Unit Iv - Sleep

Front 1

Why is sleep important to us?

Back 1

-influences and regulates physiological functioning & behavioral responses
-body's basic needs
-allows for physical and psychological repair

Front 2

Functions of sleep?

Back 2

-restore normal levels of activity & normal balance among parts of the nervous system
-BP and HR lower, peripheral vessels dilate, skeletal muscles relax, BMR decreases 10-30%

Front 3

Brain centers that control sleep

Back 3

-RAS-reticular activating system
-cerebral cortex

Front 4

Reticular activating system (RAS)

Back 4

-located in brain stem
-neurons in RAS integrate sensory information and relay this information to the cerebral cortex
-with the cerebral cortex the RAS helps to regulate sleep-wake cycles

Front 5

Cyclic rhythms

Back 5

-biological rhythms
-circadian rhythm

Front 6

Circadian rhythm

Back 6

-regulates sleep-wake cycles, body temp, BP, and other physiological functions
- ~1 day long

Front 7

What and how many stages are involved in the sleep cycles

Back 7

-NREM-4 stages
-REM-1 stages
-a complete cycle has 4 stages of NREM and 1 stage of REM

Front 8

Characteristics of sleep stages

Back 8

-1 & 2 are lighter
-3 & 4 are deeper-become shorter with each successive cycle
-REM-increases with each successive cycle up to 60 min.
- ~35 stage changes occur during 1 night of sleep

Front 9

Adult sleep cycle?

What does REM always proceed?

Back 9

-1 to 2 to 3 to 4 to 3 to 2 to REM to 2

-its always proceeded by 2

Front 10

What are the functions of REM sleep

Back 10

-emotional resoration
-sorting out of problems
-filtering daily intake of information
-aids in psychological coping (safety valve)
-keeps us from "bottoming out" in VS

Front 11

How are sleeping problems diagnosis?

Back 11

-EEG-electroencephalogram-monitors electrical activity in cerebral cortex
-EMG-electromyogram-monitors muscle tone
-EOG-electrooculgram-monitors eye movement

Front 12

Normal sleep patterns for Infants

Back 12

-sleep ~22hr/day w/ 2 naps
-20-30% REM
-rituals helpful

Front 13

Normal sleep patterns related to Toddlers

Back 13

-sleep ~10-12 hr/day w/ 1 nap
-20-30% REM
-resist bedtime
-rituals helpful

Front 14

Normal sleep patterns for preschoolers

Back 14

-sleep 11-12 hr/day
-nap or rests
-rituals improtant
-20-30% REM
-nightmares, bedwetting

Front 15

Normal sleep pattern for
-school aged
-adolescents
-yound adults

Back 15

-school age-8-12 hr/day, 20%REM
-Adolescents-8-10 hrs/day, late risers, afternoon naps
-Yound adults 7-8 hrs/day

Front 16

Sleep patterns related to middle age adults

Back 16

-6-8 hrs/day, 20% REM, less stage 4

Front 17

Sleep and older adult

Back 17

-sleep ~6 hrs
-less resorative sleep
-20% REM
-stage 4 markedly decreased

Front 18

What are some causes of sleep disturbances in elders

Back 18

-S.E. of medications
-GERD
-resp and cardiac disorders
-Pain
-nocturia
-depression
-confusion
-loss of partner

Front 19

Sleep patterns in Alzheimer's

Back 19

-diff. sleeping at night and nap during the day
-keep pt active
-maintain routine
-alternate active/passive activities
-bedtime rituals
-backrubs/ bedtime snacks

Front 20

Why does SPICES lead to longer hospital stays?

Back 20

S-sleep disorders
P-problems w/ eating
I-incontinence
C-confusion
E-evidence of falls
S-skin breakdown

Front 21

What implications can a patients cultural beliefs have on sleep?

