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Hey, what's up everyone, Doctor 
Zishan here. 

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I really wanted to take a moment
to thank everyone that listens 

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to our podcast, that subscribes 
to the podcast, that even shares

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it amongst other people and your
peers. 

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Thank you so much from myself 
and the team at NCLEX High 

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Yield. 
It's because of the audience 

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that we have the people that 
follow us on here on Instagram, 

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on Facebook, on YouTube and on 
TikTok that really keeps us 

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going and motivated to keep 
bringing you some new content as

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often as we can remember. 
We do have our free weekly Zoom 

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every single Wednesday that we 
do a new topic, practice 

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questions as well to try to come
to that free weekly Zoom, free 

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education. 
Why not? 

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And then also right after that, 
we started doing trivia. 

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It helps the neurons fire. 
So on on test day, you get that 

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association real quick. 
You're not wasting a lot of that

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brainpower. 
And lastly, remember, we always 

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have the on demand going. 
If you like the podcast, if you 

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like our YouTube channel, 
imagine having 70 hours of 

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content with the notes with 
myself lecturing on pretty much 

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every topic and seeing all these
people get 85 and out. 

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So again, thank you all so much 
and good luck. 

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All right, so today's podcast 
we're going to focus on sleep. 

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Now you may ask me, well, Doctor
Z sleep really for the boards. 

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What can they possibly ask me 
that's so pertinent for the 

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boards that we have to talk 
about sleep? 

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There's a lot of different 
things that affect sleep and 

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that's something that we talk 
about when we talk about my 

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pneumonic needs, right? 
Always teach your patients about

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their needs, nutrition, 
exercise, ETOH to avoid that, 

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don't smoke and we added in 
sleep. 

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So Doctor Z Shanz needs sleep is
so important because there's so 

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many different parts of sleep 
and it may be something that we 

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deal with with patients 
outpatient or even inpatient. 

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So some of the topics that we're
going to get into today are 

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sleep hygiene, super important 
when you're educating your 

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patients. 
We're going to talk about 

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circadian rhythm, especially 
when we're talking about 

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patients in the ICU or 
hospitalizations. 

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We're going to talk about 
restless leg syndrome. 

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We're going to talk about 
narcolepsy. 

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We're going to talk about 
obstructive sleep apnea as well.

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So a lot of these topics get 
overlooked along with the stages

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of sleep. 
And then we're going to try and 

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get into some practice questions
and see how the boards are going

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to ask them, whether it be 
pharmacological, whether it be 

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education, whether it be just 
teaching our patients and doing 

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that basic care and comfort in 
these situations and what they 

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pertain to. 
So as there's a lot of different

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things that we can talk about 
here and we're definitely going 

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to get into them in depth. 
So let's get started. 

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A good starting point is 
understanding our circadian 

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rhythm. 
So what is our circadian rhythm?

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It is in fact our body's 
internal 24 hour biological 

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clock. 
So for 24 hours, what's 

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happening? 
What's regulating our sleep, 

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wake cycles, our temperature, 
our hormones, bodily functions, 

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things of that nature. 
Because in a 24 hour period, 

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that rhythm needs to be as 
consistent as possible. 

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So we don't have any type of 
sleep disruptions and things 

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like hospitalizations, things 
like ICU, these are going to 

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disrupt our circadian rhythm. 
So as nurses, it is very 

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important for us to do 
interventions well. 

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What type of a question is that?
Which of the following should 

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the nurse provide? 
It's education. 

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It's a select all that applied. 
So we want to maintain a 

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consistent schedule for 
sleeping. 

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Wake up at the same time, go to 
sleep at the same time, dim 

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lights in the evening, bright 
lights during the day, 

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activities during the day. 
Don't schedule anything at night

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time and encourage that 
relaxation or techniques for 

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relaxation, things like reading,
things like meditation, things 

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like breathing. 
And again, we want to minimize 

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any type of interruptions at 
night time, especially when 

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these patients are in for an 
extended period of time. 

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It's very easy to mess with that
circadian rhythm. 

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But some of this is not in our 
control. 

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There are things like sleep 
disorders that actually are hard

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for us to control. 
We may have more interventions 

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that need to be done. 
So what are sleep disorders at 

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the board's like? 
And the type of question that I 

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would ask here is 100% a case 
study with the matrix or grid. 

