Treatment and Nursing Interventions for Sleep and Wakefulness Disorders
The treatment of sleep and wakefulness disorders depends on the type, cause, and severity of the disorder. The main goals of treatment are to improve sleep quality and quantity, reduce daytime symptoms and impairment, and enhance health and well-being .
The treatment options for sleep and wakefulness disorders include :
- Sleep hygiene: lifestyle measures that promote better sleep, such as establishing and maintaining a regular bedtime and rising time, avoiding caffeine, alcohol, nicotine, and heavy meals before bed, limiting naps, exercising regularly but not too close to bedtime, creating a comfortable and quiet sleeping environment, following a relaxing bedtime routine, avoiding exposure to bright light at night and increasing exposure to natural light during the day, using the bed only for sleep and sex, avoiding clock-watching or checking the phone during the night, etc.
- Behavioral interventions or cognitive-behavioral therapy (CBT): techniques that aim to modify maladaptive thoughts and behaviors that interfere with sleep, such as stimulus control, sleep restriction, relaxation training, biofeedback, imagery training, paradoxical intention, cognitive restructuring, etc.
- Psychotherapy: counseling or therapy that addresses the underlying psychological issues or stressors that contribute to sleep problems, such as depression, anxiety, trauma, grief, etc.
- Medications: drugs that are prescribed to treat specific symptoms or causes of sleep and wakefulness disorders, such as benzodiazepines, non-benzodiazepine hypnotics, melatonin receptor agonists, antidepressants, antihistamines, anticonvulsants, dopamine agonists, stimulants, etc. Medications should be used with caution and under medical supervision, as they may have side effects or interactions with other drugs or substances. They should also be used only as a short-term or adjunctive treatment, as they may cause dependence or tolerance if used long-term or chronically.
- Referral to sleep specialist: consultation with a physician who specializes in sleep medicine for further evaluation or management of complex or refractory cases of sleep and wakefulness disorders. A sleep specialist may also recommend other treatments such as surgery, oral appliances, continuous positive airway pressure (CPAP), bright light therapy, chronotherapy, etc., depending on the type and severity of the disorder.
The nursing interventions for sleep and wakefulness disorders are based on the nursing process that involves assessment, diagnosis, planning, implementation, and evaluation. Some of the nursing interventions are :
- Assessment: collecting data from the patient about their medical history, sleep history, physical examination, sleep diary, questionnaires or scales, PSG results, etc., to identify the type and cause of the disorder and its impact on health and quality of life
- Diagnosis: formulating nursing diagnoses based on the assessment data that reflect the patient’s problems related to sleep and wakefulness disorders. Some examples of nursing diagnoses are:
- Sleep pattern disturbance
- Insomnia
- Sleep deprivation
- Risk for injury
- Fall risk
- Social isolation
- Spiritual distress
- Grieving
- Caregiver role strain
- Planning: setting realistic and measurable goals and outcomes for the patient based on their needs and preferences. Some examples of goals are:
- The patient will report improved sleep quality and quantity within 4 weeks of treatment. - The patient will demonstrate reduced daytime sleepiness and fatigue within 2 weeks of treatment. - The patient will adhere to the prescribed treatment regimen and follow-up appointments. - The patient will practice good sleep hygiene and behavioral interventions daily. - The patient will verbalize understanding of the causes and consequences of sleep and wakefulness disorders and the available treatment options. - The patient will express satisfaction with the treatment outcomes and quality of life.
- Implementation: carrying out the planned interventions in collaboration with the patient, family, and health care team. Some examples of interventions are:
- Educating the patient and family about sleep and wakefulness disorders, their types, causes, symptoms, diagnosis, treatment, prevention, and complications.
- Providing information and resources on sleep hygiene, behavioral interventions, CBT, psychotherapy, medications, or other treatments as indicated.
- Assisting the patient with setting up and using PSG equipment, sleep diary, questionnaires or scales, or other tests as needed.
