Sleep and Rest - Ch 43 - Craven - NUR 101

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sccc fall 2010 nursing nur101 craven

Sleep

is a naturally occurring altered state of consciousness characterized by decreases in awareness and responsiveness to stimuli

rest

awareness of the environment is maintained, but motor or cognitive response is decreased

Polysomnogram

Polygraph recordings of electrophysiologic changes in brain waves (electroencephalogram [EEG]), eye movements (electrooculogram [EOG]), and muscles (electromyogram [EMG]

Sleep Stages

Stage 1 -between drowsy and sleep
Stage 2 - bursts of sleep spindles, rolling eye movements and snoring
Stage 3&4 - deep, slow-wave sleep
REM - closely resembles wakefulness

Stage 1 Sleep

lasts a few min - transitional stage between drowsiness and sleep - a shift from alpha waves to low-voltage, fast theta waves on the EEG. Muscles relax, respirations become even, and pulse rate decreases

Stage 2 Sleep

a relatively light sleep from which the person is easily wakened. Bursts of sleep spindles appear on the EEG - Rolling eye movements continue, and snoring may occur

Stage 3&4 Sleep

"deep" sleep, sometimes termed slow-wave sleep or delta sleep after characteristic waves seen on the EEG - muscles are relaxed, but muscle tone is maintained; respirations are even; and blood pressure, pulse, temperature, urine formation, and oxygen consumption by muscle decrease.

REM Stage Sleep

closely resembles wakefulness except for very low muscle tone, indicated by a reduction in amplitude of the EMG - Blood pressure and pulse rate show wide variations and may fluctuate rapidly. Respirations are irregular, and oxygen consumption increases. Thermoregulation is lost. Vaginal secretions increase in women, and erections may occur in men. Dreams occurring during REM sleep tend to be vivid and implausible, sometimes including a sense of being unable to move.

somnambulism

sleep-walking

enuresis

bed-wetting

Sleep Rhythm

a rhythmic pattern of approximately 90-minute cycles during which people progress in sequence through the sleep stages

Reticular Activating System (RAS)

consists of a network of interconnecting neurons in the medulla, pons, and midbrain, with projections to the spinal cord, hypothalamus, cerebellum, and cerebral cortex - fills in the spaces in the brainstem among the major tracts, bringing in sensory messages and relaying motor ones

Serotonin

a major neurotransmitter associated with sleep - produced in the raphe nuclei in the brainstem, serotonin is derived from its precursor, tryptophan

Psychological Functions of Sleep

Sorting and discarding of neurophysiologic data - Character reinforcement and adaptation for mental and emotional stability

Sleepiness

an urge of varying intensity to go to sleep. It may occur in response to too little or too much sleep or to lack of adequate sensory stimulation

Fatigue

a subjective state of weariness in which intense or rapid tiring accompanies physical activity. It is a common human response to illness, suggesting the need to conserve energy through rest and sleep.

Anabolism

synthesis of cell constituents - shift toward this state during sleep

short sleepers

those who sleep for less than 6 hours in 24) tend to be efficient, hard-working people

long sleepers

(those who sleep for more than 9 hours in 24) have a higher percentage of REM sleep, and there is some suggestion that as a group they are more creative - tend to die at a younger age

Sleep latency

timer required to fall asleep - averages 10-30 min

changes of position during sleep

typically occur 20 to 40 times during the night

Circadian Rhythms

Biologic rhythms that follow a cycle of about 24 hour

Melatonin

synthesized in the pineal gland during the hours of darkness, has an apparent rhythm-setting function closely related to light conditions

suprachiasmatic nucleus (SCN)

located above the optic chiasm in the anterior hypothalamus, functions essentially as the "clock" for most circadian rhythms by relaying information from the retina to the pineal gland

Growth hormone and prolactin levels (sleep)

are closely tied to actual sleep time, changing immediately in relation to variations in the sleep period, irrespective of light-dark conditions. Secretion of both hormones increases early in the sleep period

