Nursing 105

Essentials of Nursing Study Guide

©2018 Achieve Page 125 of 160 are when the sleep problem is the main disorder, as seen in insomnia, hypersomnia, narcolepsy, sleep apnea, and parasomnias. Secondary sleep disorders are sleep disturbances caused by other disorders such as, thyroid dysfunction, depression, andalcoholism. Insomnia is the most common sleep disorder. Initial insomnia is difficulty falling asleep. Intermittent or maintenance insomnia is difficulty in staying asleep because of frequent or prolonged waking. Terminal insomnia is early morning or premature waking. Subjective or imaginary insomnia are obtaining more sleep than they say they do. Insomnia can result from pain but is more often related to mental overstimulation due to anxiety. Treatment for insomnia frequently requires the client to develop new behavior patterns that induce sleep. Hypersomnia is excessive sleep, particularly in the daytime. Contributing medical conditions include CNS damage and certain kidney, liver, or metabolic disorders, such as diabetic acidosis and hypothyroidism. Hypersomnia is used as a coping mechanism to avoid facing daily responsibilities. Narcolepsy is an overwhelming sleepiness that occurs during the day. Narcolepsy is a genetic defect of the CNS in which REM sleep cannot be controlled. Narcolepsy is often treated with CNS stimulants, such as amphetamines. A drug called Modafil is a central nervous system stimulant approved by the FDA that increases alertness without affecting other body systems. Physical Condition • Illnesses that cause pain or physical distress can result in sleep problems. • Health status, such as respiratory conditions, can disturb sleep. SOB makes sleep difficult. Patients with gastric or duodenal ulcers may find their sleep disturbed because of pain. Hyperthyroidism can lengthen pre-sleep time. Enuresis disrupts sleep and obesity contributes to sleep apnea. Environmental Factors Absence of usual stimuli or presence of unfamiliar stimuli can disturb sleep. Noise level can affect sleep. Relevance of the noise is important. Ventilation and environmental temperature affects sleep. Light levels can be another factor. Medications Drugs can disrupt REM sleep, delay onset of sleep, decrease sleep time, cause nightmares, and increase daytime drowsiness. Specific drugs known to effect sleep are alcohol, amphetamines, antidepressants, beta- blockers, bronchodilators, caffeine, decongestants, narcotics, and steroids. 6.4 Common Disturbances in Sleep Primary sleep disorders