- Administering or monitoring medications or other treatments as prescribed and observing for their effects or side effects.
- Encouraging the patient to adhere to the treatment regimen and follow-up appointments and addressing any barriers or concerns.
- Supporting the patient’s coping skills and emotional well-being and referring to mental health services if needed.
- Promoting a safe and comfortable sleeping environment for the patient by minimizing noise, light, temperature, or other disturbances.
- Facilitating the patient’s adjustment to different time zones or work schedules by providing guidance on chronotherapy, bright light therapy, or other strategies as appropriate.
- Advocating for the patient’s rights and preferences regarding their sleep and wakefulness needs and issues.
- Evaluation: measuring the outcomes of the interventions and comparing them with the goals. Some examples of evaluation methods are:
- Reassessing the patient’s sleep history, physical examination, sleep diary, questionnaires or scales, PSG results, etc., to determine any changes or improvements in their sleep patterns or symptoms.
- Asking the patient to rate their sleep quality and quantity, daytime sleepiness and fatigue, concentration and memory, mood and irritability, headaches or body aches, etc., on a scale of 0-10 before and after treatment.
- Obtaining feedback from the patient and family about their satisfaction with the treatment outcomes and quality of life.
- Reviewing the patient’s adherence to the treatment regimen and follow-up appointments and identifying any challenges or difficulties.
- Modifying the goals or interventions as needed based on the evaluation results.
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Questions on Treatment and Nursing Interventions for Sleep and Wakefulness Disorders
Correct Answer is D
Explanation
No explanation
Correct Answer is D
Explanation
<p>Parasomnias involve abnormal behaviors, experiences, physiological events, or psychological events occurring during sleep or sleep-wake transitions. These include disorders like sleepwalking, night terrors, sleep-related eating disorders, and rapid eye movement (REM) sleep behavior disorder. These behaviors are outside the range of normal sleep activities and differentiate parasomnias from other sleep disorders.</p>
Correct Answer is A
Explanation
<p>Asking about falling asleep at inappropriate times during the day is more aligned with narcolepsy, a disorder characterized by sudden and uncontrollable episodes of falling asleep. While some individuals with insomnia might experience daytime sleepiness, it's not a defining feature of the disorder.</p>
Correct Answer is A
Explanation
<p>Expressing that the client experiences intense headaches during the day is not a specific symptom of insomnia. Headaches could be related to various causes and might not be directly linked to the client's sleep patterns.</p>
Correct Answer is C
Explanation
<p>Avoiding alcohol and caffeine is generally a good practice for promoting healthy sleep, but it alone is not the commonly recommended intervention for a sleep disorder characterized by excessive daytime sleepiness despite adequate nighttime sleep. While avoiding alcohol and caffeine can help prevent sleep disturbances, it might not fully resolve the underlying disorder causing excessive sleepiness.</p>
Correct Answer is D
Explanation
<p>Pauses in breathing (apnea) during sleep are often associated with obstructive sleep apnea (OSA). OSA is characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep, leading to temporary pauses in breathing. These pauses can cause oxygen levels to drop and disrupt the sleep cycle, resulting in fragmented sleep and excessive daytime sleepiness.</p>
Correct Answer is C
Explanation
<p>Circadian rhythm sleep-wake disorder involves disruptions in the sleep-wake cycle due to misalignments between a person's internal body clock and external cues like light and darkness. It is not characterized by abnormal movements of the limbs or body during sleep. Circadian rhythm sleep-wake disorder can lead to difficulties falling asleep or staying awake at appropriate times but is distinct from the disorder described.</p>
Correct Answer is ["B","C"]
Explanation
<p>Chronic stress. Chronic stress can worsen RLS symptoms, but it is not a direct cause. Stress can exacerbate the discomfort and restlessness in the legs, making the symptoms more pronounced.<strong></strong></p>
Correct Answer is ["A","C","D"]
Explanation
<p>Medication (dopamine agonists). Medications are not commonly used for the treatment of obstructive sleep apnea (OSA). Dopamine agonists are typically used to treat conditions like Parkinson's disease and restless legs syndrome, not OSA.<strong></strong></p>