Back 21

-in can influence sleep and sleep pattern
-include dietary, practices, privacy, noise
-know whats normal for your patient!
-a thorough history is necessary to identify cultural implications

Front 22

What is insomnia

Back 22

-difficulty falling or staying asleep
-premature awakening

Front 23

Causes of insomnia

Treatment of insomnia

Back 23

-causes-stress, depression, addiction, unknown

treatment-meds, caffeine, ETOH, heavy meals, exercise at bedtime

Front 24

Nonpharmacological sleep aids

Back 24

-L-tryptophan (milk, cheese, PB, turkey)
-carbs
-backrubs
-quiet environment
-talk
-exercise, not <3hrs
-bedtime rituals

Front 25

Obstructive sleep apnea (OSA)

Back 25

-periodic stoppage of breathing during sleep
-begins w/ snore, breathing ceases
-CO2 levels increase
-periods can last 10sec-2min, 50-600x/night

Front 26

What does OSA lead to or put you at risk for?

Back 26

-increased incidence of cardiac arrythmias, heart failure, pul. HtN, angina, stroke, HtN
-unexplained death between 1-6am
-c/o excessive daytime sleepiness (EDS)

Front 27

Treatment of sleep apnea

Back 27

-CPAP
-weight loss
-sleep hygiene
-smoking cessation

Front 28

Symptoms of sleep apnea

Back 28

-obesity
-morning HA
-sore throat
-intellectual deterioration
-personality changes
-behavioral disorders
-enuresis
-impotence
-complaints from partner

Front 29

What can sleep apnea make you crave?

Back 29

-swee, starch, and salty snacks

Front 30

What is likely to happen if you have less that 7 hrs and more than 9 hours of sleep in a night?

Back 30

-significantly more likely to be overweight or obese

Front 31

Narcolepsy

Back 31

-mechanisms that regulate sleep and waking are not working properly
-may have catapexy-sudden muscle weakness during periods of intense emotions

Front 32

Meds that treat Narcolepsy

Back 32

-modafinil (Provigil, Alertec) promote wakefulness
-schedule IV drug
-CNS stimulant
-directly stimulates alpha 1-adrenergic receptors

Front 33

Restless leg syndrome

Back 33

-neurological movement disorder
-irresistable urge to move legs because of unpleasant sensation which interfere with sleep
-Familial, Fe deficiency, neuro lesion, pregnancy, uremia, medications
-1/2 cases are heredity, others are idiopathic

Front 34

Barbituates-A medication for sleep

Back 34

-act primarily on reticular formation
-reduces nerve impulses traveling to cerebral cortex
-potentiate the action of GABA, an inhibitory neurotransmitter
-sedation and can also cause resp depression
-stimulates enzymes in the liver that metabolize many drugs

Front 35

Adverse effects of barbituates

Back 35

-drowsiness
-lethargy
-dizziness
-hangover
-paradoxical restlessness or excitement (children/elderly)

Front 36

Benzodiazepine - medication for sleep

Back 36

-most commonly prescribed sedative-hypnotic
-action-depress CNS activity
-act similarly to the neurotransmitter GABA
-uses sedation relief, sleep induction, skeletal muscle relaxation

Front 37

What are some adverse effects of benzodiazepine

Back 37

-HA, drowsiness, parodoxical, vertigo, cognitive impairment, lethargy

Front 38

Examples of benzodiazepines

Back 38

-estazolam (Prosom
-tamazepan (restoril)
-zolpidem (ambien)
-esoplicone (Lunesta)

Front 39

benzodiazepine drug interaction

Back 39

-CNS depressant
-Herbs-kava kava, valerian
-foods-grapefruit (alters absorption)
-cimetidine (Tagemet) prolongs action

Front 40

When assessing a sleeping problems what are things we must know?

