Pulmonary Notes
I. Nursing Management: Insomnia
Assessment
● Sleep History: Assess sleep duration, patterns, and daytime alertness using self-reports
and objective data. Keep in mind that many patients won't volunteer this info; you must
ask directly.
● Substance Use: Ask about diet, caffeine, alcohol (often misused as a sleep aid), and
sleep aids (OTC, prescription, and herbal).
○ Caution with Supplements: Herbal supplements (valerian, melatonin, kava) lack
FDA oversight. Kava is specifically noted for causing liver toxicity.
● Sleep Diary: Encourage patients to keep a 1- to 2-week sleep diary (apps or printable
logs) to track sleep patterns.
● Medical History: Screen for conditions that disrupt sleep, such as benign prostatic
hyperplasia (frequent nighttime voiding), mental health disorders (depression, PTSD),
and chronic pain (e.g., arthritis).
● Lifestyle: Assess work schedules (shift work) and travel.
Implementation & Care
● Mild to Moderate Insomnia: Focus on sleep hygiene practices.
○ Caffeine: Limit intake. Caffeine has a half-life of ~6 hours (up to 9 hours in older
adults). Avoid caffeinated beverages 6 to 9 hours before bedtime.
○ Environment: Keep the bedroom dark, quiet, and cool. Remove or hide the clock
to reduce sleep-anxiety.
● Chronic Insomnia: Requires more intensive interventions, primarily Cognitive-
Behavioral Therapy for Insomnia (CBT-I).
● Medication Teaching:
○ Take sleep medications right before bedtime.
○ Ensure the patient has time for a full night's sleep (6 to 8 hours).
○ Avoid high-fat foods near bedtime (delays medication absorption).
○ Do not mix with alcohol or other CNS depressants.
○ Do not plan activities requiring fine psychomotor coordination for the next
morning.
II. Obstructive Sleep Apnea (OSA)
OSA (also called sleep-disordered breathing) is characterized by partial or complete upper
airway obstruction during sleep.
Pathophysiology & Triggers
● Mechanism: Occurs due to narrowing of air passages from muscle relaxation, or the
tongue/soft palate falling backward.
● Apnea vs. Hypopnea: * Apnea: Cessation of airflow (90%+ decrease) lasting longer
than 10 seconds.
○ Hypopnea: Shallow respirations (30% to 90% decrease in airflow).
● The Cycle: Obstruction causes hypoxemia (decreased oxygen) and hypercapnia
(increased carbon dioxide) $\rightarrow$ stimulates ventilation $\rightarrow$ patient
I. Nursing Management: Insomnia
Assessment
● Sleep History: Assess sleep duration, patterns, and daytime alertness using self-reports
and objective data. Keep in mind that many patients won't volunteer this info; you must
ask directly.
● Substance Use: Ask about diet, caffeine, alcohol (often misused as a sleep aid), and
sleep aids (OTC, prescription, and herbal).
○ Caution with Supplements: Herbal supplements (valerian, melatonin, kava) lack
FDA oversight. Kava is specifically noted for causing liver toxicity.
● Sleep Diary: Encourage patients to keep a 1- to 2-week sleep diary (apps or printable
logs) to track sleep patterns.
● Medical History: Screen for conditions that disrupt sleep, such as benign prostatic
hyperplasia (frequent nighttime voiding), mental health disorders (depression, PTSD),
and chronic pain (e.g., arthritis).
● Lifestyle: Assess work schedules (shift work) and travel.
Implementation & Care
● Mild to Moderate Insomnia: Focus on sleep hygiene practices.
○ Caffeine: Limit intake. Caffeine has a half-life of ~6 hours (up to 9 hours in older
adults). Avoid caffeinated beverages 6 to 9 hours before bedtime.
○ Environment: Keep the bedroom dark, quiet, and cool. Remove or hide the clock
to reduce sleep-anxiety.
● Chronic Insomnia: Requires more intensive interventions, primarily Cognitive-
Behavioral Therapy for Insomnia (CBT-I).
● Medication Teaching:
○ Take sleep medications right before bedtime.
○ Ensure the patient has time for a full night's sleep (6 to 8 hours).
○ Avoid high-fat foods near bedtime (delays medication absorption).
○ Do not mix with alcohol or other CNS depressants.
○ Do not plan activities requiring fine psychomotor coordination for the next
morning.
II. Obstructive Sleep Apnea (OSA)
OSA (also called sleep-disordered breathing) is characterized by partial or complete upper
airway obstruction during sleep.
Pathophysiology & Triggers
● Mechanism: Occurs due to narrowing of air passages from muscle relaxation, or the
tongue/soft palate falling backward.
● Apnea vs. Hypopnea: * Apnea: Cessation of airflow (90%+ decrease) lasting longer
than 10 seconds.
○ Hypopnea: Shallow respirations (30% to 90% decrease in airflow).
● The Cycle: Obstruction causes hypoxemia (decreased oxygen) and hypercapnia
(increased carbon dioxide) $\rightarrow$ stimulates ventilation $\rightarrow$ patient
