FUNDAMENTALS EXAM 4 (Sleep/Rest)

State of relaxation free from stressors; body is in decreased state of activity and feels refreshed

Rest

a state of rest accompanied by altered consciousness and relative inactivity; associated with healing and restoration

Sleep

Average adult sleep is _______ hours per day

7-8

Average adolescent sleep is _____ hours per day

9-10

Average infant/toddler sleep is ______ hours per day

9-15

Control center for sleep and wake

hypothalamus

Facilities reflex + voluntary movements; controls cortical activities related to state of alertness

Reticular activating system (RAS)

__________ synchronizing region takes over when you decrease your stimulus (dark room, quiet)

Bulbar

Natural sleep-wake cycle repeated every 24 hours. Known as the bodies "Internal clock". Needs consistency.

Circadian rhythm

How many stages of sleep are there?

4

This stage of sleep is the lightest stage. Your breathing is regular and your muscle tons is present. You are awakened easily. (NREM)

Stage 1

This stage lasts 10-20 minutes; deeper sleep; no eye movement detected. Still easily aroused but more restful. More relaxed (NREM)

Stage 2

This stage is short term; hibernation period; deepest sleep; delta waves; mental cloudiness when woken. Vitals decrease (NREM)

Stage 3

Occurs 90 minutes after falling asleep, vivid dreaming occurs, irregular breathing, rapid eye movement, Vitals increase. Lasts about 20 minutes. 20-25% of sleep (REM)

Stage 4

NREM accounts for what % of sleep?

75%

NREM stands for

non rapid eye movement

REM stands for

rapid eye movement

Newborn (birth-28 days) needs how much sleep?

14-17

Infants (1 month-1 year) need how much sleep

12-15

Toddlers (1-3yr) need how much sleep

11-14

Preschool (3-6) need how much sleep

10-13

School aged (6-12) need how much sleep

9-11

As a nurse, we should limit waking client throughout the night by performing _________ care when you can.

Cluster

Avoid caffeine, coffee, tea, and alcohol _______ hours before bedtime

4

Limit fluids ___ to ____ hours before bedtime.

2-4

Avoid exercise _____ to _____ hours before bedtime

2-3

Abnormalities in the amount, quality, or timing of sleep. Characterized by insomnia or excessive sleepiness disorders

Dyssomnias

Insomnia, hypersomnia, narcolepsy, hypersomnolence disorder, sleep apnea, restless leg syndrome, sleep deprivation are all types of

Dyssomnias

Most common sleep disorder. Inability to get adequate amount of sleep and to feel rested. Chronic is lasting 1 month or longer. Intermittent between good sleep and then bad sleep. Usually have fatigue, headache, behavioral problems.

Insomnia

Abnormal daytime drowsiness despite adequate sleep at night. Affects daily living. Signs are poor memory, depression, short attention span, irritability. Treat with wakefulness promoting agents, psychostimulants

Hypersomnia

Can be dangerous. Sudden sleepiness and sudden period of sleep. Sudden uncontrollable attacks. Can hallucinate. Bouts of muscle weakness, cataplexy.

Narcolepsy

With narcolepsy, you should eat small ______ _______ meals and exercise regularly and take prescribed stimulants

High protein

Onset for narcolepsy

15-30 years old

Excessive daytime sleepiness that lasts at least 3 months. Impairs social activities. Increased risk for injury. To help with this, Maintain a regular sleep/wake schedule, provide ampule sleep opportunities, take prescribed stimulants

Hypersomnolence disorder

More than 5 breathing cessations lasting longer than 10 seconds every hour during sleep. Decreased O2 sat.

Sleep apnea

Sleep apnea is most common in males above age _______, individuals who are _______, people with large _______, and people who __________

60, obese, necks, smoke

CNS dysfunction in the respiratory control center of the brain that fails to trigger breathing during sleep

central sleep apnea

Structures in the mouth and throat relax during sleep and occlude the upper airway (OSA)

Obstructive sleep apnea

Someone who has sleep apnea may

Snore

You can help sleep apnea by managing your _______, decreasing _______ consumption, and smoking __________

Weight, alcohol, cessation

Sleep apnea can lead to decrease ______ function and ________ failure

Cardiac, heart

People who have sleep apnea may wear a _______ at night

CPAP

Sleep apnea is diagnosed usually by a _________ at the hospital or outpatient setting

Sleep study

CPAP stands for

continuous positive airway pressure

Irresistible urge to move legs. Usually at night and worsens with age. Movement of the legs gives relief. Usually described as creepy/crawly/twitch or electric feeling.

