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What are the two stages of sleep & the respective percentages?

1. NREM = Non-Rapid Eye Movement (has 4 stages) 75%
2. REM = Rapid Eye Movement

What the two NREM characteristics?

1. Parasympathetic nervous system dominates
2. ↓ pulse, ↓ RR, ↓ BP, ↓ temp, ↓ metabolic rate

Stage 1 of NREM (4)

1. light sleep
2. 5% of sleep time
3. Can be aroused with relative ease
4. usually only 10 min long (if longer could be sleep disturbance)

Stage 2 of Sleep (3)

1. sleeping but easily aroused
2. 50% of sleep time
3. light sleep

Stage 3 of Sleep (3)

1. delta wave sleep or slow-wave sleep
2. deeper sleep /arousal becomes more difficult
3. 10% of sleep time

Stage 4 of Sleep (4)

1. delta wave sleep or slow-wave sleep
2. deepest level
3. most difficult to arouse (out of it)
4. body temp & metabolism are down

REM Sleep (5)

1. Rapid Eye Movement
2. more difficult to arouse than NREM
3. 20-25% of sleep time
4. awaken people state they were dreaming
5. ↑ RR, ↑ Temp, ↑ BP, ↑ metabolic rate, ↓ DTR

Normal Sleep Cycle characteristics & path (3)

1. usually only 2 stage 4's a night
2. 4 to 5 cycles a night about 100 min each
3. Path = 1-2-3-4-3-2-REM-2-3-2-REM

During sleep the brain is Dormant or Active?

Active

What is the normal amount of sleep for infants?

14-20 hours

What is the normal amount of sleep for teens?

10-14 hours

What is the normal amount of sleep for adults?

7-9 hours

How is sleep differ from child to older adult?

Children need more sleep

Older Adults have less stage 4 & shorter REM

What are ten factors affecting sleep?

1. Development considerations = develop patterns of sleep
2. Motivation = desire to be awake & alert
3. Culture
4. Lifestyle = Melatonin → working the night shift
5. Physical activity = affects REM & NREM. activity 2 hours before sleep can affect sleep
6. Diet = caffeine, tobacco, alcohol
7. Environment = change from usual. affects both REM & NREM
8. Psychological stress = disturbed sleep, ↓ REM leads to anxiety/stress
9. Illness = ↓ gastric secretions
10. Medications = Barb, amph, diuretics

What should you avoid at least 2 hours before bed?

- exercise
- proteins
- alcohol
- tobacco
- caffeine
- televsion

If you're hungry before bed what should you eat?

a small carb

What is Insomnia? (6)

1. Difficulty falling asleep or
2. Intermittent sleep or
3. Early awakening
4. more common in women >60 (especially menopause, stress, travelers, depression
5. Will affect performance/mood the next day. Tired, lethargic, irritable during the day
6. Tx: promote good sleep habits

What is Narcolepsy? (5)

1. uncontrollable desire to sleep regardless of activity
2. life threatening
3. usually appears in adolescents
4. tx: sedatives & stimulants (Ridalin, Provigil)
5. may be genetic

What is Sleep Apnea? (5)

1. stop breathing for 10sec to 2min
2. caused by malfunctioning neurons
3. caused by fat buildup & loss of muscle tone in & around airway
4. Causes: overweight & short necks
5. can lead to: heart disease, attack, failure/stroke/ depression/breathing problems

What is the Dx & Tx of Sleep Apnea?

Diagnosis: through sleep studies / EEG electrodes to your head

Treatment:
CPAP Mask
avoid laying on your back
weight loss

What is Restless Leg Syndrome? (4)

1. unpleasant creeping, crawling, tingling
2. must move legs for relief
3. more common in elderly, anemic (Fe deficiency), pregnant, & diabetic & end stage renal disease
4. Tx: ropinirole (Requip), ankle to thigh massage, walking, eliminate caffeine, tobacco, alcohol, mild analgesic

What is Sleep Deprivation? (5)

1. seen in hospitalized patients
2. different than insomnia
3. ↓ amount, consistency, or quality REM, NREM
4. Impairs concentration and attention
5. Imposes serious safety risks

- give 2 hours of uninterrupted sleep

What are six S/S of Sleep Disturbances?

1. ↓ energy level
2. puffy eyes / glazed / droopy eyelids
3. crabby / don't make sense / yawning
4. large neck
5. obesity
6. deviated septum

What are the components of Sleep Disturbance Assessment?

1. sleep/wake patterns
2. effects on everyday functions (remembering things)
3. use of sleep aids (Rx or OTC)
4. presence of sleep disturbances

What are the five components of a targeted sleep disturbance history?

