Sleep and Rest

Question 1

Compare and contrast sleep and rest. How are they different? Alike?

Answer 1

Sleep is a state of rest accompanied by altered consciousness and relative inactivity. Sleep
is characterized by reduced skeletal muscle activity. Blood pressure and pulse rate decrease, and skin vessels dilate. The metabolism falls
by 20% to 30%, so energy is conserved. At rest, the body is disturbed by all exterior noises, whereas in sleep, it is screened from them by altered consciousness. Rest is a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed. Although necessary and beneficial, rest without sleep is inadequate. Sleep restores the normal levels of normal brain activity
and “balance” in the central nervous system; rest alone cannot do this. Many organs that function during rest suspend their activities
in sleep.

Question 2

Why is promoting sleep an important nursing intervention?

Answer 2

because it enhances wellness and speeds recovery from illness. Sleep and illness are interrelated. Prolonged lack of sleep can result in illness, and illness interferes with sleep. Sleep and rest are both essential to life and for keeping the body, mind, and spirit in excellent physiological shape. Rest and sleep restore energy, improve learning, and strengthen the immune system. Without the proper amount of sleep, the body ceases to function efficiently.

Question 3

List the five stages of sleep.

Answer 3

Sleep includes the following stages of NREM and REM sleep:
• NREM (non–rapid eye movement, also called slow-wave sleep) is stages I, II, III, and IV
• REM (rapid eye movement) is stage V

Question 4

What is the stage that must be “made up” if not enough time is spent in it?

Answer 4

REM (stage V) sleep must be made up.

Question 5

What is the most common dyssomnia?

Answer 5

Insomnia is the most common dyssomnia.

Question 6

What are the clinical signs of sleep deprivation?

Answer 6

• Daytime drowsiness
• Difficulty performing daily tasks
• Perceptual disorders
• Impaired cognitive functioning, problem-solving, and decision making
• Irritability
• Slowed reaction time
• Somatic (body) complaints
• General feeling of malaise
If sleep deprivation is severe and prolonged, delusions, paranoia, and other psychotic behaviors may occur.

Question 7

Why are sleeping pills not recommended for chronic insomnia?

Answer 7

• They are habit forming.
• They become less effective with long-term use.They can have serious side effects.
However, sedative–hypnotic treatment is justified in short-term insomnia to avoid the known consequences of insomnia on mood and performance. Short-term, aggressive treatment may prevent the development of chronic insomnia

Question 8

Why is snoring significant?

Answer 8

Snoring is a physical sign of obstructive sleep apnea. Snoring can also significantly reduce the quality of sleep for the bed partner.

Question 9

Sleepwalking (somnambulism) occurs during

Answer 9

stages III and IV of NREM sleep, usually 1 to

2 hours after falling asleep.

Question 10

Sleeptalking occurs during

Answer 10

NREM sleep, just before the REM stage. It does not usually interfere with the person’s rest. Speech is often nonsensical and garbled.

Question 11

Bruxism,

Answer 11

grinding and clenching of the teeth,

Question 12

Bruxism, grinding and clenching of the teeth, usually occurs during

Answer 12

stage II NREM sleep. It can eventually erode tooth enamel, loosen the teeth, and lead to misalignment.

Question 13

Night terrors are sudden arousals in which the person (usually a child) is physically active and expresses fear or strong emotion. which occur during

Answer 13

REM, night terrors occur during stage IV (deep NREM) sleep.

Question 14

Nocturnal enuresis (bedwetting) is nighttime incontinence. It has incorrectly been associated with dreaming; however, most incidents occur during

Answer 14

NREM sleep, during the first third of

the night when the child is difficult to rouse.

Question 15

Describe ways in which depression can affect sleep.

Answer 15

• Difficulty falling asleep
• Less slow-wave (deep) sleep
• Less time in REM sleep
• Awaken early
• Less total sleep time
• Hypersomnia (excessive sleeping)

Question 16

Sleep Pattern Disturbance

Answer 16

NANDA-I nursing diagnosis defining a time-limited interruption in sleep resulting from external factors, such as room temperature and humidity, noise, lighting, noxious odors, sleep partner, unfamiliar sleep surroundings or bed, interruptions, lack of privacy, and physical restraints.

