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What regions of the brain control sleep?
The Reticular Activating System and the Bulbar synchronizing region control the cyclic nature of sleep.
What does the RAS do to regulate sleep?
It facilitates reflex and voluntary movements, Controls cortical activities related to the state of alertness. Cortical and peripheral stimulation activate it resulting in wakefulness.
What is the region of the brain that contains the RAS?
The hypothalmus. Which is the control center for sleeping and waking.
What is the circadian rhythm?
It is a 24 hour biological clock that regulates sleep.
What physiological aspects does the circadian rhythm influence?
Vital signs, hormone secretions, metabolism, and mood.
What is circadian synchronization?
It is when the sleep-wake patterns coincide with the circadian rhythm.
What can cause circadian desynchronization?
Shift work, frequent alterations in the sleep-wake pattern, attempting to sleep during high rhythims, working during periods when the body is physiologically prepared to rest.
What are the two types of sleep?
NREM (non-rapid eye movement) and REM (rapid eye movement)
How many stages of NREM sleep are there and what are their characteristics?
There are four stages of NREM sleep. I-II are light sleep, and II-IV are deep sleep (delta sleep)
What are the characteristics of stage I NREM sleep?
Stage I is a transitional stage between wakefulness and cleep. A person is in a relaxed state but still somewhat aware of their surroundings. Involuntary muscle jerking may occur and wake the person. The person can be easily aroused. This stage constitutes about 5% of total sleep.
What are the characteristics of stage II NREM sleep?
This is the first stage of actual sleep. The person can be aroused with relative ease. This stage constitutes 50%-55% of sleep.
What are the characteristics of stage III NREM sleep?
The depth of sleep increases, and arousal becomes difficult. This stage composes about 10% of sleep.
What are the characteristics of stage IV NREM sleep?
This is the greatest depth of sleep known as delta sleep. Arousal is difficult. Physiologic changes include slow brain waves on the EEG, decreased pulse and respiratory rates, decreased BP, relaxed muscles, slowing of metabolism, and lowering of body temperature. This stage constitutes about 10% of sleep.
What are the characteristics of REM sleep?
Eyes dart back and forth, small muscle twitching, large muscle immobility, irregular respirations occasionally with apnea, rapid or irregular pulse, BP increases or fluctuates, EEG tracings are active, roughly 10% of sleep.
What are the benefits of REM sleep
It is essential for mental and emotional equilibrium.
What is REM rebound?
It is when your body makes up for missed REM sleep on a different night.
In what order to people move through a sleep cycle?
NREM I -> II -> III -> IV -> III -> II -> REM -> II
What factors affect sleep?
Developmental stage, psychological stress, motivation, culture, lifestyle and habits, physical activity/exercise, dietary hapbits, enviromental habits, illiness, medications.
What are the developmental considerations for infants sleep patterns?
Newborns: 16 hours/day in 4 hour blocks
Infants: 10-12 hrs/ night with several naps during the day.
Usually sleeping through the night by 8-16 weeks of age. Much of the sleep cycle is REM sleep.
What are the nursing implications for infants and sleep?
Teach back sleeping. Prone sleeping increases the risk of SIDS. Teach parents that eye movements, groaning, grimacing, and moving during sleep are normal. Encourage parents to sleep in a seperate space from the infants. Caution about pilows, bumpers, and stuffed animals in the crib as the pose a suffocation risk.
What are the developmental considerations for toddlers and sleep patterns?
The need for sleep declies and this stage progresses. They may initally begin wtih sleeping 12 hrs a night with 2 naps during the day and end sleeping 8-10 hours a night with 1 nap during the day. Toddlers may resist napping during the day and going to sleep at night. They can make the switch from crib to a youth/regular bed around 2 yrs old.
What are the nursing implications for toddlers and sleep?
Establish a regular bedtime routine, adive the parents of the value in a routine pattern with minimal variation. Encourage attention to safety once the child switches to a bed. A gate may be necessary to prevent wandering.
What are the developmental considerations for preschoolers and sleep patterns?
During this stage children sleep 9-16 hours a night (ave 12). Their REM pattern is similar to that of an adult. Daytime napping decreases up to about age 5 when it disappears. They may continue to resist going to bed at night.
What are the nursing implications for preschoolers and sleep?
Encourage parents to continue routines. Advies parents that waking from nightmare or night terrors is common during this stage. Waking the child or using a night light may help.
What are the developmental considerations for school-aged children?
Younger children may need 10-12 hours while older children may average 8-10 hours. Sleep needs increase when physical growth peaks.
What are the nursing implications for school-aged children and sleep?
Discuss the fact that the stress of beginning school may interrupt normal sleep patterns. A relaxed bedtime routine is most helpful at this stage. Inform parents that a child's awareness of the concept of death may occur during this stage. Parental presence and support can help alleviate concerns.
What are the developmental considerations for young adults and sleep?
The average amount of sleep required is 8 hrs, but many need less. Sleep is affected by many factors including physical health, type of occupation, and exercise. Lifestyle demands may interfere with sleep patterns. REM sleep averages about 20% of sleep.
What re the nursing implications for young adults and sleep?
Reinforce that developing good sleep habits has a positive effect on health particularly as an individul ages. If loss of sleep is a problem explore lifestyle demands and stress as possible causes. Suggest stress reducing exercises and relaxation techniques rather than medications to induce sleep as they can be habit forming and lose their effectiveness.
What are the developmental concerns for Middle-aged adults and sleep?
Total sleep time decreases during these years with a decrease in stage IV sleep. The percentage of time spent awake in bed increases. Individuals become more aware of sleep disturbances during this period.