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And I'm going to compare because
as you know, it's a differential

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diagnosis or comparison of 
different types of diagnosis 

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that have similar or overlapping
types of signs and symptoms. 

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So what sleep disorders would I 
throw into a case study? 

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Well, how about insomnia? 
How about sleep apnea? 

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How about narcolepsy? 
And the last one, restless leg 

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syndrome? 
I think this would be an 

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amazing, amazing case study or a
matrix type grid type question. 

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But before we get into those 
sleep disorders, let's just talk

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about regular sleep hygiene. 
Super important that we educate,

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educate, educate our patients on
sleep hygiene. 

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Well, it's it comes back to one 
of those things that I'm so 

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repetitive and so annoying about
and it is Doctor Zeeshan's 

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needs. 
Always take care of your 

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patients needs N EE DS and we 
added in that last S. 

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So what is the needs as a 
refresher nutrition. 

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When do we say the opposite? 
We don't exercise. 

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Give me what you can. 
We don't say the opposite ETOH, 

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which is alcohol avoid, avoid, 
avoid DS is don't smoke in the 

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last S is sleep. 
These things are so important in

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our day-to-day health and in any
situation that we talk about, we

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talk about basic care and 
comfort all the time. 

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Well, if I'm going to think 
about if I'm going to think 

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about somebody's basic care in 
any situation, I'm always going 

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to take care of their needs. 
So the last one, sleep and sleep

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hygiene is super important. 
So what are some types of things

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that I'm going to talk about 
with sleep hygiene when I'm 

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trying to educate my patients? 
So when I talk about education, 

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it's going to be a select all 
that apply question and or 

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further teaching further 
intervention. 

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So the first one, our sleep 
environment, we want to try to 

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keep it as dark as possible. 
So can we encourage blackout 

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curtains or eye masks or things 
to block out light? 

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Absolutely, absolutely. 
We want to, again, like we're 

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talking about our circadian 
rhythm in our patients that are 

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hospitalized or in the ICU. 
We want to keep it dim or dark 

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at night and we want to make it 
bright or open up the the 

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curtains or the blinds during 
the daytime, get that natural 

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light. 
That natural light is so 

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important for our patients, 
especially when they're 

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hospitalized, if we have the 
ability to do so. 

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Noise control, minimize, or some
people even like white noise, 

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something in the background like
a fan. 

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These things tend to soothe 
people as well, too comfortable 

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bed, pillows, blankets, things 
of that nature and temperature 

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control. 
So keeping the room at a decent 

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temperature, at a cool 
temperature where patients feel 

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comfortable. 
Again, basic care and comfort 

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when it comes to their 
environment. 

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But when we're educating our 
patient, especially outpatient, 

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we're looking at their pre sleep
routine. 

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So again, things like relaxation
techniques, meditation, deep 

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breathing, reading, limiting 
screen time. 

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I know a lot of us love either 
watching TV, maybe sitting on 

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our phones, on our tablet, on 
our computer, but that is actual

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stimulation. 
So read a book or just meditate 

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or breathe. close your eyes. 
You'll be surprised how quickly 

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this can change your sleep 
habits. 

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Things like supplementation. 
Now my caveat with 

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supplementation is always going 
to be consult your primary care 

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physician, your nutritionist, 
whoever it is that takes care of

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your health before you do 
anything. 

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But in a personal sense, I'm 
going to talk about my 

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experience with supplementation.
As studies progressed, we 

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learned that magnesium and if we
talk about hypomagnesemia, think

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about that. 
When do we lose magnesium? 

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Well, we lose magnesium with 
diuretics, we lose magnesium 

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with alcohol intake. 
But what is the side effect of 

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hypomagnesemia? 
We get tremors, we get that 

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nerve instability. 
If we supplement magnesium, then

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we're going to get that nerve or
neurological stability. 

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Do you think that helps us with 
maybe anxiety or going to sleep?

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Studies have shown so. 
So I've been taking magnesium 

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personally and that's been 
helping me. 

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So again, supplementation in our
pre sleep routine is very 

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important if your primary care 
and or whoever takes care of 

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your health deems necessary. 
Another thing that I take is a 

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product called Magic Mind. 
Now Magic Mind I take two times 

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a day. 
One is in the morning and one of

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the sleep hygiene rules is 
caffeine, caffeine, caffeine, 

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right? 
We don't want to overtake 

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caffeine. 
We don't want to take caffeine 

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into the late afternoon or into 
the evening. 

