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52 Cards in this Set
- Front
- Back
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Sleep Architecture
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Sleep architecture refers to the basic organization of normal sleep.
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Types of Sleep
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NREM: (non-rapid eye movement)
REM: (rapid eye movement) |
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Sleep Disorder
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During sleep NREM & REM sleep alternate in cycles. Irregular or missing sleep stages = sleep dirorder
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Circadian Synchronization
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When a person's biological clock coincides w/ the sleep-wake cycles, the person is said to be in circadian synchronization, that is the person is awake when the body temp is highest & asleep when it's the lowest. Circadian regularity begins to develop by the 6th week of life & by 3 to 6 mos. most infants have a reg. sleep-wake cycle.
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Biological Rhythms
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Biological rhythms exist in plants, animals and humans.
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Circadian Pattern
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The most familiar biological rhythm is the circadian. Sleep & waking cycle, body temps, B/P & many other functions follow a circadian pattern.
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Melatonin & Cortisol
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With the beginning of daylight, melatonin is @ it's lowest level in the body & the stimulating hormone cortisol is at it's highest.
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Serotonin
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Serotonin is thought to lesssen the response to sensory stimulation & gamma-aminobutyric acid (GABA) to shut off the activity in the neurons of the reticular activating system.
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RAS
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Darkness & preparing for sleep causes a decrease in stimulation of the RAS (Reticular Activating System)
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Reticular Activating System
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The upper part of the reticular formation consists of a network of ascending nerve fibers called the reticular activating system (RAS), which is involved w/ the sleep-wake cycle. An intact cerebral cortex & reticular formation are necessary for the regulation of sleep & waking states.
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Cyclic nature of sleep
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The cyclic nature of sleep is thought to be controlled by centers located in the lower part of the brain (brain stem) & is affected by the individual's circadian rhythm.
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Sleep Disorders
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50 to 70 million Americans suffer from a chronic disorder of sleep & wakefulness that hinders daily functioning & adversely affects health.
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Somnology
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The study of sleep
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Sleep benefits
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humans spend 1/3 of their lives asleep. We require sleep for many reasons: to cope w/ daily stresses, to prevent fatigue, to conserve energy, to restore the mind & body, & to enjoy life more fully. sleep enhances day time functioning. rate of healing of damaged tissue is greatest during sleep.
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Sleep Cycles
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During a normal night's sleep, an adult has 4 to 6 sleep cycles, ea. w/ NREM (quiet sleep) & REM (rapid-eye movement) sleep.
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NREM Sleep
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*occurs when activity in the RAS is inhibited
*75% to 80% of sleep is NREM *Stage I, II, III,IV - light to deep sleep *stages are essential for : tissue repair, cell repair, enzyme function & brain function |
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Physiologic changes during NREM sleep
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*Arterial B/P falls
*Pulse rate decreases *Peripheral blood vessels dilate *cardiac output decreases *skeletal muscles relax *Basal metabolic rate decreases *growth hormone level peaks *Intracranial pressure decreases |
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REM Sleep
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*usually occurs every 90 min.
*Most dreams take place here *brain is highly active |
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Sleep Quality
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subjective characteristic & is often determined by whether a person wakes up feeling entergetic or not
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Sleep Quantity
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total time the individual slept
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Factors Affecting Sleep
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1. Illness
2. Environment (strange noises, temp, lighting, bed size/comfort, snoring of partner) 3.Lifestyle (irregular schedule, exercise) 4. Emotional Stress (#1 cause of short term sleeping difficulties) 5. Stimulants & Alcohol 6. Diet 7. Smoking 8. Motivation (boredom helps, but cannot motivate oneself to sleep) 9. Medication |
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Insomnia
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Insomnia is the most common sleep complaint in America.
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Manifestations of Insomnia
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*difficulty falling asleep
*waking up frequently during the night *difficulty returning to sleep *waking up too early in the am *unrefreshing sleep *daytime sleepiness *difficulty concentrating *irritability |
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Common Sleep Disorders
Insomnia |
inability to fall asleep or remain asleep. Person awakens not feeling rested
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Common Sleep Disorders
Excessive Daytime Sleepiness-Hypersomnia |
conditions where the affected individual obtains sufficient sleep @ night but still can't stay awake during the day.