Question 17

Sleep Deprivation

Answer 17

is the NANDA-I nursing diag- nosis for a patient who has a decreased amount, consistency, or quality of sleep over prolonged periods of time

Question 18

Readiness for Enhanced Sleep

Answer 18

NANDA-I diagnosis for a client who has no particular sleep problem but desires improved quality of sleep.

Question 19

What is the classification of zolpidem tartrate? Why is it an especially desirable medication for sleep?

Answer 19

Zolpidem tartrate is classified as a sedative/hypnotic nonbarbiturate. It is an especially desirable medication for sleep because it is short acting and does not produce a hangover effect.

Question 20

What are two other classes of medications that are sometimes prescribed for sleep?

Answer 20

Answers may include the following classes of medications (other than sedative/hypnotic, nonbarbiturate) prescribed for sleep:
• Benzodiazepines
• Tricyclic antidepressants • Barbiturates

Question 21

what is rest?

Answer 21

decreased activity with a feeling of being refreshed

people rest by doing things they find calm and relaxing

Question 22

what is sleep?

Answer 22

state of rest accompanied by an altered state of consciousness
its is complex and rhythmic with a cyclic nature

Question 23

where is sleep controlled

Answer 23

the lower part of the brain

Question 24

What are the functions of sleep

Answer 24

restores normal levels of activity
restores balance among parts of the nervous system
Facilities protein synthesis
restores psychological well-being (how we look, feel, and perform on a daily basis)

Question 25

The nurse is preparing to teach a client about the important of rest and sleep. Which statement made by the client would indicate the need for further teaching? A. The client verbalizes that circadian rhythms do indeed influence sleep B. The client suggests that their Reticular Activating System is responsible for maintaining restfulness C. The client verbalizes that they may be less likely to develop an infection if they sleep less than 5 hours per day D. The client suggests they it may be easier to gain weight if they do not get enough regular sleep

Answer 25

C. The client verbalizes that they may be less likely to develop an infection if they sleep less than 5 hours per day When adequate sleep is not maintained the bodies ability to maintain glucose is lessened therefore responds with insulin resistance. This leads to reduced energy expenditure, all of which can lead to obesity and type 2 diabetes All of the other options suggests adequate information

Question 26

Reticular Activating System route in the brain

Answer 26

Medula --> Pons --> Midbrain --> Hypothalamus

Question 27

what does the Reticular Activating System do?

Answer 27

facilitates reflex and voluntary movement and cortical activity related to state of alertness also relays impulses into the cerebral cortex and spinal cord

Question 28

Wakefullness occurs when the ______ is activated

Answer 28

RAS (reticular activating system) by cerebral cortex and periphery organs/cells (pain or noise)

Question 29

what is the Bulbar Synchronizing Region

Answer 29

plays a part in releasing neurotransmitters which either cause excitation or inhabitation

Question 30

What does the pineal gland do for sleep/wake cycle

Answer 30

secretes melatonin which is a hormone that helps control your sleep/wake cycle

Question 31

NREM (non-rapid eye movement) Stage 1

Answer 31

``` the Pre-sleep stage lasts only a few minutes 5% of total sleep times easily awakened from stage 1 drift in and out of sleep eyes move very slowly involuntary muscle jerking ```

Question 32

NREM (non-rapid eye movement) Stage 2

Answer 32

person falls into a light sleep but can be aroused with relative ease 50-55% of total sleep

Question 33

NREM (non-rapid eye movement) Stage 3

Answer 33

the depth of sleep continues and arousal becomes increasingly difficult composes about 10% of sleep

Question 34

NREM (non-rapid eye movement) Stage 4

Answer 34

person reaches greatest depth of sleep ( delta sleep) | arousal is very difficult - if awaken they dont adjust immediately and feel groggy and disoriented

Question 35

Body changes in NREM (non-rapid eye movement) Stage 4

Answer 35

Pulse and respiration drops 20-30 % B/P decreases metabolism and body temp decreases

Question 36

Characteristics of REM Sleep

Answer 36

``` eyes dart back and forth twitching of small muscles in the face immobile of large muscles respirations irregular pulse is rapid/irregular metabolism and body temp increases gastric secretions increase ```

Question 37

The nurse is performing parent teaching to the parent of a client recently diagnoses with somnambulism. The nurse knows that teaching has occurred when the parent verbalizes the following: Select all that apply A. A complete cycle is 90-100 minutes B. It may be harder for my child to wake up when she is in stage 4 of sleep C. Muscles in the face are likely to twitch during REM Sleep D. If my child were to sleep walk, it will most likely occur during NREM sleep stage 3

