sleep wake disorders

normal sleep cycle

goes through cycle multiple times throughout night

NREM: 3 stages
N1: sleep latency; easily aroused
N2: more difficult to awake, low RR and HR
N3: delta sleep

REM: dreams, atonia (lack of muscle movement)

healthy sleep

requirements: age, basal sleep

patterns: as we age, require less sleep

regulation: sleep drive, circadian drive

functions: immune system, memory

lack of sleep

excessive sleepiness: subjective, impacts work/social functioning, can be self imposed

sleep deprivation: long term discrepancy, widespread negative impact

lack leads to: mental and physical problems (obesity, DM, HTN, depression) and safety concerns (psychomotor impairment, increase risk of errors)

healthy people 2030 goals

reduce rate of vehicle crashes due to drowsy driving

increases proportion of adults with sleep apnea symptoms who get evaluated by a provider

increase proportion of adults who get enough sleep

increase the proportion of high school students who get sufficient sleep

increase the proportion of children who get sufficient sleep

increase the proportion of infants who are put to sleep on their back

increase the proportion of infants who are put to sleep in a safe sleep environment

increase the proportion of secondary schools with a start time of 830am or later

insomnia

adequate sleep opportunity must exist

difficulty initiating or maintaining sleep

daytime consequence

dissatisfied with sleep quality

hypersomnolence

excessive sleepiness

high injury risk

treatment: 10+ hrs of sleep; stimulants; maintain regular sleep wake cycles

narcolepsy

irresistible need for sleep

starts at REM

can be misdiagnosed for psychosis

treatment: lifestyle modification

obstructive sleep apnea

upper airway collapse

obesity

loud snoring

CPAP

central sleep apnea

no increased ventilation effort

older persons

those with cardiac/pulmonary disease

sleep related hypoventilation

oxygen desaturation without apnea

morbid obesity

pulmonary disease

circadian rhythm disorder

interruption of sleep due to timing of normal sleep pattern; shift work

diagnosis: sleep diaries; clinical evaluation

treatment: lifestyle management, adapting/modifying sleep

sleep disorders

arousal disorders (NREM): sleep walking, sleep terrors. treatment: education, stress reduction, sleep hygiene, benzos

nightmares: REM, need clinical eval to diagnose. treatment: lifestyle mod, stress reduction, hypnotic therapy

REM sleep behavior disorder: elaborate motor activity. treatment: safety

restless leg syndrome

sensory/movement

treatment: lifestyle mod; gabapentin (calms nervous system down)

comorbidity

can lead to multiple medical diseases; obesity, HTN, inhibits immune system

associated with high number of psychiatric disorders: dementia, depression, anxiety

effects of technology: use of screens inhibits sleep

nurses role: anticipatory guidance; positive sleep practices; sleep diary, sleep hygiene, no screens

assessment

sleep patterns: causing dissatisfaction in quality of sleep

safety: client, others

self assessment: nurses at high risk for sleep disorders

medications

benzos; will help short term

benzos like; Z hypnotics

melatonin receptor agonists

antidepressants; TCA

orexin receptor agonist

antihistamines; benadryl

evaluation

does the pt report improved sleep quality

how we interpret progress/success and how pt interprets may be different