Sleep Student Notes PDF

Sleep ◦ NURS 2510 CLIENT AND CONTEXT 1: HUMAN GROWTH AND DEVELOPMENT ◦ PAWANDEEP GILL RN,MN ◦ U n l es s o th e rw is e ci te d – a l l p h o to s a n d i m a g es i n cl u ded h a v e b e e n cr e a te d b y th e a u th o r , h a v e b e e n p e r mi tte d to u s e o r b y u n k now n a u th o r s...

Sleep ◦ NURS 2510 CLIENT AND CONTEXT 1: HUMAN GROWTH AND DEVELOPMENT ◦ PAWANDEEP GILL RN,MN ◦ U n l es s o th e rw is e ci te d – a l l p h o to s a n d i m a g es i n cl u ded h a v e b e e n cr e a te d b y th e a u th o r , h a v e b e e n p e r mi tte d to u s e o r b y u n k now n a u th o r s , a n d h a v e b e e n l i cen se d u n d e r Cr e a ti ve Co m m o ns BY - SA) At the end of the class, students will be able to: ◦ Explain the concept of sleep ◦ Discuss the purpose of sleep as related to health and wellness ◦ Describe the sleep cycle ◦ Differentiate normal sleep patterns across the lifespan ◦ Explore strategies to promote healthy sleep ◦ Create a care plan for an individual displaying signs and symptoms of sleep deprivation ◦ A special thanks to Dr. Diana Macmillan(, Registered Nurse and Associate Professor in the College of Nursing, Rady Faculty of Health Sciences at the University of Manitoba, as well as the Clinical Chair, Research for the Health Sciences Center ) for contributing and reviewing the content for today’s class. What is sleep? ◦ The natural periodic suspension of consciousness during which the powers of the body are restored. (Merriam-Webster). For general purposes, the most essential idea is that sleep is natural, necessary, involves a shift in physiological and neurological activity and is intended to be restorative. What causes sleep? Two internal biological mechanisms regulate wakefulness and sleep: Sleep-Wake Homeostasis/ Homeostatic drive Circadian rhythms Sleep-Wake Homeostasis/ Homeostatic sleep drive ◦ Need or pressure to sleep. ◦ The longer one stays awake, the pressure gets stronger and reaches lower after good quality sleep ◦ Drive for sleep is higher under some circumstances ◦ Sleep Debt: ◦ Not getting adequate sleep causes a “sleep debt” to build over time; sleep is needed to “pay down” this debt Circadian rhythms CIRCADIAN RHYTHMS ARE PHYSICAL, MENTAL, AND BEHAVIOURAL CHANGES THAT FOLLOW A 24-HOUR CYCLE. CONTROL A WIDE VARIETY OF BODY FUNCTIONS. DIRECTED BY A MASTER CLOCK, A GROUP OF NEURONS CALLED THE SUPRACHIASMATIC NUCLEUS, LOCATED IN THE HYPOTHALAMUS THE LIGHT/DARK CYCLE OF THE SUN IS THE STRONGEST CUE FOR CIRCADIAN RHYTHMS * THINK ABOUT THE EFFECT OF ARTIFICIAL LIGHT Melatonin, produced in the pineal gland, is a modulator of the circadian rhythm, with concentrations varied based on the light level. ◦. Creative Commons Reticular Formation & Reticular Activating System (RAS) ◦ The reticular activating system (RAS) is a complex bundle of brain nerves responsible for regulating wakefulness and sleep-wake transitions. Need : Calm mind and calm body Neurotransmitters and Hormones Glymphatic System and sleep ◦ Newly discovered waste-removal pathway in the brain. ◦ First described by researchers at the University of Rochester Medical Center in 2012. ◦ The term is a combination of "glial" cells, a type of brain cell, and the "lymphatic" system, responsible for clearing waste from tissues in the rest of the body. ◦ The glymphatic system is most active during sleep, especially deep sleep. During this stage, the space between brain cells increases, allowing the CSF to flow more freely and efficiently remove waste products such as amyloid-beta, which is the protein known to accumulate in the brains of Alzheimer’s patients. ◦ By removing this protein, the glymphatic system might help fight off neurodegenerative diseases such as Alzheimer's. ◦ Impaired glymphatic function has been linked to several neurological disorders, such as multiple sclerosis and Alzheimer's, where there is a buildup of amyloid-beta in the brain. ◦ Research on the glymphatic