Sleep and Sleep Disorders for your nursing exam. Sleep is defined as a physical and mental state in which consciousness is essentially suspended, the nervous system is relatively inert, and the eyes are closed. It normally lasts for an hour. Sleep disorders are situations where continuous sleep is repeatedly disrupted over extended periods of time.
Sleep Disorders Nursing Quiz
Which sleep statement is accurate?
a. Lack of sleep causes medical and psychiatric disorders.
b. Adults generally require at least 5 hours of sleep every 24 hours.
c. During sleep, an individual is not consciously aware of his or her environment.
d. Less than 10% of adults report at least one sleep problem, such as difficulty falling asleep.
Answer Key:
c. During sleep, individuals are not consciously aware of the environment. Lack of sleep does not cause medical and psychiatric disorders, although people with these diagnoses may have fragmented sleep. Most adults need 7 to 8 hours of sleep per day. In 2011, 87% of Americans reported sleep problems.
What are the clinical manifestations of insomnia (select all that apply)?
a. Narcolepsy
b. Fragmented sleep
c. Long sleep latency
d. Morning headache
e. Daytime sleepiness
f. Difficulty concentrating
Answer Key:
b, c, e, f. Manifestations of insomnia include difficulty falling asleep, frequent awakenings, prolonged nighttime awakening, awakening too early and not being able to fall back to sleep, feeling unrefreshed on awakening, and having daytime sleepiness and difficulty concentrating
What is a typical parasomnia?
a. Cataplexy
b. Hypopnea
c. Sleep apnea
d. Sleep terrors
Answer Key:
d. Sleep terrors, sleepwalking, and nightmares are parasomnias and unusual and often undesirable behaviors that occur while falling asleep, transitioning between sleep stages, or arousing from sleep. Cataplexy is a brief and sudden loss of skeletal muscle tone and is experienced with narcolepsy episodes. Hypopnea is slow, shallow respirations, and sleep apnea is the cessation of spontaneous respirations for longer than 10 seconds.
What controls the cyclic changes between waking and sleep?
a. Fluctuating levels of melatonin
b. The environmental light-dark cycles
c. A suprachiasmatic nucleus in the hypothalamus
Answer Key:
c. The suprachiasmatic nucleus in the hypothalamus is the master clock and controls the cyclic changes of wake and sleep through a complex arrangement of nerve pathways within the brainstem, hypothalamus, and thalamus. Melatonin is an endogenous hormone that increases sleep efficiency and is released in the evening related to darkness. The light-dark cycles influence our circadian rhythms and neuropeptides influence wake behavior. These all play a role in the sleep/wake cycle and are components of the nervous system but are regulated by the suprachiasmatic nucleus in the hypothalamus.
Match the descriptions to the stages of sleep. Some descriptions may have more than one stage, and some stages may be used more than once.
| a. Brain waves resemble wakefulness | 1. NREM stage 1 |
| b. Deepest sleep | 2. NREM stage 2 |
| c. Associated with specific EEG waveforms | 3. NREM stage 3 |
| d. Most vivid dreaming occurs | REM |
| e. 20% to 25% of sleep | |
| f. Person easily awakened | |
| g. Most of the night of sleep | |
| h. Slow eye movements | |
| i. Slowed heart rate, decreased body temperature | |
| j. Decreased occurrence in older adults |
Answer Key:
a. 4; b. 3; c. 2, 3; d. 3; e. 4; f. 1; g. 2; h. 1; i. 2; j. 3
List at least three behaviors or practices that can contribute to insomnia.
a.
b.
c.
Answer Key:
Any three of these can contribute to insomnia:
• Consumption of stimulants (caffeine, nicotine, methamphetamine) close to bedtime
• Side effect of medications (antidepressants, antihypertensives, corticosteroids, psychostimulants, analgesics)
• Drinking alcohol, or using over-the-counter medications as a sleep aid
• Long naps in the afternoon
• Sleeping in late
• Exercise near bedtime
• Jet lag
• Nightmares
• Stressful life event
• Medical conditions or psychiatric illnesses
• Irregular sleep/wake schedules
• Worry about getting enough sleep
Polysomnography (PSG) may be performed on a patient with signs and symptoms of a sleep disorder. What measures and observations does this study include (select all that apply)?
