking it gives more sleep opportunity), worrying, moving activities into the bedroom.

-- meds early can prevent development of problem behaviors

Front 20

Cognitive behavioral therapy for insomnia?

Back 20

sleep restriction -- reduce time in bed

stimulus control -- only in bed to sleep

sleep hygiene -- stop habits that disrupt sleep

cognitive component -- relaxation

Front 21

Obstructive sleep apnea syndrome (OSAS)?

Back 21

disturbed or interrupted breathing during sleep
-- diagnosed by sleep study

Front 22

risk factors for sleep apnea?

Back 22

-- overweight
-- male
-- small airway
-- snorer

-- females - hormones regulate muscle tone, but risk increase after menopause

Front 23

health consequences of sleep apnea?

Back 23

-- severe daytime sleepiness
-- hypertension & CV disease
-- poor oxygenation

Front 24

Berlin Questionaire for OSAS screening

Back 24

1. Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?

2. Do you often feel tired, fatigued, or sleepy during daytime?
3. Has anyone noticed you stop breathing during your sleep?
4. Do you have or are you being treated for high blood pressure?

Front 25

continuous positive airway pressure (CPAP)

Back 25

gold standard for treatment of sleep apnea
--- Hard to tolerate
--- ↓ sleepiness, ↑ energy
---Can quickly reverse health problems (e.g., HTN)

Front 26

treatment options for sleep apnea

Back 26

-- CPAP
-- Surgery
-- Dental appliance
-- Repositioning (side-lying)

Front 27

Nursing actions for OSAS?

Back 27

-- If suspicious from assessment (especially snoring) advise to follow up with PCP.
-- If diagnosed encourage:
Weight loss
-- Use the CPAP (if prescribed)
-- Avoid alcohol in evening
-- Help with CPAP in hospital

Front 28

restless legs syndrome (RLS)

Back 28

-- subjective unpleasant symptoms
-- Sensation of crawling leg and needing to move legs
-- Occurs during awake and sleep
-- May be r/t renal disease, OSAS, pregnancy 3rd trimester

Front 29

Periodic Leg Movement Disorder

Back 29

-- objective (observable involuntary jerking of the limbs)
-- Repetitive contraction anterior tibialis
-- Occurs only during sleep

Front 30

treatments for RLS & PLMD?

Back 30

iron supplements, meds

Front 31

Delayed Sleep Phase Syndrome (DSPS)

Back 31

Circadian disorder
Affects young people
-- Body wants to sleep 1a-10am (delay)
-- Need to get up for school at 6am
-- but not sleep until 12am
-- social timing occurs before physiological timing

Front 32

Advance Sleep Phase Syndrome

Back 32

Circadian Disorder
-- affects older people
-- Body wants to sleep 8pm-4am (advance)
-- but still wants to stay up for The Mentalist (10pm-11pm)
-- Still wakes up at 4am.

Front 33

Treatment options for circadian disorders?

Back 33

-- medical grade melatonin. must be carefully timed (requires expert)

-- light therapy
----- to help Delay sleep earlier, use in morning
------ to help Advanced sleep later, use in evening

-- natural treatment -go for a walk in daylight without sunglasses
------ sunrise or early morning for Delayed
------ sunset or evening for ASPS

Front 34

narcolepsy

Back 34

-- Instability of wake maintenance in the absence of sleep deprivation
-- wake to REM-including atonia
------cataplexy
-- orexin/hypocretin producing neurons destroyed by autoimmune process

Front 35

What group is narcolepsy most common in?

Back 35

men in their 20's

Front 36

Treatment options for narcolepsy?

Back 36

sleep aids & stimulants

Front 37

Parasomnia

Back 37

-- complex behaviors during sleep

-- non-REM: sleep talking, sleep walking, sleep terrors
------ incomplete arousal from stage 3 or 4.
------ usually not remembered

REM: dream related movement
------- lack of atonia in REM sleep
------- act out dreams
------- may be violent (usually men)
------- are often remembered
------- linked to Parkinson's risk

-- uncommon in adults
-- in adults, usually linked to history of sleep walking

Front 38

complex behaviors in sleep-linked to in parasomnia?

Back 38

-- alcohol
-- meds (antidepressants, antihistamines)
-- febrile illness
-- sleep deprivation
-- stress

Front 39

treatment for REM parasomnia?

Back 39

Klonipin (clonazepam)

Front 40

atonia?

Back 40

lack of muscle tone

Front 41

Theories of Why we sleep

Back 41

-- Inactivity Theory
-- Energy conservation
-- restorative
-- Brain plasticity