Taylor - Fundamentals Of Nursing -Chapter 34 Rest & Sleep

Front 1

rest

Back 1

a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed.

Front 2

sleep

Back 2

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.

Front 3

the two systems in the brain stem that are believed to work together to control the cyclic nature of sleep are the

Back 3

RAS-reticular activating system & the bulbar synchronizing region.

Front 4

RAS-reticular activating system.

Back 4

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.

Front 5

sleeping and waking is controlled by the

Back 5

hypothalamus

Front 6

Various neurotransmitters are involved with the sleeping process

Back 6

excitation is controlled by norepinephrine, acetylcholine, dopamine, serotonin and histamine.
GABA is necessary for inhibition.

Front 7

There are two major stages of sleep

Back 7

NREM - non-rapid eye movement
&
REM-rapid eye movement.

Front 8

NREM sleep consists of 4 stages

Back 8

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.

Front 9

Stage 1 NREM

Back 9

pre-sleep.
5% of total sleep.few minutes.
lasts only minutes.
relaxed yet aware of surroundings.
easily aroused.
involuntary muscle jerking occurs.

Front 10

Stage 2 NREM

Back 10

begins deeper sleep.
50% of total sleep.10-20 minutes.
can still be aroused easily.

Front 11

Stage 3 NREM

Back 11

sleep deepens.
arousal becomes difficult.
10% of sleep. 10-30 minutes.

Front 12

Stage 4 NREM

Back 12

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.

Front 13

REM sleep

Back 13

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.

Front 14

Sleep architecture

Back 14

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.

Front 15

Sleep cycle

Back 15

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.

Front 16

Hypothyroidism can interfere stages

Back 16

NREM 2 & 4
hypothyroidism may reult in difficulty falling asleep.

Front 17

chest pains associated with coronary artery disease and MI occur more frequently during which sleep cycle?

Back 17

REM

Front 18

Epileptic seizures occur more frequently during which cycles?

Back 18

NREM
REM sleep appears to depress seizures.

Front 19

Gastric secretions increase during which cycle?

Back 19

REM
many people with peptic ulcers awaken during this period.

Front 20

REM deprivation may cause

Back 20

symptoms of psychosis.
dreaming is absent
sensitivity to pain increases
mental alertness decreases.

Front 21

Sleep patterns
neonates

Back 21

16-20 hours
day/night patterns not established.

Front 22

Sleep patterns
infants

Back 22

12-16 hours
some patterns develop.
REM sleep constitutes much of an infants sleep.

Front 23

Sleep patterns
toddlers

Back 23

12-14 hours with naps during day.

Front 24

Sleep patterns
preschoolers

Back 24

10-12 hours, decreased desire for naps.
REM sleep pattern resembles that of an adult.
resists going to bed at night.

Front 25

Sleep patterns
school-aged

Back 25

10- 12 hours.

Front 26

Sleep patterns
adolescents

Back 26

8-12 hours.
sleeping patterns become irregular.
restlessness due to stressors.
most do not get enough sleep.

Front 27

Sleep patterns
young adults

Back 27

8 hours.some require less.
lifestyle may interfere with patterns.
REM averages 20% of sleep.

Front 28

Sleep patterns
middle adults

Back 28

6-8 hours.
a decrease in stage 4 NREM occurs.
sleep disturbances are present in some.
more time spent awake in bed.

Front 29

Sleep patterns
older adults

Back 29

5-7 hours.
stage 4 NREM is absent or considerably decreased.
REM sleep periods are shortened.

Front 30

based on the circadian rhythm, the body prepares for sleep by:

Back 30

decreasing body temperature and releasing melatonin.

Front 31

excessive Alcohol intake affects sleep by

Back 31

decreasing stage 4 NREM and REM.
alcohol should be avoided 4-6 hours before sleep begins.

Front 32

drugs that decrease REM sleep include

Back 32

barbiturates
amphetamines
antidepressants

Front 33

the common sleep disorders are

Back 33

dyssomnias and parasomnias.

Front 34

Dyssomnias-Insomnia

Back 34

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.

Front 35

Common health problems associated with Chronic insomnia

Back 35

obesity
type II diabetes
psychiatric disorders-depression
cardiovascular disorders such as heart failure,stroke,hypertension and MI.

Front 36

Chronotherapeutics

Back 36

the strategic timing in the administration of medications that take bodily rhythms into account.

Front 37

Parasomnias

Back 37

patterns of waking behavior that appear during sleep.common are:
somnambulism-sleepwalking
sleeptalking
bruxism-teeth grinding
enuresis-bedwetting.

Front 38

sleep hygiene

Back 38

nonpharmacologic recommendations that help get a better night's sleep.
involve lifestyle and environmental changes.

Front 39

hypersomnia

Back 39

excessive sleep, particularly during the day.

Front 40

Narcolepsy

Back 40

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

Front 41

cataplexy

Back 41

sudden loss of motor tone usually experienced during periods of strong emotion.

Front 42

hypnagogic hallucinations

Back 42

nightmares or vivid hallucinations.

Front 43

sleep-onset REM

Back 43

person moves directly to REM sleep when experiencing a sleep attack.

Front 44

sleep paralysis

Back 44

skeletal paralysis that occurs during the transition from wakefulness to sleep.

Front 45

Sleep apnea

Back 45

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.

Front 46

during long periods of apnea, the body may experience

Back 46

drop in blood oxygen levels
irregular pulse
a rise in blood pressure.
excessive daytime sleepiness

Front 47

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

Front 48

sleep deprivation

Back 48

a decrease in the amount,consistency or quality of sleep.
it may involve NREM or REM sleep.

Front 49

Central sleep apnea

Back 49

a dysfunction of the respiratory center of the brain(hypothalamus).

Front 50

nocturnal myoclonus

Back 50

marked muscle contractions that result in the jerking of one or both legs during sleep.

Front 51

RLS- restless leg syndrome

Back 51

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.

Front 52

URGE acronym for RLS

Back 52

U-urge to move legs
R-rest-induced
G-gets better with activity
E-evening symptoms more severe

Front 53

Medications used to induce sleep

Back 53

Benzodiazepines-the sedative-hypnotics:
flurazepam-Dalmane
temazepam-Restoril

nonbenzodiazepines:
eszopiclone-Lunesta
zolpidem-Ambien

Melatonin agonist
ramelteon-Rozerem

Front 54

benzodiazepines used for sleep interfere with

Back 54

REM and NREM sleep.
produce an unnatural sleep and
often lose their effect after 1-2 weeks.

Front 55

Sleep-weight link

Back 55

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.