Chapter 19 SleepWake Disorders Copyright 2014 2010 2006

Consequences of Sleep Loss Excessive sleepiness Sleep deprivation Mental and physical problems Psychomotor impairment

Normal Sleep Cycle Complex interaction between CNS and environment Non-REM (NREM) sleep Ø Composed

Regulation of Sleep Complex interaction between two processes Homeostatic process or sleep drive—promotes sleep

Sleep Requirements Varies from individual to individual Long sleepers Ø Require more than 10

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

Sleep Disorders (Cont. ) Nightmare disorder Rapid eye movement sleep behavior disorder Restless leg

Case Study Your best friend tells you that she is experiencing insomnia. What are

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

Narcolepsy/Hypocretin Deficiency Symptoms Ø Irresistible attacks of refreshing sleep, cataplexy, sleep paralysis, and hypnagogic

Breathing-Related Sleep Disorders Obstructive sleep apnea hypopnea syndrome (OSAHA) Repeated episodes of upper airway

Circadian Rhythm Sleep Disorder Misalignment between the timing of normal circadian rhythm and external

Insomnia Disorder Difficulty with sleep initiation Sleep maintenance Early awakening Nonrefreshing, nonrestorative sleep Symptoms

3 P Model of Insomnia Predisposing Precipitating and Perpetuating factors Copyright © 2014, 2010,

Nursing Process Assessment General assessment—sleep patterns Ø Identifying sleep disorders Ø Functioning and safety

Nursing Process (Cont. ) Nursing diagnosis Insomnia Ø Sleep deprivation Ø Disturbed sleep pattern

Nursing Process (Cont. ) Outcomes identification Sleep Ø Rest Ø Risk control Ø Personal

Nursing Process (Cont. ) Implementation Counseling Ø Health teaching and health promotion Ø Pharmacological

Nursing Process (Cont. ) Evaluation Ø Based on whether the patient experiences improved sleep

Audience Response Questions 1. Narcolepsy is a type of A. Amnesia B. Sleep disorder

Audience Response Questions 2. Which medication for insomnia is classified as an antidepressant rather

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Consequences of Sleep Loss Excessive sleepiness Sleep deprivation Mental and physical problems Psychomotor impairment Increased risk for errors Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2

Normal Sleep Cycle Complex interaction between CNS and environment Non-REM (NREM) sleep Ø Composed of three stages REM sleep Reduction and absence of skeletal muscle tone Ø Bursts of rapid eye movement Ø Myoclonic twitches of facial and limb muscles Ø Dreaming Ø Autonomic nervous system variability Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3

Regulation of Sleep Complex interaction between two processes Homeostatic process or sleep drive—promotes sleep Ø Circadian process or circadian drive—promotes wakefulness; influenced by Ø • Endogenous factors • Exogenous factors Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4

Sleep Requirements Varies from individual to individual Long sleepers Ø Require more than 10 hours of sleep each night Short sleepers Ø Can function effectively on fewer than 5 hours of sleep per night Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5

Sleep Disorders Hypersomnia disorders Narcolepsy/hypocretin deficiency Breathing-related sleep disorders Circadian rhythm disorders Disorders of arousal Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6

Sleep Disorders (Cont. ) Nightmare disorder Rapid eye movement sleep behavior disorder Restless leg syndrome Substance-induced sleep disorders Insomnia Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7

Case Study 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? Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8

Hypersomnolence Disorders Excessive daytime sleepiness Chronic—begins in young adulthood Excessive sleepiness impairs social and vocational functioning Treatment—maintain regular sleep-wake schedules, pharmacotherapy Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9

Narcolepsy/Hypocretin Deficiency Symptoms Ø Irresistible attacks of refreshing sleep, cataplexy, sleep paralysis, and hypnagogic hallucinations Do not feel rested regardless of amount of sleep Treatment—lifestyle modifications and longacting stimulant medication Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10

Breathing-Related Sleep Disorders 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 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11

Circadian Rhythm Sleep Disorder 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 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12

Insomnia Disorder Difficulty with sleep initiation Sleep maintenance Early awakening Nonrefreshing, nonrestorative sleep Symptoms three times a week for at least 3 months Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13

Nursing Process (Cont. ) Nursing diagnosis Insomnia Ø Sleep deprivation Ø Disturbed sleep pattern Ø Readiness for enhanced sleep Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16

Nursing Process (Cont. ) Implementation Counseling Ø Health teaching and health promotion Ø Pharmacological interventions Ø Advanced practice interventions Ø Cognitive-behavioral therapy Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18

Nursing Process (Cont. ) Evaluation Ø 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 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 19

Audience Response Questions 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) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 21