What are the nursing implications for middle-aged adults and sleep.
Encourage adults to investigate sleep difficulties to exclude pathology or anxiety and depression as causes. Encourage adults to avoid use of sleep-inducing medication on a regular basis.
What are the deveelopmental concerns for older adults and sleep?
An average of 5-7 hours is usually adequate for this age group. Sleep is less sound, and stage IV sleep is absent or considerably decreased. Periods of REM sleep shorten. Elderly people frequently have great difficulty falling asleep and have more complaints of problems sleeping. A decline in physical health, psychological factors, effects of drug therapy (eg. nocturia), or enviromental factors may be implicated as causes of inability to sleep.
What are the nursing implications for older adults and sleep?
A comprehensive nursing assessment and individualized interventions may be effective in the long term care of this group. Emphasize concern for a safe enviroment because it is not uncommon for older people to be temporarily confused and disoriented when they first awake. Encourage discussion about sleep concerns with their physicians.
How can working at night affect a person's sleep cycle?
The circadian rhythm naturally lowers a persons body temperature and releases melatonin (a natural chemical produced at night that decreases wakefulness and promotes sleep). Working at night disrupts this process which can lead to loss of sleep, anxiety, personal conflicts, lonliness, depression, and GI symptoms.
What effects do physical activity and exercise have on sleep?
Physical activity and exercise both increase NREM and REM sleep and contribute to restful sleep. Actvity within 2 hours of sleep can hinder sleep. Excessive exercise or exhaustion can also decrease the quality of sleep.
What dietary habits can affect sleep?
A small carbohydrate snack before bed can promote sleep. Alcohol, in moderation, can promote sleep, but large quantities limit REM and delta sleep. Caffeine is a stimulant that can affect sleepiness. Nicotine is a stimulant. Smokers tend to have a harder time falling asleep and are more easily aroused. Smoking can be limited to right after dinner to help this problem. Complete withdrawal can also cause temporary sleep disturbances.
What enviromental factors can affect sleep patterns?
Sleeping in a new enviroment can affect both NREM and REM sleep.
In what ways does psychological stress affect sleep?
The person experiencing stress can find it difficult to obtain sleep. As REM sleep decreases anxiety can set in an also affect sleep.
What illnesses are likely to affect sleep patterns?
Peptic ulcers due to increased gastric secretions during REM (a snack or antacid can help). Pain from CAD or MI. Seizures from epilepsy are more likely during NREM and are depressed by REM sleep. Liver failure and encephalitis tend to reverse the day-night sleeping habits. Hypothyroidism tends to decrease the amount of NREM sleep (especially in stages II and IV). ESRD disrupts nocturnal sleep and promotes daytime sleepiness. ESRD pts who receiv dialysis are also more likely to experience RLS (can be treated with ropinirole/Requip)
Which drug classes decrease REM sleep?
Barbituates, amphetamines, and antidepressants.
What other medications are common causes of sleep problems?
Some antidepressants and anti-hypertensives, steroids, decongestants, caffeine, and asthma medications.
What medications are commonly prescribed for short term treatment of sleep problems?
zalepon (Sonota) and zolpidem tartrate (Ambien)
Are there any medications prescribed for long term treatment?
Yes, eszopiclone (Lunesta) was aproved in 2004 for long term treatment of insomnia.
What should you inquire about when interviewing a pt about their sleep.
  • Pts sleep-wakefulness patters
  • effect of patterns on everyday functioning
  • Pt's use of sleep aids
  • The pressence of sleep disturbances and contributing factors
What parameters are used when assesing a sleep disturbance?
  • Nature and cause of problem
  • accompanying signs/symptoms
  • date of occurance and effect on everyday living
  • severity of the problem
  • treatment of problem
  • how the pt is coping with the problem
What characteristics of a pt's sleep need to be assesed?
  • restlessness
  • sleep postures
  • sleep activities
  • snoring
  • leg jerking
What needs to be tracked in a pt's sleep diary?
  • Time pt retires
  • time pt tries to fall asleep
  • approximate times pt falls asleep
  • time of any awakening during the night and resumption of sleep
  • time of awakening in morning
  • presence of any stressors affecting sleep
  • record of food, drink, or medication affecting sleep
  • record of physical and mental actvities
  • record of activities peformed 2-3 hours before bedtime
  • presence of worries or anxieties affecting sleep
What are the key findings of a physical assesment that would suggest a sleep disturbance?
  • Energy level (weakness, lethargy, fatigue)
  • Facial characteristics (narrow/glazed eyes, swollen eyelids, decreased animation)
  • Behavioral characteristics (yawning, rubbing eyes, slow speech, slumped posture)
  • Physical data suggestive of sleep problems (obesity, enlarged neck, deviated nasal septum)
  • snoring (indicitive of an obstructed airway)
  • nocturnal myoclonus (a marked muscle contraction involving one or both legs lasting about 28 seconds) observed in 10%-20% of insomniacs.
How are sleep disorders classified?
As dysomnias (characterized by insomnia or excessive sleepiness), parasomnias (patterns of waking behavior that occur during sleep), sleep disorders associated with medical or psychiatric disorders,
What are the common dyssomnias?
  • Insomnia
  • Hypersomnia
  • narcolepsy
  • sleep apnea
  • restless leg syndrom
  • sleep deprivation
What is insomnia? What are it's causes and common treatments?
Insomnia is characterized by a difficulty in falling asleep, intermittent sleep, or early awakening from sleep.Treatment is not usally necessary because most episodes only last 3-4 weeks. It is often caused by depression, or misuse of alcohol and caffeine. Short term pharmacologic treatment is done with sedatives and hypnotics.
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