Sleep and Rest Nursing Review (Video Notes)

Flashcards covering sleep functions, physiology, sleep stages, age-related sleep patterns, sleep promotion and disorders, pharmacologic and nonpharmacologic interventions, hospital sleep management, and PN scope of practice.

What are the four major brain regions involved in sleep regulation?

Cerebrum, cerebellum, diencephalon, and brain stem.

Which structures within the diencephalon regulate sleep and autonomic functions?

Thalamus, hypothalamus, and pineal gland.

What is the role of the suprachiasmatic nucleus (SCN) in sleep regulation?

The SCN acts as the body’s internal clock, regulating the circadian rhythm in response to light cues detected by the eyes.

Which gland produces melatonin and what is its function?

The pineal gland; melatonin regulates the sleep-wake cycle.

Which neurotransmitter reduces arousal centers to promote sleep?

GABA (gamma-aminobutyric acid).

Define circadian rhythm.

A natural 24-hour internal clock that regulates the sleep-wake cycle in response to environmental cues like light and temperature.

Define sleep-wake homeostasis.

The body's drive to sleep after a period of wakefulness; sleep depth increases with sleep deprivation.

Name factors that can disrupt circadian rhythm.

Bright light at night, medications, caffeine, certain foods, sleep environment, and stress.

List the four sleep stages described (NREM stages 1-3 and REM stage 4) and a key feature of each.

Stage 1 (NREM): light sleep with transition from wake; alpha waves fade; lasts 1-5 minutes (~5% of sleep). Stage 2 (NREM): sleep spindles and K-complexes; heart rate/temperature drop; ~50% of sleep. Stage 3 (NREM): deep sleep with delta waves; immune/restoration; lowest vital signs. Stage 4 (REM): dreaming; beta-like brain activity; muscle atonia; irregular breathing; ~20-25% of sleep.

What brain structure helps block external stimuli during most sleep, and what happens during REM sleep with regard to dream content?

The thalamus blocks external distractions during most sleep; during REM sleep it transmits sensory information that influences dream content.

What EEG patterns correspond to Stage 1 and Stage 2 sleep?

Stage 1: alpha waves transitioning to low-frequency, mixed activity. Stage 2: sleep spindles (11–15 Hz) and K-complexes.

What is the characteristic brain activity during REM sleep?

Beta-like activity similar to wakefulness with rapid eye movements and muscle atonia.

What is the typical distribution of sleep stages in a healthy adult night (percentages)?

Stage 1 ~5%; Stage 2 ~45–55%; Stage 3 ~10–20%; REM ~20–25%.

How does aging affect sleep stages, particularly stage 3 and stage 2?

Older adults have fewer stage 3 (deep sleep) cycles and more stage 2, with more frequent awakenings.

What are the CDC-recommended hours of sleep for adults 18–60 years old?

Seven or more hours per night.

What are the common consequences of sleep deprivation?

Impaired judgment and reaction time, decreased concentration and memory, mood disturbances, and increased risk of accidents, depression, and chronic diseases.

Name several nonpharmacologic sleep-promoting interventions.

Avoid stimulants (caffeine, nicotine, alcohol) 4–6 hours before bed; keep room dark and quiet; bedtime routine; cool room; go to bed only when tired; if awake, engage in quiet activity; keep naps under 30 minutes; regular exercise (finish at least 3 hours before bed); remove work items and electronics from bedroom.

What hospital-related strategies help minimize sensory overload and promote sleep?

Dim lights, lower alarms, provide blindfolds and earplugs when appropriate, coordinate and organize care to reduce interruptions, establish quiet times, and create a peaceful sleep environment.

Identify three factors that contribute to poor sleep in everyday life.

Cell phone use at night, shift work/rotating schedules, and menopause, among other factors like stress and medications.

Define insomnia and its potential impact on health.

Ongoing difficulty falling asleep or staying asleep despite opportunity; can affect physical, emotional, and mental health.

What is obstructive sleep apnea (OSA) and its common treatment?

Recurrent upper airway collapse during sleep with obstruction; treated commonly with continuous positive airway pressure (CPAP) to keep the airway open.

What is central sleep apnea (CSA) and a common cause?

CNS reduction of nerve signals to respiratory muscles causing pauses in breathing; common causes include opioid overdose and heart failure.

What is narcolepsy and how is it categorized?

Chronic sleep disorder with sudden sleepiness and sleep attacks; NT1 (with cataplexy and hypocretin deficiency) and NT2 (without cataplexy).

What is restless legs syndrome (RLS) and a common contributing factor?

Uncontrollable urge to move the legs, worse in the evening; can be linked to iron deficiency and has a familial tendency.

What is night terrors and how do they differ from nightmares?

Parasomnia with episodes of terrifying arousal in the first third of the night; little to no dream recall (common in children). Nightmares occur during REM sleep in the second half of the night with recall of frightening dreams.

What pharmacologic sleep therapies are discussed and what are key cautions?

GABA agonists (benzodiazepines) like lorazepam; risk of dependence and memory impairment; nonbenzodiazepine hypnotics (Z-drugs) like zolpidem; melatonin; OTC antihistamines; use with caution and under clinician guidance.

What nonpharmacologic therapies are mentioned for improving sleep?

Acupuncture, massage, guided imagery, mindfulness/meditation, music therapy, yoga; education on sleep hygiene and the use of a sleep diary for personalized planning.

Describe the PN scope of practice in relation to sleep planning and care.

PNs typically work under RN supervision; scope and allowance to contribute to plans of care vary by state; nurses must practice within their state guidelines and coordinate with RNs to ensure safe, comprehensive sleep plans.

What is the PN nursing process as it relates to promoting comfort and sleep?

Data collection, planning, implementation, evaluation, and promoting comfort; ongoing assessment and collaboration with clients to address physical and emotional needs while respecting cultural and spiritual beliefs.