Correct Answer is C
Explanation
<p>Periodic limb movement disorder (PLMD). PLMD is characterized by repetitive limb movements during sleep, often involving the legs. It is not associated with teeth grinding.</p>
Correct Answer is C
Explanation
<p>Medications and substance use are recognized contributors to sleep and wakefulness disorders. Many medications can interfere with sleep patterns, including stimulants, antidepressants, and certain antihypertensive drugs. Substance use, particularly alcohol and recreational drugs, can disrupt sleep architecture and lead to insomnia and poor sleep quality.</p>
Correct Answer is ["B","D"]
Explanation
<p>Enhanced physical strength is not a common symptom of sleep and wakefulness disorders. Sleep disturbances are more likely to result in fatigue and decreased physical performance due to disrupted sleep patterns, rather than enhanced strength.<strong></strong></p>
Correct Answer is A
Explanation
<p>Experiencing muscle spasms at night is not a classic symptom of sleep and wakefulness disorders. Muscle spasms could be related to various factors such as electrolyte imbalances, restless legs syndrome, or nocturnal leg cramps, but they are not among the primary symptoms of these disorders.</p>
Correct Answer is C
Explanation
<p>Sleep history involves collecting information about an individual's sleep patterns, habits, and behaviors over time. While it provides important insights into sleep-related problems, it doesn't directly involve monitoring physiological parameters during sleep like PSG does. Sleep history is typically obtained through interviews and questionnaires.</p>
Correct Answer is D
Explanation
<p>Sleep apnea involves repeated interruptions in breathing during sleep, leading to disrupted sleep and symptoms such as loud snoring, gasping for air, and excessive daytime sleepiness. The client's symptoms of snoring loudly and waking up gasping for air are characteristic of obstructive sleep apnea, where the airway becomes blocked or collapses during sleep, leading to temporary pauses in breathing.</p>
Correct Answer is B
Explanation
<p>Mood disorders, such as depression and anxiety, can certainly impact sleep and wakefulness. However, the client's symptoms of struggling with time zone adjustments and frequent travel are more closely associated with disruptions in circadian rhythms due to changes in sleep schedules rather than being solely indicative of a mood disorder.</p>
Correct Answer is C
Explanation
<p>The Epworth Sleepiness Scale is a self-report questionnaire used to assess an individual's likelihood of falling asleep in various situations. It's a subjective measure of daytime sleepiness and doesn't involve monitoring physiological parameters during sleep, so it's not the correct choice.</p>
Correct Answer is ["A","D"]
Explanation
<p>Enhanced physical strength is not a lifestyle factor that affects sleep patterns. While physical activity can impact sleep, this specific factor does not have a direct correlation with sleep-wake disorders.<strong></strong></p>
Correct Answer is ["B","D"]
Explanation
<p>Caffeine consumption is a lifestyle factor, not a medical disorder. While caffeine intake, especially close to bedtime, can interfere with sleep, it is not classified as a medical disorder contributing to sleep and wakefulness disorders.<strong></strong></p>
Correct Answer is C
Explanation
<p>These symptoms are primarily related to a lack of physical activity. Rationale: This choice is incorrect. While physical activity can contribute to overall well-being and sleep quality, the client's symptoms are not primarily related to a lack of physical activity. The described symptoms are more indicative of sleep-related issues rather than solely being attributed to a lack of exercise.</p>
<p>Creating a quiet and comfortable sleeping environment is indeed a key sleep hygiene recommendation. A conducive sleep environment includes factors like a comfortable mattress and pillows, proper room temperature, minimal noise and light, and a relaxing bedtime routine. These factors can significa
<p>Inquiring about nightmares frequency can provide insight into sleep quality and potential sleep disturbances. Frequent nightmares can lead to fragmented sleep and contribute to sleep pattern disturbances.<strong></strong></p>
<p>CBT techniques are effective on their own and do not require the use of medication treatments. In fact, CBT is often recommended as a first-line treatment for insomnia and other sleep disorders due to its efficacy without the potential side effects of medications.</p>
