8
Sleep and Sleep Disorders
Diana Taibi Buchanan and Nathan J. Dreesmann
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Functional Ability Sleep
Mood and Affect
LEARNING OUTCOMES
1. Define sleep. 5. Describe the etiology, clinical manifestations, and
2. Describe the stages of sleep. interprofessional and nursing management of obstructive
3. Explain the relationship of various health problems and sleep apnea.
sleep disorders. 6. Describe clinical manifestations and interprofessional
4. Describe the etiology, clinical manifestations, and management of narcolepsy, parasomnias, and circadian
interprofessional and nursing management of insomnia. rhythm disorders.
7. Select strategies for managing sleep problems associated
with shift work sleep disorder.
KEY TERMS
circadian rhythms shift work sleep disorder
continuous positive airway pressure (CPAP) sleep
insomnia sleep-disordered breathing (SDB)
jet lag disorder sleep disorders
narcolepsy sleep disturbance
obstructive sleep apnea (OSA) sleep hygiene
parasomnias wake behavior
periodic limb movement disorder (PLMD)
SLEEP
Most adults need 7 to 8 hours of sleep within a 24-hour period.1
Sleep is a state in which a person lacks conscious awareness of Sleep insufficiency is sleep that does not support optimal alertness,
environmental surroundings but can be easily aroused. Sleep functioning, and health. It may be caused by sleep deprivation or
is distinct from unconscious states such as coma, in which the sleep fragmentation. Sleep deprivation is too little sleep to meet
person cannot be aroused. Sleep is a basic, dynamic, highly the person’s needs. Sleep fragmentation means a person frequently
organized, and complex behavior that is essential for healthy wakes up or almost wakes (called an arousal), interrupting con-
functioning and survival. Over a life span of 80 years, a per- tinuous sleep. Sleep fragmentation may create negative outcomes
son who sleeps 7 hours each night will spend around 24 years even when a person gets the right amount of sleep.
sleeping. Sleep influences mood, behavior, and physical func- Sleep disturbance is a broad term that refers to poor sleep
tioning. Some functions sleep affects are memory, mood, hor- quality from various causes. Sleep disturbance may be related to
mone secretion, glucose metabolism, immune function, and environmental factors such as noise or light. It can be caused by
body temperature. health-related factors such as pain or by sleep disorders. Sleep
105
, 106 SECTION 2 Problems Related to Comfort and Coping
DC
28.5%–31.9%
32.0%–34.9%
35.0%–37.9%
38.0%–44.1%
Fig. 8.1 US adults that obtain less than 7 hours of sleep each night. (Modified from www.cdc.gov/sleep/
data_statistics.html.)
disorders include insomnia, obstructive sleep apnea syndrome, reticular activating system (ARAS), promote general activation
periodic limb movement disorder, circadian sleep disorders, of the cerebral cortex, which is responsible for higher brain
narcolepsy, and parasomnias. functions. This activation gives rise to typical wake behaviors
Sleep disturbances and sleep disorders can result in insuf- such as alertness and attention. Various neurotransmitters (glu-
ficient sleep. Many people get insufficient sleep because they tamate, acetylcholine, norepinephrine, dopamine, histamine,
simply are not in bed long enough to allow for an adequate serotonin) promote wake behavior.5
amount of sleep. About 35% of Americans get less than the rec- People with Alzheimer disease lose cholinergic neurons in
ommended 7 hours of sleep per night. An estimated 50 to 70 the forebrain, which results in sleep disturbances. In Parkinson
million people in the United States have a sleep disorder.2 Many disease, wake-promoting dopamine neurons in the ARAS
are unaware that they have a problem (Fig. 8.1). People with degenerate. This causes daytime sleepiness. Histamine neurons
chronic illnesses have the greatest risk for sleep disturbances. in the hypothalamus also stimulate cortical activation and wake
Untreated sleep disorders cause considerable health, safety, behavior. The sedating properties of certain sleep medications
and economic consequences. Severe daytime sleepiness can result from inhibiting histamine-related arousal.6
interfere with work and social functioning. Driving while Orexin (also called hypocretin) is a neuropeptide found in
drowsy is related to around 90,000 accidents and nearly 800 the hypothalamus. Orexin is involved in regulating the sleep-
deaths per year.3 Sleep disorders, sleep loss, and excessive day- wake cycle. It plays an important role in keeping people awake.