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Common Sleep Disorders- Excessive sleepiness-
Narcolepsy |
disorder of excessive daytime sleepiness caused by the lack if the chemical hypocretin in the area of CNS that regulates sleep.
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Common Sleep Disorders- Excessive sleepiness-
Sleep Apnea |
characterized by frequent short breathing pauses during sleep.
OSA=Obstructive Sleep Apnea |
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Common Sleep Disorders-
Excessive Sleepiness- Insufficient sleep |
Not enough sleep:)
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Parasomnia
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behavior that may interfere w/ sleep & may even occur during sleep.
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Parasomnia: Bruxism
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clenching & grinding teeth
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Parasomnia: Enuresis
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bed wetting
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Parasomnia: Periodic limb movements disorder
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legs jerk 2 to 3 times a min.
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Parasomnia: Sleeptalking
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talking during sleep
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Parasomnia: Somnambulism
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sleep walking
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Parasomnia: Night mares
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Night mares:)
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Diagnosis (NANDA)
Insomnia |
usually used w/ descriptions
"difficulty falling asleep" "difficulty staying asleep" |
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Diagnosis (NANDA)
Risk for Injury |
r/t somnambulism
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Diagnosis (NANDA)
Ineffective Coping |
r/t insufficient quality and quantity of sleep
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Diagnosis (NANDA)
Fatigue |
r/t insufficient sleep
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Diagnosis (NANDA)
Risk for Impaired gas Exchange |
r/t sleep apnea
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Diagnosis (NANDA)
Deficient Knowledge |
r/t misinformation (non-prescription remedies for sleep)
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Diagnosis (NANDA)
Anxiety |
r/t sleep apnea &/or the diagnosis os a sleep disorder
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Diagnosis (NANDA)
Activity Intolerance |
r/t sleep deprivation or excessive daytime sleepiness
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Sleep hygiene
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term referring to interventions used to promote sleep -
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Implementation
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These involve health teaching about sleep habits, support of bedtime rituals, the provision of a restful environment, specific measures to promote comfort & relaxation & appropriate use of hypnotic medications
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Client Teaching
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*the conditions that promote sleep & those that interfere w/ sleep
*safe use of sleep medications *effects of other prescribed medications on sleep *effects of their disease states on sleep |
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Promoting Sleep
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*establish reg. bedtime & wake-up times & short daytime nap (esp. for elders) is restorative.
*establish a reg., relaxing bedtime routine *avoid dealing with office work or family problems before bedtime *Use bed for sleep and sex only *when unable to sleep, get out of bed, go in another room until drowsy * dark, quiet, comfortable and cool *avoid heavy meals 2 to 3 hrs before *avoid alcohol and caffeine containing foods and beverages at least 4 hrs before *If you must snack before bedtime, drink milk, no heavy or spicy foods *sleeping medication as last resort. *take analgesic before for relief of aches & pains *Check other medications that may inhibit sleep |
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Reducing Environmental Distractions in Hospital
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*Close window curtains & curtains between clients in semiprivate rooms
*reduce overhead lighting *use flashlight to check drainage bags etc. *ensure clear pathway around bed to avoid bumping, jamming bed or patient. *close clients door *lower ring of nearby phones *discontinue use of paging system during sleep hrs.(or reduce vol.) *keep staff conversations at low levels *wear rubber soled shoes *ensure all cart wheels are well oiled |
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Drugs
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Zolpidem: short term management of insomnia. rapid onset. side effects: daytime drowsiness/dizziness
Modafinil: treatment of narcolepsy, excessive daytime sleepiness associated with OSA & shift work sleep disorder |
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Half-Life
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represents how long it takesfor 1/2 of the medication to be metabolized & eliminated by the body; hence, those with shorter 1/2 lifes are less likely to cause residual drowsiness after administration, but may be less effective for the treatment of sleep maintenance insomnia
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Nonpharmacologic interventions
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used to induce & maintain sleep are always the preferred intervention
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Polysomnography
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EEG (electroencephalogram) - measures brain waves
EMG (electromyogram) - meaures face muscles EOG (electro-oculogram) measures eye movements |
