10 Sleep Disorders
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- Words: 1,137
- Pages: 27
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 1
Fifth Edition
Linda D. Urden Kathleen M. Stacy Mary E. Lough
Chapter 6 Sleep Alterations and Management
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 2
Overview • Characteristics of normal human sleep and chronobiology • Changes in sleep associated with aging and pharmacology • Abnormal sleep patterns affecting critically ill patients • Research-based nursing care for critically ill patients with sleep disturbances
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 3
Objectives • Identify the stages of sleep. • Explain the physiologic effects of rapid eye • • • • •
movement (REM) sleep. Describe circadian desynchronization and its primary effects. Depict the changes in sleep resulting from the aging process and chronic illness. Name the commonly prescribed medications that affect REM sleep. Delineate the consequences of disrupted sleep. Describe nursing interventions that are essential in the treatment of disturbed sleep patterns. Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 4
Sleep Physiology Definition of Sleep A reversible behavioral state of perceptual disengagement from and unresponsiveness to the environment • • •
Electroencephalography (EEG) Electrooculography (EOG) Electrocardiography (ECG)
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 5
Sleep Stages Non-rapid eye movement (NREM) sleep
• Stage 1: 2-5% • Stage 2: 45-55% • Stage 3: 3-8%
Transitional lighter sleep Deeper sleep Slow wave activity 20% of
EEG Stage 4: 10-15% EEG
Slow wave activity 50% of
•
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 6
Sleep Stages (cont’d) Stages 3 and 4 are referred to as slow-wave sleep or delta sleep • • • •
Parasympathetic nervous system predominates Hormonal changes to promote anabolism Protein synthesis and tissue repair Restorative period
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 7
Sleep Stages (cont’d) Rapid Eye Movement Sleep • • •
20-25% in young adults “Dream” stage Sympathetic nervous system predominates – Increased oxygen consumption – Increased BP, pulse, respirations, CO – Increased chance of plaque rupture due to surges in pressure and changes in coronary artery tone
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 8
Sleep Changes in Aging • Less restful sleep • Fragmented sleep patterns
Cardiac disease, diabetes, nocturia, restless legs, pain Respiratory disorders and sleep apnea Altered circadian rhythms
• Social and physical changes
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 9
Elderly Sleep in Critical Care Altered sleep patterns
Pain, stress, respiratory insufficiency Accommodate age-related changes
Interventions • • •
Control of environmental noise and light Use of white noise, music, massage Allow blocks of time for sleep
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 10
Chronobiology Circadian Rhythms from Suprachiasmatic Nucleus (SCN) in Hypothalamus •
Internal controls – Body temperature – Sleep/wake cycle
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 11
Chronobiology (cont’d) Circadian Rhythms •
•
External controls – Posture – Exercise – Light Homeostatic mechanisms of sleep regulation
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 12
Chronobiology (cont’d) • Models of sleep regulation
Two-process model Two-oscillator model
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 13
Pharmacology of Sleep Hypnotics •
• •
Lighter sleep stages and higher lipophilicity – Night tremors, nightmares, agitation in elderly – Decreased metabolism by steroids – Increased metabolism if smokers Antegrade amnesia May affect breathing in COPD
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 14
Pharmacology of Sleep (cont’d) Stimulants: High Abuse Potential • • • •
Irritability, PNS symptoms, insomnia, GI complaints, dyskinesias Euphoria, dysphoria, paranoia, psychosis Sustained use: cognitive and behavior problems can occur TRY ALTERNATIVES!
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 15
Pharmacology of Sleep (cont’d) Alcohol • • • •
Suppresses REM sleep >2 drinks increases Stage 1 and 2 NREM sleep and decreases onset of slow-wave sleep May cause shallow fragmented sleep May aggravate airway maintenance
Look for alternative medicine (herbs, etc.)
