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What does sleep maintain?
Mood, memory, and cognitive performance
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Which systems does sleep play a pivotal role?
Endocrine and Immune
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What does getting an extra hour of sleep per night translate to?
33% reduction in the development of coronary artery calcification
more sleep, less risk for coronary disease
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What are the 4 characteristics of sleep?
- 1. minimal physical activity
- 2. variable levels of consciousness
- 3. changes in body's physiologic processes
- 4. decreased responsiveness to external stimuli
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What happens to aterial blood pressure during NREM sleep?
Arterial blood pressure falls
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What happens to pulse rate during NREM sleep?
pulse rate decreases
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What happens to peripheral blood vessels during NREM sleep?
Dilate
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What happens to cardiac output during NREM sleep?
decreases
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What happens to skeletal muscles during NREM sleep?
Relax
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What happens to the basal metabolic rate during NREM sleep?
decreases 10-30%
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What do the growth hormone levels do during NREM sleep?
levels peak
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How long is a sleep cycle?
90 min
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How long does REM sleep last?
5-30min
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When do most dreams take place?
During REM sleep
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What happens to the brain during REM sleep?
The brain is highly active and brain metabolism increases 20%
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What happens to the voluntary muscle tone during REM sleep?
It dramatically decreases
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What's absent during REM sleep?
Absent deep tendon reflexes
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When do distinct eye movements occur?
During REM sleep
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What is the study of sleep called?
Somnology
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What is the prevalence of inadequate sleep?
Greater than half of adults 65 and older report at least one chronic sleep complaint
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What results from sleep disturbances? List 11 possible things.
- 1. cognitive impairment
- 2. poor concentration
- 3. irritability
- 4. difficulty making decisions
- 5. compromised endocrine and immune function
- 6. hypertension
- 7. heart attack
- 8. stroke
- 9. impaired healing of damaged tissues
- 10. obesity
- 11. diabetes
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What can sleep deprivation result in? List 7 possible results.
- 1. confusion
- 2. exacerbate existing confusion or cause confusion
- 3. depression
- 4. decrease pain tolerance
- 5. profound fatigue
- 6. slowed responses
- 7. difficulty making decisions
*greater car accidents result from sleep deprivation
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How many hours a day do newborns sleep?
16-18hr/day
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How many hours do newborns stay awake?
1-3 hours
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What sleep phase do newborns enter into immediately?
REM
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What do we observe when newborns sleep?
Body movements and irregular respirations may be observed
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Infants wake up every...
3-4 hrs
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How many hours of sleep do infants sleep?
14-15 hours/day
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How are babies advised to sleep?
on their back to prevent SIDS
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What did the Back To Sleep campaign do?
Decreased SIDS, Sudden Infant Death Syndrome by 50%
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What kind of sleep do infants have?
50% light sleep
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How many hours of sleep do toddlers get?
They get 12-14 hours/day including naps.
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What do toddlers need to sleep?
Security objects like blankets
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How many hours do preschool children get?
11-13 hours/day
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What do preschool children need to sleep good?
A consistent regular routine
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How many hours a day do school age children sleep?
10-11 hours/day
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What is considered school age?
5-12 yrs
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What is considered adolescent age?
12-18 yrs
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How many hours of sleep do school age children need?
10-11 hours/day
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How many hours of sleep do adolescents need?
9-10 hrs/day
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What can happen if adolescents don't get enough sleep?
Lower grades, negative moods, potential for car accidents
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What happens to the circadian rhythm when one becomes adolescent age?
It shifts, wake later in AM, and stay up later at night.
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How many hours of sleep do adults need?
7-9 hrs/day
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What happens if adults do not get enough sleep?
Lower concentration and irritability.
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How many hours of sleep do elders need?
6.5-7.5 hrs/day
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Why do elders have a difficult time sleeping?
Illness and pain
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What happens if elders do not get enough sleep?
Negative quality of life, mood, and alertness
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What did the Sleep in America Study of 2003 find?
The better the health of older adults, the more likely they are to sleep.
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List 11 factors that affect sleep.
- 1. Illness-increase need for more sleep
- 2. Respiratory conditions can cause SOB and nasal congestion
- 3. Gastric ulcers
- 4. Endocrine disorders– Hypothyroidism causes difficulty in sleeping
- 5. Hormonal– hot flashes/night sweats
- 6. Elevated temp– fever interferes
- 7. Diet– spicy foods interfere, alcohol, caffeine
- 8. Smoking can make it difficult
- 9. Lifestyle– stress
- 10. Motivation
- 11. Meds– narcotics suppress sleep, beta blockers cause nightmares, diuretics disrupt sleep
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What are 4 common sleep disorders?
