Comfort, Pain, and Sleep Student Version-1 PDF

Comfort, Pain and Sleep NUR 112 Mrs. Amber Samples Comfort Concept Learning Outcomes Analyze the physiology of comfort in the body D i ff e re n t i a t e a l t e r a t i o n s i n c o m f o r t O u t l i n e t h e re l a t i o n s h i p b e t w e e n c o m f o r t a n d...

Comfort, Pain and Sleep NUR 112 Mrs. Amber Samples Comfort Concept Learning Outcomes Analyze the physiology of comfort in the body D i ff e re n t i a t e a l t e r a t i o n s i n c o m f o r t O u t l i n e t h e re l a t i o n s h i p b e t w e e n c o m f o r t a n d o t h e r c o n c e p t s E x p l a i n t h e p ro m o t i o n o f c o m f o r t D i ff e re n t i a t e c o m m o n a s s e s s m e n t p ro c e d u re s a n d t e s t s u s e d t o ex a m i n e c o m f o r t Analyze independent interventions nurses can implement for patients with alterations in comfort S u m m a r i z e c o l l a b o r a t i v e t h e r a p i e s u s e d b y i n t e r p ro f e s s i o n a l t e a m s f o r p a t i e n t s w i t h alterations in comfort D i ff e re n t i a t e c o n s i d e r a t i o n s re l a t e d t o t h e a s s e s s m e n t a n d c a re o f p a t i e n t s w i t h a l t e r a t i o n s i n c o m f o r t t h ro u g h o u t t h e l i f e s p a n What makes you think of “comfort?”  What is comfort? A state of physical ease and freedom from pain or constraint The easing or alleviation of a person’s feelings of grief or distress Ease the grief or distress of, to console  Comfort A feeling based on past Is subjective experiences + expectations Nurses are morally and Central concept of nursing legally responsible for is the provision of comfort managing pain and relieving suff ering What if you were the patient? What would bring you comfort?  Comfort at end of life Pa l l i a t i v e c a re , h o s p i c e Focuses on comfor t at the end of li fe Pa i n m a n a g e m e n t Psychological support for the patient + family Social and environmental concerns Spiritual and religious aspects of care Cultural aspects Communicate signs and symptoms of worsening condition Ethical + legal Organ donation Alterations in Comfort Pain Fatigue Sleep rest disorders Caring Behaviors At t e n t i v e l i s t e n i n g Comforting Honesty Pa t i e n c e Re s p o n s i b i l i t y Pro v i d i n g i n f o rm a t i o n f o r i n f o rm e d decisions To u c h Sensitivity Re s p e c t Ad d re s s i n g p a t i e n t b y n a m e Pain Concept Learning Outcomes A na l y z e a c ut e + c hroni c pa i n a s i t re l a te s to c om f ort Des c ri be t he pa thophy si ol ogy of a c ute + c hroni c pa i n Des c ri be t he e ti ol ogy of a c ute + c hroni c pa i n Com pa re the ri sk fa c tors a nd pre v e nti on of a c ute + c hroni c pa i n I dent i fy t he c l i ni c a l m a ni f e sta t i ons of a c ut e + c hroni c pa i n Summ a ri z e di a gnosti c te st s + t he ra pi e s us e d by i nte rprofe ssi ona l t e a m s i n the c ol l a bora t i v e c a re of a n i ndi v i dua l wi t h a c ute + c hroni c pa i n Di ff e renti a t e c a re of pa ti e nts wi th a c ut e + c hroni c pa i n a c ross the l i f e spa n A ppl y the nursi ng proc e ss i n prov i di ng c ul tura l l y c om pe t e nt c a re to a n i ndi v i dua l wi th a c ute + c hroni c pa i n  What is pain? Unpleasant sensory and emotional experience Can impact a person’s psychosocial, emotional, or physical functioning “it is what the patient says it is” Aff ects individuals of every age, gender, race, and socioeconomic class. 