Adrenocorticotropic hormone secretion from the pituitary

is high during the early part of the sleep period, and levels of cortisol, its target hormone from the adrenal cortex, rise toward the end of the nocturnal sleep period

hormonal dysynchrony

which hormonal levels adjust at different rates to alterations in the timing of the sleep period

Lifespan Sleep Patterns

Infants REM sleep is 50% higher than adults
REM content gradually drops to about 20% at puberty
Older Adults phase advance

Phase Advance (sleep)

tendency to go to bed earlier but also waken earlier

Core Sleepiness

associated with the loss of core sleep and reflected in impaired cerebral functioning

Optional Sleepiness

associated with the loss of optional sleep and mostly affecting motivation

Temperature and REM sleep

thermoregulation is impaired and shivering does not occur

sleep and relationships

Security needs are heightened at bedtime for people of all ages

sleep and Shift Work

The accumulated sleep debt may compromise clinical judgment and decision making, an increasing concern in healthcare in terms of patient safety

Exercise and sleep

Habitual exercise contributes to deeper and longer sleep. In physically fit people, light-intensity exercise seems to decrease sleep latency, and intensive exercise increases the proportion of slow-wave sleep

Lifestyle, Habits and sleep

bedtime rituals become habits - A regular time of rising is one of the most effective means of improving sleep quality and synchronizing circadian rhythms with clock time.

Hyperthyroidism and sleep

causes fragmented, short sleep with excessive slow-wave stages

Hypothyroidism and sleep

seems to cause excessive sleepiness and a lack of slow-wave sleep.

Hypnotics

sleeping pills - used to decrease sleep latency and improve sleep maintenance, are among the medications most prone to disturb sleep architecture. REM sleep is most vulnerable.

Medications and Chemicals (sleep)

hypnotics - alcohol - morphine - antidepressants - phenytoin (epilepsy) - caffeine - nicotine

Manifestations of Altered Sleep

s/s associated with sleep deprivation are fatigue, headache, nausea, increased sensitivity to pain, decreased neuromuscular coordination, general irritability, and inability to concentrate. Eventually, disorientation and hallucinations

Insomnia

perceived difficulty in sleeping

Onset Insomnia

prolonged sleep latency

Maintenance Insomnia

multiple awakenings

early-awakening insomnia

duh!

Psychophysiologic Insomnia

persistent insomnia associated with somatized tension and learned sleep-preventing associations

Narcolepsy

a disorder of excessive daytime sleepiness characterized by short, almost irresistible daytime sleep attacks, usually lasting 10 to 15 minutes, and abnormal manifestations of REM sleep

Cataplexy

Episodes of profound weakness during intense emotion - reported by 70% of narcoleptics

Sleep Apnea

recurrent periods of absence of breathing for 10 seconds or longer, occurring at least five times per hour

Obstructive Sleep Apnea

involves collapse of the upper airway despite respiratory effort
- Common treatments include continuous positive airway pressure applied through a nose mask and surgical reconstruction of the upper airway with removal of most of the uvula, posterior portion of the soft palate, and tonsils

Hypopnea

recurrent periods of very shallow breathing

Untreated Sleep Apnea

can increase the chance of having high blood pressure and even a heart attack or stroke & can also increase the risk of diabetes and for other accidents

Central Apnea

occurs because of neurogenic failure to trigger respiratory effort - most commonly seen with neurologic conditions such as stroke or brainstem involvement. Severely affected clients may require ventilatory support at night.

Mixed Apnea

combo of obstructive sleep and central apneas

Delayed Sleep Phase Syndrome

mismatch of personal circadian rhythm against societal expectations

Parasomnias

activities that are normal during waking but abnormal during sleep, such as somnambulism, talking, and enuresis - usually occur during slow-wave sleep - most common in children

Night Terrors

repeated, sudden awakenings accompanied by screaming, acute anxiety, and disorientation. They occur mainly among children and are associated with incomplete arousal from slow-wave sleep early in the night

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