Sleep apnea is a sleep disorder characterized by the repeated cessation and resumption of breathing during sleep, preventing the body from getting adequate oxygen.
There are two types of sleep apnea:
- Obstructive sleep apnea (OSA) is the most common type and occurs when the upper airways become obstructed while sleeping, reducing or completely stopping air intake.
- Central sleep apnea (CSA) occurs when there is a brief disruption between the brain and the muscles that control breathing.
Clinical manifestations of sleep apnea include:
- Breathing that ceases and restarts during sleep (often observed by another person)
- Gasping for air during sleep
- Loud snoring
- Dry mouth in the morning
- Daytime tiredness and sleepiness
- Insomnia
The following are risk factors for sleep apnea:
- Obesity
- Narrowed airways or enlarged tonsils
- Large neck circumference
- Male gender
- Older age
- Use of alcohol or sedatives
- Smoking
- Chronic conditions such as congestive heart failure, asthma, and hypertension
Sleep apnea is diagnosed through a sleep study, medical history, and physical examination.
Nursing Process
Treatment and management of sleep apnea will depend on the severity of the condition. Mild cases will only require lifestyle modifications, including losing weight, treating nasal allergies, and smoking cessation. Moderate to severe sleep apnea will require treatments like continuous positive airway pressure (CPAP), airway pressure devices, supplemental oxygenation, or wearing an oral device to keep the throat open.
Nurses support their patients with sleep apnea by providing interventions and patient education to maintain cardiopulmonary status, improve breathing patterns and gas exchange, and improve quality of life.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for sleep apnea, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for sleep apnea.
Deficient Knowledge
Patient education about appropriate lifestyle modifications and equipment use is essential in managing sleep apnea.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation
- Inadequate participation in care planning
- Inadequate knowledge of resources
- Inadequate awareness of resources
- Inadequate commitment to learning
- Inadequate information
- Inadequate interest in learning
As evidenced by:
- Incorrect demonstration of CPAP/BiPAP use
- Inaccurate follow-through of instructions
- Inaccurate statements about sleep apnea
- Nonadherence with lifestyle recommendations
Expected outcomes:
- Patient will verbalize their risk factors for sleep apnea.
- Patient will verbalize adherence with using their CPAP machine.
Assessment:
1. Assess the patient’s knowledge about the condition.
Understanding what the patient knows will help determine what additional information is needed and correct misinformation.
2. Assess the patient’s motivation and adherence.
Managing sleep apnea through CPAP use requires a commitment to wearing the device. Lifestyle modifications may also be challenging. The patient may need the support of a spouse or family member for adherence.
Interventions:
1. Educate on sleep hygiene.
General sleep hygiene improvements will result in the most restful sleep. Educate on maintaining sleep/wake times, keeping a quiet, cool, and dark environment while sleeping, cutting off caffeine in the evening, and not eating too late.
2. Manage chronic conditions.
The patient with a history of asthma, diabetes, CHF, and hypertension is at an increased risk for sleep apnea. Ensure these conditions are properly managed.
3. Encourage lifestyle modifications.
Exercise, weight loss, quitting smoking, and avoiding alcohol at bedtime are necessary modifications to improve sleep apnea.
4. Provide resources for supplies.
CPAP supplies can be costly and prevent some patients from adhering to their CPAP regimen. Provide the patient with resources for free or low-cost supplies.
Impaired Gas Exchange
In sleep apnea, alveolar ventilation is reduced to zero during an apneic episode. As the body compensates, metabolic demands for oxygen are derived from the oxygen stores within the body. When oxygen within the lungs is depleted, impaired gas exchange occurs with arterial oxyhemoglobin desaturation.
Nursing Diagnosis: Impaired Gas Exchange
Related to:
- Altered oxygen supply
- Airway obstruction
- Ineffective breathing pattern
- Ineffective airway clearance
As evidenced by:
- Hypoxia
- Hypoxemia
- Decreased oxygen saturation
- Cyanosis
- Abnormal arterial pH
- Altered respiratory rhythm
- Altered respiratory depth
Expected outcomes:
- Patient will demonstrate reduced apneic episodes during sleep.
- Patient will demonstrate SpO2 within normal limits during sleep.
Assessment:
1. Assess the patient’s respiratory status and other parameters.
Apnea can cause alterations in the patient’s vital signs, ABGs, and SpO2.
2. Assess the effects of poor sleep.
Assess if the patient is experiencing excessive daytime sleepiness, fatigue, difficulty concentrating, and disturbed sleep patterns related to sleep apnea.
Interventions:
1. Do not take sedatives before bed.
Patients with sleep apnea may not be safe to take sedatives like narcotics or benzodiazepines at night as these can cause further respiratory depression.
2. Use the CPAP machine as indicated.
A CPAP machine adjusts the pressure to help maintain airflow while the patient sleeps.
3. Consider surgical options.
Surgery is considered a last resort for patients who have failed other treatments. This can include implants, tissue removal, jaw repositioning, and tracheostomy.
4. Administer supplemental oxygen as indicated.
Supplemental oxygen is recommended for patients with central sleep apnea.
Ineffective Breathing Pattern
Patients with sleep apnea experience ineffective breathing patterns as the airways can become obstructed and collapse during sleep, leading to breathing problems and affecting oxygen consumption.
Nursing Diagnosis: Ineffective Breathing Pattern
Related to:
- Disease process
- Airway obstruction
- Impaired regulation
- Body position that inhibits lung expansion
As evidenced by:
- Bradypnea
- Cyanosis
- Apnea during sleep
- Hypoventilation
- Hypoxemia
- Hypoxia
Expected outcomes:
- Patient will demonstrate interventions to prevent apnea from occurring during sleep.
- Patient will maintain a normal breathing pattern, rate, and rhythm.
Assessment:
1. Assess breathing frequency and pattern.
Mild sleep apnea can occur with 5 to 10 apnea events per hour. Determining the pattern and frequency of breathing can help determine the progression of the patient’s condition and formulate an appropriate plan of care.
2. Assess diagnostic test results.
Sleep apnea may be diagnosed through nocturnal polysomnography and home sleep tests that monitor heart rate, air flow, oxygen levels, and breathing patterns.
Interventions:
1. Encourage the patient to sleep in a side-lying position.
Sleeping on the back with the neck bending too far backward or forward can block the airways, leading to ineffective breathing patterns.
2. Consider oral devices.
Though CPAP is more effective, oral devices may be easier for some patients. These devices open the throat and bring the jaw forward to relieve obstruction.
3. Evaluate oxygen saturation during sleep.
An apnea monitor and pulse oximeter can help evaluate the patient’s oxygen saturation levels during sleeping.
4. Administer medications as ordered.
Methylxanthines can help relax smooth muscles for spontaneous breathing.
References
- Sleep Apnea. Mayo Clinic. Reviewed: July 28, 2020. From: https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631
- Sleep Apnea. WebMD. Reviewed: September 7, 2021. From: https://www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea
- Sleep Apnea. Cleveland Clinic. Reviewed: November 15, 2022. From: https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea
- Sleep Apnea. Sleep Foundation. Updated: December 16, 2022. From: https://www.sleepfoundation.org/sleep-apnea