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But the thing about Magic Mind 
is it gives me that start in the

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daytime, that caffeine that's 
time released. 

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So that way I'm not getting that
surge of caffeine and then 

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crashing hard where it's ruining
my entire day. 

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And I'm getting that excessive 
daytime sleepiness, which we'll 

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talk about in some of these 
sleep disorders here later. 

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So the active ingredients in 
Magic Mind are going to help me,

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lion's mane, ashwagandha 
throughout the daytime. 

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But now I'm starting to take 
their nighttime formula, Their 

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Magic Minds sleep right before 
bed, along with about 30 minutes

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before bed, along with my 
magnesium, something that's been

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studied by doctors. 
Again, for me, it's all about 

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studies and validation, 
Something that's been studied 

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over 10 years and has scientific
advisory by a board of doctors. 

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I'm going to trust it a lot more
than somebody that claims 

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things. 
So my magic minds for sleep, my 

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magic mind for the daytime is 
way more important to me than 

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getting a cup of coffee or tea 
throughout the day or taking one

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of those energy drinks. 
I like things that are natural. 

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I like things that are more 
sustained. 

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And the cool thing with Magic 
Mind is that they're giving our 

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students 45% off. 
If you buy the two combination, 

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all you have to do is go to 
magicmind.com/high Yield Jan, 

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like January and get started. 
So again, that's 

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www.magicmind.com/high Yield Jan
and they're giving 45% off to 

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our students. 
The last thing in our pre sleep 

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routine is avoid heavy meals or 
alcohol prior to bedtime. 

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We don't want to take a type of 
stimulants. 

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So these are things that we want
to do as a pre sleep routine, 

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consistent sleep schedule when 
it comes to sleep hygiene, 

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daytime nighttime, when you wake
up, when you go to sleep, it 

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doesn't matter what day of the 
week it is, keep it consistent. 

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And then again, exercising 
regularly and that daylight 

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exposure. 
So just common things that we're

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going to educate our patients on
when it comes to a sleep cycle. 

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Now we've got to talk about 
these different types of sleep 

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disorders because the boards are
going to love to compare the 

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four aforementioned sleep 
disorders, insomnia, obstructive

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sleep apnea, narcolepsy, and 
restless leg syndrome. 

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So let's start with one that I 
think comes up more frequently 

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than not, and that is insomnia. 
It's one of those things that we

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have a hard time falling asleep,
staying asleep, or we're waking 

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up too early or we're not able 
to go back to sleep. 

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And it's not because we have 
things to do or we have to wake 

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up. 
It's the fact that we actually 

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have the opportunity to rest, 
but we just can't. 

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And it is associated with these 
following risk factors, anxiety,

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depression, chronic pain, select
all that apply. 

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So the risk factors are very 
important to understand. 

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Ultimately, risk factors are 
what type of question they are. 

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In fact, select all that apply. 
What are the signs and symptoms 

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of insomnia that excessive 
daytime sleepiness or EDS, 

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excessive daytime sleepiness? 
We're going to have difficulty 

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concentrating, we're going to 
have memory issues, we can have 

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irritability, we can have 
anxiety, we can have increased 

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risk for accidents because we 
have that excess daytime 

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sleepiness. 
So signs and symptoms select all

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that apply. 
And as I go through each one of 

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these signs and symptoms, you're
going to notice that there are 

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things that overlap. 
This is why I said this is a 

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perfect matrix or a grid type 
question. 

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So what are we going to do about
it? 

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Well, let's talk about our 
nursing interventions and or 

229
00:13:23,480 --> 00:13:27,000
treatment, basic care and 
comfort, pharmacological or non 

230
00:13:27,000 --> 00:13:29,960
pharmacological interventions. 
Obviously we go from least 

231
00:13:29,960 --> 00:13:32,320
invasive to most invasive. 
And when we're talking about 

232
00:13:32,320 --> 00:13:34,440
insomnia, if we're talking about
the underlying cause being 

233
00:13:34,440 --> 00:13:36,960
something, something like 
anxiety or depression, well, 

234
00:13:36,960 --> 00:13:40,920
let's go back to mental health. 
With mental health, if we have 

235
00:13:40,920 --> 00:13:43,840
anxiety or we have a depression 
in general with mental health, 

236
00:13:43,840 --> 00:13:46,760
unless it's something like 
bipolar or something like 

237
00:13:47,120 --> 00:13:50,880
psychosis or things that need 
medication in that moment, what 

238
00:13:50,880 --> 00:13:55,640
is our first go to cognitive 
behavioral therapy? 

