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55 Cards in this Set
- Front
- Back
rest
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a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed.
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sleep
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a state of rest accompanied by altered consciousness and relative inactivity.
a rhythmic state involving a progression of repeated cycles each representing different phases of body and brain activity. |
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the two systems in the brain stem that are believed to work together to control the cyclic nature of sleep are the
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RAS-reticular activating system & the bulbar synchronizing region.
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RAS-reticular activating system.
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extends upward through the medulla, pons and midbrain up into the hypothalamus.
it facilitates reflex and voluntary movements as well as cortical activities related to the state of alertness. nerve cells and fibers relay impulses into the cerebral cortex and spinal cord. during sleep the RAS receives few signals from the cerebral cortex and the periphery of the body. wakefullness occurs when this system is activated.ex: an alarm clock. |
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sleeping and waking is controlled by the
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hypothalamus
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Various neurotransmitters are involved with the sleeping process
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excitation is controlled by norepinephrine, acetylcholine, dopamine, serotonin and histamine.
GABA is necessary for inhibition. |
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There are two major stages of sleep
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NREM - non-rapid eye movement
& REM-rapid eye movement. |
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NREM sleep consists of 4 stages
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Stages 1 to 4.
comprising of about 75% of total sleep. parasympathetic nervous system dominates. pulse, respiratory rate, blood pressure, body temperature and metabolic rate all decrease. |
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Stage 1 NREM
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pre-sleep.
5% of total sleep.few minutes. lasts only minutes. relaxed yet aware of surroundings. easily aroused. involuntary muscle jerking occurs. |
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Stage 2 NREM
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begins deeper sleep.
50% of total sleep.10-20 minutes. can still be aroused easily. |
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Stage 3 NREM
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sleep deepens.
arousal becomes difficult. 10% of sleep. 10-30 minutes. |
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Stage 4 NREM
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deepest sleep cycle.
Delta or slow wave sleep. 10%. 15-30 minutes. longer if sleep deprivation occurs. phsysiologic functions at their lowest. arousal very difficult. restorative sleep. |
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REM sleep
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20%. 20 minutes.
eye movement occurs.face twitching. arousal is difficult. large muscles are immobile, resembles paralysis. irregular respirations/periods of apnea. rapid/irregular pulse. blood pressure fluctuates. increased gastric secretions. metabolism, temperature increases. active encephalogram activity. REM entered from NREM 2 and NREM reentered at stage NREM 2. |
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Sleep architecture
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the alternating cyclic patterns between NREM and REM sleep.
each cycle lasts about 90 minutes. normally 4-5 cycles occur each night. cycles become longer as morning approaches. NREM 4 sleep is deeper in the first half of the night, especially if tired or sleep deprived. REM increases in duration as morning approaches. |
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Sleep cycle
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NREM 1 to 4
then,reversed-NREM 4 to NREM 2 then, REM is entered, then reenters NREM 2 and repeats. stage 1 is not reentered unless awakened and process starts over from beginning. |
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Hypothyroidism can interfere stages
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NREM 2 & 4
hypothyroidism may reult in difficulty falling asleep. |
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chest pains associated with coronary artery disease and MI occur more frequently during which sleep cycle?
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REM
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Epileptic seizures occur more frequently during which cycles?
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NREM
REM sleep appears to depress seizures. |
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Gastric secretions increase during which cycle?
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REM
many people with peptic ulcers awaken during this period. |
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REM deprivation may cause
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symptoms of psychosis.
dreaming is absent sensitivity to pain increases mental alertness decreases. |
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Sleep patterns
neonates |
16-20 hours
day/night patterns not established. |
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Sleep patterns
infants |
12-16 hours
some patterns develop. REM sleep constitutes much of an infants sleep. |
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Sleep patterns
toddlers |
12-14 hours with naps during day.
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Sleep patterns
preschoolers |
10-12 hours, decreased desire for naps.
REM sleep pattern resembles that of an adult. resists going to bed at night. |
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Sleep patterns
school-aged |
10- 12 hours.
