Term
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Definition
| A condition in which the body is inactive or engaging in mild activity, after which the person feels refreshed. |
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Term
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Definition
A cyclically occurring state of decreased motor activity and perception. NREM/REM sleep cycle repeats four to six times throughout the night. Each cycle lasts approx 100 min.
Body functions slow, and metabolism falls by 20% - 30% , so the body conserves energy.
Sleep is characterized by altered consciousness.
A sleeping person is unaware of the environment and responds selectively to external stimuli. |
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Term
| What is an electroencephalogram (EEG) used for? |
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Definition
To record the electrical activity of the neurons in the brain.
Electrical impulses are transmitted from the brain through electrodes attached to the scalp. These impulses create five different wave patters, or brain waves.
The greater the brain activity, the more rapid the brain waves on the EEG. |
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Term
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Definition
| High-frequency, medium-amplitude, irregular waves. These occur in the drowsy stage. |
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Term
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Definition
High-frequency, low amplitude, irregular waves.
These occur during periods of wakefulness. |
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Term
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Definition
| Peaked, irregular wave-forms that occur in the earlier phases of NREM sleep. |
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Term
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Definition
High-amplitude waves that are common in children but rare in adults.
These occur with delta waves when transitioning to a deeper sleep stage. |
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Term
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Definition
| Low-frequency, high-amplitude, regular waves common in deep sleep. |
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Term
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Definition
Non-rapid eye movement sleep
Generally the restful phase of sleep where physiological function in slow.
Divided into 4 stages - each deeper than the one preceding it. |
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Term
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Definition
Rapid eye movement sleep - Paradoxical sleep (more spontaneous awakenings occur during this stage than any other).
About 90 minutes after the onset of sleep and after stage IV. The brain is highly active, with brain waves similar to those that occur when a person is awake and alert.
Dreaming occurs.
Less restful than NREM sleep.
Essential for mental and emotional restoration.
Loss of REM sleep impairs memory and learning.
Eyes move rapidly, small muscle twitch, apnea may occur, pulse may be rapid and irregular, metabolism, temp, pulse, and BP increase, gastric secretions increase, large muscle activity and deep-tendon reflexes are depressed. If awakened, will react normally but difficult to rouse.
Accounts for about 25% of total sleep. |
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Term
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Definition
Transition between wakefulness and sleep.
Light sleep; can be awakened easily.
Relaxed but aware of surroundings.
Groggy, heavy lidded.
Regular, deep breathing, eyelids open and close slowly.
Accounts for about 5% of total sleep.
Dreams are usually not remembered.
Typical duration - 5-10 min.
Brain activity consists of alpha waves, with occasional low-frequency theta waves. |
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Term
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Definition
Also light sleep.
Brain activity slows, characterized by sleep spindles.
Body processes begin to slow down (temp, HR, BP)
Spontaneous periods of muscle tone mixed with periods of muscle relaxation.
Lasts for 10-15 minutes.
Accounts for about 50% of total sleep. |
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Term
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Definition
Deeper sleep.
Progressively more delta and slow-wave activity begins to occur.
Person is difficult to rouse, slow eye movement stops, skeletal muscles are very relaxed, and snoring may occur.
Parasympathetic nervous system predominates: temp, pulse, respirations, and BP slow even more.
Lasts 5-5 minutes.
8% of time spent here |
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Term
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Definition
Deepest sleep.
Delta waves are highest in amplitude, slowest in frequency, and highly synchronized.
The body,, mind, and muscles are very relaxed.
Person difficult to awake, if wakened may appear confused.
Some dreams may occur here but less vivid than if they occur in REM.
Important for restorative processes such as protein synthesis, cell division, and tissue renewal.
Releases human growth hormone, which is essential for repair and renewal of brain and other cells.
11% of time spent here.
Lasts 20-50 minutes. |
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Term
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Definition
Sleep disorders characterized by insomnia or excessive sleepiness.
Include insomnia, sleep apnea, restless leg syndrome, hypersomnia, and narcolepsy. |
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Term
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Definition
Patterns of waking behavior that appear during sleep
(sleepwalking, sleeptalking, bruxism, night terrors, REM sleep behavior disorders, and nocturnal enuresis) |
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Term
| What is the difference between rest and sleep? |
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Definition
Rest - the body is disturbed by all external stimuli.
Sleep - the body is screened from them by altered consciousness. Restores the body. |
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Term
| Why are sleep and rest important? |
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Definition
Essential for physical, mental, and spiritual well-being.
Sleep also reduces stress and anxiety, improving our ability to cope and concentrate on ADLs.