<p>The correct choice, this statement accurately reflects the guideline for using medications to treat sleep and wakefulness disorders. Medications for sleep disorders should be used cautiously and under medical supervision. This is because sleep medications can have potential side effects such as d
<p>The correct choice, this goal is appropriate for a patient with insomnia. It focuses on ensuring that the patient understands the available treatment options for sleep disorders. Educating the patient about treatment options empowers them to make informed decisions about their care. Treatment opt
<p>Administering medications to induce sleep at the patient's desired time might lead to dependence on medications for sleep initiation. It's important to address the underlying causes of sleep disorders and use medications judiciously under medical supervision, as stated in Choice D.<br />
<p>Reviewing the patient's family history of sleep disorders is important for understanding potential genetic predispositions to sleep problems. However, it is not a method for directly assessing changes in the patient's sleep patterns and symptoms resulting from interventions.</p>
<p>Checking the phone frequently during the night is not a recommended sleep hygiene practice. The blue light emitted by phones can suppress melatonin production and disrupt sleep. Additionally, waking up to check the phone can fragment sleep and make it harder to achieve restful sleep.<strong></str
No explanation
<p>Prescribing medications without consulting a healthcare provider is not within the nurse's scope of practice. Furthermore, medication should not be the first line of treatment for sleep concerns, and it's important to explore non-pharmacological interventions first.</p>
<p>Decreased sexual function like low libido is a potential impact of sleep deprivation, but it's related to sexual health rather than cognitive function.</p>
<p>Enhanced memory and learning is not a potential impact of sleep deprivation. On the contrary, sleep is crucial for memory consolidation and optimal cognitive function, and sleep deprivation can hinder learning and memory processes.<strong></strong></p>
<p>"I've been feeling really impatient and getting upset easily.". While irritability and impatience are potential consequences of sleep deprivation, this choice does not directly address the mention of vivid dreams and nightmares during the night. While irritability is a common sympto
<p>"Sleep deprivation is associated with a higher susceptibility to infections.". While sleep deprivation can indeed weaken the immune system and increase susceptibility to infections, this choice, like Choice C, does not directly address the impact on metabolic function that the question
<p>"Sleep deprivation has no effect on physical appearance.". While the statement might be tempting to consider, it is inaccurate. Sleep deprivation can affect physical appearance by causing under-eye circles, skin issues, and a generally tired and worn-out appearance. The choice does not
<p>Enhanced blood clotting. Enhanced blood clotting is not a potential impact of sleep and wakefulness disorders on cardiovascular risk. Sleep deprivation is associated with increased inflammation and changes in blood clotting factors that can actually elevate the risk of blood clot formation, poten
<p>"Sleep deprivation can increase the risk of inflammation.". This is the correct answer. Sleep deprivation is known to increase the levels of pro-inflammatory cytokines in the body. These inflammatory markers can lead to chronic inflammation, which is associated with various health probl
<p>Altered hormonal levels. This is the third correct answer. Sleep deprivation can disrupt the normal balance of hormones in the body. It can lead to changes in hormones such as cortisol (the stress hormone) and growth hormone. These hormonal disruptions can have widespread effects on various physi
<p>Impaired judgment and decision-making is a correct potential impact of sleep deprivation. Sleep-deprived individuals often struggle with making sound judgments and decisions. The prefrontal cortex, responsible for higher-order cognitive functions, is particularly affected by sleep loss. This can
<p>"Sleep deprivation is linked to improved menstrual cycles" is an incorrect statement. Sleep deprivation is more likely to disrupt menstrual cycles rather than improve them. Irregular or absent menstrual cycles can result from hormonal disturbances caused by inadequate sleep. Hormonal im
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