Factors Affecting Sleep

5. Factors Affecting Sleep

A. developmental considerations – how many hrs. sleep each dev. stage sleeps.

B. psychological stress – may not get proper sleep, with stress REM sleep ↓, so anxiety ↑

C. motivation – desire to be wakeful, alert

D. culture – ie. kids who sleep with parents, bedtime rituals, place, position, pattern of sleep

E. lifestyle & habits – physical activity & exercise (exercise at least 2 hrs. prior to bedtime

contributes to sleep, if exercise ½ hr before bedtime, not help sleep. nicotine is a stimulant

6. Factors affecting sleep – con't.

A. dietary habits: L-tryptophan in cheese, milk, carbohydrates promote relaxation through

effects on brain serotonin

B. environmental factors – lighting, odors, ventilation, noise

C. medications – barbituates, amphetamines, antidepressants all ↓REM sleep, caffeine is CNS

stimulant. diuretics should not be given at bedtime, anti-Parkinsonian meds. and some

antihypertensives, caffeine, steroids, decongestants, or asthma meds can cause sleep problem

D. illness or large quantities of alcohol intake limit REM & Delta sleep

7. Medications

A. Tricyclic antidepressants – Amitriptyline & Doxepin

B. Antihistamines – Benadryl, Vistaril, & Atarax

C. Sedatives / Hypnotics – Lunesta, Ambien, & Sonata (all for sleep)

D. Benzodiazapine – Dalmane, Restoril (for sleep & anxiety)

E. Melatonin – Rozerem

8. Illness Associated with Sleep Disturbances

A. peptic ulcer (GI secretions ↑during REM sleep)

B. coronary artery disease – pain

C. epilepsy – seizures occur during NREM sleep

D. liver failure & encephalitis – reversal in day and night sleep

E. hypothyroidism ↓NREM sleep, especially stage II and stage IV

F. ESRD (end-stage renal disease) – disrupt nocturnal sleep, want to sleep in daytime

9. Sleep Disturbance Assessment Parameters

A. nature & cause of problem

B. signs & symptoms

C. Date & occurrence & effect on everyday living

D. severity of problem

E. treatment of problem

F. how the patient is coping with the problem

*hypothyroidism can alter stage II and stage IV sleep

10. Sleep Characteristics to Assess

    A. restlessness – can use Requip

    B. sleep posture – ie. pillows, on back, vs stomach

    C. sleep activities – smoking in bed (need to educate patient)

    D. snoring – obstruction to airflow through nose / mouth

    E. leg jerking – nocturnal "nyoclomus" muscle contraction

11. Information Recorded in a Sleep Diary

A. time patient retires

B. time patient tries to fall asleep

C. Approximate time patient falls asleep

D. Time of any awakening during the night & resumption of sleep

E. time awakening in the morning

F. presence of any stressors affecting sleep

12. Information Recorded in a Sleep Diary – con't

A. record of food, drink, or medications affecting sleep

B. record of physical & mental activities

C. record of activities 2-3 hrs before bedtime

D. presence of worries or anxieties affecting sleep

13. Key Findings of Physical Assessment

A. energy level – lethargic

B. facial characteristics – eyes glazed

C. behavioral characteristics – yawn, rub eyes, slumped, speech slow

D. physical data suggestive of sleep problems – very obese, enlarged neck, deviated septum

14. Classification of Sleep Disorders

A. dyssomnias

B. parasomnia

C. sleep disorders associated with medical or psychiatric disorders

D. other proposed disorders