NURS 4200 CH 8.pdf

Sleep and Sleep Disorders Overview Sleep Disorders: State where a person lacks conscious awareness of their surroundings but can be easily aroused. Sleep Insufficiency: Does not support optimal alertness, functioning, and health. Sleep Deprivation: Too little sleep to meet needs. Sleep Frag...

Sleep and Sleep Disorders Overview Sleep Disorders: State where a person lacks conscious awareness of their surroundings but can be easily aroused. Sleep Insufficiency: Does not support optimal alertness, functioning, and health. Sleep Deprivation: Too little sleep to meet needs. Sleep Fragmentation: Frequent awakenings or arousal. Sleep Disturbances: Conditions of poor sleep quality caused by health-related or environmental factors. Sleep Disorders: Abnormalities unique to sleep, such as insomnia, OSA, periodic limb movements, circadian sleep disorders, narcolepsy, parasomnias. Brain Control: The cerebral cortex, hypothalamus, thalamus, and brainstem interact to regulate the complex sleep-wake cycle. Wake Behavior: ARAS and various neurotransmitters activate the cerebral cortex, influencing alertness and attention. Sleep Behavior: Sleep-promoting neurons in the hypothalamus inhibit the ARAS and promote sleep. Melatonin: Hormone made by the pineal gland, linked to the environmental light-dark cycle. 24-Hour Biologic Rhythm Fluctuations: Regulated by the suprachiasmatic nucleus (SCN) in the hypothalamus. Circadian Rhythms: Pattern of nighttime sleep, measured with polysomnography (PSG), EEG (electromyogram), EOG (electrooculogram), and EEG (electroencephalograph). Two Sleep States: Rapid eye movement (REM) and Non–rapid eye movement (NREM). Effects of Sleep Deprivation and Sleep Disorders: Hospitalization, disrupted normal sleep stages, disordered circadian rhythms, delirium, pain intolerance, and delayed recovery. Nurses: Create an environment to promote sleep and consider sleep-aid medications. Most Common Sleep Disorder: Insomnia, short-term insomnia disorder, chronic insomnia disorder, and more common in women, divorced, widowed, and low socioeconomic, less educated individuals. Manifestations: Difficulty falling asleep, maintaining sleep, waking earlier than desired, avoidance or resistance to scheduled bedtime, and inability to sleep without intervention. Insomnia and Its Impact on Health and Lifestyle Insomnia and Job Loss A patient with insomnia and anxiety reports job loss and struggles to pay bills. The nurse would provide a response based on the patient's health and potential job opportunities. Interprofessional Care Preventing short-term insomnia from becoming chronic and treating chronic insomnia. Educating on sleep and behavioral strategies. Using cognitive-behavioral therapy for insomnia (CBT-I). Advocating for regular exercise and avoiding naps within 7-9 hours of waking. Drug Therapy Individualized for specific insomnia patterns. Recommended for short-term treatment but can cause day-time impairment. Rebound insomnia can worsen sleep from abruptly stopping certain sleep medications. Benzodiazepine-receptor agonists Recommended for intermittent use for sleep onset and maintenance insomnia. Alert patients to stop drug immediately if they experience sleepwalking, sleep driving, or other activities while not fully awake. Orexin-receptor antagonist Blocks effects of orexin. Used for sleep onset or sleep maintenance insomnia. Melatonin Receptor Agonists Rapid onset medication for insomnia with difficulty falling asleep. Not always effective. Not recommended for sleep onset or sleep maintenance insomnia. Complementary and Alternative Therapies  Melatonin effective for circadian rhythm disorders. Herbal remedies need further testing in clinical trials. Assessment and Treatment Personal habits and environmental factors contributing to poor sleep. Assess diet and caffeine intake. Identify sleep aids being used. Sleep diary. Clinical Problems Impaired sleep and fatigue. Implementation depends on severity and duration of sleep problems. Patient education on sleep hygiene may be inadequate for chronic insomnia. CBT-I for chronic insomnia. Reduce caffeine intake. Reduce light and noise. Teach safe use of sleep medications/aids. Obstructive Sleep Apnea Most diagnosed Sleep-Disordered Breathing (SDB) problem. Occurs in about 25% of US adults. Risk factors include obesity, older age, neck circumference, males, and postmenopausal women. Case Study A 52-year-old man with a case study of obstructive sleep apnea. Manifestations include frequent arousals during sleep, insomnia, excessive daytime sleepiness, witnessed apneic episodes, snoring, morning headache, irritability, and personality changes. Sleep Apnea Assessment and Treatment Assessment data includes sleep and medical history, symptoms suspicious of OSA, Berlin questionnaire, STOP-BANG questionnaire, and Epworth Sleepiness Scale diagnostic studies. PSG study measures sleep stages and wakefulness, including chest and abdominal movement, oral and nasal airflow, SpO2, lung movements, EEG, and HR Clinical Sleep Laboratory. AHI (Hourly average of apneic events or hypopneas of at least 10 seconds’ duration) is used to diagnose OSA. Behavioral treatment includes positioning therapy, weight loss, avoiding sedatives and alcohol, and referring for insomnia treatment when indicated. Medical devices like Continuous Positive Airway Pressure (CPAP) and Bilevel positive airway pressure (BiPAP) are used for severe sleep apnea. Surgical treatment includes Uvulopalatopharyngoplasty (UPPP or UP3), Genioglossal advancement and hyoid myotomy (GAHM), and Radiofrequency ablation (RFA). Surgical treatment includes Neurostimulators, which are still being tested for effectiveness and safety. Treatment includes a sleep study, diagnosis, and CPAP machine use. Interventions to improve sleep patterns include reducing noise and dimming lights at bedtime, administering opioid pain medication, setting room temperature at 78°F to induce drowsiness, and offering back massages. PLMS (periodic limb movements in sleep) is diagnosed with detailed history and PSG, and medications are used to reduce or eliminate limb movements or arousals. Sleep Disorders and Their Impact on Nursing Care Periodic Limb Movement Disorder (PLMD): Symptoms include muscle activity reduction and dopaminergic agent selegiline. Jet lag disorder: Disrupts sleep-wake cycle and quality of sleep. Shift work sleep disorder: Common symptoms include insomnia and excessive sleepiness. Chronic neurologic disorder: Brain unable to regulate sleep-wake cycles. Cataplexy: Brief and sudden loss of skeletal muscle tone. Treatment: Antidepressants, history, PSG, multiple sleep latency tests (MSLTs). Unusual and undesirable behaviors: Unusual and often undesirable behaviors that occur while falling asleep, transitioning between sleep stages, or during arousal from sleep. Fragmented sleep and fatigue: Parasomnias, arousal parasomnias, sleep terrors, and nightmares.  Age-related sleep disorders: Some sleep disorders increase with age, with some sleep disorders shifting with age. Older age: Shorter total sleep time, decreased sleep efficiency, more awakenings, and increased fall risk and injury. Chronic conditions: Depression, CV disease, pain, cognitive problems, chronic conditions common in older adults. Sleep assessment: Importance of sleep assessment, caution with use of sleep medications, and avoid long- acting benzodiazepines. Altering and rotating shifts: Decreased job satisfaction, less social engagement, more job-related stress, and increased risk for shift work sleep disorder. Special sleep needs of nurses: Disruption of synchrony between circadian rhythms and the environment, increased morbidity and mortality risks from CV problems, mood disorders, nursing mistakes and accidents, distortion of perceptual skills, judgment and decision-making abilities, and decreased coping skills.