- 1. Insomnia
- 2. Hypersomnia
- 3. Narcolepsy
- 4. Sleep Apnea
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How would you describe insomnia?
Inability to fall or remain sleep
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How do you know if you have chronic insomnia?
If insomnia lasts longer than 1 month
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Who are at risk for insomnia?
Older age and females
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What are the manifestations of insomnia? List 8 things.
- 1. Difficulty falling asleep
- 2. Waking up frequently during the night
- 3. Difficulty returning to sleep
- 4. Waking up too early in the AM
- 5. Unrefreshing sleep
- 6. Daytime sleepiness
- 7. Difficulty concentrating
- 8. Irritability
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What are two types of excessive daytime sleepiness?
Hypersomnia and Narcolepsy
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This individual obtains sufficient sleep at night but still cannot stay awake during the day. What kind of sleep disorder does this person have?
Hypersomnia
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This person has excessive daytime sleepiness combined with sudden muscle weakness, can have "sleep attacks" and may occur randomly (ex. while driving). What sleep disorder does this person have?
Narcolepsy
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What sleep disorder can lead to hypersomnia?
Sleep Apnea
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What are 6 symptoms of sleep apnea?
- 1. Loud snoring
- 2. excessive daytime sleepiness
- 3. frequent episodes of obstructed breathing during sleep
- 4. morning headache
- 5. unrefreshing sleep
- 6. dry mouth upon awakening
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What are 4 nonsurgical treatments of sleep apnea?
- 1. change sleep position
- 2. decrease wt
- 3. CPAP (Constant Positive Airway Pressure)
- 4. Drug therapy
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What are 4 surgical treatments of sleep apnea?
- 1. Adenoidectomy
- 2. Uvulectomy
- 3. Remodeling posterior oropharynx
- 4. Tracheostomy
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Who are more likely to develop sleep apnea? What is also a contributing factor?
Men and African Americans.
Obesity contributes to sleep apnea.
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What are the 3 types of sleep apnea?
- 1. Obstructive
- 2. Central Apnea
- 3. Mixed– combo of Central and Obstructive
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What happens with obstructive sleep apnea?
The person wakes a little at a time which leads to not very good sleep.
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What would be some assessments for sleep?
- 1. How many hours?
- 2. Why do you wake up?
- 3. Do you have any rituals?
- 4. Do you take any meds to help with sleep? What meds do you take?
- 5. Any medical problems
- 6. Any pain?
- 7. Does the person have an enlarged neck, uvula, soft palate, are they obese?
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What is the general term for the diagnostic testing of sleep?
Polysomnography
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This diagnostic test measures brain waves, what is it called?
Electroencephalogram (EEG)
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This diagnostic testing measures the muscles (jaw), what is it called?
Electromyogram (EMG)
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This diagnostic testing measures eyes (rapid eye movement), what is it called?
Electro-oculogram (EOG)
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What 7 possible nursing diagnoses for sleep?
- 1. Risk for injury
- 2. Ineffective coping
- 3. Fatigue
- 4. Risk for impaired gas exchange
- 5. Knowledge deficit
- 6. Anxiety
- 7. Activity Intolerance
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What has been used in the hospitals as a visual reminder to keep noise level down?
Yacker Tracker
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What's "SHHH" stand for?
- Silent
- Hospitals
- Help
- Healing
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What are the 5 effects of excessive noise on patients?
- 1. sleep disturbance
- 2. increased BP
- 3. increased HR
- 4. Stress
- 5. interferes with "speech" privacy (shut door, turn down tv)
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What are 6 effects of excessive noise on the health care provider?
- 1. increased stress
- 2. increased annoyance
- 3. fatigue
- 4. emotional exhaustion
- 5. burnout
- 6. interferes with staff communication during report
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What are the strategies for reducing noise?
- 1. design of the unit
- -location of equipment
- -sound blocking materials
- -staggering room doorways
- -carpeting
- 2. moving tv speakers closer to listener (on call bell remote)
- 3. personal pagers for staff instead of using intercom
- 4. use of white noise– nature sounds
- 5. location of report
- 6. changing IV bags before alarm goes off
- 7. lowering volume of IV pump
- 8. restocking supplies during evening shift vs. night shift
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What are some things the nurse can do to promote sleep?
- 1. minimize outside noise
- 2. maintain regular wake/sleep routine (same time)
- 3. dark quiet room
- 4. avoid heavy, spicy foods
- 5. avoid alcohol, caffeine
- 6. light carbs, warm milk
- 7. meds– last resort! Some meds interfere with sleep. Time the pain meds so don't interrupt sleep of pt.
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