Page 221 - Cardiac Nursing

/09
/09
1
6
/29
/29
6 P
6 P
M
1
0:1
0:1
7-2
03.
03.
17
17
7-2
xd
xd
6
q
q
q
M
t
ara
ara
p
p
t
In
c.
c.
a
a
In
g
g
e 1
Pa
Pa
g
A
A
p
e 1
97
97
K34
LWB
08_
0-c
LWB K34 0-c 08_ p p pp177-203.qxd 6/29/09 10:16 PM Page 197 Aptara Inc.
LWBK340-c08_
C HAPTER 8 / Sleep 197
22 hours), estazolam (10 to 24 hours), quazepam (25 to 100 hours), physiological changes during sleep that adversely affect their
and flurazepam (74 to 160 hour for active metabolite). 317 health status. Sleep disorders contribute to risk for cardiac disease
and to other cardiac risk factors. Although beliefs regarding the re-
Nonbenzodiazepines lationship between sleep and well being are widely shared, hospi-
The nonbenzodiazepines, recently approved by the FDA for in- tal practices are rarely designed to encourage optimal sleep. Re-
somnia, possess chemical structures that differ from each other as search is needed to clarify the role of night-time sleep and daytime
well as the traditional benzodiazepines. 315,317 These medications naps in recovery from cardiovascular disease and surgery (e.g.,
bind to the GABA receptor at a selective and limited recognition what are optimal sleep patterns?) and to identify nursing inter-
site, explaining the absence of myorelaxant and anticonvulsant ef- ventions that prevent sleep deprivation, minimize adverse sleep-
fects. Three nonbenzodiazepine drugs (and their half-lives) are in- related physiological changes, and promote good sleep.
dicated for insomnia—zolpidem (regular formulation 2.5 hour;
continued release 2.8 hours), zaleplon (1 hour), and eszopiclone
(6 hours in adult; 9 hours in elderly) (see Table 8-1). These med- R EFERENCES
ications have demonstrated efficacy in acute management of 1. Javaheri, S. (2005). Sleep and cardiovascular disease: Present and future.
chronic insomnia. Longer term studies also suggest their efficacy. In M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles and prac-
Potentially serious side effects include nocturnal falls, sleep walk- tice of sleep medicine (pp. 1157–1160). Philadelphia: Elsevier Saunders.
ing, and sleep eating. 315,318 This class of medications does not ap- 2. Somers, V. K., White, D. P., Amin, R., et al. (2008). Sleep apnea and car-
pear to adversely affect nocturnal respiration or apnea severity. 315 diovascular disease. An American Heart Association/American College of
Cardiology Foundation Scientific Statement from the American Heart As-
sociation Council for High Blood Pressure Research Professional Education
Committee, Council on Clinical Cardiology, Stroke Council, and Council
THE HEALTH CARE PROVIDERS’ on Cardiovascular Nursing Council. Circulation, 118, 1080–1111.
SLEEP 3. Thorpy, M. J. (19991). History of sleep and man. In M. J. Thorpy &
J. Yager (Eds.), The encyclopedia of sleep and sleep disorders (pp. ix–xxxiii).
New York: Oxford.
Hospital nurses, physicians, and others who work the night shift 4. Carskadon, M. A., & Dement, W. C. (2005). Normal human sleep: An
or rotating schedules often experience irregular sleep–wake sched- overview. In M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles
ules and inferior sleep, causing reduced alertness and general fa- and practice of sleep medicine (pp. 13–23). Philadelphia: WB Saunders
Company.
tigue. This reduced alertness and fatigue is accentuated by the 5. Collop, N. A., Salas, R. E., Delayo, M., et al. (2008). Normal sleep and
pronounced circadian alertness–sleepiness rhythm, with maximal circadian processes. Critical Care Clinics, 24, 449–460.
4
4
sleepiness and lowest performance at approximately 4:00 to 5:00 AM, 6. Andruskiene, J., Varoneckas, G., Martinkenas, A., et al. (2008). Factors
at the low point of the body temperature rhythm. 319 Mental tasks associated with poor sleep and health-related quality of life. Medicina
that require sustained visual attention, such as monitoring an (Kaunas), 44, 240–246.
