1. Chapter 19 Sleep-Wake Disorders Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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

3.  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 3 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

4.  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 4 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

5.  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 5 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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

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

8.  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 8 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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

10.  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 10 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

11.  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 11 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

12.  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 12 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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

14.  Predisposing  Precipitating and  Perpetuating factors 3P Model of Insomnia 14 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

15.  Assessment  General assessment—sleep patterns  Identifying sleep disorders  Functioning and safety Nursing Process 15 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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

17.  Outcomes identification  Sleep  Rest  Risk control  Personal well-being  Planning Nursing Process (Cont.) 17 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

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

19.  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.) 19 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

20. 1.Narcolepsy is a type of A.Amnesia B.Sleep disorder C.Somaticization disorder Audience Response Questions 20 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

21. 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 21 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.