Chapter 19

Sleep-Wake Disorders

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Excessive sleepiness Sleep deprivation Mental and physical problems Psychomotor impairment Increased risk for errors

Consequences of Sleep Loss

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Complex interaction between CNS and environment

Non-REM (NREM) sleep Composed of three stages

REM sleep Reduction and absence of skeletal muscle tone Bursts of rapid eye movement Myoclonic twitches of facial and limb muscles Dreaming Autonomic nervous system variability

Normal Sleep Cycle

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Complex interaction between two processes Homeostatic process or sleep drive—promotes sleep Circadian process or circadian drive—promotes

wakefulness; influenced by • Endogenous factors

• Exogenous factors

Regulation of Sleep

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Varies from individual to individual Long sleepers

Require more than 10 hours of sleep each night Short sleepers

Can function effectively on fewer than 5 hours of sleep per night

Sleep Requirements

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Hypersomnia disorders Narcolepsy/hypocretin deficiency Breathing-related sleep disorders Circadian rhythm disorders Disorders of arousal

Sleep Disorders

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Nightmare disorder Rapid eye movement sleep behavior disorder Restless leg syndrome Substance-induced sleep disorders Insomnia

Sleep Disorders (Cont.)

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Your best friend tells you that she is experiencing insomnia.

What are some questions you could ask her to help assess what might be going on?

Case Study

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Excessive daytime sleepiness Chronic—begins in young adulthood Excessive sleepiness impairs social and

vocational functioning Treatment—maintain regular sleep-wake

schedules, pharmacotherapy

Hypersomnolence Disorders

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Symptoms Irresistible attacks of refreshing sleep, cataplexy,

sleep paralysis, and hypnagogic hallucinations Do not feel rested regardless of amount of sleep Treatment—lifestyle modifications and long-

acting stimulant medication

Narcolepsy/Hypocretin Deficiency

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Obstructive sleep apnea hypopnea syndrome (OSAHA)

Repeated episodes of upper airway collapse and obstruction—results in sleep fragmentation

Treatment—continuous positive airway pressure (CPAP) therapy

Breathing-Related Sleep Disorders

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Misalignment between the timing of normal circadian rhythm and external factors that affect the timing or duration of sleep

Treatment—aggressive lifestyle management strategies aimed at adapting to or modifying the required sleep schedule

Circadian Rhythm Sleep Disorder

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Difficulty with sleep initiation Sleep maintenance Early awakening Nonrefreshing, nonrestorative sleep Symptoms three times a week for at least 3

months

Insomnia Disorder

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Predisposing Precipitating and Perpetuating factors

3P Model of Insomnia

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Assessment General assessment—sleep patterns Identifying sleep disorders Functioning and safety

Nursing Process

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Nursing diagnosis Insomnia Sleep deprivation Disturbed sleep pattern Readiness for enhanced sleep

Nursing Process (Cont.)

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Outcomes identification Sleep Rest Risk control Personal well-being

Planning

Nursing Process (Cont.)

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Implementation Counseling Health teaching and health promotion Pharmacological interventions

Advanced practice interventions Cognitive-behavioral therapy

Nursing Process (Cont.)

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Evaluation Based on whether the patient experiences improved

sleep quality, as evidenced by• Decreased sleep latency• Fewer nighttime awakenings• Shorter time to get back to sleep after awakening• Improvement in daytime symptoms of sleepiness

Nursing Process (Cont.)

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1. Narcolepsy is a type of

A. Amnesia

B. Sleep disorder

C. Somaticization disorder

Audience Response Questions

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2. Which medication for insomnia is classified as an antidepressant rather than a hypnotic?

A. Zaleplon (Sonata)

B. Zolpidem (Ambien)

C. Triazolam (Halcion)

D. Trazodone (Desyrel)

Audience Response Questions

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