239
00:13:56,040 --> 00:13:58,400
So how does that change here? 
It doesn't. 

240
00:13:58,960 --> 00:14:01,680
So again, now we're tying in 
mental health again, teaching 

241
00:14:01,680 --> 00:14:04,920
them about sleep hygiene, 
cognitive behavioral therapy. 

242
00:14:05,480 --> 00:14:08,040
This is going to be our gold 
standard when we're talking 

243
00:14:08,040 --> 00:14:11,840
about non pharmacological 
nursing interventions for 

244
00:14:11,840 --> 00:14:15,840
insomnia. 
We can use pharmacological 

245
00:14:15,960 --> 00:14:17,960
interventions. 
So let's do a little bit of 

246
00:14:17,960 --> 00:14:21,760
farm. 
We can give them a sedative, 

247
00:14:21,760 --> 00:14:24,560
hypnotic, something like 
zolpidem. 

248
00:14:24,640 --> 00:14:27,440
If they were to ask anything 
about any type of farm with 

249
00:14:27,440 --> 00:14:30,520
zolpidem, what would they ask? 
Well, I would probably ask 

250
00:14:30,520 --> 00:14:33,560
identification. 
Remember, farm drugs are going 

251
00:14:33,560 --> 00:14:37,000
to be freebie questions. 
So identification, the fact that

252
00:14:37,000 --> 00:14:39,560
we don't want to use this for an
extended period of time because 

253
00:14:39,560 --> 00:14:45,000
we can develop tolerance, we can
develop dependency. 

254
00:14:46,200 --> 00:14:49,560
We also want to educate them 
about things that we don't want 

255
00:14:49,560 --> 00:14:53,200
to mix it with, IE other types 
of sedatives, things like 

256
00:14:53,200 --> 00:14:56,400
benzodiazepines, things like 
alcohol. 

257
00:14:57,640 --> 00:15:02,360
And we want to talk about a side
effect that can develop if we 

258
00:15:02,360 --> 00:15:05,800
use it too long, which is 
rebound insomnia. 

259
00:15:05,800 --> 00:15:09,680
Meaning we use it for insomnia, 
we take it away and then boom, 

260
00:15:09,680 --> 00:15:12,560
our insomnia actually gets 
worse. 

261
00:15:12,720 --> 00:15:18,760
Rebound insomnia. 
And also educating to not use it

262
00:15:18,760 --> 00:15:22,520
in elderly patients. 
So with zolpidem and again, the 

263
00:15:22,520 --> 00:15:24,240
brand name, we're not going to 
worry about, but those that 

264
00:15:24,240 --> 00:15:27,280
don't know the brand name or can
tie the brand name to it, it is 

265
00:15:27,280 --> 00:15:30,600
in fact Ambien. 
The next one is narcolepsy. 

266
00:15:31,840 --> 00:15:34,320
Not necessarily something I 
think is super, super high 

267
00:15:34,320 --> 00:15:36,960
yield, but I think it would be a
great way to throw in a matrix 

268
00:15:36,960 --> 00:15:39,000
or grid. 
So what is narcolepsy? 

269
00:15:39,000 --> 00:15:40,640
Well, it's actually a 
neurological disorder. 

270
00:15:41,480 --> 00:15:45,840
It's excessive daytime 
sleepiness and sudden attacks of

271
00:15:45,840 --> 00:15:48,480
sleep. 
There may be some certain signs 

272
00:15:48,480 --> 00:15:52,200
and symptoms, so here goes that 
matrix or grid where I'm going 

273
00:15:52,200 --> 00:15:56,200
to compare it to these other 
sleep disorders, signs and 

274
00:15:56,200 --> 00:15:58,120
symptoms. 
Excessive daytime sleepiness. 

275
00:15:59,160 --> 00:16:01,640
Cataplexy. 
What is cataplexy? 

276
00:16:01,920 --> 00:16:04,560
It's a sudden or brief loss of 
muscle tone. 

277
00:16:05,240 --> 00:16:09,440
You just kind of like become 
limp and it can be triggered by 

278
00:16:09,720 --> 00:16:13,160
emotions. 
You become toneless and limp. 

