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33 Cards in this Set
- Front
- Back
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Sleep wake cycle |
Sleep-wake cycle refers to our 24 hour daily sleep pattern which consists of approximately 16 hours of daytime wakefulness and 8 hours of night-time sleep. The complex process of the sleep-wake cycle is controlled by the body’s circadian rhythm and sleep homeostasis (the amount of accumulated sleep need that builds during time spent awake).
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NREM and REM sleep |
REM rapid eye movement
NREM- non-rem sleep; 3 stages, occurring in order |
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What is sleep/definition |
a cyclicly occuring state of decreased motor and perception activity |
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sleep hygiene |
things you do to get your brain and body ready for sleep |
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NREM sleep |
restoring sleep |
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3 stages of NREM sleep |
each stage is deeper than the one before Stage 1- stage between wakefulness and sleep; dreams very rare, jerking common; typically < 10 mins Stage 2- 1st unequivocal stage of sleep; 40-50% of total sleep time spent in this stage; Stage 3- deep sleep; parasomnias occur in this stage; elderly have little stage 3 sleep- kids have lots |
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REM sleep |
most active not as deep brain acty similar to being awake - effects mental and emotional fx - if you don't get this type of sleep memory and learning will be impaired |
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dysomnias |
- obstructive sleep apnea - insomnias - narcolepsy - restless leg syndrome - non-24 sleep/wake disorder |
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Parasomnias |
- sleep walking - sleep terrors - nightmares -- SIDS |
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subjective data; contributing factors |
- smoking - urinary frequency - food and beverage consumption - psychological issues - medication and drug abuse - daytime sleepiness - ability to concentrate - personality changes - sleep hygiene/habits - work schedule |
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Objective data; contributing factors |
- BMI/obesity - short neck - snoring -sleep-wake cycle - sleep diary -oral pharyngeal structures |
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diagnostic procedures |
- polysomnography - actigraphy - overnight pulse oximetry |
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polysomnography |
sleep study |
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Actigraphy |
fit-bit like watch worn by user for 1 week to track sleep vs activity cycles |
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Overnight pulse ox |
wear pulse ox overnight to see if sleep apnea is a possibility |
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Drugs used for Insomnia: |
- Benzodiazepams - Antidepressants - Benzodiazepine-receptor like agents; -- Eszopicione (Lunesta) -- Zolpiden (Ambien) |
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Eszopicione (Lunesta) dosing: |
: 2 mg immediately before bedtime, may beqto 3 mg if needed (3 mgdose is more effective for sleep maintenance); Geriatric patients—1 mg immediatelybefore bedtime for patients with difficulty falling asleep, 2 mg for patients whodifficulty staying asleep |
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eszopicione s/e: |
May result in short-term memory impairment, hallucinations, impaired coordination,and dizziness. Do not increase dose or discontinue without notifying healthcare professional. Dose may need to be decreased gradually to minimize withdrawalsymptoms. Rebound insomnia may occur upon discontinuation and usuallyresolves within 1– 2 nights. ● May cause daytime drowsiness. Caution patient to avoid driving or other activitiesrequiring alertness until response to medication is known. - don't drink alcohol while on it; CNS depressant |
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Zolpidem (Ambien) dosing |
PO, SL (Adults): Tablets, spray, or SL tablets (Edluar)—5 mg (for women) and5– 10 mg (for men) at bedtime; mayqto 10 mg at bedtime if 5–mg dose not effective;SL tablets (Intermezzo)—1.75 mg (for women) or 3.5 mg (for men) onceupon awakening in the middle-of-the-night; Extended-release tablets—6.25 mg(for women) and 6.25– 12.5 mg (for men) at bedtime; mayqto 12.5 mg at bedtimeif 6.25–mg dose not effective |
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Zolpidem cautions: |
- daytime sleepiness - dizziness -abnormal thinking - drugged feeling -sleep driving - hallucinations |
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Drug used to treat RLS: |
dopamine agonists |
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Drugs used to treat narcolepsy |
- Amphetamines; -- dextroamphetamine (Dexadrine) - Non-amphetamine wake promotion -- modafinil (provigil) |
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Dextroamphetamine dosing |
5-60 mg in single or divided doses; do not use SR as initial therapy |
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dextroamphetamine s/e: |
- hyperactivity - restlessness -insomnia - tremor -palpations -tachycardia - anorexia |
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dextroamphetamine contraindications: |
Pregnancy or lactation; Hyperexcitablestates, including hyperthyroidism; Psychotic personalities; Suicidal or homicidaltendencies; Glaucoma; Some products contain tartrazine; avoid in patients withknown hypersensitivity |
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dextroamphetamine cautions: |
Use Cautiously in: Cardiovascular disease (sudden death has occurred in childrenwith structural cardiac abnormalities or other serious heart problems); Hypertension;Diabetes mellitus; History of substance abuse; Debilitated patients; Continualuse (may produce psychological dependence or physical addiction); Geri: Appearson Beers list. Elderly are atqrisk for cardiovascular side effects |
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Modafinil (Provigil) contraindicated in: |
- Hypersensitivity; -History of left ventricular hypertrophy or ischemicECG changes, - chest pain, - arrhythmia, or other significant manifestations ofmitral valve prolapse in association with CNS stimulant use |
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modafinil s/e: |
- HA -rhinitis - increased liver enzymes - nausea - can cause angioedema |
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modafinil dosing: |
200 mg/day 100 mg/day geri |
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Med-Surg interventions |
- CPAP - adenoidectomy - UPPP (uvulopalatopharynoplasty) - wt loss/bariatric surgery - oral appliance |
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ADA accomodations for narcolepsy |
- such as scheduled nap times during work hours or flexible start and end times for the workday - Focus on your less exciting tasks at times when you are most alert.Stay active at work by reading while standing up, keeping your office cool, and taking a break every 20 minutes to walk around. |
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psychomotor interventions |
- positioning - safety precautions - sleep environment - sleep hygiene - CPAP |
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nutrition interventions |
- caffeine intake - alcohol intake - weight loss |
