Term
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Definition
Self-sustaining, repetitve patterns
Rhythmic, biological clock
Circadian: (circa dies) around/about a day
20-28 hour pattern
Provide feedback to regulate body functions |
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Term
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Definition
Daily cycles in behavior and physiology that are controlled by an endogenous system of biological clocks.
Sleep-wake cycle and many daily activites influenced by circadian rhythms
Many physiological processes also display circadian variations: temperatures, heart rate, mitosis, electrolytes, hormones, neurotransmitters, etc |
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Term
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Definition
Stage last a few minutes
It includes the lightest level of sleep
Decreased physiological activity with gradual fall in vital signs and metabolism
Sensory stimuli such as noise easily arouses person
Awakened, person feels as though daydreaming has occurred |
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Term
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Definition
Stage last 10 to 20 minutes
It is a period of sound sleep
Relaxation progresses
Body functions continue to slow
Arousal remains relatively easy |
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Term
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Definition
Stage last 15 to 30 minutes
It involves initial stages of deep sleep
Muscles are completely relaxed
Vital signs decline but remain regular
Sleeper is difficult to arouse and rarely moves |
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Term
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Definition
Stage last 15 to 30 minutes
It is the deepest stage of sleep
If sleep loss as occurred, sleeper spends considerable portion of night in this stage
Vital signs are significantly lower than during waking hours.
Sleepwalking and enuresis (bed-wetting) sometimes occur
It is very difficult to arouse sleeper |
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Term
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Definition
Stage usually begins about 90 minutes after sleep has begun
Duration increases with each cycle and averages 20 minutes.
Vivid, full-color dreaming occurs; less vivid dreaming occurs in other stages
Stage is typified by rapidly moving eyes, fluctuating heart and respiratory rates, increased or fluctuating blood pressure, loss of skeletal muscle tone, and increase of gastric secretions.
It is very difficult to arouse sleeper. |
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Term
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Definition
Non rapid eye movement (NREM)
Rapid eye movement (REM) |
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Term
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Definition
| The stage at the end of each sleep cycle |
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Term
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Definition
A sleeper progresses through four stages during a typical 90 minute sleep cycle.
The quality of sleep from stage 1 through stage 4 becomes increasingly deep. |
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Term
| Stages of adult sleep cycle |
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Definition
1. NREM(stage 1)
2. NREM(stage 2)
3. NREM(stage 3)
4. NREM(stage 4)
5. NREM(stage 3)
6. NREM(stage 2)
7. REM Sleep
8. NREM(stage 2) |
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Term
| Nursing Interventions to Promote Rest |
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Definition
1.Help clients feel physically comfortable
2.Help clients verbalize and resolve psychological concerns
3.Teach appropriate activities for age and state of health |
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Term
| Evaluation of Rest Related Goals |
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Definition
1. Clearly stated client goals facilitate evaluation, that is: “Client will rest for three minutes after donning clothes before donning shoes.”
2. Subjective reports made by the client will also be used to judge goal achievement, that is “I am feeling more rested today.”