system is still in its early stages, and more studies are needed to fully understand its role in brain function and its implications for various neurological conditions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636982/#:~:text=Intriguingly%2C%20the%20glymphatic%20system%20function,pr oducts%2C%20including%20%CE%B2%2Damyloid Sleep Stages Two main phases of sleep: REM and NREM A full sleep cycle takes 90 to 110 minutes, and most people typically cycle through four to six cycles per night. NREM phase has three stages: Stage 1, Stage 2, Stage 3 An EEG or electroencepha logram measures the electrical activity in the brain while a person is asleep. Lumen learning.com Light Sleep Awake Wave Beta waves Movement Physiologic active and alert state of the brain when a person is awake and engaged in activities. Cognition N1 Deep Sleep N2 N3 Alpha Brain waves slow-Theta waves, sleep spindles and K complexes Delta waves with smaller faster waves Uncontrolled muscle jerks, hypnotic jerks Eye movement stops The transition from wakefulness to sleep. Drift in and out, easily awaked. Pulse rate, respirations slow and body temp decreases Hypnogenic hallucinations - - HR and breathing further slow Difficult to awaken N4 REM Delta waves exclusively Theta waves, brain looks like when person is awake Muscle activity limited to completely absent Rapid eye movement, muscle paralysis - Increase in heart rate, respirations and brain activity Difficult to awaken Vivid dreams Stages of Sleep -Must move through all four stages before entering into REM sleep -REM becomes progressively longer as the person completes sleep cycles -Picture in the Giddens Figure 11.5 (page 94) Stages of Adult Sleep Cycle is a good reference and Importance of sleep HEALTHY BRAIN FUNCTION AND EMOTIONAL WELL-BEING PHYSICAL HEALTH DAYTIME PERFORMANCE IMMUNE SYSTEM Life span consideration ◦ American Academy of Sleep Medicine (AASM) and the American Academy of Pediatrics AGE RECOMMENDED AMOUNT OF SLEEP Infants aged 4-12 months 12-16 hours a day (including naps) Children aged 1-2 years 11-14 hours a day (including naps) Children aged 3-5 years 10-13 hours a day (including naps) Children aged 6-12 years 9-12 hours a day Teens aged 13-18 years 8-10 hours a day Adults aged 18 years or older 7–8 hours a day Sleep Needs Vary by: Age - more sleep required during rapid growth Healthy adults need 7-9 hours sleep Health*** - stress, illness Genetics Sleep debt* Circadian rhythm (National Sleep Foundation, 2015) Sleep State fragmentation ◦ Children tend to sleep more soundly, deeply ◦ Sleep of older adults more fragmented,and lighter ACUTE & AND CHRONIC CONSEQUENCES OF SLEEP DISTURBANCE Cardiovascular disturbance: Fatigue-vehicle crashes, worker errors Cognitive impairment, memory, and taskshifting- Motor impairment Chronic diseases such as heart disease, diabetes, and cancer Mood changes – anxiety, poor coping, emotionally reactive, depression Hormonal: Growth hormone, insulin resistance, melatonin Immune changes Circulation Glymphatic system closure Pain perception Obesity Sleep Disorders ◦ Primary Sleep disorders: Insomnia, Obstructive sleep apnea, Restless leg syndrome, Circadian rhythm sleep disorders, hypersomnia(Narcolepsy), and Parasomnias include various behaviours such as sleepwalking, sleep terror and REM behaviour disorders. ◦ Secondary sleep disorders: These disorders occur due to other situations and correcting that situation should resolve the problem. This Photo by Unknown author is licensed under CC BY-NC. Jet lag/shift work sleep disruptions Circadian rhythm sleep disorders Advanced sleep phase disorder Delayed sleep phase disorder Shift work sleep disruptions National Institute for Occupational Safety and Health Sleep-disordered breathing Obstructive sleep apnea Obesity hypoventilation syndrome Central sleep apnea This Photo by Unknown author is licensed under CC BY-SA. Restless Leg Syndrome & Periodic Limb Movements During Sleep Cause: Low