Back 40

-nature of problem
-s/s
-onset/duration
-severity
-predisposing factors
-effects on pt's life

Front 41

Narcolepsy

Back 41

-mechanisms that regulate sleep and waking are not working properly
-may have catapexy-sudden muscle weakness during periods of intense emotions

Front 42

Meds that treat Narcolepsy

Back 42

-modafinil (Provigil, Alertec) promote wakefulness
-schedule IV drug
-CNS stimulant
-directly stimulates alpha 1-adrenergic receptors

Front 43

Restless leg syndrome

Back 43

-neurological movement disorder
-irresistable urge to move legs because of unpleasant sensation which interfere with sleep
-Familial, Fe deficiency, neuro lesion, pregnancy, uremia, medications
-1/2 cases are heredity, others are idiopathic

Front 44

Barbituates-A medication for sleep

Back 44

-act primarily on reticular formation
-reduces nerve impulses traveling to cerebral cortex
-potentiate the action of GABA, an inhibitory neurotransmitter
-sedation and can also cause resp depression
-stimulates enzymes in the liver that metabolize many drugs

Front 45

Adverse effects of barbituates

Back 45

-drowsiness
-lethargy
-dizziness
-hangover
-paradoxical restlessness or excitement (children/elderly)

Front 46

Benzodiazepine - medication for sleep

Back 46

-most commonly prescribed sedative-hypnotic
-action-depress CNS activity
-act similarly to the neurotransmitter GABA
-uses sedation relief, sleep induction, skeletal muscle relaxation

Front 47

What are some adverse effects of benzodiazepine

Back 47

-HA, drowsiness, parodoxical, vertigo, cognitive impairment, lethargy

Front 48

Narcolepsy

Back 48

-mechanisms that regulate sleep and waking are not working properly
-may have catapexy-sudden muscle weakness during periods of intense emotions

Front 49

Examples of benzodiazepines

Back 49

-estazolam (Prosom
-tamazepan (restoril)
-zolpidem (ambien)
-esoplicone (Lunesta)

Front 50

Meds that treat Narcolepsy

Back 50

-modafinil (Provigil, Alertec) promote wakefulness
-schedule IV drug
-CNS stimulant
-directly stimulates alpha 1-adrenergic receptors

Front 51

benzodiazepine drug interaction

Back 51

-CNS depressant
-Herbs-kava kava, valerian
-foods-grapefruit (alters absorption)
-cimetidine (Tagemet) prolongs action

Front 52

Restless leg syndrome

Back 52

-neurological movement disorder
-irresistable urge to move legs because of unpleasant sensation which interfere with sleep
-Familial, Fe deficiency, neuro lesion, pregnancy, uremia, medications
-1/2 cases are heredity, others are idiopathic

Front 53

When assessing a sleeping problems what are things we must know?

Back 53

-nature of problem
-s/s
-onset/duration
-severity
-predisposing factors
-effects on pt's life

Front 54

Barbituates-A medication for sleep

Back 54

-act primarily on reticular formation
-reduces nerve impulses traveling to cerebral cortex
-potentiate the action of GABA, an inhibitory neurotransmitter
-sedation and can also cause resp depression
-stimulates enzymes in the liver that metabolize many drugs

Front 55

Adverse effects of barbituates

Back 55

-drowsiness
-lethargy
-dizziness
-hangover
-paradoxical restlessness or excitement (children/elderly)

Front 56

Benzodiazepine - medication for sleep

Back 56

-most commonly prescribed sedative-hypnotic
-action-depress CNS activity
-act similarly to the neurotransmitter GABA
-uses sedation relief, sleep induction, skeletal muscle relaxation

Front 57

What are some adverse effects of benzodiazepine

Back 57

-HA, drowsiness, parodoxical, vertigo, cognitive impairment, lethargy

Front 58

Examples of benzodiazepines

Back 58

-estazolam (Prosom
-tamazepan (restoril)
-zolpidem (ambien)
-esoplicone (Lunesta)

Front 59

benzodiazepine drug interaction

Back 59

-CNS depressant
-Herbs-kava kava, valerian
-foods-grapefruit (alters absorption)
-cimetidine (Tagemet) prolongs action

Front 60

When assessing a sleeping problems what are things we must know?

Back 60

-nature of problem
-s/s
-onset/duration
-severity
-predisposing factors
-effects on pt's life

Front 61

How can we promote sleep in the hospitalized patient?

Back 61

-evaluate current care routines to avoid waking patients
-during night hours, necessary care should be delivered at 1.5-3 hr intervals (multiples of the 90 minute sleep cycles)
-encourage a plan for patients to enjoy undisturbed daytime naps