Answer 37

All of the Above

Question 38

Normal sleep patterns for newborns

Answer 38

sleep 16 or more hours/day usually in 4 hour increments | 50/50 NREM and REM

Question 39

normal sleep patterns for Infants

Answer 39

10-12 hours night 2-3 during the day | usually sleep through the night by 6 months

Question 40

problems for infants when sleeping

Answer 40

used to parental assistance at bedtime and may signal their parents to help them return to sleep at night putting infants to bed when drowsy - helps them to become self-soother

Question 41

normal sleep patterns for Toddlers

Answer 41

12 hours per night decreasing to 8-10 as they reach preschool age the need for midmorning naps gradually decrease moving to crip to bed may be difficult

Question 42

Normal sleep patterns for Preschoolers

Answer 42

9-16 - having a relaxing bedtime routine will promote a good sleep schedule and decrease nightmares

Question 43

Normal sleep patterns for Elementary/ School-age

Answer 43

8-12 hours per night - may increase when physical growth peaks less sleep because of homework, sports, activities good time to teach the importance of a healthy sleeping habit

Question 44

sleep patterns for adolescents

Answer 44

vary widely but average 9-10 hours changes in circadian rhythm sleep deprivation from staying up later (video games)

Question 45

sleep patterns for older adults

Answer 45

may sleep 7-9 hours | considerably less or absent stage 4 NREM

Question 46

What is Sundowning Syndrome

Answer 46

seen in older patients with Alzheimer's disease not asleep disorder directly to a pattern of symptoms that occurs late afternoon and can last through the night disrupting sleep

Question 47

Environment factors for sleeping

Answer 47

``` familiar surroundings Noise Temperatures Ventilation Light levels Comfort and size of the bed a person partner ```

Question 48

lifestyle factors affecting sleep

Answer 48

``` routines/schedules substances (alcohol, caffeine, medications) exercise/activities before bed shift at work stress TV viewing diet smoking motivation ```

Question 49

medications that interpret sleep

Answer 49

``` Hyponicts Beta-blockers narcotics tranquilizers antidepressants ```

Question 50

Medications that promote sleep

Answer 50

zaleplon (sonata) Zolpidem (ambien) Eszopiclone (lunesta)

Question 51

What is insomnia

Answer 51

associated with sleep hygiene, stress, and or mental health issues

Question 52

What is hypersomnia

Answer 52

sufficient sleep at night but cannot stay awake during the day caused by a medical or psychological disorder

Question 53

What is narcolepsy

Answer 53

``` excessive daytime sleepiness, sudden episodes of falling asleep, sleep paralysis sleep attacks hypotonia hallucinations nighttime wakefulness no cure ```

Question 54

what is sleep apnea

Answer 54

lack of airflow through the nose and mouth | abnormal is considered when there are more than 5 apneic episodes or 5 breathing pauses longer than 10seconds per hour

Question 55

what is polysomnography?

Answer 55

``` a test overnight while the patient is sleeping measuring multiple sleep-related signals EEG EMG ECG Respiration ```

Question 56

what is parasomnia? and some examples

Answer 56

``` behavior that may interfere with or occur during sleep more common in children Examples: night or sleep terrors nightmares sleepwalking (somnambulism) nocturnal enuresis bruxism (teeth grinding) ```

Question 57

what is night or sleep terror?

Answer 57

partial arousal from deep, non-dreaming sleep

Question 58

what is a nightmare

Answer 58

frightening dreams followed by full arousal

Question 59

what is dyssomnia

Answer 59

difficulty falling asleep, overstimulation, bedtime fears

Question 60

what is nocturnal enuresis?

Answer 60

bedwetting

Question 61

simple interventions for nocturnal enuresis

Answer 61

``` fluid restriction near bedtime scheduled wakening reward system bladder training enuresis training ```

Question 62

what is restless leg syndrome?

Answer 62

condition in which the client cannot lay still - unpleasant creeping, crawling, or tingling sensation in the legs, making the legs move

Question 63

what are the components of a sleep history?

Answer 63

``` age nature of the problem signs and symptoms severity onset and duration predisposing factors or stressors medications effect on client what has been done to help it ```