3. Assess for improved activity tolerance |
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Term
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Definition
1. A state in which one’s perception of and response to the environment is reduced.
2. A minimal physical activity
3. Variable levels of consciousness
4. Changes in body physiology
5. Decreased response to external stimuli |
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Term
| Reticular Activating System (RAS) |
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Definition
1. Extends from the lower brain stem upward throughout the cerebral cortex.
2. Primary neurohormone is norepinephrine.
3. Most active during wakefulness
4. Response to sensory and cognitive process |
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Term
| Bulbar Synchronizing Region (BRS) |
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Definition
1. As sleep occurs activity in the RAS declines and the BRS becomes dominant
2. The area is located primarily in pons and medulla
3. The primary neurohormone is serotonin |
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Term
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Definition
1. Transition between waking and sleeping
2. Relaxed but easy to arouse
3. Muscle may jerk involuntarily
4. EEG resembles wakefulness with a few slow waves |
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Term
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Definition
1. Still light
2. Relatively easy to arouse
3. Muscles more relaxed and body functions slow
4. EEG waves are more regular and rounded with sleep spindles |
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Term
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Definition
1. Beginning of deep (slow wave) sleep
2. Arousal increasingly difficult
3. Muscles relaxed, may snore
4. EEG slow rounded high amplitude waves
5. Metabolism slow |
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Term
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Definition
1. Deepest sleep
2. Arousal very difficult
3. EEG waves slowest with highest amplitude
4. Vital Signs slow and temperature is low
5. Growth Hormone is released
6. Function is growth and repair of tissue |
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Term
| REM (Sleep)Characteristics |
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Definition
1. Eyes- dart back and forth quickly
2. muscles- Small muscles twitch, large muscles immobile (resembling paralysis)
3. respirations- irregular, sometimes interspersed with apnea
4. Pulse- rapid or irregular
5. Blood Pressure- increases or fluctuates
6. EEG- Active with short rapid waves resembling wakefulness
7. Gastric Secretions- increase
8. Metabolism- Increases; including body temperature (O2 sats decrease, chest pain may occur)
9. Arousal- very difficult
10. Dreams- most vivid
11. Penile and clitoral engorgement occur (independent of erotic dreams)
12. **Function is consolidation of memory, learning, and psychological coping |
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Term
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Definition
1. Slow eye movements
2. Restful sleep
3. Decreased metabolism
4. Decreased vital signs
5. Muscle tone maintained
6. No vivid dreams |
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Term
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Definition
1. Rapid eye movements
2. Non-restful sleep
3. Increased metabolism
4. Irregular vital signs
5. Muscle tone depressed
6. Dreams occur |
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Term
| Progression of Sleep Cycle |
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Definition
1. NREM stage I
2. NREM stage II
3. NREM stage III
4. NREM stage IV
5. NREM stage III
6. NREM stage II
7. REM sleep
8. NREM stage II etc.
a) Nightly there are approximately 4-6 cycles each 90 minutes long
b) As sleep progresses the length of time spent in NREM 3 & 4 decreases while REM increases. |
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Term
| Sleep and Developmental Variables |
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Definition
1. Developmental level also affects sleep
2. Elderly rarely in Stage IV NREM , less REM sleep, and frequent awakenings
3. Infants have more total sleep time and spend up to 50% in REM |
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Term
| Polysomnography Sleep Studies |
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Definition
1. EEG
2. EOG
3. EMG
4. May include oxygen saturation monitoring, EKG, chest wall and leg movement monitoring |
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Term
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Definition
1. Insomnia
2. Hypersomnia
3. Sleep Apnea
4. Narcolepsy
5. Parasomnias
a. Somnambulism
b. Enuresis
c. Night Terrors |
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Term
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Definition
1. Excessive sleep, especially in daytime
2. Sleep greater than 10 hours
3. Often sleeps until noon and takes many naps throughout the day
4. Can be caused by medical conditions or used as a coping mechanism |
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Term
| Hypersomnia (medical causes) |
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Definition
Medical causes
a. CNS damage
b. Kidney, liver, or metabolic disorders
c. Chronic sleep deprivation |
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Term
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Definition
Inadequate or poor quality sleep characterized by one or more of the following:
1. Difficulty falling asleep
2. Difficulty maintaining sleep
3. Waking up too early in am
4. Non-refreshing sleep |
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Term
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Definition
Periods of sleep difficulty lasting between one night and a few weeks
Often caused by emotional or physical discomfort such as:
a. Significant life stress
b. Acute illness
c. Environmental disturbances
d. Sleeping at a time inconsistent with the daily biorhythm—jet lag, shift work, etc.
