Sleep And Rest - Nurs 145

Front 1

stage of sleep that is only a few minutes long, is very light, person can be awakened easily-but feels relaxed/drowsy, vital signs and metabolism are just beginning to diminish

Back 1

stage 1 NREM

Front 2

deeper sleep lasting 10-20 minutes, increased relaxation-but person can still be awakened easily

Back 2

stage 2 NREM

Front 3

deep sleep lasting 15-30min, difficult to awaken, relaxation is such that person seldom moves

Back 3

stage 3 NREM

(stage 3 and 4 NREM are often called "deep" or "delta" sleep. The only difference between the two is the % of delta waves that occur in a 30 second period)

Front 4

deepest sleep 15-30min in length, vital signs very low compared to when awake, very difficult to awaken.

The stage in which the body achieves PHYSICAL rest and restoration

The stage at which enuresis and talking/walking in one's sleep occur

Back 4

stage 4 NREM

Front 5

stage of sleep in which dreams occur, 5-30 min long and start 50-90 min after falling asleep, varying vital signs, very difficult to awaken.
Brain is highly active, brain metabolism may increase as much as 20%

The stage at which MENTAL rest and restoration occur

Back 5

REM

Front 6

Describe the sleep cycle

Back 6

the sleep cycle consists of NREM and REM sleep. Typically, after a person experiences stage 1 of NREM, he will cycle through the other stages 4-6 times throughout the night.

Front 7

difficulty falling asleep or the inability to receive restorative sleep

Back 7

insomnia

(more common in women than men)

Front 8

Disorder of the sleep and wake mechanisms. Person may lose ability to stay awake.

Back 8

narcolepsy

often happens at inappropriate times, putting person at risk

Front 9

absence of breathing for > than 10 seconds 5 times per hour during sleep

Back 9

sleep apnea

Front 10

instructions for the narcoleptic client

Back 10

participate in regular exercise

eat small meals that are high in protein

avoid activities that increase sleepiness (sitting too long, warm environments, alcohol)

avoid activities that would cause injury should they fall asleep (driving, heights)

take naps when narcoleptic events are likely to occur

take stimulants as prescribed by PCP

Front 11

nursing interventions for the client experiencing difficulty with sleep

Back 11

assist client to establish and follow a bedtime routine

attempt to minimize number of times client is awakened during the night while hospitalized

offer to assist client with hygiene needs or back rub prior to sleep to increase comfort

Instruct the client to:
exercise regularly at least 2 hours before bedtime
keep sleep environment comfortable
limit caffeine, alcohol, nicotine in late afternoon/evening
limit fluids 2-4 hours before bedtime
use muscle relaxation if anxious or stressed

use CPAP for clients with sleep apnea (if ordered)

provide pharmacological agent as ordered by PCP-should be last resort

Front 12

assessment tool used to determine presence of sleep problem and gauge its extent

Back 12

Epworth Daytime Sleepiness Scale

<10 probably normal
10-12 mild sleepiness
13-17 moderate sleepiness
18-24 severe sleepiness

when the last two items on the list are rated as "chance of happening", client requires counseling and referral.
(last 2 are falling asleep at stoplight and falling asleep while driving alone on monotonous road for an hour)

Front 13

Typical sleep requirements by age

Back 13

birth-3 months....16hr a day

infants (3 months-1 year)...8-10 hrs with 2-3 daytime naps

preschoolers....12 hrs with less napping during the day

school-age....11-12 for younger children, 9-10 for older children

adolescents....7.5hrs per night

young adults....6-8.5 hrs per night

middle adults....6-8.5 hrs per night

older adults....6-8.5 hrs with daytime naps possibly
accounting for some of the hours

Front 14

Three types of sleep apnea

Back 14

Obstructive apnea, central apnea, and mixed apnea

Front 15

What is obstructive apnea?

Back 15

occurs when structures of the pharynx or oral cavity block the flow of air. Person continues to try to breathe, chest/abdominal muscles still continue to move. Diaphragm movements become stronger and stronger until obstruction is cleared. (That's why a person will often "snort" when coming out of an apneic episode.)

Front 16

What is central apnea?

Back 16

thought to involve a defect in the respiratory center of the brain. All actions involving breathing, such as airflow and chest movement, cease during a central apneic episode.

(clients who have brain stem injuries and muscular dystrophy often have central apnea)

Front 17

what is mixed apnea?

Back 17

a combination of obstructive and central apnea

Front 18

condition in which individual gets sufficient sleep at night but still cannot stay awake during the day

Back 18

hypersomnia

usually caused by a medical condition. (CNS damage, some kidney, liver, metabolic disorders-such as diabetic acidosis and hypothyroidism)

hypersomnia rarely has a psychological origin.

Front 19

four types of drugs that can cause excessive daytime sleepiness

Back 19

antidepressants
antihistamines
beta-blockers
narcotics

Front 20

what effect can beta-blockers have on sleep?

Back 20

they have been known to cause nightmares and insomnia

Front 21

What effects can narcotics have on sleep?

Back 21

some narcotics (Demerol, morphine) are known to suppress REM sleep and cause frequent awakenings and drowsiness

Front 22

What effect can antidepressants have on sleep?

Back 22

They suppress REM sleep, HOWEVER... this is considered a therapeutic effect. Selectively depriving a depressed client of REM sleep will result in an immediate but transient improvement in mood.

Front 23

what instruction should be given to a client who is planning on discontinuing long-term antidepressant or hypnotic medication?

Back 23

REM rebound may occur.

(a period of more intense dreams)

Front 24

What effect does nicotine have on sleep?