5th vital sign Pathophysiology of Pain Pain is triggered by the peripheral nervous system Nociceptors—sensory receptor that respond to pain Categories of pain includes: biological, mechanical, thermal, electrical, and chemical Cellular injury can trigger release of biochemicals that act to directly or indirectly initiate pain Etiology—origin (nociceptive vs. neuropathic) 1. Burned finger 2. Length of the nerve to the dorsal horn on the spinal cord 3. Related to hypothalamus (sensory center) 4. Cortex 5. Pain relief begins as signal from brain descends by way of the spinal cord 6. Endorphin S are released to diminish pain message from injured finger 4 Stages of Pain Process Transduction: activation of pain receptors Transmission: conduction along pathways Perception: awareness of characteristics of pain Modulation: initiation of the protective refl ex response  Pain Categories DURATION ORIGIN Acute Nociceptive Chronic Neuropathic Categories of Pain: Duration ACUTE PAIN CHRONIC PAIN Pain that lasts only through Pain that lasts longer then 6 the expected recovery months and persists beyond the expected period of healing. period, usually lasts 30 days Recurrent, intractable, to 6 months progressive Temporary, self limiting Ongoing Physiologic responses Psychosocial implications Behavioral responses Idiopathic pain Other Types of Pain Breakthrough pain: Continuous chronic pain with more intense acute exacerbations; spontaneous Central pain: Arises from central nervous system Psychogenic pain: Pain is associated with psychological factors vs. physiological factors Referred pain: Pain originates in one part of the body but is perceived in an area distant from its point of origin Phantom pain: Pain felt in an amputated limb or body part. Discussed on another slide. Categories of Pain: Origin NOCICEPTIVE NEUROPATHIC A r i s e s f ro m d a m a g e t o o r i n fl a m m a t i o n Arises from abnormal or of tissue damaged peripheral or central T h ro b b i n g , a c h i n g nerves resulting from trauma, Opioids and non-opioids disease, chemicals, infections 3 Ty p e s : Intense, shooting pain Somatic Adjuvant medications and Vi s c e r a l topicals Cutaneous Nursing Process: Assessment Assessment and Data Collection It is what the patient says it is Qua nti t y + i nte nsi ty of pa i n Exists when the patient says it Qua l i ty of pa i n does Chronol ogy of pa i n Self report of pain is the most A ggra v a ti ng + a l l e v i a t i ng fa c t ors reliable diagnostic measure of Phy si ol ogi c a l i ndi c a tors of pa i n pain B e ha v i ora l re s ponse s Client Interview + Observation Eff e c t of pa i n on a c ti v i t i e s a nd Patient’s verbalization + l i f e sty l e description of pain OL DCA RTS Location + duration of pain Pain Assessment O—o n se t : de s c ri be whe n t he pa i n be ga n L —l o cat i o n : whe re i s the pa i n? D —du r at i o n : how l ong ha s t he pa i n be e n goi ng on? C — ch ar ac t e r i st i c s: de s c ri be t he pa i n ( c rushi ng, sha rp, dul l , a c i ng, s ta bbi ng) A —aggr avat i ng o r asso c i at i n g fac t o r s: wha t m a ke s the pa i n worse ? A re t he re a ny othe r a ssoc i a t ed sy m ptom s? ( na us e a , v om i ti ng, we a kne ss, di a rrhe a , f a ti gue ) R— r e l i e vi ng fact o r s: wha t m a ke s the pa i n be tt er? T—t r e at me n t : wha t ha s be e n tri ed t o c ontrol t he pa i n? Wa s i t s uc c e ss ful ? S—se ve r i t y: how i nte nse i s the pa i n? Ra t e i t on a pa i n sc a l e. Common Responses to Pain Physiologic: hypertensive, tachycardia, tachypneic Behavioral: grimacing, guarding Aff ective: withdrawn, anxiety, depression, fear  Ongoing Assessment + Reassessment of Pain A s s e s s a n d re a s s e s s p a i n a t l e a s t e v e r y 4 h o u r s (5th vital sign) O b s e r v e f a c i a l ex p re s s i o n s , b o d y m o v e m e n t , a n d p o s t u re W h e n p a i n i s p re s e n t , i t i s a l w a y s re a s s e s s e d t o m a ke s u re t h e t re a t m e n t h a s b e e n e ff e c t i v e Re a s s e s s m e n t o f p a i n PO analgesia—reassess in an hour IV analgesia—reassess within 15-30 minutes PRN education A n y a d v e r s e e ff e c t s ?  