279
00:16:14,320 --> 00:16:20,360
Sleep paralysis, meaning you 
have this temporary inability to

280
00:16:20,360 --> 00:16:23,160
move, like you're kind of stuck 
in a dream and you're, you're, 

281
00:16:23,160 --> 00:16:25,600
you're trying to move, you're 
trying to scream, but you can't.

282
00:16:27,200 --> 00:16:30,680
And that can happen right before
waking up or falling asleep. 

283
00:16:32,240 --> 00:16:37,440
And the last one is a term that 
we should know, hypnagogic 

284
00:16:37,600 --> 00:16:40,240
hallucinations. 
So what are hypnagogic 

285
00:16:40,360 --> 00:16:42,880
hallucinations? 
It's this vivid dreamlike 

286
00:16:42,880 --> 00:16:46,040
hallucination when you're about 
to fall asleep. 

287
00:16:46,880 --> 00:16:48,840
It almost feels like you're 
right there and it's happening 

288
00:16:48,840 --> 00:16:50,440
and it's real life, but it's 
not. 

289
00:16:50,640 --> 00:16:54,400
It's actually a hallucination, 
but it feels super real and 

290
00:16:54,400 --> 00:16:57,960
super vivid. 
So the signs and symptoms of 

291
00:16:57,960 --> 00:17:01,280
narcolepsy, how do we diagnose 
it? 

292
00:17:01,680 --> 00:17:05,400
Well, here's a freebie question.
How do we diagnose it with the 

293
00:17:05,400 --> 00:17:10,040
polysomnography? 
A sleep study catch them going 

294
00:17:10,040 --> 00:17:11,520
into that hypnagogic 
hallucination. 

295
00:17:11,800 --> 00:17:16,160
Check out their sleep paralysis,
see if they're having any type 

296
00:17:16,160 --> 00:17:19,800
of cataplexy, and then during 
the daytime, that excessive 

297
00:17:19,800 --> 00:17:23,160
daytime sleepiness. 
So what can we do about 

298
00:17:23,160 --> 00:17:25,280
narcolepsy? 
Well, we try to treat it 

299
00:17:25,440 --> 00:17:27,359
pharmacologically. 
This is one of those things that

300
00:17:27,359 --> 00:17:29,360
we cannot use cognitive 
behavioral therapy for. 

301
00:17:29,440 --> 00:17:32,800
We use a medication called 
Modafinil and it is a stimulant.

302
00:17:33,040 --> 00:17:36,040
So with Modafinil, what are we 
concerned about? 

303
00:17:36,040 --> 00:17:39,120
If it's a stimulant, We're 
worried about our vital signs. 

304
00:17:39,280 --> 00:17:40,840
We're worried about our blood 
pressure. 

305
00:17:41,120 --> 00:17:43,880
We're worried about our heart 
rate, we're worried about when 

306
00:17:43,880 --> 00:17:46,080
we're going to take it. 
Are we going to take it towards 

307
00:17:46,080 --> 00:17:48,240
the end of the night or we can 
take it towards the daytime. 

308
00:17:48,920 --> 00:17:52,480
So of course QAM or upon 
awakening. 

309
00:17:52,680 --> 00:17:56,000
We're also going to be worried 
about their appetite because 

310
00:17:56,000 --> 00:17:57,840
stimulants are going to be 
appetite suppressant. 

311
00:17:58,080 --> 00:18:02,360
So we have to worry about 
weight, BMI, electrolyte 

312
00:18:02,360 --> 00:18:07,520
disturbances, education, 
education, education Modafinil 

313
00:18:08,000 --> 00:18:10,600
educate them about safety 
precautions. 

314
00:18:10,720 --> 00:18:13,680
Well, doctor Z you narcolepsy 
safety precautions, I told you 

315
00:18:13,680 --> 00:18:15,680
they can develop cataplexy, 
meaning they go toneless. 

316
00:18:16,160 --> 00:18:19,200
Fall precautions, fall 
precautions. 

317
00:18:19,440 --> 00:18:25,280
The next one is our OSA 
obstructive sleep apnea. 