Strengthens the immune system. |
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Term
| Important nursing intervention |
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Definition
| Promoting sleep because it enhances wellness and speeds recovery from illness. |
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Term
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Definition
Newborns 16-20
Infants 14-16
Toddlers 12-14
Preschoolers 11-13
Middle and late childhood 10-11
Adolescents 8-9 (growth spurt increases the need for sleep)
Young adults 7-8
Middle-age adults 7
Older adults 5-7 (usually nap or rest during the day/spend less time sleeping but need more rest) |
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Term
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Definition
| When things happen at the same time, or work or develop on the same time scale as something else. |
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Term
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Definition
| Biological clocks that are controlled within the body and synchronized with environmental factors. Biorhythms influence many physical and mental functions (body temp is lowest when the person wakes up in the morning). |
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Term
| What is a circadian rhythm? |
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Definition
Based on the day-night pattern in a 24-hour cycle.
A person's circadian rhythm is regulated by a cluster of cells in the hypothalamus of the brain stem that respond to changing levels of light. |
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Term
| When is sleep quality best? |
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Definition
| When the time at which you go to sleep and wake up is in synchrony with your circadian rhythm. |
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Term
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Definition
| By centers in the lower part of the brain, which produce sleep by actively inhibiting wakefulness. A major factor in regulating sleep is the amount of light received through the eyes. The increasing light of a dawning sky signals the hypothalamus to induce gradual arousal from sleep. |
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Term
| What is reticular formation? |
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Definition
| A collection of nerve cell bodies within the brain stem. Is responsible for maintaining wakefulness. Activated by stimuli from the cerebral cortex. |
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Term
| Reticular and cortical neurons are called? |
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Definition
The reticular activating system (RAS)
Works to regulate sleep and wakefulness. |
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Term
| What neurotransmitters are associated with excitatory and inhibitory sleep mechanisms? |
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Definition
Catecholamines
Acetylcholine
Serotonin
Histamine
Prostaglandins |
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Term
| What neurotransmitters promote feelings of sleepiness? |
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Definition
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Term
| What brain waves are present in a person that is awake? |
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Definition
| Brain waves are very rapid, irregular, and low in amplitude, mostly alpha and beta waves. |
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Term
| What brain waves are present in a person who is relaxed? |
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Definition
Most alpha activity.
During sleep, alpha waves disappear and are replaced by slower, higher amplitude delta waves. |
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Term
| What is NREM sleep also called? |
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Definition
| Slow-wave sleep (SWS) because it is characterized by the presence of delta waves. |
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Term
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Definition
| The parasympathetic branch of the autonomic nervous system becomes progressively more dominant during each stage. The muscles relax, body temp lowers, and heart rate, respirations, and BP decrease. |
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Term
| What happens to a person who is deprived of REM sleep for several nights? |
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Definition
| Will usually experience REM rebound. They will spend a greater amount of time in REM sleep on successive nights, keeping the total amount of REM sleep constant over time. |
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Term
| What is an important factor affecting the duration of sleep? |
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Definition
Age
Sleep patterns are also affected by age. |
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Term
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Definition
| Related to the total amount of sleep, how well the person slept, and whether the person obtained the needed amounts of NREM and REM. |
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Term
| Two out of three young children experience sleep-related problems a few times a week |
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Definition
| Trouble falling asleep, frequent awakenings, nightmares, and heavy snoring. |
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Term
| How much sleep do parents lose? |
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Definition
| As many as 200 hours of sleep a year because of their children's poor sleeping patterns. |
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Term
| Why do older adults lose sleep? |
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Definition
| Many suffer sleep disturbances because of nocturia, side effects of meds, and discomfort or pain. Levels of melatonin, the natural hormone that controls sleep, decline in the latter decades of life. |
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Term
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Definition
| If exercise occurs at least 2 hours before bedtime, it will promote sleep. |
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Term
| The more tired a person is... |
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Definition
| The shorter the first period of REM sleep is. |
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Term
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Definition
Foods high in saturated fat near bedtime may interfere with sleep.
L-tryptophan, an amino acid found in mile and cheese, may induce sleep.
Carbohydrates promote relaxation through their effects on brain serotonin levels.
Satiation induces sleep. |
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Term
| Caffeine, nicotine, and alcohol |
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Definition
Caffeine bocks adenosine and inhibits sleep.
Nicotine is a stimulant and may interfere with sleep.
Alcohol may hasten the onset of sleep, but it disrupts REM and slow wave sleep and may cause spontaneous awakenings and difficulty returning to sleep. |
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Term
| Disease conditions altering the quality of sleep are? |
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Definition
Allergies, hyperthyroidism, and parkinson's disease.