Restless leg syndrome

Restless leg syndrome may be seen in due to low _______ or ________

Pregnancy, iron or B12

Not enough sleep; changes in physical and mental functioning. Can cause tension headache, loss of concentration, mood swings, and depression

Sleep deprivation

patterns of waking behavior that appear during sleep

parasomnias

Somnambulism, REM behavior disorder (RBD), sleep terrors, nightmares, bruxism, enuresis, sleep related eating disorder are all types of

Parasomnias

Sleep walking. Get out of bed and walk around, do activities, sit up in bed, open eyes, glassy eyed expression describes what type of parasomnias?

Somnambulism

Somnambulism (sleepwalking) is most common in

Children

Sleep walking normally happens in what stage of sleep?

3

How many hours after falling asleep does sleep walking normally begin?

1-2 hours

When it comes to somnambulism, what is the most IMPORTANT concern?

Safety

Vivid Dream enactment behaviors that occur during REM sleep where someone will act out the dreams they are having. Normally they will scream, hit, kick, physically act out. They will usually remember the dreams.

REM behavior disorder (RBD)

REM behavior disorder (RBD) is common in patients who have _________ and _________. Safety is also a huge priority.

Parkinson's and dementia patients

AKA night terrors. Common with kids. They REMAIN asleep. They may experience screaming, crying, and intense fear.

Sleep terrors

Bad dream that common with kids but they are AWAKENED by it

Nightmare

Teeth grinding or clenching during sleep that can cause headaches, jaw pain, damaged teeth. A mouth guard may be necessary. Most common during stage 2 of sleep (NREM)

Bruxism

Bruxism can be triggered by ________, _________, and __________ such as SSRIs

Stress, anxiety, certain medications

Bed wetting. Risk factors include: Stress, anxiety, family history, ADHD

Enuresis

Before age ______, enuresis is not a concern

7

Enuresis in a child could be a sign of

UTI or Type 1 Diabetes

Unusual eating behaviors during sleep. Most have an episode of this every night. It's ongoing and a lasting problem. Normally eating or drinking inedible or toxic substances. Safety is a huge concern! They have little to no recall of the episode.

Sleep related eating disorder

Someone who has a sleep related eating disorder usually will eat foods that are

Thick, sugary, high calorie

A daily log used to track a persons sleep patterns, habits, and disturbances over a period of time. Typically 1-2 weeks. It's a helpful tool in diagnosing sleep disorders like insomnia.

Sleep diary

Most commonly prescribed for sleep disorders

Z-Drugs

Zolpidem, which is a Z-drug most commonly used for sleep disorders is also known as

Ambien

Zolpidem (Ambien) is a

Sedative/Hypnotic

This class of drugs are "benzo-like" but there's less risk of dependency. They help you fall asleep quickly

Z-drugs

This class of drugs Mimics natural melatonin to help sleep-wake cycle. Ramelteon is an example.

Melatonin agonist

This drug class enhances GABA and is a CNS depressant. Examples of this drug class is Diazepam, lorazepam, flurazepam, triazolam

Benzodiazepines

This drug class is an Over the counter sleep aid. Can be sedating. An example is Benadryl (diphenhydramine)

Antihistamines

This drug class helps sleep by treating depression/anxiety. Examples are Doxepin (sinequan), Trazadone (Desyrel), Buproprion (Wellbutrin), Amitriptyline (Elavil)

Antidepressants

This drug class promotes sleep in neuropathic pain, anxiety. An example is Gabapentin (Neurotin)

Anticonvulsants

Name 6 drug classes used for sleep disorders

Anticonvulsants, antidepressants, antihistamines, benzodiazepines, Z-drugs, melatonin agonists