318
00:18:26,040 --> 00:18:28,800
Obstructive sleep apnea, meaning
there's some sort of an 

319
00:18:28,800 --> 00:18:31,240
obstruction during my sleep 
that's causing me not to 

320
00:18:31,240 --> 00:18:34,480
breathe. 
Obstructive sleep apnea with 

321
00:18:34,480 --> 00:18:40,160
obstructive sleep apnea are risk
factors can be non modifiable or

322
00:18:40,160 --> 00:18:44,080
modifiable. 
What are the non modifiable risk

323
00:18:44,080 --> 00:18:47,680
factors? 
Things like gender, male sex, 

324
00:18:48,160 --> 00:18:53,120
age greater than 40, 
postmenopausal women or family 

325
00:18:53,120 --> 00:18:57,480
history of obstructive sleep 
apnea or any type of anatomical 

326
00:18:57,480 --> 00:19:01,440
obstruction. 
But modifiable risk factors, 

327
00:19:01,440 --> 00:19:05,440
things that we can actually work
on and change are obesity, which

328
00:19:05,440 --> 00:19:09,960
is probably the major risk 
factor ABMI over 30 next 

329
00:19:09,960 --> 00:19:13,480
circumference because that 
pressure from an enlarged next 

330
00:19:13,720 --> 00:19:16,800
circumference can close our 
upper airway, causing that 

331
00:19:16,800 --> 00:19:19,920
obstruction. 
A next circumference of greater 

332
00:19:19,920 --> 00:19:24,440
than 17 inches in men and 
greater than 16 inches in women.

333
00:19:25,240 --> 00:19:30,920
Smoking, alcohol use, especially
before bed, sedatives, these are

334
00:19:30,920 --> 00:19:33,760
all things that we can modify 
prior to. 

335
00:19:34,840 --> 00:19:37,080
What are some signs and symptoms
that we're going to see when 

336
00:19:37,080 --> 00:19:39,080
we're talking about obstructive 
sleep apnea? 

337
00:19:39,600 --> 00:19:43,680
Loud intermittent snoring. 
Loud intermittent snoring. 

338
00:19:44,120 --> 00:19:46,720
You're going to typically see 
this by the partner. 

339
00:19:47,200 --> 00:19:49,920
The partner is going to be like 
they snore so loud, they snore 

340
00:19:49,920 --> 00:19:52,320
so loud, and then sometimes I 
think they stop breathing. 

341
00:19:53,200 --> 00:19:59,080
So witnessed apnea by the 
partner gasping or choking or 

342
00:19:59,080 --> 00:20:02,440
snorting sounds. 
So they're falling asleep, 

343
00:20:02,440 --> 00:20:04,040
falling asleep, falling asleep, 
and they stop breathing. 

344
00:20:04,040 --> 00:20:06,040
Then all of a sudden the 
respiratory system in our brain 

345
00:20:06,040 --> 00:20:08,360
kicks in and it says, wake up, 
wake up, wake up, you're not 

346
00:20:08,360 --> 00:20:11,800
breathing. 
And they do one of those and 

347
00:20:11,800 --> 00:20:13,600
then they wake up and you're 
like, whoa, what just happened? 

348
00:20:14,600 --> 00:20:17,400
How do we diagnose this? 
Again, polysomnography. 

349
00:20:17,760 --> 00:20:20,520
So again, a sleep study gold 
standard. 

350
00:20:21,800 --> 00:20:24,120
How are we going to treat this? 
Well, things that are 

351
00:20:24,120 --> 00:20:27,080
modifiable, we teach them about 
their needs, right? 

352
00:20:27,080 --> 00:20:30,400
Again, it comes back to the same
concept, but things that are non

353
00:20:30,400 --> 00:20:32,640
modifiable, what are we going to
do about it? 

354
00:20:33,480 --> 00:20:38,360
And this is when we get into a 
continuous positive airway 

355
00:20:38,480 --> 00:20:43,200
pressure, we continuously give 
them this positive pressure 

356
00:20:43,960 --> 00:20:48,320
through their airway or what's 
called a CPAP continuous 

357
00:20:48,320 --> 00:20:52,600
positive airway pressure. 
We'll be surprised at how many 

358
00:20:52,600 --> 00:20:55,040
different things can be affected
by obstructive sleep apnea. 

359
00:20:55,040 --> 00:20:55,960
Well, let's just think about 
this. 

360
00:20:55,960 --> 00:20:58,040
Let's go from head to toe. 
You know, I like to do 

361
00:20:58,040 --> 00:20:59,680
progression. 
Let's start with the brain. 

