T3 ch8 sleep

obstructive sleep apnea

partial or complete upper airway obstruction

usually occur during REM cycle (airway muscle tone is lowest here)

occur repeatedly throughout the night

apnea & hypopnea

no single cause

most diagnosed SDB problem

apnea

≥ 90% cessation of respiratory airflow lasting > 10 sec

hypopnea

30 - 90% decrease in airflow

sleep apnea risk factors

obesity → BMI > 30kg

65+ yrs

neck circumference ≥ 16in

male

postmenopausal women

sleep apnea consequences

HTN

T2DM

dysrhythmias

CHD

HF

mortality

impacted ADLs

NREM sleep

75 - 85% sleep time

divided into 3 stages

NREM N1

beginning transition from wakefulness to sleep

slow eye movements

easily awakened

NREM N2

most of the night sleep

HR and temp decrease

EEG depicts specific brain wave forms

NREM N3

deep or slow wave sleep (SWS)

EEG shows delta waves that measure sleep intensity

REM sleep

20 - 25% sleep

follows NREM

• brain waves resemble wakefulness

• postural muscles inhibited → pt cannot initiate muscle movement

• most vivid dreams occur

short term insomnia

problems falling asleep or remaining asleep for at least 3 nights/wk for < 3 months

chronic insomnia

difficulty falling asleep or remaining asleep for at least 3 nights/wk for 3 months or more

what occurs in 10% of americans and is more common in

• women

• divorced, widowed & separated than married people

• low socioeconomic, less educated individuals

chronic insomnia

chronic insomnia treatment

cognitive - behavioural therapy for insomnia (CBT-I)

• avoid or limit naps to 15- 20 min, once a day, only w/in 7 - 9 hrs of waking in the morning

• regular exercise but not w/in several hrs of bedtime

sleep - disordered breathing (SDB)

abnormal respiratory patterns associated w/ sleep

• snoring

• apnea - absent respiratory airflow

• hypopnea - reduced respiratory

causes frequent sleep disruptions & changes in sleep

continuous positive airway pressure (CPAP)

nasal or oral - nasal mask attaches to a high - flow blower

benefits are dose dependent based on length of use

effective but poor adherence

bilevel positive airway pressure (BiPAP)

delivers higher inspiration pressure & lower expiration pressure

may be better tolerated

jet lag disorder

most common when crossing at least 3 time zones

severity & recovery time increased w/ number of zones

melatonin & daylight exposure to help resynch bodys rhythm

older age associated with

overall shorter total sleep time

decreased sleep efficiency

more awakenings

gerontologic considerations

amt of sleep does not change w/ age

some sleep disorders increase w/ age

circadian sleep timing can shift w/ age

• sleepy earlier in evening; awaken earlier in morning

↑ fall risk, injury, cognitive disturbances