Risk Factors Undertreatment of pain Cultural and societal attitudes Lack of knowledge Fe a r o f a d d i c t i o n E x a g g e r a t e d f e a r o f re s p i r a t o r y d e p re s s i o n Population at risk for undertreatment of pain Infants C h i l d re n Older adults Pa t i e n t s w h o h a v e s u b s t a n c e u s e d i s o rd e r  Pain in the Cognitively Impaired Wa t c h f o r Fa c i a l ex p re s s i o n s Ve r b a l i z a t i o n s Body movements Changes in interpersonal interactions C h a n g e s i n a c t i v i t y o r p a t t e rn s Changes in mental status Factors Aff ecting Pain Experience Tr a u m a Surgery Cancer Age Fa t i g u e Cognitive function Pr i o r ex p e r i e n c e s Anxiety and fear Support systems C u l t u re Pain Assessment Tools Pain Assessment Tools Wong-Baker FACES Pain Assessment Tools Numeric pain scale 0-10 Pain Assessment Tools Verbal descriptor scale Pain Assessment Tools CHEOPS pain scale Pain Assessment Tools FLACC Behavioral pain assessment scale used for nonverbal or preverbal patients who are unable to self– report their pain level. Pain is assessed through observation of 5 categories 0-3 none/mild pain 4-6 moderate pain 7-10 severe pain Pain Assessment Tools Behavioral pain scale Can be used to assess pain in adults, including those in ICU both for intubated and non- intubated patients 0-3 painless 4-6 mild pain 7-9 moderate pain 10 severe pain  Diagnosis and Analyze Cues Type of pain Etiologic factors Behavioral, physiologic, and aff ective response Other factors aff ecting pain Nonpharmacologic Pain Relief Measures Position Biofeedback Distraction Therapeutic touch Humor Yoga Music Animal facilitated Imagery therapy (therapy dogs) Relaxation, meditation Heat + ice application Acupuncture TENS unit Hypnosis Pharmacological Pain Relief Measures Three classes of analgesics Non-opioids Opioids Adjuvants Parenteral route is best for immediate and short-term relief of acute pain Oral route is best for chronic, non-fl uctuating pain Non-Opioids Treatment of mild-moderate pain Acetaminophen Hepatotoxic eff ects NS AIDS (non-steroidal anti-infl ammatory drugs) Ibuprofen Ketorlac Salicylates (aspirin) Monitor for bleeding Opioids Treatment of moderate to severe pain Morphine, codeine, oxycodone, meperidine, hydromorphone, fentanyl methadone Controlled substances Highly addictive Adverse Eff ects of Opioids Sedation Respiratory depression Orthostatic hypotension Urinary retention Nausea Vomiting Constipation Sexual dysfunction Pruritis Patient Controlled Analgesia PCA Medication delivery system that allows clients to self-administer safe doses of opioids Common with morphine, hydromorphone, or fentanyl The patient should press the button TOLERANCE ADDICTION Normal physiologic A pattern of compulsive response that can occur use of addictive with regular substances for means administration of an opioid and consists of a other than those decrease in one or more prescribed eff ects of the opioid  Numeric Sedation Scale 1—awake and alert: no action necessary 2—occasionally drowsy but easy to arouse: no action necessary 3—frequently drowsy, drifts off to sleep during conversation: reduce dosage 4—somnolent with minimal or no response to stimuli: discontinue opioid, consider naloxone. Call rapid response. Opioid Reversal Agent Naloxone (AKA Narcan)--treats narcotic overdose in emergency situations Intranasal, IM, SQ, or IV  Nursing Interventions That Must Be Implemented Immediately Call rapid response or code blue Resuscitation per ambu-bag with 100% O2 IV Narcan to reverse the opioid Other Methods for