362
00:20:59,800 --> 00:21:02,200
If I don't have enough oxygen, 
do you think I can develop 

363
00:21:02,240 --> 00:21:06,640
anxiety, depression, fogginess, 
fatigue? 

364
00:21:06,840 --> 00:21:09,680
Yeah. 
Let's move down to the heart. 

365
00:21:10,520 --> 00:21:12,760
Increase blood pressure, 
Tachycardia. 

366
00:21:12,960 --> 00:21:16,800
Yeah. 
Let's go down to the pancreas. 

367
00:21:17,120 --> 00:21:20,400
Insulin resistance, increased 
blood sugar levels. 

368
00:21:20,520 --> 00:21:25,240
Yeah. 
So we talk about GI. 

369
00:21:25,240 --> 00:21:28,000
Can we start to develop weight 
gain? 

370
00:21:28,040 --> 00:21:31,680
Can we develop GERD? 
Yeah, We're talking about system

371
00:21:31,680 --> 00:21:35,200
by system, the fact that we're 
not getting enough sleep, that 

372
00:21:35,200 --> 00:21:39,000
our body is being affected from 
head to toe. 

373
00:21:39,440 --> 00:21:41,680
And you'll see these signs and 
symptoms start to resolve when 

374
00:21:41,680 --> 00:21:43,680
this patient starts on AC PAP. 
They'll be like, whoa, I can't 

375
00:21:43,680 --> 00:21:46,560
believe I was not sleeping 
properly. 

376
00:21:46,560 --> 00:21:50,760
They get used to it. 
So educate, educate, educate 

377
00:21:50,760 --> 00:21:56,040
them. 
The last one is restless leg 

378
00:21:56,160 --> 00:22:00,200
syndrome. 
With restless leg syndrome, it 

379
00:22:00,200 --> 00:22:05,600
is a neurological disorder with 
this uncontrollable urge to move

380
00:22:05,600 --> 00:22:09,640
the legs. 
And it's because we've got this 

381
00:22:09,640 --> 00:22:13,280
like tingling, numbness, 
crawling, burning, itching on 

382
00:22:13,280 --> 00:22:16,120
the legs. 
It's so uncomfortable that we 

383
00:22:16,120 --> 00:22:19,840
continuously have to move our 
legs, and it typically happens 

384
00:22:20,280 --> 00:22:23,040
when we're getting ready to 
sleep, while we're sleeping, or 

385
00:22:23,040 --> 00:22:26,720
when we're inactive. 
Moving or stretching or walking 

386
00:22:26,720 --> 00:22:30,880
alleviates the symptoms, but 
that's very inconvenient when 

387
00:22:30,880 --> 00:22:34,680
we're trying to sleep. 
Daytime fatigue and irritability

388
00:22:34,680 --> 00:22:36,200
because I'm not sleeping 
properly. 

389
00:22:36,200 --> 00:22:37,640
I've got this restless leg 
syndrome. 

390
00:22:37,760 --> 00:22:41,440
The causes or the risk factors? 
Typically, we're worried about 

391
00:22:41,840 --> 00:22:45,560
genetics. 
Here it is, family history and 

392
00:22:45,720 --> 00:22:48,720
age, if it starts before the age
of 45. 

393
00:22:48,920 --> 00:22:51,840
But there are some other things 
that can cause it, one being 

394
00:22:51,840 --> 00:22:55,920
iron deficiency. 
So what type of lab values am I 

395
00:22:55,920 --> 00:22:57,600
going to look at? 
Well, let's look at ferritin 

396
00:22:57,600 --> 00:23:00,880
levels less than 50. 
That is something I can 

397
00:23:00,880 --> 00:23:02,600
supplement. 
Remember if it is iron 

398
00:23:02,600 --> 00:23:05,160
deficiency that's causing 
restless leg syndrome, here goes

399
00:23:05,160 --> 00:23:08,520
one of my concepts. 
Give them what they don't have, 

400
00:23:08,880 --> 00:23:12,520
give them iron. 
It could be chronic conditions, 

401
00:23:12,720 --> 00:23:16,280
things like end stage renal 
disease, diabetes or peripheral 

402
00:23:16,280 --> 00:23:20,400
neuropathy. 
Things like antihistamines, 

403
00:23:20,400 --> 00:23:24,040
antipsychotics, antidepressants 
may make the situation worse. 