Back 24

As nicotine is a stimulant, smokers often have more difficulty falling asleep than non-smokers, and are often more easily aroused from sleep.

Refraining from smoking after the evening meal usually helps the person to sleep better.

former smokers report iimproved sleep patterns following tobacco cessation.

Front 25

What effect does caffeine have on sleep?

Back 25

caffeine disrupts sleep by stimulating the central nervous system

Front 26

What effect does alcohol have on sleep?

Back 26

Alcohol disrupts REM sleep, but it hastens the onset of sleep.

person will "make up" lost REM sleep once alcohol has worn off, but may experience nightmares

Front 27

Describe effects illness can have on sleep

Back 27

Respiratory conditions such as shortness of breath, nasal congestion, sinus drainage make it difficult to breathe and may disrupt sleep.

Hyperthyroidism lengthens presleep time, making it difficult for the individual to fall asleep.

Hypothyroidism decreases stage IV NREM sleep

Pain from gastric and duodenal ulcers may disrupt sleep due to increased gastric secretions that occur at night.

Women with low levels of estrogen often complain of fatigue

elevated body temperatures cause some reduction in delta and REM sleep

Front 28

It is difficult to note sleep abnormalities during a physical assessment, but there are clinical signs of sleep apnea... what are they?

Back 28

enlarged and reddened uvula and soft palate

enlarged tonsils and adenoids (in children)

obesity (in adults)

neck size greater than 17.5 inches in males

Front 29

what is somnambulism and in which sleep stage does it occur?

Back 29

sleepwalking

it occurs during stages III and IV of NREM, usually 1-2 hours after falling asleep

Front 30

define parasomnia and give examples

Back 30

behavior that may interfere with sleep and even occur during sleep

arousal disorders (sleepwalking, sleep terrors)

sleep-wake transition disorders (sleep talking)

nightmares and bruxism are also types of parasomnias

Front 31

What is bruxism?

Back 31

clenching and grinding of teeth usually occurring during stage II NREM sleep.

Eventually erodes teeth, can cause fractures of teeth, may loosen them due to occlusal trauma, and lead to deterioration of the TMJ

Front 32

compare/contrast sleep history and sleep diary

Back 32

a sleep history is a brief assessment regarding a client's sleep patterns such as hours per night, presence of snoring, bedtime rituals, medications taken to help with sleep. It should be done for all clients entering a healthcare facility and can be done in conjunction with the physical assessment. A more detailed assessment should be done if excessive daytime sleepiness is an issue, if sleep problems have been present for more than 6 months. This in-depth assessment, along with any diagnostic studies, must be performed by a nurse practitioner with specialized training

A sleep diary is a log of sleep patterns over the course of 1-2 weeks kept by the client.

Front 33

define polysomnography

Back 33

Polysomnography is a diagnostic test in which a number of physiologic variables are recorded during sleep

Electroencephalogram (EEG, electromyogram (EMG), and electro-oculogram (EOG) are in included in a polysomnography. Respiratory effort and airflow, ECG, leg movements, oxygen saturation are also monitored.

Front 34

Describe functions of sleep

Back 34

to cope with daily stresses

to prevent fatigue

to conserve energy

to restore the mind and body

to enjoy life more fully

enhances daytime functioning

vital for optimum psychological and physiological function as well as tissue repair

Front 35

Describe characteristics of sleep for adolescents

Back 35

require 9-10 hrs per night

circadian rhythms tend to shift at the onset of adolescence, later sleep and wake patterns are biologically determined

Front 36

Describe characteristics of sleep for adults

Back 36

need 7-9 hrs per night (although this # varies, some do well with as little as 6, while others require 10)

Lifestyle changes for young adults such as new jobs, pregnancy, babies affect sleep

Lifestyle changes for middle-aged adults such as care for aging parents or chronically ill partners may affect sleep

Front 37

Describe characteristics of sleep for elders

Back 37

need as much sleep as adults, but the ability to sleep becomes more difficult

hallmark change with age is a tendency toward earlier bedtimes and wake times-they awaken 1.3 hours earlier and go to bed 1 hour earlier

elderly clients with dementia may experience sundown sydrome

Front 38

Describe the sleep patterns of newborns

Back 38

sleep 16-18 hours a day on a irregular schedule with periods of 1-3 hours of wakefulness

newborns enter REM sleep immediately

newborns spend about 50% their sleep time in each stage of sleep. The sleep cycle is about 50min.

best to put newborns to sleep when they are sleepy, but not asleep

Front 39

Describe the characteristics of sleep for infants

Back 39

14-15 hrs in 24 hrs.

At first, they awaken every 3-4hrs to eat

by 6mos, most will sleep through the night

usually take 2 naps per day

like infants, should be put to bed when they are sleepy, not asleep. Helps them to become "self-soothers" rather than "signalers"

Front 40

Describe the characteristics of sleep for toddlers (1-3 years)

Back 40

12-14 hrs per night

most still need an afternoon nap

may exhibit a great deal of resistance to going to bed and may awaken during the night

nighttime fears and nightmares are common

Front 41

Describe the characteristics of sleep for preschoolers (3-5 years)

Back 41

11-13 hrs per night

sleep needs fluctuate with activity and growth spurts

night terrors or nightmares may be a problem

Front 42

Describe the characteristics of sleep for the school age child (5-12 years)

Back 42

needs 10-11 hours per night, but most get less due to increasing demands of homework, sports, etc.)

May spend more time at the computer or watching tv, may drink caffeinated beverages-all of which may lead to difficulty with sleep