Sleep

Question 1

What are the 9 things to promote sleep?

Answer 1

1. Avoid stimulants at least 4-6 hours before bedtime (caffeine, alcohol, nicotine)
2. Remove unnecessary light and noise
3. Establish bedtime routine
4. Keep room dark, quiet, and comfortable, cool temperature
5. Only go to bed when tired. Read or listen to music if unable to fall asleep
6. Keep consistent sleep-wake cycle
7. Keep naps short (>30 minutes)
8. Engage in regular exercise and healthy eating. Stop exercise AT LEAST 3 hours before going to bed
9. Remove work and electronics (TVs, computers, tablets) from bedroom.

Question 2

What are the 4 contributing factors to sensory overload?

Answer 2

Use of cellphone, night-shift workers, eating too close to bedtime, menopause

Question 3

What are some sleep disorders?

Answer 3

• Insomnia –> difficulty falling asleep or staying asleep, waking up early, or feeling tired when waking.
• Central sleep apnea –> brain doesn’t send proper signals to the respiratory muscles resulting in the stops of breathing.
• Obstructive sleep apnea –> the muscles that control your airway relax too much, narrowing your throat & blocking airway.
• Narcolepsy –> sudden sleepiness and sudden periods of sleep. Clients with narcolepsy have difficulty staying awake. They may also experience nocturnal hallucinations, paralysis while asleep, and vivid dreams
• Hypersomnia –> excessive daytime fatigue without improvement after more sleep.
• Restless leg syndrome –> uncontrollable urge to move the legs

Question 4

What are the Pharmacological Nursing interventions to promote rest & sleep?

Answer 4

1. GABA agonists
2. Nonbenzodiazepine hypnotics (Ambien/Zolpidem)
   - don’t take it long term bc it can cause addictions
3. Benzodiazepines (reversal agent = Flumazenil)
   - Long half-life (8-24hrs)
   - Effects: CNS depression, tolerance, drowsiness, dependence, withdrawal, anterograde amnesia, vivid dreams
   - Use no longer than 3-4 weeks
   - Avoid alcohol & other CNS depressants
4. Melatonin
5. Antidepressants
6. Antihistamines –> EX: Benadryl. Not used for sleep!

Question 5

What is the reversal agent for Benzodiazepines?

Answer 5

FLUMAZENIL!!

Question 6

What are the Non-pharmacological Nursing interventions to promote rest & sleep?

Answer 6

Alternative therapies:
- Acupuncture,
- Thermotherapy
- Massage
- Yoga
- CAM :
1. Valvarian - mild sedative
2. Kava Kava - risk of liver toxicity; shouldn’t be used indefinitely
3. Chamomile - mild sedative
- Lifestyle changes
- Stress reductions
- Keeping a sleep diary

Question 7

What do you need to keep in mind about Pharmacology medications for older adults?

Answer 7

1. Absorption differs
2. Starts with lower dose
3. Find & treat cause
4. Avoid barbiturates
5. Don’t take benzodiazepines more than 4x a week!
   - Try NSAIDS to alleviate pain

Question 8

What are some Pharmacological challenges with sleep aides?

Answer 8

1. Hangover - residual drowsiness
2. REM rebound - vivid dreams/nightmares with sustained hypnotic use and sudden stop
3. Physical and/or psychological dependence with chronic use:
   A. Symptoms start within 24 hours, may last for several days
   B. Symptoms: twitching/tremors, dizziness, orthostatic hypotension, delusions, hallucinations, delirium, and seizures
4. Tolerance - requiring increased dose for same effect over time (Reversible with discontinuation)
5. Respiratory depression due to suppression of center in medulla (breathing r slower & shallower than normal)
   - Assess this when your patient has taken a Benzo for sleep!!
6. Excessive depression due to long term use: lethargy, sleepiness, confusion, physiological dependence
7. Avoid CAM therapies: kava kava (liver) and valerian

Question 9

What are some Physiological vs Psychological symptoms of the sleep deprivation?

Answer 9

PHYSIOLOGICAL:
1. Ptosis/droopy eye, blurred vision
2. Fine-motor clumsiness
3. Decreased reflexes
4. Slowed response time
5. Decreased reasoning and judgement
6. Decreased auditory and visual alertness
7. Cardiac arrhythmias (irregular heartbeat)

PSYCHOLOGICAL:
1. Confused and disoriented
2. Increased sensitivity to pain
3. Irritable, withdrawn (unsociable), apathetic (uninterested)
4. Agitated
5. Hyperactive
6. Decreased motivation
7. Excessive sleepiness

Question 10

What’s the difference between sleep and rest?

Answer 10

People can sleep but not affectively rest.
Resting allows the person to close their eyes, relax their mind, and clear their thoughts. Although the individual is still awake, their muscles and organs have a chance to relax.

Question 11

The nurse is administering a benzodiazepine sleep aid to an older adult. What should be the priority assessment for the patient?
A. Incontinence
B. Nausea and vomiting
C. Bradycardia
D. Respiratory depression

Answer 11

ANSWER: D

Because remember the pharmacological challenges with sleep aides include Respiratory Depression where breathing are slower & shallower than normal. SO, assess this when your patient has taken a Benzo for sleep!!

Question 12

What is an example of an Antihistamines?
In which case should you not use Antihistamine?

Answer 12

Benadryl!!
Don’t use for sleep!! It will make you drowsy

Question 13

What is an examples of nonbenzodiazepine hypnotics?

Answer 13

Ambien/Zolpidem

Question 14

What is an adverse effects of Benzodiazepines?

Answer 14

CNS depressions, tolerance, drowsiness, dependance, withdrawal, anterograde amnesia, vivid dreams