404
00:23:24,600 --> 00:23:27,000
And another one that comes up 
that we were talking about 

405
00:23:27,000 --> 00:23:31,800
earlier in maternity is 
pregnancy typically seen in the 

406
00:23:31,800 --> 00:23:36,640
third trimester in pregnancy. 
If we start to see this, what 

407
00:23:36,640 --> 00:23:39,520
are we going to do about it? 
Well, we're going to educate 

408
00:23:39,520 --> 00:23:42,320
them that this typically 
resolves postpartum. 

409
00:23:43,080 --> 00:23:45,560
So alleviate it by walking 
around, by getting up, as 

410
00:23:45,560 --> 00:23:47,520
uncomfortable as it sounds, 
especially when we're trying to 

411
00:23:47,520 --> 00:23:49,320
sleep, especially when we're 
pregnant, especially when we're 

412
00:23:49,320 --> 00:23:51,840
fatigued. 
But because it resolves 

413
00:23:51,840 --> 00:23:55,720
typically after birth, we're not
going to do any type of 

414
00:23:56,040 --> 00:23:57,560
pharmacological intervention 
here. 

415
00:23:59,320 --> 00:24:02,440
So clinical diagnosis, again, 
clinically we're going to 

416
00:24:02,440 --> 00:24:05,640
diagnose it by the signs and 
symptoms, but again, we can rule

417
00:24:05,640 --> 00:24:09,440
out an actual lab value by 
getting ferritin levels, give 

418
00:24:09,440 --> 00:24:13,120
them what they don't have with 
any type of neuropathy. 

419
00:24:13,320 --> 00:24:17,640
Here's a drug that you must 
know, a little bit of farm here,

420
00:24:18,440 --> 00:24:24,440
the drug pregabalin or 
gabapentin, super high yield. 

421
00:24:24,480 --> 00:24:31,360
Why with any type of neuropathy,
with restless leg syndrome, we 

422
00:24:31,360 --> 00:24:35,280
can use a commonly prescribed 
drug. 

423
00:24:35,280 --> 00:24:39,960
So identify pregabalin, identify
gabapentin for any type of 

424
00:24:39,960 --> 00:24:41,120
neuropathy. 
Well, where do we see 

425
00:24:41,120 --> 00:24:45,640
neuropathy, diabetic neuropathy,
peripheral neuropathy and PAD. 

426
00:24:46,680 --> 00:24:50,440
These drugs are going to help 
stabilize those, stabilize those

427
00:24:50,440 --> 00:24:53,400
nerves and get rid of that 
neurological pain that 

428
00:24:53,400 --> 00:24:56,720
neuropathy. 
So again, super high yield drug 

429
00:24:56,720 --> 00:24:58,480
with pregabalin. 
Little recap. 

430
00:24:58,760 --> 00:25:01,640
Well, we talked about circadian 
rhythm, how our sleep wake 

431
00:25:01,640 --> 00:25:05,280
cycles work. 
We moved on to sleep hygiene, 

432
00:25:05,760 --> 00:25:09,680
very important to educate our 
patients, great way to ask, 

433
00:25:09,680 --> 00:25:12,240
select all that apply and real 
life. 

434
00:25:12,960 --> 00:25:15,520
We talked about sleep disorders.
We talked about narcolepsy, 

435
00:25:15,800 --> 00:25:19,440
insomnia, obstructive sleep 
apnea and restless leg syndrome.

436
00:25:19,680 --> 00:25:21,480
We talked about the signs and 
symptoms because it makes a 

437
00:25:21,480 --> 00:25:25,520
perfect case study or matrix 
grid type question risk factors.

438
00:25:25,680 --> 00:25:28,840
Another one of those six 
questions, nursing 

439
00:25:28,840 --> 00:25:33,280
interventions, another one of 
those matrix grid questions in 

440
00:25:33,280 --> 00:25:38,320
your case study, treatment 
freebie questions, 

441
00:25:38,320 --> 00:25:40,440
pharmacological non 
pharmacological interventions 

442
00:25:40,680 --> 00:25:44,600
and education, education 
education, nursing interventions

443
00:25:44,600 --> 00:25:49,960
that basic care and comfort. 
So again with sleep, very 

444
00:25:49,960 --> 00:25:53,600
important to take a look at 
these and I hope you enjoy it. 

445
00:25:53,880 --> 00:25:54,520
Thank you for joining.