Anxiety increases gastric secretions, intestinal motility, HR, and respiration, all of which contribute to a restless night. Anxiety also stimulates the sympathetic nervous system, increasing the level of norepinephrine. This decreases stage IV and REM sleep and leads to more awakenings. |
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Term
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Definition
The inability to fall asleep, remain asleep, or go back to sleep. May be transient / short time, or chronic (longer than a month).
Most common sleep disorder.
More prevalent in women (hormone imbalances) and in adults over 60 years. |
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Term
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Definition
| Short sleep episodes that the person is not aware of. |
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Term
| Restless leg syndrome (RLS) |
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Definition
A disorder of the central nervous system characterized by an uncontrollable movement of the legs while resting or before sleep onset.
Tends to run in families and associated with low levels of iron.
Symptoms include unpleasant creeping, crawling, itching, or tingling sensations in the legs. Relieved only by moving the legs.
Treatment includes neuroleptic agents and meds used to treat Parkinson's disease. |
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Term
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Definition
Not a sleep disorder, but a result of prolonged sleep disturbances.
NANDA-I nursing diagnosis. |
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Term
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Definition
Excessive sleeping, especially in the daytime.
Sleep disorders that commonly cause hypersomnia are obstructive sleep apnea and narcolepsy.
May also be caused by disorders of the central nervous system, kidney, or liver or by metabolic disorders (diabetic acidosis and hypothyroidism).
Can also be a symptom of depression. |
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Term
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Definition
A periodic interruption in breathing during sleep - an absence of air flow through the nose or mouth during sleep.
Typically the soft tissue of the pharynx and soft palate collapse and obstruct the airway.
During apnea, O2 levels drop and CO2 levels rise causing the person to wake up.
To diagnose sleep apnea - EEG, arterial O saturation, and electrocardiogram is recommended.
Untreated apnea is associated with polycythemia, hypertension, angina, CAD, right-sided heart failure, stroke, impotence, depression, personality changes, and mood swings. |
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Term
| Two main types of sleep apnea |
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Definition
Obstructive sleep apnea (OSA)
Central sleep apnea (CSA) |
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Term
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Definition
| is a combination of the two main types (OSA and CSA) |
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Term
| Obstructive sleep apnea (OSA) |
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Definition
caused by airway occlusion (usually by the tongue or palate) during the sleep, but the person continues to try to breathe. Grunting, snoring, snorting, or thrashes about during sleep.
The person is not aware of waking.
Treatment includes surgery, CPAP. |
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Term
| Central sleep apnea (CSA) |
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Definition
A complete suspension of breathing resulting from a dysfunction of central respiratory control.
Accounts for only about 10% of sleep apnea.
People with CSA tend to awaken during sleep, therefore, experience daytime sleepiness. |
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Term
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Definition
A hallmark sign of sleep apnea.
Snoring results when the muscles at the back of the mouth relax during sleep, obstruct the airway, and vibrate with each breath. |
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Term
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Definition
Is a chronic disorder caused by the brain's inability to regulate sleep-wake cycles normally.
The person experiences a suden, uncontrollable urge to sleep lasting from seconds to minutes.
Awakens easily.
Characterized by sleepiness, slurred speech, slackening of the facial muscles, feeling of impending weakness of the knees, paralysis, and hallucinations.
Will awaken feeling refreshed.
Thought to be caused by a genetic defect of the central nervous system in which REM sleep cannot be controlled. |
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Term
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Definition
Characterized by involuntary episodes of sleep but are related by acute or chronic sleep deprivation.
When the person is well rested, the episodes resolve. |
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Term
| Sleepwalking (somnambulism) |
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Definition
Occurs during stages III and IV of NREM sleep, usually 1 to 2 hours after the person falls asleep.
Stress, fatigue, and some drugs can trigger sleepwalking.
(drugs to suppress stage IV sleep to help) |
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Term
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Definition
| Occurs during NREM sleep, just before the REM stage. Does not usually interfere with sleep. |
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Term
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Definition
Grinding and clenching of the teeth, usually occurs during stage II NREM sleep.
Can eventually erode tooth enamel and loosen the teeth. |
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Term
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Definition
Are sudden arousals in which the person is physically active, often hallucinatory, and expresses a strong emotion such as terror.
Appears to be fully awake but is not.
Often children.
Unlike nightmares which occur during REM sleep, night terrors occur during stage IV NREM sleep. |
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Term
| REM sleep behavior disorders |
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Definition
| Are disorders associated with REM (or dreaming period) sleep, in which the sleeper violently acts out the dream. People have injured themselves or others without waking. |
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Term
| Nocturnal enuresis (bedwetting) |
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Definition
Nighttime incontinence. Most incidents occur during NREM sleep, during the first third of the night, when the child is difficult to rouse.
