Sleep.pptx

Chapter 7 Sleep and Sleep Disorders Sleep  State in which a person lacks conscious awareness of environmental surroundings but can be easily aroused    Insufficient sleep Fragmented sleep Nonrestorative sleep Sleep Disturbances and Disorders  Sleep disturbance    Conditions of poor sleep qua...

Chapter 7 Sleep and Sleep Disorders Sleep  State in which a person lacks conscious awareness of environmental surroundings but can be easily aroused    Insufficient sleep Fragmented sleep Nonrestorative sleep Sleep Disturbances and Disorders  Sleep disturbance    Conditions of poor sleep quality Chronic illness; external factors Sleep disorders  Abnormalities unique to sleep Insomnia, OSA, Periodic limb movements, Circadian sleep disorders, Narcolepsy, and Parasomnias  Often missed or unreported Sleep–Wake Cycle (1 of 2)   Controlled by the brain Wake behavior   ARAS and various neurotransmitters Orexin (hypocretin) Reduced levels = narcolepsy Sleep–Wake Cycle (2 of 2)  Sleep behavior   Involves a variety of neurologic structures Neurotransmitters and peptides promote sleep Infection Postprandial  Melatonin—light-dark cycle Circadian Rhythms   24-hour biologic rhythm fluctuations Regulated by the suprachiasmatic nucleus (SCN) in hypothalamus   Master clock Synchronized through light detectors in retina  Light is the strongest time cue Sleep Architecture  Nighttime sleep recorded by polysomnography (PSG)     Brain waves Eye movements Muscle tone Two sleep states   Rapid eye movement (REM) Non–rapid eye movement (NREM) NREM Sleep   75% to 80% of sleep time Divided into three stages    N 1—slow eye movements N 2—HR and temperature decrease N 3—deep, or slow wave sleep (SWS); delta waves— measure sleep intensity REM Sleep   20% to 25% of sleep Follows NREM    Brain waves resemble wakefulness Postural muscles inhibited Most vivid dreams Effects of Sleep Deprivation and Sleep Disorders Fig. 7-3 Sleep Disturbances in the Hospital  Hospitalization associated with decreased/poor sleep time and altered circadian rhythms   Environmental sleep-disruptive factors  Acute and critical illness  Medications Nurses—create environment to promote sleep; administer sleep meds PRN Assessment        Sleep history Diet Alcohol intake Sleep aids- include OTC and prescribed Medications Supplements Exercise      Illness Current life events Emotional/mental stress Bedtime routines Environment Insomnia (1 of 12)  Characterized by:     Difficulty falling asleep Difficulty staying asleep Waking up too early Waking up feeling unrefreshed Insomnia (2 of 12) Acute insomnia  Difficulty falling asleep or remaining asleep for at least 3 nights/wk for less than 1 month Chronic insomnia  Difficulty falling asleep or remaining asleep for greater than 3 months Insomnia (3 of 12)  Etiology and pathophysiology       Behaviors Lifestyle Medications Stressful events Psychiatric conditions Medical problems Insomnia (4 of 12)  Manifestations     Difficulty falling asleep (long sleep latency) Frequent awakening (fragmented sleep) Prolonged nighttime awakenings Feeling unrefreshed on awakening (nonrestorative sleep) Insomnia (5 of 12)  Diagnostic studies    Self-report—diary/log or screening questionnaires Actigraphy—measures gross motor activity, time awake and asleep Polysomnography (PSG)—electrodes monitor muscle tone, eye movement and brain activity; other: HR, RR, resp effort, airflow, pulse ox Audience Response Question (1 of 2) A patient at the outpatient clinic reports insomnia and anxiety. He tells you that he recently lost his job and is not able to pay the bills. Which response would be the most appropriate? a. “You are healthy and will be able to find another job.” b. “Can you tell me more about what is happening in your life?” c. “If you stop focusing on your problems, you will sleep better.” d. “Did you receive a severance package from your employer?” Audience Response Question (2 of 2) Answer: B “Can you tell me more about what is happening in your life?” Insomnia (6 of 12)  Interprofessional care      Education Sleep hygiene Cognitive-behavioral therapy for insomnia (CBT-I) Drug therapy Complementary and alternative therapies Insomnia (7 of 12)  Interprofessional care  Drug therapy—See Table 7-4 Benzodiazepine hypnotics  Triazolam and Temazepam *Nonbenzodiazepine hypnotics  Zaleplon, Zolpidem, Eszopliclone Orexin-receptor antagonists  Suvorexant Insomnia (8 of 12)  Interprofessional care  Drug therapy Melatonin-receptor agonist  Ramelteon Antidepressants   Tricyclic antidepressants (doxepin, amitriptyline) Trazadone Antihistamines  Diphenhydramine, OTC pain meds; doxylamine Insomnia (9 of 12)  Interprofessional care  Complementary and alternative therapies Melatonin—effective related to jet lag and shift work Valerian—safe but not effective White noise and relaxation strategies Insomnia (10 of 12)  Nursing assessment    Sleep history (See Table 7-5) Assess diet, caffeine, and alcohol intake Ask about sleep aids OTC, prescription, herbal, dietary supplements   Sleep diary 1 to 2 weeks Medical history, work schedule, travel Insomnia (11 of 12)  Nursing diagnoses   Sleep deprivation Impaired sleep Insomnia (12 of 12)   Nursing implementation Patient education      Sleep hygiene (Table 