a. Heart rate monitoring
b. Noninvasive oxygen saturation (SpO2)
c. Surface body temperature fluctuations
d. Blood pressure monitoring (noninvasive)
e. Airflow measured at the nose and mouth
f. Muscle tone measured by electromyogram (EMG)
g. Respiratory effort around the chest and abdomen
h. Eye movements recorded by electrooculogram (EOG)
i. Brain activity recorded by an electroencephalogram (EEG)
j. Actigraph watch worn on the wrist to monitor motor activity
k. Gross body movements monitored via cameras and microphones
Answer Key:
a, b, e, f, g, h, i, k
What is the best therapy to try first for insomnia?
a. Complementary therapies such as melatonin
b. Cognitive-behavioral therapies such as relaxation therapy
c. Benzodiazepine-receptor agents (e.g., zolpidem [Ambien])
d. Over-the-counter medications such as diphenhydramine
Answer Key:
b. Cognitive-behavioral therapies for insomnia (CBT-I) are effective therapies for insomnia and should be tried first. These include relaxation techniques, guided imagery, education about good sleep hygiene, and regular exercise several hours before bedtime. The other therapies are used to treat insomnia, with benzodiazepine-receptor agents being the first choice for drug therapy. Many patients will try over-the-counter medications such as diphenhydramine, but tolerance develops rapidly. Complementary and alternative therapies such as melatonin have been found to be useful to help individuals with jet lag.
The nurse knows that a patient taught sleep hygiene practices needs further instruction when he says
a. “Once I go to bed, I should get up if I am not asleep after 20 minutes.”
b. “It’s okay to have my usual two glasses of wine in the evening before bed.”
c. “A couple of crackers with cheese and a glass of milk may help to relax before bed.”
d. “I should go to the gym earlier in the day so that I’m done at least 6 hours before bedtime.”
Answer Key:
b. Alcohol should not be consumed within 6 hours of bedtime. It is not recommended that a person lie in bed awake. A light snack with milk and cheese, which contain tryptophan, may help the person relax. Exercise is good but not within 6 hours of bedtime.
Patient-Centered Care: The patient is complaining of insomnia and daytime fatigue. Which beverage would be the best option for this patient with an afternoon snack?
a. Diet Coke
b. Dr. Pepper
c. Decaffeinated coffee
d. A&W root beer float
Answer Key:
d. A&W Root beer float has no caffeine, so this would be the best beverage in the afternoon. Diet Coke has 23–49 mg of caffeine; Dr. Pepper has 36–42 mg; decaffeinated coffee has 2–12 mg.
A nurse caring for a patient in the intensive care unit (ICU) implements strategies to create an environment conducive to sleep. Which strategy would be most effective?
a. Turning off the lights in the room during the night
b. Having the television on at all times for background noise
c. Silencing the alarms on the bedside monitor and infusion pumps
d. Administering ordered analgesics around the clock, even if the patient denies pain
Answer Key:
a. Reducing the light and noise levels in the ICU can help to promote opportunities for sleep. Having the TV on at all times will only add to the noise level. The alarms should not be silenced except for short periods to address why they were alarming. Silencing alarms to prevent them from making noise puts the patient at risk because the nurse may not be alerted to patient changes on the monitor or problems with the infusion device. Analgesics given for actual pain may help a patient to sleep or rest but they may also alter sleep.
Which medication is a nonamphetamine wake-promotion drug that may be used for narcolepsy?
a. Modafinil (Provigil)
b. Suvorexant (Belsomra)
c. Protriptyline (Vivactil)
d. Desipramine (Norpramin)
Answer Key:
a. Modafinil (Provigil) is a nonamphetamine wake-promotion drug used with narcolepsy. Suvorexant (Belsomra) is an orexin receptor antagonist for insomnia. Protriptyline and desipramine are both tricyclic antidepressants used to treat narcolepsy with cataplexy.
The nurse in a clinic is talking with a patient who will be traveling from the Midwest time zone to Moscow to attend a 4-day conference. The patient asks the nurse how he can minimize the effects of jet lag. What are at least two recommendations that the nurse could give to the patient?
Answer Key:
Any of these responses would be appropriate:
• Start to get in harmony with the Moscow time zone several days before you travel.
• Be sure to expose yourself to daytime daylight, which will assist with synchronizing your body's clock to environmental time.
• Melatonin has been shown to be an effective sleep aid to help synchronize the body's rhythm for jet lag.
• Resynchronization of the body's clock will occur at a rate of 1 hr/day if the patient travels eastward.
