Understanding Sleep Patterns, Cycles, and Disorders, Exams of Nursing

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Sleep 1430 Test 1Questions with Verified Answers Latest Update Hypnos Greek God of Sleep - Correct Answers -Half Brother Death Survey on Sleep - Correct Answers 27% of Americans had trouble falling/staying asleep 68% struggled w/sleep at least once a week Reasons Contributed to Less Sleep - Correct Answers -Longer work week -Longer commutes -Less time for chores -Varying work hrs. -Electronic device use Sleep Learning Outcomes - Correct Answers -Describe what the Concept Means(Definition Antecedents and Attributes) -Identify conditions that place an individual at risk for sleep imbalance -Identify when sleep imbalance is developing or has developed -Discuss exemplars of common sleep disorders -Apply the nursing process w/collaborative interventions & evaluation for individuals experiencing sleep imbalance Sleep Definition - Correct Answers -Sleep is a state of rest accompanied by natural altered consciousness Components of Sleep - Correct Answers -Circadian Rhythms -Sleep Regulation -Sleep Cycle/Stages of Sleep Circadian Rhythm - Correct Answers -24 hour, Day-Night Cycle -Developed about the 6th week of Life -Triggered by Light & Darkness -Biological Rhythm of Sleep Synchronized w/other Bodily Functions -Factors affecting Circadian Rhythm(and thereby sleep-wake cycle) include: -Light,Temperature,Social Activates and Work Routines Circadian Rhythm 2 - Correct Answers -Synchronized when Biological Clock coincides w/Sleep-wake Cycle -Physiologic & Psychological Rhythms High when Awake Low when Asleep ex. Person is awake when body temp is the highest & asleep when body temp is the lowest (temp peaks in the afternoon, tapers & declines significantly after sleep) Physiologic & Psychological Rhythms - Correct Answers -High when Awake -Low when Asleep ex. Person is awake when body temp is the highest & asleep when body temp is the lowest (temp peaks in the afternoon, tapers & declines significantly after sleep) When Cycle becomes disrupted - Correct Answers -Other Physiological functions usually change as well & vice versa Sleep Regulation - Correct Answers -Reticular Activating System(RAS) -Controls reflex & voluntary movements -Controls cortical activities related to state of alertness -When RAS activated, Person wakes up -Bulbar synchronizing region -Hypothalamus controls center for sleeping & waking Sleep Cycle/Pattern (NREM Sleep) (Attributes-Defining Characteristics) - Correct Answers 1.Nonrapid Eye Movement(NREM) -Stage 1 Light Sleep, Lasts a few minutes, easily aroused, aware of surroundings, muscle jerks 5% of sleep -Stage 2 Period of Sound Sleep, Body Functions start to slow but still easily aroused, muscles start to relax last 10-20 minutes, 50-55% of sleep -Stage 3 start of deep sleep, muscles relaxed, difficult to arouse, lasts 15-30 minutes,10% of sleep -Stage 4 Deepest stage of sleep, Difficult to arouse, Sleepwalking occurs, lasts 15-30 minutes,10 % of sleep, Delta Sleep, Vitals decrease REM Cycle - Correct Answers 2.REM(Rapid Eye Movement)Sleep -Vivid Dreams (Difficult to Arouse) -Lasts about 20 minutes -Frequency dependent on length of sleep -Metabolic & Vital Signs Increase -Dreams essential to mental & emotional functioning -20-25% of sleep Sleep Architecture - Correct Answers -How much Sleep is needed? -As much as it takes to stay awake & alert the next day w/o caffeine Practice Questions - Correct Answers What instructions can be provided to an adult to promote/improve healthy sleep? -What instructions can be provided to the parent of an infant or young child to promote healthy sleep for the infant or child? -Discuss the risks & benefits of over the counter sleep drugs such as Advil PM;Nytol;Sominex;Tylenol PM -What is alternative sleep medicine? Give Examples Healthy Sleep Habits - Correct Answers -Get up at same time, even weekends -Soak up morning & afternoon sun -Exercise(avoid 1-2 hrs. before sleep) -Time caffeine carefully -Avoid Naps -Have an early light dinner -Power down electronic gadgets 2 hrs. before sleep -Engage in a relaxing activity an hr before sleep -Reduce light, noise at bedtime -Don't watch the clock -Don't stay in bed if you cannot sleep(20 mines) Sleep Disorders - Correct Answers *Dyssomnias -Sleep deprivation(Exemplar) -Insomnia(Exemplar) -Sleep Apnea(Exemplar) -Other: Hypersomnia,Narcolepsy,Restless Leg Syndrome *Parasomias -Somnambulism -Enuresis Sleep Deprivation Definition - Correct Answers -Prolonged inadequate Quality & Quantity Sleep Deprivation - Correct Answers -Causes of : -Age -Prolonged Hospitalization -Drugs/Substance Abuse -Illness -Frequent changes in lifestyle pattern -Can lead to: -Confusion -Seizures -Postoperative Delirium Examples of Sleep Deprivation - Correct Answers -Elderly male w/Pneumonia & its coughing at frequent intervals -Younger mother w/new baby -Hospitalization teenager on orthopedic unit