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 16
Abnormal Sleep: Disturbances in Critically Ill Patients • Definition: Insufficient duration or stages of sleep that result in discomfort and interfere in quality of life • Lack of sleep in critical care Disturbance in sleep architecture Diminished daytime performance
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 17
Abnormal Sleep: Disturbances in Critically Ill Patients (cont’d) • Lack of sleep in critical care Residual daytime fatigue Dependence, tolerance REM suppression and rebound sleep
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 18
Abnormal Sleep: Disturbances in Critically Ill Patients (cont’d) Etiology • • • • • • • •
Psychological stress/anxiety Environment stressors Surgical stress Noise, interruptions for care/lack of sleep Painful procedures Excessive light Bed rest Isolation
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 19
Abnormal Sleep: Disturbances in Critically Ill Patients (cont’d) Pathophysiology • • • •
Physiologic and psychologic exhaustion Hormonal changes Changes in mood and performance Increased pain due to decreased somatostatin and increased substance
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 20
Assessment and Diagnosis of Sleep Problems in Critical Care • • • • •
Description of normal sleep pattern Habits to enhance sleep Recent changes in normal sleep pattern Recent problems during sleep hours History of chronic illnesses (e.g., COPD, arthritis, GI problems) • Assess psychological response to critical care
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 21
Management of Sleep Problems in Critical Care • Medical management
Sedative/hypnotics Nonbenzodiazepine, short-acting hypnotics
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 22
Management of Sleep Problems in Critical Care (cont’d) • Nursing management
Nursing interventions • • • • • •
Massage Audiotapes Promote caring, relaxing environment Limit interruptions Reduce environmental noise Maintain lighting according to circadian rhythms
Assess results Design units to support rest
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 23
Sleep Apnea Syndrome • Definition: sleep-disordered breathing
Obstructive apnea (>10 seconds or more) • Hypopnea: partial obstruction
Central: lack of muscle effort Mixed: both types in one apneic event
• Apnea-hypopnea index
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 24
Sleep Apnea Syndrome • Obstructive sleep apnea
Definition and etiology Pathophysiology • • • • •
Hypoxemia Hypercapnia Acidosis Systemic and pulmonary hypertension Cardiac dysrhythmias: fast and slow
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 25
Sleep Apnea Syndrome (cont’d) • Obstructive sleep apnea
Assessment and diagnoses Medical management Nursing management
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 26
Sleep Apnea Syndrome (cont’d) • Central sleep apnea
Definition, etiology, and pathophysiology Assessment and diagnoses Medical management Nursing management
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 27
Slide 1
Fifth Edition
Linda D. Urden Kathleen M. Stacy Mary E. Lough
Chapter 6 Sleep Alterations and Management
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 2
Overview • Characteristics of normal human sleep and chronobiology • Changes in sleep associated with aging and pharmacology • Abnormal sleep patterns affecting critically ill patients • Research-based nursing care for critically ill patients with sleep disturbances
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 3
Objectives • Identify the stages of sleep. • Explain the physiologic effects of rapid eye • • • • •
movement (REM) sleep. Describe circadian desynchronization and its primary effects. Depict the changes in sleep resulting from the aging process and chronic illness. Name the commonly prescribed medications that affect REM sleep. Delineate the consequences of disrupted sleep. Describe nursing interventions that are essential in the treatment of disturbed sleep patterns. Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 4
Sleep Physiology Definition of Sleep A reversible behavioral state of perceptual disengagement from and unresponsiveness to the environment • • •
Electroencephalography (EEG) Electrooculography (EOG) Electrocardiography (ECG)
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 5
Sleep Stages Non-rapid eye movement (NREM) sleep
• Stage 1: 2-5% • Stage 2: 45-55% • Stage 3: 3-8%
Transitional lighter sleep Deeper sleep Slow wave activity 20% of
EEG Stage 4: 10-15% EEG
Slow wave activity 50% of
•
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 6
Sleep Stages (cont’d) Stages 3 and 4 are referred to as slow-wave sleep or delta sleep • • • •
Parasympathetic nervous system predominates Hormonal changes to promote anabolism Protein synthesis and tissue repair Restorative period
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 7
Sleep Stages (cont’d) Rapid Eye Movement Sleep • • •
20-25% in young adults “Dream” stage Sympathetic nervous system predominates – Increased oxygen consumption – Increased BP, pulse, respirations, CO – Increased chance of plaque rupture due to surges in pressure and changes in coronary artery tone