time sleepiness cost the United States billions of dollars each Orexin inhibitors, a newer class of prescription sleep medica-
year in health care, work-related accidents, and lost productiv- tion, block the wake-promoting effects of orexin. Decreased
ity.4 Opportunities to address sleep problems are often missed levels of orexin or its receptors lead to problems staying awake,
because health care providers (HCPs) do not ask, and patients which is a syndrome called narcolepsy.6
do not readily talk about them.
Sleep Behavior
PHYSIOLOGIC SLEEP MECHANISMS An area in the hypothalamus just above the optic chiasm con-
tains many sleep-promoting neurons. These neurons inhibit the
Sleep-Wake Cycle ARAS and promote sleep. A variety of neurotransmitters and
The brain controls the cyclic changes between sleep and waking. peptides promote sleep. These include γ-aminobutyric acid
Complex networks in the areas of the forebrain (cerebral cortex, (GABA), galanin, melatonin, adenosine, somatostatin, growth
hypothalamus, thalamus) and brainstem interact to regulate the hormone–releasing hormone (GHRH), delta-sleep–inducing
sleep-wake cycle. peptide, prostaglandins, and proinflammatory cytokines. When
a person has an infection, proinflammatory cytokines (interleu-
Wake Behavior kin-1, tumor necrosis factor, interleukin-6) contribute to sleep-
Wake behavior is maintained by an integrated network of iness and lethargy.5
arousal systems from the brainstem and forebrain. A cluster Melatonin is a hormone made by the pineal gland in the brain.
of neuron structures in the brainstem, called the ascending Melatonin secretion is linked to the environmental light-dark
Sleep and Sleep Disorders
Diana Taibi Buchanan and Nathan J. Dreesmann
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Functional Ability Sleep
Mood and Affect
LEARNING OUTCOMES
1. Define sleep. 5. Describe the etiology, clinical manifestations, and
2. Describe the stages of sleep. interprofessional and nursing management of obstructive
3. Explain the relationship of various health problems and sleep apnea.
sleep disorders. 6. Describe clinical manifestations and interprofessional
4. Describe the etiology, clinical manifestations, and management of narcolepsy, parasomnias, and circadian
interprofessional and nursing management of insomnia. rhythm disorders.
7. Select strategies for managing sleep problems associated
with shift work sleep disorder.
KEY TERMS
circadian rhythms shift work sleep disorder
continuous positive airway pressure (CPAP) sleep
insomnia sleep-disordered breathing (SDB)
jet lag disorder sleep disorders
narcolepsy sleep disturbance
obstructive sleep apnea (OSA) sleep hygiene
parasomnias wake behavior
periodic limb movement disorder (PLMD)
SLEEP
Most adults need 7 to 8 hours of sleep within a 24-hour period.1
Sleep is a state in which a person lacks conscious awareness of Sleep insufficiency is sleep that does not support optimal alertness,
environmental surroundings but can be easily aroused. Sleep functioning, and health. It may be caused by sleep deprivation or
is distinct from unconscious states such as coma, in which the sleep fragmentation. Sleep deprivation is too little sleep to meet
person cannot be aroused. Sleep is a basic, dynamic, highly the person’s needs. Sleep fragmentation means a person frequently
organized, and complex behavior that is essential for healthy wakes up or almost wakes (called an arousal), interrupting con-
functioning and survival. Over a life span of 80 years, a per- tinuous sleep. Sleep fragmentation may create negative outcomes
son who sleeps 7 hours each night will spend around 24 years even when a person gets the right amount of sleep.