1. Nature of the problem
2. Associated s/s
3. Onset and frequency of occurrence
4. affect on everyday life severity
5. how is patient coping - might want them to do a sleep diary

What are two assessment tools?

1. Pittsburg sleep quality index
2. Epworth sleepiness scale

What are the components of a sleep diary? (3)

1. Daily record for 2 weeks
2. Include: Bedtime, onset of sleep, awakenings, food, activities, events before sleep, stressors
3. Maybe graph of the awakening

What four s/s should you look for in a physical exam?

1. Energy level
2. Facial characteristics = glazing eyes, ↓ animation, swollen eyes
3. Behavioral characteristics = yawning, rubbing eyes, slow speech
4. Physical data = obesity & large neck

What are four Nursing Diagnoses for Sleep?

1. Disturbed Sleep Pattern = problem is time limited
2. Sleep Deprivation = problem is prolonged
3. Readiness for Enhanced Sleep = asking for more information on how to improve sleep
4. RC Sleep Apnea

What are five Disturbed Sleep Pattern Interventions?

1. create a restful environment
2. appropriate snack = (carbs)
3. promote relaxation & comfort
4. support usual sleep-wake patterns
5. avoid alcohol, caffeine & excessive fluids

What are four types of medications?

1. Hypnotics - Barbiturates, Benzodiazipines, Misc
2. Antidepressants
3. Antihistamines
4. Herbal medicine = Melatonin

The only drug approved for long term treatment of insomnia is?

Lunesta (eszopiclone)

What is sleep? ****

a state of rest accompanied by altered consciousness and relative inactivity

What stage of sleep does hypothyroidism affect?

↓ NREM (especially II & IV)

What is a natural herbal therapy for sleep?

Melatonin (but if DM can effect blood sugar)

What are the three actions of Barbiturates?

1. reduce nerve impulse transmission to cerebral cortex
2. raises seizure threshold
3. inhibits REM sleep

What are the three concerns of Barbiturates?

1. Drowsiness, hangover, increased risk of injury
2. OD: respiratory depression, coma, death
3. habit forming

What are three examples of Barbiturates?

1. Secobarbitol (Seconal)
2. Pentobarbitol (Nembutal)
3. Phenobarbitol (Luminal)

What are the three actions of Benzodiazipines?

1. depress CNS activity to promote calm
2. Reduces sensory stimulation & relaxes skeletal muscles
3. Depresses REM somewhat

What are the three concerns of Benzodiazipines?

1. HA, drowsiness, increases fall risk
2. hangover effect
3. OD: confusion, coma

What are three examples of Benzodiazipines?

1. Flurazepam (Dalmane)
2. Temazepam (Restoril)
3. Triazolam (Halcion)

What are the actions of non-Benzodiazipines?

similar to benzodiazipines

What are the two concerns of non-Benzodiazipines?

1. risk for fall
2. ↑ residual sleepiness in elderly

What are three examples of non-Benzodiazipines?

1. zolpidem (Ambien)
2. zalepion (sonata)
2. Eszopilone (Lunesta)

What are the actions & examples of Chloral Hydrate (Noctec)?

1. depresses CNS activity w/o suppressing REM
2. doesn't last long / stops quickly (lasts a couple days)
3. Tachyphylaxis = doesn't induce sleep, no reaction
4. Micky Finn (date rape drug w/ alcohol, slip a mickey)

What are the two actions of Eszopilone (Lunesta)?

1. Slows brain activity to allow sleep w/o suppressing REM
2. Approved for LT treatment of insomnia

What are the three concerns of Eszopilone (Lunesta)?

1. Risk for injury
2. Daytime drowsiness
3. Requires weaning

What are antihistamines?

1. Depress CNS activities
2. OTC sleep aids

Herbal Therapy (Valerian) (7)

1. root used for sleep disorders
2. Depresses CNS
3. doesn't affect REM
4. also for menstrual cramps & anxiety control
5. risk for falls
6. avoid machinery
7. caution w/ ETOH

Herbal Therapy (Kava) (4)

1. Not FDA approved
2. plant rhizome that promotes sleep
3. yellowing of skin
4. liver failure

What is Melatonin? (6)

1. hormone produced by pineal gland to control sleep-wake cycles
2. levels change in response to light
3. possible uses: jet lag / seasonal / shift work
4. only works if you have abnormal levels
5. risk for injury
6. changes levels of hormones = thyroid, Cortisol, Estradiol, Vasopressin, Glucose (↑ BG for DM)

Readiness For Enhanced Sleep (6)?

1. don't exercise w/in 2 hrs of bedtime
2. avoid caffeine, alcohol, tobacco & proteins late in day
3. snack on carbs at bedtime
4. maintain same wake time
5. sleep rituals
6. OOB to other room if unable to sleep

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