due to motor vehicle accident -Adult in the Critical Care Unit after surgical procedure, being reassessed every 30 min -Caregiver of a sick family member who requires frequent care What actions can Nurses take to promote sleep in the hospital? - Correct Answers Nursing Interventions to Prevent Sleep Deprivation for the Hospitalized Patient - Correct Answers -Prepare a restful environment -Promote bedtime rituals -Other appropriate bedtime snacks & beverages -Promote relaxation & comfort -Respect normal sleep-wake patterns -Schedule Nursing Care to avoid disturbances -Use medications to produce sleep -Teach about rest & sleep Insomnia Most Common Sleep Disorder - Correct Answers -Difficulty falling asleep -Difficulty staying asleep -Waking up to early -Poor quality of sleep -Differ between acute vs. chronic Insomnia -People older than 60 years of age, women (especially after menopause), and people with a history of depression are more likely to experience insomnia. Prescription Drugs - Correct Answers *Classifications -Benzodiazepines(temazepam)-Enhance GABA -Non-benzodiazepines(zolpidem,exczopiclone)-Enhance GABA -New Belsomra-Targets orexin that keeps pal awake -Limited Benefits -The morning after effects(drowsiness, increased risk for MVAs) -Dangers(dizziness & falls,Confusion,Dependence w/Benzos,Bizarre sleep driving or eating Safe use of Sleeping Pills - Correct Answers -Use short term -Alert MD to all drugs & supplement being used(interactions) -Take only if time for 7-8 hrs. of sleep -Don't drive if drowsy -Don't take extra doses if awaken at night -NEVER mix sleeping pills & alcohol -Start w/lowest dose -Frequent use may breed dependency & increase adverse effects Cognitive Behavioral Therapy(CBT-1) - Correct Answers *Behavioral Therapy for Insomnia that focuses on changing habits that disrupt sleep -Meeting w/CBT-1 therapist -Keeping a Sleep Diary -Determining strategies to change nagging thoughts & bad habits *American Academy recommends as 1st choice treatment for Insomnia Sleep Apnea Definition - Correct Answers -Sleep-disordered breathing in which a person experiences absence of breathing(Apnea) or diminished breathing(Hypopnea) during sleep between snoring intervals -Blood Oxygen level drops -Pulse becomes Irregular -BP Increases -Patient awaken & startle from -Common in middle aged men, obese & thick necks -Enlarged tonsils and adenoids, a deviated nasal septum, and thyroid enlargement -Narrowing of nasal passageways caused by allergic rhinitis or nasal polyps Obstructive Sleep Apnea - Correct Answers *Airway becomes occluded -Collapse of Hypo pharynx -Structural abnormalities -Narrowing *Risk Factors -Age & Obesity *Diagnostic Tests -Polysomnography -Oxygen Saturation -EKG Continuous Positive Airway Pressure(CPAP) - Correct Answers -How CPAP controls Sleep Apnea Sleep Definition - Correct Answers -State of Rest accompanied by Natural Altered Consciousness Sleep Antecedents - Correct Answers -Age Predictor -Eustress -Adequate Daytime Functioning -Normal Upper Airway Physiology -Normal Circadian Rhythm -Sufficient Time Sleep Attributes - Correct Answers -NREM(Non-rapid Eye Movement) -REM(Rapid Eye Movement) Circadian synchronization - Correct Answers -Exists when a person's sleep-wake patterns follow the inner biologic clock located in the hypothalamus Fatigue - Correct Answers -Considered a normal, protective body mechanism and nature's warning that sleep is necessary -Chronic fatigue, however, is abnormal and is often a symptom of illness. Work Shift Changes - Correct Answers -Can experience adverse effects, including anxiety, personal conflicts, loneliness, depression, gastrointestinal symptoms, an increased risk for breast and colorectal cancer, increase in type 2 diabetes, hypertension, higher rates of cardiovascular disease including strokes, and substance abuse Self-Care for Better Sleep - Correct Answers -Follow a regular routine for bedtime and morning awakening. -Accept individual differences in need for sleep. -Use relaxation exercises to relax before bedtime, especially if feeling stressed. -Avoid caffeine, smoking, and alcohol before bedtime. -Adjust bedcoverings, room temperature, and lighting to your preferences. -Eat a small carbohydrate snack before going to bed. -Be aware of the potential dangers of sleeping pills. -Use some part of each day for quiet, enjoyable activities such as crafts, hobbies, and reading, watching television, listening to music, and visiting with friends. -Incorporate three or four periods of regular exercise into each week. Psychological stress affects - Correct Answers -Sleep in two ways: (1) the person experiencing stress may find it difficult to obtain the amount of sleep needed; and (2) REM sleep decreases in amount, which tends to add to anxiety and stress. Illness & Sleep - Correct Answers -Physiologic as well as a psychological stressor, influences sleep -Gastric secretions increase during REM sleep. Many people with