iron, genetics (5-10%); secondary to other health conditions Symptoms: Sleeprelated movement disorders Crawling feeling, urge to move limbs > women, esp. during pregnancy Worse in evening and night Disturbs sleep PLMS common Tx: moderate daytime exercise, iron*, calcium? dopaminergic agents, anticonvulsants, benzodiazepines, opioids (severe) Rule out mild dehydration – does water help? If so, > daytime H20 Insomnia Insomnia refers to the inability to fall asleep. It is a common disorder with several risk factors. Advancing age Family history of insomnia Sex Lifestyle/Sleep habits Stress Medical and psychiatric disorders This Photo by Unknown author is licensed under CC BY. Factors affecting Insomnia Spiritual factors: Spiritual beliefs, needs Spiritual crisis “Coming to terms with one’s life path” Social factors: Responsibilities, work, family, peer pressure, loneliness, boredom, Reduction in circadian cues Physiological Factors: Pain and discomfort, respiratory distress, immobility and medications, environment. Psychological Factors: anxiety, depression, dementia, grief, loss and transitions Narcolepsy AN UNCOMMON SLEEP DISORDER THAT CAUSES PERIODS OF EXTREME DAYTIME SLEEPINESS AND SUDDEN, BRIEF EPISODES OF DEEP SLEEP DURING THE DAY. A CHRONIC NEUROLOGICAL DISORDER CAUSED BY A DEFICIENCY OF NEUROPEPTIDE (HYPOCRETIN) THAT RESULTS IN THE BRAIN’S INABILITY TO REGULATE PROPERLY SLEEP–WAKE CYCLES. This Photo by Unknown author is licensed under CC BY-SA. ◦ What is Narcolepsy? ◦ YouTube video, Harvard Medical School, Published on Feb 21, 2014, Dr. Tom Scammell, Professor of Neurology at Harvard Medical School and a Sleep Medicine specialist, provides an overview of narcolepsy He uses animated brain illustrations to discuss the disorder’s symptoms and why it occurs. He also provides insight into areas of research that may lead to better treatment for narcolepsy. https://www.youtube.com/watch?v=Ucpf_OYvs4E. More on Narcolepsy Living with Narcolepsy–YouTube video, Harvard Medical School; Published on Feb 21, 2014, ◦ This video is a roundtable discussion among persons with narcolepsy and some of their family members. It provides insights about how persons are affected by the disorder and how they cope with their symptoms. https://www.youtube.com/watch?v=wxQ5dAQC9wo. Somnambulism( Sleep walking)This condition occurs most frequently among children (especially school-aged children) but can also occur among adults Parasomnias Sleep terrors (also known as night terrors) are ? Enuresis: Bed wetting uncontrolled urination during sleep; usually grow out of it Sleep Assessment Health Assessment and History Physical examination ◦ ◦ Height and Weight t, growth charts (BMI > 95th percentile or low BMI at risk) Otolaryngological assessment -micrognathia, retrognathia, enlarged tonsils ◦ turbinate, palate, tonsils, tongue, jaw; chronic sinusitis ◦ Respiratory -scoliosis? Lungs -asthma? ◦ GI –gastric irritation? Serum ferritin (Restless Leg Syndrome) ◦ Neuro (e.g., muscle tone, RLS); cardiovascular (Hypertension ~ OSA) ◦ Medical History (?psychiatric; pain, respiratory) (many medications -> Insomnia Medication Review Image source: World Chronicle Polysomnography Market Research Report Analysis ◦ Polysomnography ‘PSG’ is the ‘Gold Standard’EEG, EMG, ECG, respiration, and temperature. Sleep Assessment ◦ Actigraphy ◦ Adult Questionnaires: Pittsburgh Sleep Quality Index (Buysse et al., 1989) https://www.thoracic.org/members/assemblies /assemblies/srn/questionaires/psqi.php Pediatric Questionnaire: parent or self; e.g., Children’s Sleep Habits Questionnaire (Owens, 2000) https://depts.washington.edu/dbpeds/Screening %20Tools/CSHQ%20article.pdf, Pediatric Sleep Questionnaire (Chervin, 2000), https://www.thoracic.org/members/assemblies/a ssemblies/srn/questionaires/psq.php Sleep Disturbance Scale for Children (Bruni et al., 1996) https://www.med.upenn.edu/cbti/assets/usercontent/documents/Sleep%20Disturbance%20Sc ale%20for%20Children%20(SDSC).pdf