e. Results in sleepiness, negative mood, impaired performance
f. Severity related the amount of sleep lost. |
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Term
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Definition
1. Caused by many different factors, acting singly or in combination
2. Often occurs in conjunction with other health problems: physical, emotional, or neurological
3. Emotional/Psychological: a common source of chronic insomnia
4. Mood and anxiety disorders are the most common psychological disorders associated with insomnia |
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Term
| Chronic Insomnia(Medical Disorders) |
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Definition
1. Pain, immobility, difficulty breathing, dementia, hormonal changes associated with pregnancy, peri menopause, and menopause
2. Many medical disorders worsen at night, either from sleep, per se, circadian influence, or recumbency (GERD, COPD) |
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Term
| Drugs Commonly associated with insomnia |
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Definition
1. Stimulants and/or antidepressants
2. Caffeine and nicotine
3. Alcohol and other CNS depressants
4. Decongestants (antihistamines)
5. Beta blockers
6. Steroids
7. Recreational Drugs |
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Term
| Insomnia Associated Sleep Disorders |
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Definition
1. Restless leg syndrome
2. Periodic limb movement
3. Sleep apnea
4. Circadian rhythm sleep disorders |
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Term
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Definition
1. Unpleasant sensations in the legs or feet, temporarily relieved by moving the limbs
2. Increase at night, esp. when lying down and remaining still
3. Difficulty falling asleep and often accompanied by periodic limb movements |
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Term
| Periodic Limb Movement Disorder |
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Definition
1. Bilateral, repeated, rhythmic, small amplitude jerking or twitching movements in the lower extremities and less frequently in the arms
2. Movements occur every 20-90 seconds and can lead to arousals which are usually not perceived by the patient
3. Results in non-refreshing sleep |
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Term
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Definition
1. An incapacitating and sometimes life threatening failure of respiration during sleep
2. Respiratory pauses of 10 seconds or longer
3. Normal--30 or less respiratory pauses/night
4. Greater than 30 pauses considered pathological
5. Some patients have over 300 episodes/night
a) Central Apnea—the absence of chest wall movement
b) Obstructive Apnea—inspiratory effort but blocked airflow—noisy snoring, snorts
c) Mixed Apnea—elements of both are present; begins with a failure of respiratory effort, followed by unsuccessful effort before breathing resumes |
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Term
| Risk factors for Sleep Apnea |
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Definition
1. Central Apnea—neurological damage to the brainstem usually involved.
2. Obstructive Apnea:
3. Obesity
4. Short neck
5. Reduced mandible
6. Large tongue
7. Small pharynx
8. Nasal-septum deviation
9. Chronic rhinitis |
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Term
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Definition
1. CPAP-continuous positive airway pressure
2. Position adjustment of some help since apnea increases when supine
3. Tracheostomy
4. Surgical removal of excessive tissues (uvula, parts of palate and pharynx, tonsils)
5. In the very obese, simple weight loss can be sufficient |
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Term
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Definition
1. A sudden wave of overwhelming sleepiness that occurs during the day
2. Cause unknown
3. Believed to be a genetic defect of the CNS in which REM sleep cannot be controlled
4. Sleep starts with the REM phase
5. Patients sleep well at night yet still nod off several times/day even when conversing with someone or driving a car
6. Often controlled by CNS stimulants— amphetamines or modafinil. |
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Term
| Circadian rhythm sleep disorders |
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Definition
1. An inability to sleep because of a mismatch between the circadian sleep rhythm and the desired or required sleep schedule.