gastro esophageal reflux (GERD) awaken at night with heartburn or pain -The pain associated with coronary artery disease and myocardial infarction is more likely with REM sleep -Epilepsy seizures are most likely to occur during NREM sleep and appear to be depressed by REM sleep -Liver failure and encephalitis tend to cause a reversal in day-night sleeping habits -Hypothyroidism tends to decrease the amount of NREM sleep, especially stages II and IV, while hyperthyroidism may result in difficulty falling asleep -End-stage renal disease (ESRD) disrupts nocturnal sleep and leads to excessive daytime sleepiness -Patients with ESRD who receive dialysis also have a higher incidence of restless leg syndrome which possibly is related to the iron deficiency common in ESRD. Drugs that decrease REM Sleep - Correct Answers -Barbiturates, Amphetamines, and Antidepressants. Diuretics, Antiparkinsonian drugs -Some Antidepressants and Antihypertensives, steroids, Decongestants, Caffeine, and Asthma Medications are seen as additional common causes of sleep problems Chronotherapeutics - Correct Answers -Study that involves the strategic use of time in the administration of medicine -Paying attention to biologic rhythms may influence drug tolerance and medication effectiveness. 4 Sleep Disorder Categories - Correct Answers -Dyssomnias -Parasomnias -Sleep disorders associated with medical or psychiatric disorders -Other proposed disorders Most Common Sleep Disorders - Correct Answers -Dyssomnias & Parasomnias Dyssomnias - Correct Answers -Characterized by Insomnia or Excessive Sleepiness Parasomnias - Correct Answers -Patterns of waking behavior occurring during sleep ex. Bruxism, Somnambulism, Enuresis,Snoring,REM Behavior Disorder (RBD), Nightmares, Sleep Terrors, Sleep-related eating disorder Common medications that may result in Insomnia - Correct Answers -Include those taken for hypertension and cardiovascular disease, cold and allergies, thyroid disease, asthma, and depression Acute vs. Chronic Insomnia - Correct Answers -Insomnia that lasts less than 4 weeks is termed Acute insomnia -Chronic insomnia persists for more than 1 month and even years -Chronic insomnia is frequently listed as the motivating factor for a visit to a sleep disorder clinic Chronic Insomnia - Correct Answers -Obesity; type 2 diabetes; psychiatric disorders, such as depression; and cardiovascular disorders such as heart failure, stroke, hypertension, and myocardial infarction (heart attack). Meds & Chronic Insomnia - Correct Answers -Pharmacologic options include the use of sedatives and hypnotics -Only short-term use, at the lowest dose, is recommended Hypersomnia - Correct Answers -Excessive sleep, particularly during the day -Disorder is also referred to as idiopathic hypersomnia and is a debilitating condition -A person may fall asleep for intervals during work, while eating, or even during conversations -These naps do not usually relieve their symptoms-When they awake, they are often disoriented, irritated, restless, and have slower speech and thinking processes Hypersomnia Causes - Correct Answers -Another sleep disorder, such as sleep apnea -Drug or alcohol abuse -Head trauma or other injury to the central nervous system -Effect of certain medications -Depression -Obesity -Other medical conditions (multiple sclerosis, epilepsy) Narcolepsy - Correct Answers -Uncontrollable desire to sleep -A person with narcolepsy can literally fall asleep standing up, while driving a car, in the middle of a conversation, or while swimming -Neurologic Disorder -Fall asleep quickly, find it difficult to wake up, sleep fewer hours than others, and sleep restlessly Narcolepsy Signs - Correct Answers -Sleep attacks: irresistible urge to sleep, regardless of the type of activity in which the patient is engaged -Cataplexy: sudden loss of motor tone that may cause the person to fall asleep; usually experienced during a period of strong emotion -Hypnagogic hallucinations: nightmares or vivid hallucinations -Sleep-onset REM periods: during a sleep attack, the person moves directly into REM sleep -Sleep paralysis: skeletal paralysis that occurs during the transition from wakefulness to sleep -Low hypocrite levels a chemical in the brain that causes alertness and wakefulness -Unknown at this time what causes this low hypocrite level Narcolepsy Meds - Correct Answers -CNS stimulant (e.g., methylphenidate [Ritalin]) causes wakefulness may be used to control narcolepsy -Modafinil (Provigil), a wakefulness-promoting compound -Sodium oxalate (Xylem), a sedative used for treating disturbed nocturnal sleep, have proved effective in treating narcoleptic symptoms Apnea is - Correct Answers -Sleep-disordered breathing (SDB), is a condition in which a person experiences the absence of breathing (apnea) or diminished breathing efforts (hypopnea) during sleep between snoring intervals -Breathing may cease for 10 to 20 seconds, possibly as long as 2 minutes