7-3) CBT-I for chronic insomnia Decrease caffeine intake (Table 7-6) Reduce light and noise Sleep medications/aids Sleep-Disordered Breathing (SDB)     Snoring Apnea Hypopnea Obstructive sleep apnea (OSA) Obstructive Sleep Apnea (1 of 3)    Also called obstructive sleep apnea-hypopnea syndrome (OSAHS) Partial or complete upper airway obstruction and reduced tone during sleep; last 10-90 seconds Apneic period may include hypoxemia and hypercapnia—stimulate ventilation; arousal How Sleep Apnea Occurs How sleep apnea occurs. A, The patient predisposed to obstructive sleep apnea (OSA) has a small pharyngeal airway. B, During sleep, the pharyngeal muscles relax, allowing the airway to close. Lack of airflow results in repeated apneic episodes. C, Continuous positive airway pressure (CPAP) splints the airway open, preventing airflow obstruction. (Modified from LaFleur Brooks M: Exploring medical language: a student-directed approach, ed 8, St Louis, 2012, Mosby.) Figure 7-4 Case Study (1 of 4)    52-year-old man enters his provider’s office with his wife. She is concerned because he seems to stop breathing in his sleep. He weighs 280 pounds and drinks alcohol regularly. Obstructive Sleep Apnea (2 of 3)  Manifestations         Frequent arousals during sleep Insomnia Excessive daytime sleepiness Witnessed apneic episodes Snoring Morning headache Irritability Personality changes Case Study (2 of 4)   What risk factors does the patient have for sleep apnea? Can he decrease his risk factors? Obstructive Sleep Apnea (3 of 3)  Complications can result in  Hypertension  Cardiac changes  Poor concentration/memory  Impotence  Depression Arteriosclerosis heart failure cardiovascular-related mortality Excessive daytime sleepiness may contribute to car accidents, poor work performance and family difficulties. OSA affects bed partner because concern for cessation Case Study (3 of 4) 1. Based on potential complications of sleep apnea, what assessment data will you obtain on this patient? 2. What patient teaching could be beneficial to this patient at this time? Sleep Apnea: Nursing and Interprofessional Management (1 of 3)  Mild sleep apnea Positional: Sleeping on one’s side Elevating head of bed Avoiding sedatives and alcohol 3 to 4 hours before sleep Weight loss Oral appliance Sleep Apnea: Nursing and Interprofessional Management (2 of 3)  Severe sleep apnea ( greater than 15 apnea/hypopnea events/hr) Continuous Positive Airway Pressure (CPAP); effective, but poor adherence Bilevel Positive Airway Pressure (BiPAP)  Hospitalized patients with OSA—cautious use of narcotics and sedatives If uses CPAP at home, check for continued use in hospital Devices for Sleep Apnea Examples of positive airway pressure devices for sleep apnea. A, Patient wearing a nasal mask and headgear (positive pressure only through nose). B, Patient wearing nasal pillows (positive pressure only through nose). C, Patient wearing a full face mask (positive pressure to nose and mouth). (From Goldman L, Schafer AI: Goldman’s Cecil medicine, ed 24, Philadelphia, 2012, Saunders) Sleep Apnea: Nursing and Interprofessional Management (3 of 3)  Surgical treatment Uvulopalatopharyngoplasty (UPPP or UP3) Genioglossal advancement and hyoid myotomy (GAHM) Radiofrequency ablation (RFA) New: Neurostimulators Postop: airway obstruction and hemorrhage Case Study (4 of 4)    The provider orders a sleep study. After the study, the patient is diagnosed with sleep apnea. He returns to the office to learn his results, where he is given a CPAP. Audience Response Question (1 of 2) An older adult patient in the hospital has sleep deprivation. Which intervention may improve sleep patterns for this patient? a. Decrease noise and dim the lights at bedtime. b. Administer an opioid pain medication to induce sleep. c. Set the room temperature at 78°F to induce drowsiness. d. Offer to give the patient a back massage until he falls asleep. Audience Response Question (2 of 2) Answer: A Decrease noise and dim the lights at bedtime. Circadian Rhythm Disorders  Occur when the circadian time-keeping system loses synchrony with environment    Jet lag disorder Shift work sleep disorder Common symptoms  Insomnia, excessive sleepiness Gerontologic Considerations: Sleep (1 of 2)  Older age is associated with:      Overall shorter total sleep time Decreased sleep efficiency More awakenings Sleep disordered breathing may manifest with insomnia symptoms Circadian shift Gerontologic Considerations: Sleep (2 of 2)    Sleep quality affected by medical problems, chronic conditions, and medications Awakening during the night increases risk for falls Chronic sleep disturbances  Disorientation, delirium, impaired cognition, accidents, and injury  Avoid long-acting benzodiazepines  American Academy of Sleep Medicine (AASM)NO diphenhydramine for Geri patients. Nurses and sleep  Shift Work / Image 2 retrieved from http://quotesbae.com/25-night-shift-nurse-quotes Special Sleep Needs of Nurses  Nurses on permanent night or rapidly rotating shifts are at increased risk of shift work sleep disorder    Insomnia, sleepiness, fatigue Increased stress, health risks, and patient safety issues Strategies    On-site napping Consistent sleep–wake schedule Sleep hygiene