Primary Prevention Secondary Prevention (Screening) Management Collaborative Interventions: Sleep Hygiene Pharmacologic Agents Pharmacologic Agents ◦ Anticonvulsants : Gabapentin (Neurontin) ◦ Antidepressants: Amitriptyline (Elavil) Bupropion (Wellbutrin) ◦ Antihistamines: Diphenhydramine (Benadryl) ◦ Benzodiazepines :Diazepam (Valium) and Lorazepam (Ativan) ◦ Benzodiazepine Receptor-Like Agents: Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta) ◦ Melatonin-Receptor Agonists: Ramelteon (Rozerem) ◦ Herbals – No strong evidence to support the effect of Valerian root, Catnip, Scullcap, Chamomile ◦ Melatonin is the exception; may be of help; limited use with caution and discuss with care provider ◦ Over-the-counter – Careful, short-term, discuss sleep changes with a care provider Sleep health strategies The Dos…… Make sleep a priority 20-30 min daytime nap Keep to a regular schedule –same wake time Gear down ◦ A good sleep environment that is very dark, quiet, cool, and comfortable can improve sleep ◦ Avoid watching TV, reading, or working in the bedroom. Keep bedroom temperature cool ◦ Eat a small snack before bedtime The Do Nots…… ◦ Avoid the following before bedtime: Heavy, spicy meals 2 to 3 hours before, Liquids (to avoid having to get up during sleep), and alcohol, which promotes sleep onset but causes early awakening and sleep disturbances. If you plan to drink alcohol, have it several hours before bedtime. ◦ Exercise: if you have trouble falling asleep, try finishing the exercise at least 3 hours before bedtime. ◦ Avoid caffeine and alcohol. ◦ If you have any of the following symptoms of common sleep disorders, see your healthcare provide Sleep ‘hygiene’ health strategies This Photo by Unknown author is licensed under CC BY-SA. ◦ Evidence supports that non-pharmacological txs are always considered the best 1st line treatment for insomnia; may be combined with meds shortterm ◦ Sleep ‘hygiene’ health strategies ◦ These approaches can also be helpful ◦ Distraction ◦ Imagery ◦ Thought-stopping ◦ Relaxation ◦ Massage ◦ Pacing ◦ Meditation ◦ Mindfulness ◦ Yoga Sleep enhancement interventions for patients Adjust Adjust the environment (e.g., light, noise, temperature, mattress, and bed) Encourage the patient to establish a bedtime routine to Encourage facilitate wakefulness to sleep Facilitate Facilitate maintenance of the patient’s usual bedtime routines during inpatient care Encourage elimination of stressful situations before Encourage bedtime This Photo by Unknown author is licensed under CC BY. Sleep enhancement interventions for patients cont’d…. Instruct Instruct the patient to avoid bedtime foods and beverages that interfere with sleep Encourage the patient to limit daytime sleep and Encourage participate in activity, as appropriate Bundle Bundle care activities to minimize the number of awakenings by staff to allow for sleep cycles of at least 90 minutes Consider Consider sleep apnea as a possible cause and notify the provider for a referral for a sleep study. Educate Educate the patient regarding sleep-enhancing techniques This Photo by Unknown author is licensed under CC BY. Summary Sleep is essential to physical and mental health, development, learning and quality of life Make sleep health a priority for you and your family Adopting an active lifestyle will support better quality sleep Practicing healthy sleep patterns and behaviours can make you feel, think and work and play better, smarter and safer National Sleep Foundation (great resource, polls) http://www.sleepfoundation.org Additional Resources and References Canadian Society for Exercise Physiology. (2022). ParticipACTION website. https://www.participaction.com/en-ca Canadian Sleep Society www.css.to/sleep/links.htm Centre for disease control and prevention Training for Nurses on Shift Work & Long Hours | NIOSH | CDC Cleaning the sleeping brain – the potential restorative function of the glymphatic system - ScienceDirect