2. Examples include: shift work and jet lag |
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Term
| Hypnotics:(the treatment of choice of ACute Insomnia) |
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Definition
1. Alcohol—decreases latency to sleep onset but profoundly depresses REM sleep with rebound upon withdrawal
2. Barbiturates—decrease REM sleep and rebound follows withdrawal
a. Depression of respirations during sleep, particularly in the elderly (true of alcohol as well)
b. Tolerance and abuse potential
3. Antidepressants and antipsychotics:
4. Tricyclic and lithium result in decreased REM sleep |
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Term
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Definition
Benzos” (Anti-anxiety meds)—Valium, Librium, Ativan, Xanax, Klonopin, Dalmane, Restoril, etc. Frequently the drugs of choice for insomnia
1. Decrease deep sleep (Stages III and IV)
2. Decrease REM sleep
3. May induce early am rebound
4. After prolonged use, rebound insomnia and anxiety may last for 2-3 weeks and sx’ may be worse than prior to benzo tx
5. Dangerous withdrawal once dependence occurs
6. Potentiated by alcohol use which is frequently concomitant in substance abusers; can be lethal
7. Paradoxical stimulation may occur in elderly and patients who are psychotic
8. When used solely for hypnotic purposes, should be infrequent, that is when other techniques are unsuccessful. |
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Term
| Treatment of Chronic Insomnia |
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Definition
1. Behavioral—Takes a few weeks to improve sleep but continues to provide relief after treatment sessions completed
2. Pharmacological—Provides rapid symptom relief, but long term treatment unstudied |
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Term
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Definition
1. Seek to change maladaptive sleep habits, reduce autonomic arousal, and alter dysfunctional beliefs/attitudes
2. Produce reliable and durable improvements for patients with chronic primary insomnia |
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Term
| Behavioral Approaches to treatment of Chronic Insomnia |
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Definition
1. Relaxation Therapy (Muscles)
2. Attention Focusing (Imagery/Meditation)
3. Sleep Restriction Therapy (More rapid and efficient sleep)
4. Stimulus Control Therapy
5. Cognitive Therapy |
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Term
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Definition
1. Usual sleep habits
2. Presence and nature of any known sleep problems
3. Presence of symptoms of sleep deprivation
a. Early: irritability, decreased pain tolerance, complaints of sleepiness or fatigue
b. Late: problems performing routine repetitive tasks, behavior disorders in children and psychosis
4. Identify the presence of sleep stressors |
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Term
| Assessing a complaint of sleeping problems |
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Definition
1. When did the problem begin? (Determine whether acute or chronic)
2. Does the client have a psychiatric or medical condition that may cause insomnia?
3. Is the sleep environment conducive to sleep (relative to noise, interruptions, temperature, light)
4. Does the patient report “creeping, crawling, or uncomfortable feelings” in the legs relieve by moving them (relates to restless leg syndrome)
5. Does the bed partner report that the patient’s legs or arms jerk during sleep (related to periodic limb movements in sleep)
6. Does the patient snore loudly, gasp, choke, or stop breathing during sleep
(relates to obstructive sleep apnea)
7. Is the patient a shift worker? What are the work hours? (relates to circadian sleep disorders/sleep deprivation)
8. What are the bedtimes and rise times on weekdays and weekends? (relates to poor sleep hygiene) |
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Term
| Assessing a complaint of sleeping problems (Substances) |
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Definition
a. Does the patient use caffeine, tobacco, or alcohol?
b. Does the patient take over the counter or prescription meds such as stimulating antidepressants, steroids, decongestants, beta blockers or “street drugs” (relates to substance-induced insomnia) |
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Term
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Definition
1. sleep history
2. normal sleep patterns
3. medical history
4. sleep problems |
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Term
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Definition
1. stress
2. emotional and mental |
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Term
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Definition
1. environment
2. lifestyle
3. bedtime ritual
4. bed partner |
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Term
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Definition
1. age related differences
2. developmental crises |
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Term
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Definition
1. bed time prayer
2. hopelessness |
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Term
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Definition
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Term
| Difficulty falling asleep |
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Definition
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Term
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Definition
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Term
| Insomnia (Doenges pp 549-555) |
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Definition
| 1. Definition: A sustained disruption in amount and quality of sleep that impair functioning |
