Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 5 Pharmacodynamics.
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Transcript of Chapter 19 Sleep-Wake Disorders Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier...
Chapter 19
Sleep-Wake Disorders
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Excessive sleepiness Sleep deprivation Mental and physical problems Psychomotor impairment Increased risk for errors
Consequences of Sleep Loss
2Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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
3Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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
4Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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
5Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Hypersomnia disorders Narcolepsy/hypocretin deficiency Breathing-related sleep disorders Circadian rhythm disorders Disorders of arousal
Sleep Disorders
6Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Nightmare disorder Rapid eye movement sleep behavior disorder Restless leg syndrome Substance-induced sleep disorders Insomnia
Sleep Disorders (Cont.)
7Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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
8Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Excessive daytime sleepiness Chronic—begins in young adulthood Excessive sleepiness impairs social and
vocational functioning Treatment—maintain regular sleep-wake
schedules, pharmacotherapy
Hypersomnolence Disorders
9Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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
10Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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
11Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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
12Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Difficulty with sleep initiation Sleep maintenance Early awakening Nonrefreshing, nonrestorative sleep Symptoms three times a week for at least 3
months
Insomnia Disorder
13Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Predisposing Precipitating and Perpetuating factors
3P Model of Insomnia
14Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Assessment General assessment—sleep patterns Identifying sleep disorders Functioning and safety
Nursing Process
15Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Nursing diagnosis Insomnia Sleep deprivation Disturbed sleep pattern Readiness for enhanced sleep
Nursing Process (Cont.)
16Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Outcomes identification Sleep Rest Risk control Personal well-being
Planning
Nursing Process (Cont.)
17Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Implementation Counseling Health teaching and health promotion Pharmacological interventions
Advanced practice interventions Cognitive-behavioral therapy
Nursing Process (Cont.)
18Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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.)
19Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
1. Narcolepsy is a type of
A. Amnesia
B. Sleep disorder
C. Somaticization disorder
Audience Response Questions
20Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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
21Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.