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 8
Sleep Changes in Aging • Less restful sleep • Fragmented sleep patterns
Cardiac disease, diabetes, nocturia, restless legs, pain Respiratory disorders and sleep apnea Altered circadian rhythms
• Social and physical changes
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 9
Elderly Sleep in Critical Care Altered sleep patterns
Pain, stress, respiratory insufficiency Accommodate age-related changes
Interventions • • •
Control of environmental noise and light Use of white noise, music, massage Allow blocks of time for sleep
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 10
Chronobiology Circadian Rhythms from Suprachiasmatic Nucleus (SCN) in Hypothalamus •
Internal controls – Body temperature – Sleep/wake cycle
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 11
Chronobiology (cont’d) Circadian Rhythms •
•
External controls – Posture – Exercise – Light Homeostatic mechanisms of sleep regulation
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 12
Chronobiology (cont’d) • Models of sleep regulation
Two-process model Two-oscillator model
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 13
Pharmacology of Sleep Hypnotics •
• •
Lighter sleep stages and higher lipophilicity – Night tremors, nightmares, agitation in elderly – Decreased metabolism by steroids – Increased metabolism if smokers Antegrade amnesia May affect breathing in COPD
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 14
Pharmacology of Sleep (cont’d) Stimulants: High Abuse Potential • • • •
Irritability, PNS symptoms, insomnia, GI complaints, dyskinesias Euphoria, dysphoria, paranoia, psychosis Sustained use: cognitive and behavior problems can occur TRY ALTERNATIVES!
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 15
Pharmacology of Sleep (cont’d) Alcohol • • • •
Suppresses REM sleep >2 drinks increases Stage 1 and 2 NREM sleep and decreases onset of slow-wave sleep May cause shallow fragmented sleep May aggravate airway maintenance
Look for alternative medicine (herbs, etc.)
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 16
Abnormal Sleep: Disturbances in Critically Ill Patients • Definition: Insufficient duration or stages of sleep that result in discomfort and interfere in quality of life • Lack of sleep in critical care Disturbance in sleep architecture Diminished daytime performance
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 17
Abnormal Sleep: Disturbances in Critically Ill Patients (cont’d) • Lack of sleep in critical care Residual daytime fatigue Dependence, tolerance REM suppression and rebound sleep
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 18
Abnormal Sleep: Disturbances in Critically Ill Patients (cont’d) Etiology • • • • • • • •
Psychological stress/anxiety Environment stressors Surgical stress Noise, interruptions for care/lack of sleep Painful procedures Excessive light Bed rest Isolation
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 19
Abnormal Sleep: Disturbances in Critically Ill Patients (cont’d) Pathophysiology • • • •
Physiologic and psychologic exhaustion Hormonal changes Changes in mood and performance Increased pain due to decreased somatostatin and increased substance
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 20
Assessment and Diagnosis of Sleep Problems in Critical Care • • • • •
Description of normal sleep pattern Habits to enhance sleep Recent changes in normal sleep pattern Recent problems during sleep hours History of chronic illnesses (e.g., COPD, arthritis, GI problems) • Assess psychological response to critical care
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 21
Management of Sleep Problems in Critical Care • Medical management
Sedative/hypnotics Nonbenzodiazepine, short-acting hypnotics
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 22
Management of Sleep Problems in Critical Care (cont’d) • Nursing management
Nursing interventions • • • • • •
Massage Audiotapes Promote caring, relaxing environment Limit interruptions Reduce environmental noise Maintain lighting according to circadian rhythms
Assess results Design units to support rest
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 23
Sleep Apnea Syndrome • Definition: sleep-disordered breathing
Obstructive apnea (>10 seconds or more) • Hypopnea: partial obstruction
Central: lack of muscle effort Mixed: both types in one apneic event
• Apnea-hypopnea index
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 24
Sleep Apnea Syndrome • Obstructive sleep apnea
Definition and etiology Pathophysiology • • • • •
Hypoxemia Hypercapnia Acidosis Systemic and pulmonary hypertension Cardiac dysrhythmias: fast and slow
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 25
Sleep Apnea Syndrome (cont’d) • Obstructive sleep apnea
Assessment and diagnoses Medical management Nursing management
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 26
Sleep Apnea Syndrome (cont’d) • Central sleep apnea
Definition, etiology, and pathophysiology Assessment and diagnoses Medical management Nursing management
Copyright © 2006 Mosby, Inc. All rights reserved.
Slide 27
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