Ch19_Sleep-Wake_-1859770878

Chapter 19 Sleep-Wake Disorders

  • Author: Amanda Willey EDD, MSN, RN, CM/DN, CCHP

Objectives

  • Discuss the effects of lack of sleep on overall health.

  • Describe normal sleep patterns.

  • Consider the role of sleep in major mental health disorders.

  • Identify major sleep disorders.

  • Explore treatment options for sleep disorders.

Healthy Sleep

Normal Sleep Cycle

  • NREM Sleep: Divided into 3 stages

    • N1: Sleep Latency

    • N2: Intermediate sleep stage

    • N3: Delta Sleep (deep sleep)

  • REM Sleep: About 25% of total sleep time

Approximate Percentage of Time per Stage

  • N1: 5%

  • N2: 50%

  • N3: 20%

  • REM: 25%

Healthy Sleep Requirements

Factors Influencing Sleep

  • Age: Varies sleep patterns and needs.

  • Basal Sleep Patterns: Include regulation and sleep drive.

  • Circadian Drive: Governed by biological clock and environmental cues.

Functional Impacts

  • Immune System

  • Memory consolidation

Impact of Lack of Sleep

  • Common Quote: "Without enough sleep, we all become tall two-year-olds." ~JoJo Jensen

Effects of Sleep Deprivation

  • Excessive Sleepiness: Subjective assessment, can impair social and work functioning.

  • Sleep Deprivation: Long-term discrepancies lead to widespread negative impacts.

Consequences of Lack of Sleep

Mental and Physical Health Issues

  • Obesity

  • Diabetes

  • Hypertension (HTN)

  • Depression

Safety Concerns

  • Psychomotor impairment leading to increased risk of errors.

Healthy People 2030

  • Recent research highlights the critical role of sleep in health and well-being.

  • Goals to improve public knowledge on sleep and treatment methods for better health outcomes.

Goals Include:

  1. Reduce drowsy driving-related vehicular crashes.

  2. Increase diagnosis of sleep apnea symptoms.

  3. Promote sufficient sleep among adults and teens.

  4. Ensure safe sleep environments for infants.

  5. Implement a later start time for secondary schools (8:30am or later).

Major Sleep Disorders

Insomnia

  • Must have adequate sleep opportunity.

  • Characterized by difficulty initiating or maintaining sleep, resulting in dissatisfaction with sleep quality and daytime consequences.

Sleep Disorders Model

  • Spielman 3P Model

    • Predisposing Factors: Individual-level issues.

    • Precipitating Factors: External influences.

    • Perpetuating Factors: Maladaptive sleep practices.

Excessive Sleepiness Disorders

  • Treatment: 10+ hours of sleep, stimulants, regular sleep-wake cycles

  • Conditions include hypersomnolence and narcolepsy (irresistible need to sleep).

Breathing-Related Sleep Disorders

  • Obstructive Sleep Apnea: Associated with upper airway collapse, obesity, and loud snoring. Treatment often includes CPAP.

  • Central Sleep Apnea: Lacks increased ventilation efforts, typically in older adults or those with cardiac/pulmonary disease.

  • Sleep-Related Hypoventilation: Oxygen desaturation without apnea, commonly seen in morbid obesity and pulmonary disease.

Circadian Rhythm Disorders

  • Interruption of normal sleep patterns, often due to shift work.

  • Diagnosis via sleep diaries and clinical evaluation, with lifestyle management as treatment.

Arousal Disorders

  • NREM: Conditions like sleep walking and sleep terrors; treated with education and sleep hygiene.

  • REM Sleep Behavior Disorder: Involves elaborate motor activity; requires safety measures and sometimes hypnotic therapy.

Sensory/Movement Disorders

  • Restless Leg Syndrome: Treatment through lifestyle modifications or medications like gabapentin.

  • Substance Induced: Address through cessation of use.

Comorbidity Considerations

  • Sleep disorders can lead to obesity, hypertension, and affect immune function.

  • Associated with higher rates of psychiatric disorders (dementia, depression, anxiety).

  • Technology and screen use can inhibit sleep quality.

  • Nurses play a critical role in guiding patients toward positive sleep practices.

Assessment in Sleep Disorders

  • Focus on dissatisfaction in sleep quality.

  • Questions to ask about sleep patterns what impact on safety, especially for nurses at risk for sleep disorders.

Nursing Diagnoses

  • Examples include:

    • Insomnia

    • Sleep deprivation

    • Impaired sleep

    • Readiness for enhanced sleep.

Interventions for Improving Sleep

  • Begin with assessment, providing encouragement through counseling.

  • Promote sleep hygiene and sleep restriction as non-pharmacological interventions for long-term success.

Advanced Pharmacology in Sleep Disorders

  • Considerations include psychotherapy and various medications:

    • Benzodiazepines

    • Melatonin receptor agonists

    • Antidepressants (TCA)

    • Orexin receptor agonists

    • Antihistamines.

Evaluation of Treatment

  • Evaluate if the patient reports improved sleep quality.

  • Understand that interpretations of progress/success can vary between patient and provider.

Case Study Example

  • Scenario involving a friend with irritability and difficulty staying awake, suspecting insomnia. Questions to aid assessment may include inquiries about sleep duration, patterns, and contributing factors.

Questions for Further Discussion

  • Engage audience for inquiries and clarifications on sleep disorders and treatments.