Place the events below in the order they occur in the patient with obstructive sleep apnea (beginning with 1).
a. Apnea lasting 10 to 90 seconds
b. Brief arousal and airway opened
c. Generalized startle response, snorting, or gasping
d. Hypoxemia and hypercapnia
e. Narrowing of air passages with muscle relaxation during sleep
f. Risk factors: obesity, large neck circumference, craniofacial abnormalities, acromegaly, smoking
g. Occurs 180 to 400 times during 6 to 8 hours of sleep 40
h. Tongue and soft palate obstruct pharynx
Answer Key:
a. 4; b. 7; c. 6; d. 5; e. 2; f. 1; g. 8; h. 3. Obstructive sleep apnea has the risk factors listed and age greater than 65. Airflow obstruction occurs because of narrowing of the air passages with relaxation of muscle tone during sleep or when the tongue and soft palate fall backward and partially or completely obstruct the pharynx. With apnea lasting 10 to 90 seconds, hypoxemia and hypercapnia occur, which cause a startle response with a brief arousal, so the tongue and soft palate move forward and the airway opens. This cycle occurs 180 to 400 times during 6 to 8 hours of sleep.
The health care provider has ordered continuous positive airway pressure (CPAP) for a patient with serious obstructive sleep apnea. How will CPAP help the patient?
a. Prevent airway occlusion by bringing the tongue forward
b. Be easily tolerated by both the patient and patient’s bed partner
c. Provide enough positive pressure in the airway to prevent airway collapse
d. Deliver a high inspiratory pressure and a low expiratory pressure to prevent airway collapse
Answer Key:
c. Continuous positive airway pressure (CPAP) is the treatment of choice for more serious sleep apnea. CPAP is not well tolerated and compliance is low. Compliance may be improved by involving the patient in the selection of the device and mask, showing the CPAP before therapy begins, and teaching troubleshooting to reduce anxiety. An oral appliance is used to prevent airway occlusion from the relaxed mandible and tongue. Bilevel positive airway pressure (BiPAP) is the therapy that delivers high inspiratory pressure and low expiratory pressure to prevent airway collapse.
While caring for a patient following a uvulopalatopharyngoplasty (UPPP), the nurse monitors the patient for which complications in the immediate postoperative period?
a. Snoring and foul-smelling breath
b. Infection and electrolyte imbalance
c. Loss of voice and severe sore throat
d. Airway obstruction and hemorrhage
Answer Key:
d. The most common complications in the immediate postoperative period are airway obstruction and hemorrhage. The patient may experience a sore throat, foul-smelling breath, and snoring during the recovery, but these will resolve. Infection is a potential complication of any surgery but is not common with this procedure. Loss of voice and electrolyte imbalance generally are not complications of this procedure.
Patient-Centered Care: An older patient asks the nurse why she has so much trouble sleeping. What is the most appropriate response by the nurse?
a. “Disturbed sleep is a normal result of aging.”
b. “Have you tried any over-the-counter medications to help you sleep?”
c. “Don’t worry. You don’t need as much sleep as you did when you were younger.”
d. “Tell me more about the trouble you are having. There may be some things we can do to help.”
Answer Key:
d. Assess the patient to determine what the problem is and then offer sleep hygiene instruction and collaborate with the HCP to improve the patient's sleep behavior. Disturbed sleep is not a normal result of aging, and people need about the same amount of sleep throughout their life span. Over-the-counter and prescription sleep aids must be used very cautiously in older adults, and patient response must be monitored closely.
Nurses who rotate shifts or work nights are at risk of developing shift work sleep disorders characterized by insomnia, sleepiness, and fatigue. Identify at least three negative implications for the nurse.
Answer Key:
Any three of these would be correct:
• Nurse is too sleepy to be fully awake at work
• Nurse is too alert to sleep soundly the next day
• Increased morbidity and mortality related to cardiovascular problems
• Mood disorders are higher
• Fatigue could result in errors and accidents, as perceptual skills, judgment, and decision-making abilities may be diminished
• Physical, mental and emotional exhaustion
What strategies could decrease the distress of rotating shifts for nurses (select all that apply)?
a. Take a brief onsite nap.
b. Use sleep hygiene practices.
c. Sleep just before going to work.
d. Maintain consistent sleep/wake schedules even on days off (if possible).
e. Negotiate to control work schedule rather than having someone else impose the schedule.
Answer Key:
a, b, c, d, e. All of these measures can be used to help a nurse who works rotating shifts to get adequate sleep.
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