ECG oscilloscope or driving home from work, are more affected 7. Orwelius, L., Nordlund, A., Nordlund, P., et al. (2008). Prevalence of sleep
disturbances and long-term reduced health-related quality of life after crit-
than are physical tasks. 320 Suggested strategies to improve shift ical care: A prospective multicenter cohort study. Critical Care, 12, R97.
worker’s sleep/rest include staying on a night schedule on nonwork 8. Saleh, P., & Shapiro, C. M. (2008). Disturbed sleep and burnout: Impli-
days (often socially unattractive), scheduling one or more cations for long-term health. Journal of Psychosomatic Research, 65, 1–3.
nights off after night duty, reduced work hours (no shift greater 9. Trupp, R. J. (2008). Sleep and health. Progress in Cardiovascular Nursing,
23, 60–62.
than 12 hours) fatigue management, sleep hygiene education for 10. American Academy of Sleep Medicine. (2005). The international classi-
staff, using rotation schedules that move forward around the clock fication of sleep disorders. Westchester, IL: American Academy of Sleep
rather than backward, and taking a nap before going to work. 321 Medicine.
Use of melatonin in the evening to help reset the circadian timing 11. Chervin, R. D., & Aldrich, M. S. (1999). The Epworth Sleepiness Scale
system or bright light therapy to suppress natural melatonin secre- may not reflect objective measures of sleepiness or sleep apnea.
Neurology, 52, 125–131.
tion from the pineal gland also appear to be promising strategies. 322 12. Rechtschaffen, A., & Kales, A. (1968). A manual of standard terminol-
Sleep deprivation among nurses and physicians has been ogy: Techniques and scoring system for sleep stages in human subjects.
shown to be related to serious medical errors as well as occupa- Washington, DC: U.S. Government Printing Office.
tional injuries. 320,321 Mandates from the Accreditation Council 13. Roehrs, T., Carskadon, M. A., Dement, W. C., et al. (2005). Daytime
sleepiness and alertness. In M. H. Kryger, T. Roth, & W. C. Dement
for Graduate Medical Education (ACGME) were issued several (Eds.), Principles and practice of sleep medicine (pp. 39–50). Philadelphia:
years ago limiting work hours to promote improved sleep–work Elsevier Saunders.
habits and performance and reduced sleepiness. Parthasarathy 14. Kaida, K., Takahashi, M., Haratani, T., et al. (2006). Indoor exposure to
et al 323 studied the effect of work-hour reduction on quality of life natural bright light prevents afternoon sleepiness. Sleep, 29, 462–469.
of residents and fellows and observed minor improvements in 15. Carskadon, M. A., & Rechtschaffen, A. (2005). Monitoring and staging
of human sleep. In M. H. Kryger, T. Roth, & W. C. Dement (Eds.),
sleep time, subjective sleepiness and quality of life during an ICU Principles and practice of sleep medicine (pp. 1359–1378). Philadelphia:
rotation; however, significant levels of objective sleepiness were re- WB Saunders Company.
tained. Thus, optimal scheduling and further work-hour reduc- 16. Chase, J. M. Brain electrical activity and sensory processing during
tion measures may need to be undertaken to address the persist- wakefulness and sleep states. In M. H. Kryger, T. Roth, & W. C. De-
ment (Eds.), Principles and practice of sleep medicine (pp. 101–119).
ence of sleepiness in critical care medical and nursing staff. Philadelphia: Elsevier Saunders.
17. Steriade, M. (2005). Brain electrical activity and sensory processing
during wakefulness and sleep states. In M. H. Kryger, T. Roth, & W. C.
SUMMARY Dement (Eds.), Principles and practice of sleep medicine (p. 101).
Philadelphia: Elsevier Saunders.
18. Siegel, J. M. (2005). REM sleep. In M. H. Kryger, T. Roth, & W. C. De-
Patients with cardiovascular disease often have disturbed sleep, es- ment (Eds.), Principles and practice of sleep medicine (pp. 120–135).
pecially in intensive cardiac care settings, and may be at risk for Philadelphia: Elsevier Saunders.