Administering Analgesics EPIDURAL LOCAL Injecting anesthetic into Injection; numbing a the epidural space portion of the body Adjuvant/Co- analgesics Antidepressants/Antianxiety Anticonvulsants Corticosteroids Topical anesthetics Nursing Interventions and Actions Establishing trusting nurse/patient relationship Manipulating factors aff ect pain experience Initiating non-pharmacologic pain relief measures Managing pharmacologic interventions Reviewing additional pain control measures, including complementary and alternative relief measures Considering ethical and legal responsibility to relieve pain Teaching patient about pain  Common Misconceptions About Pain The doctor has ordered pain medication which will be given routinely. If I ask for something for the pain, I may be addicted to the medication. Sometimes it is better to put with the pain than to deal with the side eff ects. I should somehow be able to control my pain. It is immature to talk about pain. It is better to wait until the pain gets really bad before asking for help. If I take the medication now for moderate pain, it won’t relieve severe pain later on. I don’t want to bother anyone—I know how busy they are. It’s natural for me to have pain after surgery. After a few days, I should notice it lessening  Right to Eff ective Pain Control Joint Commission Pain Control Standards Right to appropriate assessment and management of pain by health care professional Right to have pain controlled All clients should be assessed initially and reassessed Right to be treated with respect at all times, not as a drug-user Client and families should be educated about eff ective and safe pain management  Nursing Care + Documentation Administer pain medication before the pain is a 10 Once pain escalates, it becomes more diffi cult to control Observe for respiratory depression with narcotics Always check vital signs before and after pain medication If the patient is getting pain medication q4h and at every 2 hours, the patient is having pain…you need to call the doctor. Possibly change medication or change dosage Document patient’s pain and response to pain treatment in the pain fl ow sheet Teach family + patient to monitor pain and vital signs (signs of respiratory distress)  Pain Management Regimens for Cancer or Chronic Pain Give medications orally if possible Administer medications at recommended, scheduled intervals rather than PRN Adjust the dose to achieve maximum benefi t with minimum side eff ect Allow patients as much control as possible over the regimen Pain Syndromes  Common Pain Syndromes Producing Neuropathic Pain N eu r opat h i c pai n : a ri se s from a bnorm a l or da m a ge d pe ri phe ra l or c e ntra l ne rv e s re sul ti ng from tra um a , di se a se , c he m i c a l s, i nf e c ti ons I ntense , shooti ng pa i n Adj uv a nt m e di c a ti ons a nd t opi c a l s Type s: Com pl ex re gi ona l pa i n sy ndrom e ( c a us a l gi a ) Post he rpe ti c ne ura l gi a Pha nt om l i m b pa i n Tri ge m i na l ne ura l gi a Di a be ti c ne uropa t hy  Complex Regional Pain Syndrome Also referred to as causalgia Prolonged infl ammation to an extremity following an injury Burning, throbbing, temperature sensitivity, color changes, joint stiff ness https://www.youtube.com/watch?v=xzA APNIsxB 0 Postherpetic Neuralgia Pain syndrome following acute CNS infection, such as herpes zoster (shingles) Vesicular eruption, unilateral and encircles the body in a band like cluster Neuralgic pain lasting months to years  Phantom Limb Pain Type of neuropathic pain. Pain felt in an amputated limb or body part, usually recurring vs constant. Shooting, stabbing, squeezing, throbbing, burning. Associated with neurological activity in portions of brain once connected to the amputated