sleeping. Sleep influences mood, behavior, and physical func- Sleep disturbance is a broad term that refers to poor sleep
tioning. Some functions sleep affects are memory, mood, hor- quality from various causes. Sleep disturbance may be related to
mone secretion, glucose metabolism, immune function, and environmental factors such as noise or light. It can be caused by
body temperature. health-related factors such as pain or by sleep disorders. Sleep
105
, 106 SECTION 2 Problems Related to Comfort and Coping
DC
28.5%–31.9%
32.0%–34.9%
35.0%–37.9%
38.0%–44.1%
Fig. 8.1 US adults that obtain less than 7 hours of sleep each night. (Modified from www.cdc.gov/sleep/
data_statistics.html.)
disorders include insomnia, obstructive sleep apnea syndrome, reticular activating system (ARAS), promote general activation
periodic limb movement disorder, circadian sleep disorders, of the cerebral cortex, which is responsible for higher brain
narcolepsy, and parasomnias. functions. This activation gives rise to typical wake behaviors
Sleep disturbances and sleep disorders can result in insuf- such as alertness and attention. Various neurotransmitters (glu-
ficient sleep. Many people get insufficient sleep because they tamate, acetylcholine, norepinephrine, dopamine, histamine,
simply are not in bed long enough to allow for an adequate serotonin) promote wake behavior.5
amount of sleep. About 35% of Americans get less than the rec- People with Alzheimer disease lose cholinergic neurons in
ommended 7 hours of sleep per night. An estimated 50 to 70 the forebrain, which results in sleep disturbances. In Parkinson
million people in the United States have a sleep disorder.2 Many disease, wake-promoting dopamine neurons in the ARAS
are unaware that they have a problem (Fig. 8.1). People with degenerate. This causes daytime sleepiness. Histamine neurons
chronic illnesses have the greatest risk for sleep disturbances. in the hypothalamus also stimulate cortical activation and wake
Untreated sleep disorders cause considerable health, safety, behavior. The sedating properties of certain sleep medications
and economic consequences. Severe daytime sleepiness can result from inhibiting histamine-related arousal.6
interfere with work and social functioning. Driving while Orexin (also called hypocretin) is a neuropeptide found in
drowsy is related to around 90,000 accidents and nearly 800 the hypothalamus. Orexin is involved in regulating the sleep-
deaths per year.3 Sleep disorders, sleep loss, and excessive day- wake cycle. It plays an important role in keeping people awake.
time sleepiness cost the United States billions of dollars each Orexin inhibitors, a newer class of prescription sleep medica-
year in health care, work-related accidents, and lost productiv- tion, block the wake-promoting effects of orexin. Decreased
ity.4 Opportunities to address sleep problems are often missed levels of orexin or its receptors lead to problems staying awake,
because health care providers (HCPs) do not ask, and patients which is a syndrome called narcolepsy.6
do not readily talk about them.
Sleep Behavior
PHYSIOLOGIC SLEEP MECHANISMS An area in the hypothalamus just above the optic chiasm con-
tains many sleep-promoting neurons. These neurons inhibit the
Sleep-Wake Cycle ARAS and promote sleep. A variety of neurotransmitters and
The brain controls the cyclic changes between sleep and waking. peptides promote sleep. These include γ-aminobutyric acid
Complex networks in the areas of the forebrain (cerebral cortex, (GABA), galanin, melatonin, adenosine, somatostatin, growth
hypothalamus, thalamus) and brainstem interact to regulate the hormone–releasing hormone (GHRH), delta-sleep–inducing
sleep-wake cycle. peptide, prostaglandins, and proinflammatory cytokines. When
a person has an infection, proinflammatory cytokines (interleu-
Wake Behavior kin-1, tumor necrosis factor, interleukin-6) contribute to sleep-
Wake behavior is maintained by an integrated network of iness and lethargy.5
arousal systems from the brainstem and forebrain. A cluster Melatonin is a hormone made by the pineal gland in the brain.
of neuron structures in the brainstem, called the ascending Melatonin secretion is linked to the environmental light-dark