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Term
| Related factors for Insomnia |
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Definition
1. Stress (depression, anxiety, fear, grief)
2. Impairment of normal sleep pattern (travel, shift work, etc.)
3. Physical discomfort (pain, body temp, cough, etc.)
4. Environment (noise, light, temperature, unfamiliar setting, etc.) |
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Term
| Defining characteristics of Insomnia |
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Definition
1. Objective:
a. observed lack of energy
b. changes in affect
c. absenteeism
2. Subjective:
a. DFA (difficulty falling asleep)
b. EMA (early morning awakening)
c. dissatisfaction with sleep
d. decreased health status/quality of life |
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Term
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Definition
| R/T anxiety and fear of pending surgery, AMB listlessness, irritability, and c/o “poor sleep ever since I was told I need this surgery” |
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Term
| Sleep Deprivation (Doenges, pp 873-877) |
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Definition
| 1. Prolonged periods of time without sleep |
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Term
| Defining Characteristics of Sleep Deprivation |
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Definition
1. Subjective:
a. daytime drowsiness
b. decreased ability to function
c. malaise
d. fatigue
e. anxiety
f. perceptual disorders (e.g., heightened sensitivity to pain)
2. Objective:
a. Restlessness
b. irritability
c. inability to concentrate
d. slowed reaction
e. listlessness
f. apathy
g. fleeting nystagmus
h. hand tremors
i. acute confusion
j. transient paranoia
k. agitation
l.combativeness
m. hallucinations |
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Term
| Related factors of Sleep Deprivation |
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Definition
a. Uncomfortable sleep environment
b. Inadequate daytime activity
c. Sustained inadequate sleep hygiene (eg, pharmacologic or dietary antisoporifics)
d. Nightmares
e. Sleep apnea |
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Term
| Sample DX; Sleep Deprivation |
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Definition
| R/T prolonged discomfort, AMB restlessness, irritability, and c/o “I’m so tired—I feel so unproductive” |
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Term
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Definition
| Defined as: Time limited interruptions of sleep amount and quality due to external factors |
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Term
| Related factors for Disturbed Sleep Patterns |
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Definition
a. Unfamiliar sleep surroundings
b. Interruptions (for caregiving activities, etc.)
c. (more on pps. 869-880 in Doenges) |
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Term
| Sample Diagnoses for Disturbed Sleep patterns |
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Definition
| R/T unfamiliar sleep surroundings AMB, “I tend to have trouble sleeping in any bed but my own” |
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Term
| Other DX for Sleep Disturbances |
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Definition
| 1. Risk for injury R/T uncontrollable sleep episodes secondary to Narcolepsy |
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Term
| Nursing Interventions designed to promote sleep |
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Definition
1. Evaluate sleep pattern and dysfunction
2. Whenever possible correct the underlying cause:
3. Noise/light
4. Pain
5. Cough
6. Itching
7. Frequent interruptions for treatment |
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Term
| Establish Optimal sleep/rest pattern |
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Definition
1. Promote relaxation--usual bedtime ritual
2. Home like environment
3. Maintain a safe environment
4. Offer light protein containing snack
5. Recognize age related changes
6. Watch for symptoms of sleep disorders |
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Term
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Definition
1. Sleep long enough to feel refreshed, but do not oversleep—if awake, get up.
2. Keep regular sleep and arousal times tofacilitate synchrony with circadian rhythms
3. Regular exercise morning or afternoon— avoid vigorous exercise within 3-4 hours of sleep
4. Try to avoid noise (earplugs if necessary or white noise)
5. Room temperature comfortable—not too hot, not too cold
6. A light snack or glass of milk @ HS
7. Avoid caffeine in the late afternoon and minimize total use
8. Avoid alcohol—leads to fragmented sleep, REM suppression/rebound, and early wakening
9. Avoid nicotine, especially at night or upon night awakenings
10. Sparing use of sleeping pills
11. Use relaxation techniques to fall asleep, I.e. deep breathing, progressive relaxation, therapeutic touch, massage, guided imagery, meditation, etc.
12. If these fail, get up, do something quiet (or boring) until you feel tired. Rhythmic and monotonous stimuli induce sleep
13. If unable to sleep within 20-30 minutes of lying down, get up and leave the bedroom
14. Do not read; watch TV in bed, etc.
15. Learn to associate the bed with sleeping
16. Minimize noise, light, and excessive temperature |
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Term
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Definition
1. Client sleeps 6-8 hours without awakening
2. Falls asleep within 20-30 minutes of retiring
3. Reports feeling rested
4. Reports feeling less irritable, confused
5. Reports less daytime sleepiness
6. Expresses an increase in pain tolerance |
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