body part. Can be triggered by the sensation of touching the stump, fatigue, atmospheric changes & emotional stress  Trigeminal Neuralgia Tic douloureux 5 t h cranial nerve is aff ected; nerve function becomes disrupted Painful sensation that causes lightening like stabbing pain around the mouth, gums, lips, nose, cheek, chin, and surface of the head Triggered by everyday activities such as talking, eating, brushing teeth Treated with anticonvulsants, antispasmodics, possible surgery Diabetic Neuropathy Common complication of long-term diabetes Metabolic + vascular changes result in damage to the peripheral and autonomic nerves Can lead to sensory loss…which leads to injury…which leads to infection…which leads to gangrene…which can lead to amputation Numbness, prickling, tingling (paresthesia ) Sleep and Rest Exemplar Learning Outcomes Analyze sleep-rest disorders as they relate to comfort Describe the pathophysiology, etiology, risk factors, and prevention of sleep-rest disorders Identify the clinical manifestations of sleep-rest disorders Summarize diagnostic tests and therapies used by interprofessional teams in the collaborative care of an individual with a sleep-rest disorder Diff erentiate considerations for care of patients with sleep-rest disorders across the lifespan REST A state of relaxation free from stressors; body is in decreased state of activity and feels refreshed SLEEP A state of rest accompanied by altered consciousness and relative inactivity; associated with healing and restoration. Average adult sleep is 7-8 hours per day, adolescents 9- 10, and infants/toddlers 9-15.  Pathophysiology of Sleep Reticular activating system (RAS) Facilitates refl ex + voluntary movements Controls cortical activities related to state of alertness Bulbar synchronizing region takes over when you decrease your stimulus (darken room, quiet) Hypothalamus—control system for sleeping + waking  Circadian Rhythm Natural sleep-wake cycle repeated every 24 hours Internal ”clock” Needs consistency. Can affect you physically + mentally. Stages of Sleep 1 2 3 4 Stage 1: NREM; Stage 2: NREM; Stage 3: NREM; REM sleep: breathing deeper sleep; no short term 20-25% of regular, muscle eye movements hibernation period; deepest sleep; vivid tone present; detected dreams; lightest stage sleep; delta waves cognitive restoration Recommended Hours of Sleep Newborns (birth to Infants (1 month Toddlers (1-3 28 days): 14 -17 to 1 year): 12-15 years): 11-14 hours hours hours Preschool (3-6 School-age Adolescents (12- years): 10-13 children (6-12 20 years): 8-10 hours years): 9-11 hours hours Young adults (20- Middle adults (35- Older adults 35 years): 7-9 65 years): 7-9 (65+): 7-8 hours hours hours  Developmental Patterns of Sleep N e w b o rn s Infants To d d l e r s Pre s c h o o l e r s S c h o o l a g e c h i l d re n Ad o l e s c e n t s Pre g n a n t w o m e n Ad u l t s Middle aged adults Older adults  Factors Aff ecting Sleep Developmental considerations Motivation C u l t u re Lifestyle + habits P h y s i c a l a c t i v i t y a n d exe rc i s e Dietary habits E n v i ro n m e n t a l f a c t o r s Ps y c h o l o g i c a l s t re s s Illness Medications Nursing Actions and Education NURSING ACTIONS EDUCATION Avoid caff eine, coff ee, tea, Follow routine alcohol 4 hours before bedtime Limit waking clients during the Limit fl uids 2-4 hours before night bedtime Quiet environment Establish routine and sleep Hygiene pattern Home routines Avoid exercise 2-3 hours prior to bedtime  Classifi cation of Sleep Disorders by American Sleep Disorders Association Dyssomnias Parasomnias  Dyssomnias A dyssomnia is characterized by insomnia or excessive sleepiness; disorders of quantity + timing of sleep. Examples include the following: Insomnia