Best strategy is patience because most grow out of it. |
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Term
| Secondary sleep disorders |
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Definition
| Occur when a disease causes alterations in sleep stages or in quantity and quality of sleep. |
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Term
| Depression (Secondary Sleep Disorder) |
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Definition
| Depressed people may spend a great deal of time in bed. However, in general, they have difficulty falling asleep, experience less slow-wave (deep) sleep, spend less time in REM sleep, awaken early, and have less total sleep time. |
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Term
| Hyperthyroidism or Hypothyroidism (secondary sleep disorders) |
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Definition
An increase in thyroid secretion causes an increase in stage III and IV sleep.
Hypothyroidism decreases those stages.
Hyperthyroidism increases metabolic rate, making it difficult for the person to fall asleep. |
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Term
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Definition
| Those that occur when signs and symptoms of the disease appear or become worse during sleep. |
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Term
| CAD (Sleep-provoked disorders) |
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Definition
| During REM sleep, dreams may increase heart rate and provoke angina and ECG changes. |
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Term
| Asthma (Sleep-provoked disorders) |
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Definition
| People with asthma may experience bronchospasm during REM sleep. |
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Term
| COPD (Sleep-provoked disorders) |
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Definition
| Persons with COPD experience lowered O2 tension and increased CO2 retention during sleep, especially during REM sleep. |
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Term
| Diabetes (Sleep-provoked disorders) |
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Definition
| BG levels vary during sleep. When diabetes is uncontrolled, it may profoundly affect the blood sugar level during sleep, when the person is not alert enough to deal with it. |
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Term
| Gastric and Intestinal Ulcers (Sleep-provoked disorders) |
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Definition
| During REM sleep, people with duodenal ulcers secrete up to 20 times more gastric acid. Peptic ulcers also contribute to increased acid, often producing nocturnal epigastric pain and sleep loss. |
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Term
| Sleeping assessment should include the following: |
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Definition
Usual sleeping pattern
Sleeping environment
Bedtime routines / rituals
Sleep aids
Sleep changes or problems |
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Term
| A sleep history includes what? |
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Definition
| In-depth questions about the person's usual times for sleep, any preparation, preferences and routines, quality of sleep, napping habits, and whether she wakes early and cannot return to sleep. |
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Term
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Definition
provides very specific information on your patient's patterns of sleep.
This allows identification of trends in sleep / wakefulness and associate behaviors interfering with sleep.
Usually kept for 14 days. |
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Term
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Definition
| One of the most common sleep studies performed in a sleep lab which records brain activity, eye movement, O2 and CO2 levels, VS, and body movements during the sleep phases. |
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Term
| When to use sleep deprivation as a nursing diagnosis |
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Definition
When the patient's amount, consistency, or quality of sleep is decreased over prolonged periods of time.
Defining characteristics of sleep deprivation are more severe than those for disturbed sleep pattern. |
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Term
| When to use disturbed sleep pattern as a nursing diagnosis |
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Definition
| When assessment data points to a time-limited sleep problem due to external factors (inability to sleep in the hospital). The problem should be one that can be treated by nursing therapy. |
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Term
| When to use insomnia in nursing diagnosis. |
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Definition
| For patients who have a disruption in the amount of quality of sleep to the extent that it impairs functioning. |
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Term
| When to use readiness for enhanced sleep in nursing diagnosis. |
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Definition
| For clients who are sleeping well enough to obtain adequate rest and desired functioning, but whose sleeping can be improved in quality. |
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Term
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Definition
| Can be used to help your patient move in his mind to a safe place, where relaxation is possible. |
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Term
| Progressive muscle relaxation |
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Definition
| Relaxing each muscle independently and progressing from head to toe, may help to promote sleep. |
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Term
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Definition
Have a short half-life so don't linger and cause "hangover".
Selective, targets specific receptors that are thought to be associated with sleep instead of depressing the entire central nervous system.
Ex - Ambien, Sonata. |
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Term
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Definition
Long-acting and short-acting.
Long-acting linger in the body and may cause daytime drowsiness.
Many were originally formulated to treat anxiety.
Ex - Valium, Xanax, Dalmane, Ativan, Halcion. |
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Term
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Definition
Anticonvulsants and are rarely prescribed for insomnia because of the risk for addiction.
Ex - Amytal, Nembutal, and Seconal. |
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Term
| Tricyclic antidepressants |
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Definition
Antidepressant
Ex - Elavil, Sinequan, Tofranil, Aventyl, Pamelor. |
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