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Sleep patterns
adolescents |
8-12 hours.
sleeping patterns become irregular. restlessness due to stressors. most do not get enough sleep. |
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Sleep patterns
young adults |
8 hours.some require less.
lifestyle may interfere with patterns. REM averages 20% of sleep. |
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Sleep patterns
middle adults |
6-8 hours.
a decrease in stage 4 NREM occurs. sleep disturbances are present in some. more time spent awake in bed. |
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Sleep patterns
older adults |
5-7 hours.
stage 4 NREM is absent or considerably decreased. REM sleep periods are shortened. |
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based on the circadian rhythm, the body prepares for sleep by:
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decreasing body temperature and releasing melatonin.
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excessive Alcohol intake affects sleep by
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decreasing stage 4 NREM and REM.
alcohol should be avoided 4-6 hours before sleep begins. |
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drugs that decrease REM sleep include
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barbiturates
amphetamines antidepressants |
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the common sleep disorders are
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dyssomnias and parasomnias.
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Dyssomnias-Insomnia
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most common sleep disorder.
difficulty falling asleep intermittent sleep\early awakening reports feeling tired,lethargic and irritable during the day Acute insomnia-lasts less than 4 weeks. Chronic insomnia- lasts 5 weeks to 6 months or more. |
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Common health problems associated with Chronic insomnia
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obesity
type II diabetes psychiatric disorders-depression cardiovascular disorders such as heart failure,stroke,hypertension and MI. |
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Chronotherapeutics
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the strategic timing in the administration of medications that take bodily rhythms into account.
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Parasomnias
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patterns of waking behavior that appear during sleep.common are:
somnambulism-sleepwalking sleeptalking bruxism-teeth grinding enuresis-bedwetting. |
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sleep hygiene
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nonpharmacologic recommendations that help get a better night's sleep.
involve lifestyle and environmental changes. |
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hypersomnia
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excessive sleep, particularly during the day.
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Narcolepsy
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an uncontrollable desire to sleep.
a neurologic disorder. common features sleep attacks-irresistible urge to sleep regardless of location/activity present. cataplexy hypnagogic hallucinations sleep-onset REM periods sleep paralysis |
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cataplexy
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sudden loss of motor tone usually experienced during periods of strong emotion.
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hypnagogic hallucinations
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nightmares or vivid hallucinations.
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sleep-onset REM
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person moves directly to REM sleep when experiencing a sleep attack.
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sleep paralysis
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skeletal paralysis that occurs during the transition from wakefulness to sleep.
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Sleep apnea
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the absence of breathing-apnea or the diminished breathing-hypopnea during sleep between snoring intervals.
breathing may cease for 10-20 seconds, possibly as long as 2 minutes. |
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during long periods of apnea, the body may experience
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drop in blood oxygen levels
irregular pulse a rise in blood pressure. excessive daytime sleepiness |
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OCA-obstructive sleep apnea
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apnea results when the airway is occluded by a collapse of the hypopharynx cause by structural abnormalities
narrowing of nasal passageways obesity |
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sleep deprivation
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a decrease in the amount,consistency or quality of sleep.
it may involve NREM or REM sleep. |
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Central sleep apnea
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a dysfunction of the respiratory center of the brain(hypothalamus).
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nocturnal myoclonus
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marked muscle contractions that result in the jerking of one or both legs during sleep.
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RLS- restless leg syndrome
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person cannot lie still and reports creeping, crawling or tingling sensations anywhere from the calf to the thigh.
seen with patients having ESRD-end stage renal disease, and pregnant women. antihistamines can exacerbate the symptoms. the acronym URGE summarizes the symptoms and criteria for diagnosis. Ropinirole(REQUIP) a drug used to treat Parkinson's disease has been approved by the FDA to treat RLS. |
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URGE acronym for RLS
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U-urge to move legs
R-rest-induced G-gets better with activity E-evening symptoms more severe |
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Medications used to induce sleep
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Benzodiazepines-the sedative-hypnotics:
flurazepam-Dalmane temazepam-Restoril nonbenzodiazepines: eszopiclone-Lunesta zolpidem-Ambien Melatonin agonist ramelteon-Rozerem |
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benzodiazepines used for sleep interfere with
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REM and NREM sleep.
produce an unnatural sleep and often lose their effect after 1-2 weeks. |
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Sleep-weight link
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related to two hormones:
leptin and ghrelin. leptin signals the brain to stop eating and sleep deprivation lowers its levels. the brain also interprets this lower level as a sign of starvation.-both increase eating urges. ghrelin promotes continued eating and is elevated by sleep deprivation. |