Hypersomnia Narcolepsy Hypersomnolence disorder Sleep apnea Restless leg syndrome Sleep deprivation Insomnia Most common sleep disorder Inability to get adequate amount of sleep and to feel rested Acute vs. chronic Intermittent Fatigue, poor concentration  Hypersomnia Abnormal daytime drowsiness despite adequate sleep at night Aff ects daily living Poor memory, depression, short attention span, irritability Wakefulness promoting agents, psychostimulants  Narcolepsy Can be dangerous Sudden sleepiness and sudden period of sleep Sudden uncontrollable attacks Can hallucinate Bouts of muscle weakness, cataplexy Exercise regularly Small high protein meals Avoid activities that increase sleepiness Avoid activities that can cause injury Take prescribed stimulants Hypersomnolence Disorder Excessive daytime sleepiness that lasts at least 3 months Impairs social activities Increased risk for injury Maintain regular sleep wake schedule Provide ample sleep opportunities Take prescribed stimulants  Sleep Apnea More than 5 breathing cessations lasting longer than 10 seconds/hour during sleep. Decreased O2 saturation. More common in males above age 60, obesity, people with large necks, smoking. Central: CNS dysfunction in the respiratory control center of the brain that fails to trigger breathing during sleep Obstructive: structures in the mouth and throat relax during sleep and occlude the upper airway (OS A) Sleep Apnea Aff ects 18 million adult Lifestyle changes Americans Weight management Excessive daytime sleepiness Smoking cessation Snoring Decrease alcohol intake Diagnosed by polysomnography CPAP Can lead to decreased cardiac function, heart failure Restless Legs Syndrome RLS Irresistible urge to move legs Usually at night Exercise, massage, hot baths Sleep Deprivation Not enough sleep Changes in physical and mental functioning Tension headache, loss of concentration, mood swings, and depression  Parasomnias Parasomnia: patterns of waking behavior that appear during sleep Somnambulism REM behavior disorder (RBD) Sleep terrors Nightmares Bruxism Enuresis Sleep related eating disorder Somnambulism Sleep-walking More common in children Get out of bed and walk around Do routine activities Sit up in bed, opened eyes, glassy eyed expression Concerned about safety REM Behavior Disorder Dream enactment behaviors that occur during loss of REM sleep Movement Noises SLEEP TERRORS NIGHTMARES AKA night terrors Bad dream Common with kids Common with kids Screaming, crying, Awakens you intense fear Remains asleep BRUXISM ENURESIS Teeth grinding Bed wetting Headaches Jaw pain Damaged teeth Mouth guard Sleep Related Eating Disorder Unusual eating behaviors during sleep Most have an episode every night Ongoing, lasting problem Thick, sugary high calorie foods Eat or drink inedible or toxic substances Safety measures Sleep and Rest Nursing Interventions  Sleep Disturbance Assessment Parameters Nature + cause of problem Accompanying signs + symptoms Date of occurrence + eff ect on everyday living Severity of the problem Treatment of the problem How the patient is coping with the problem  Information Recorded in a Sleep Diary Time patient retires Time of awakening in morning Time patient tries to fall Presence of any stressors asleep Food, drink, or medication Approximate time patient Mental and physical activities falls asleep Activities performed 2-3 Time of any awakening during hours before retiring the night and resumption of sleep Worries or anxiety  Assessment I n t e r vi e w que st i o ns: I de nt i fy t he pa ti e nt’ s sl e e p- wa ke ful ne s s pa t te rns I de nt i fy e ff e c t of t he se pa tt e rns on e v e ry da y func t i oni ng A sse s s pa t i e nt ’ s use of sl e e p a i ds A sse s s the pre se nc e of s l e e p di st urba nc e s a nd c ontri but i ng fa c t ors P h ysi c al asse ssme n t : Ene rgy l e v e l Fa c i a l c ha ra c t e ri sti c s B e ha v i ora l c ha ra c t e ri st i c s Phy si c a l da ta sugge sti v e of s l e e p probl e m s  Common Etiologies for Nursing Diagnoses Physical or emotional discomfort or pain Changes in bedtime rituals or sleep environment Disruption of circadian rhythm Exercise and diet before sleep Drug dependency and withdrawal Symptoms of physical illness  Nursing Interventions to Promote Sleep Nonpharmacologic interventions: Sleep hygiene Prepare a restful environment –cool, dark Promote bedtime rituals—warm bath Off er appropriate bedtime snacks and beverages Promote relaxation and comfort Respect normal sleep-wake patterns Schedule nursing care to avoid disturbances Teach about sleep + rest  Pharmacologic Interventions: Medications for Sleep Hypnotics + sedatives Benzodiazepines, non-benzodiazepines Anxiolytics Antihistamine Melatonin receptor agonists Antidepressants  Classification Examples Anticonvulsants Gabapentin (Neurontin) Antidepressants Amitriptyline (Elavil), Bupropion (Wellbutrin), Doxepin (Sinequan), Trazodone (Desyrel) Antihistamines Diphenhydramine (Benadryl) Benzodiazepines Diazepam (Valium), Flurazepam (Dalmane), Lorazepam (Ativan), Trazolam (Halcion) Benzodiazepine receptor like agents “Z- Zolpidem (Ambien) –sedative hypnotic, Zaleplon drugs” (Sonata), Eszopiclone (Lunesta) Melatonin receptor like agonists Ramelteon (Rozerem)  References h t t p s : / / w w w. d s h s. w a. g o v / s i t e s / d e f a u l t / fi l e s / A L T S A / s t a k e h o l d e r s / d o c u m e n t s / d u a l s / t o o l k i t / f o r m s / P a i n % 2 0 S c a l e % 2 0 F L A C C. p d f h t t p s : / / w w w. n c b i. n l m. n i h. gov / b o o k s / N B K 4 9 3 1 5 4 / # : ~ : t ex t = S o m e % 2 0 c u l t u r e s % 2 C % 2 0 s u c h % 2 0 a s % 2 0 A m e r i c a n , o r % 2 0 p e n a n c e % 2 0 fo r % 2 0 p a s t % 2 0 s i n s. h t t p s : / / m y. c l e v e l a n d c l i n i c. o r g / h e a l t h / s y m p t o m s / 2 5 2 3 8 - r e f e r r e d - p a i n h t t p s : / / m y. c l e v e l a n d c l i n i c. o r g / h e a l t h / d i s e a s e s / 2 1 5 9 1 - h y p e r s o m n i a h t t p s : / / w w w. m ayo cl i n i c. o r g / d i s e a s e s - c o n d i t i o n s / r e s t l e s s - l eg s - s y n d r o m e / s y m p t o m s - c a u s e s / s yc - 2 0 3 7 7 1 6 8 # : ~ : t ex t = O ve r v i ew, d i s c o m fo r t % 2 0 fo r % 2 0 a % 2 0 s h o r t % 2 0 t i m e. h t t p s : / / m y. c l e v e l a n d c l i n i c. o r g / h e a l t h / d i s e a s e s / 2 3 9 7 0 - s l e e p - d e p r i v a t i o n h t t p s : / / w w w. m ayo cl i n i c. o r g / d i s e a s e s - c o n d i t i o n s / s l e e p wa l k i n g / s y m p t o m s - c a u s e s / s yc - 2 0 3 5 3 5 0 6 h t t p s : / / w w w. m ayo cl i n i c. o r g / d i s e a s e s - c o n d i t i o n s / r e m - s l e e p - b e h av i o r- d i s o r d e r / s y m p t o m s - c a u s e s / s yc - 2 0 3 5 2 9 2 0 h t t p s : / / w w w. m ayo cl i n i c. o r g / d i s e a s e s - c o n d i t i o n s / s l e e p - t e r r o r s / s y m p t o m s - c a u s e s / s yc - 2 0 3 5 3 5 2 4 h t t p s : / / w w w. m ayo cl i n i c. o r g / d i s e a s e s - c o n d i t i o n s / n i g h t m a r e - d i s o r d e r / s y m p t o m s - c a u s e s / s yc - 2 0 3 5 3 5 1 5 h t t p s : / / w w w. m ayo cl i n i c. o r g / d i s e a s e s - c o n d i t i o n s / b r u x i s m / s y m p t o m s - c a u s e s / s yc - 2 0 3 5 6 0 9 5 h t t p s : / / w w w. m ayo cl i n i c. o r g / d i s e a s e s - c o n d i t i o n s / b e d -we t t i n g / s y m p t o m s - c a u s e s / s yc - 2 0 3 6 6 6 8 5 https://sleepeducation.org/sleep-disorders/sleep-eating-disorder/