When you're feeling exhausted, only one thing seems to matter: sleep. But a number of sleep disorders and other problems can keep you from catching those zzz's. To help you understand what could be keeping you from the rest you need, get familiar with the vocabulary of sleep issues.InsomniaInsomnia is a common sleep disorder that affects your ability to sleep. Insomnia can be characterized by the timing of the sleep problem:Initial insomnia, when you have trouble falling asleepMiddle insomnia, when you wake in the middle of the nightTerminal insomnia, when you wake up too early in the morningInsomnia is either primary, meaning it's not caused by another condition, or secondary, which means it's caused by another health condition or it's the side effect of a medicine. Insomnia can also be categorized as acute (short-term), lasting more than one night to a few weeks, or chronic (long-term) lasting 3 or more nights a week for over a month.Circadian rhythmCircadian rhythms are the physical and mental changes that occur throughout the course of the day and affect whether you feel awake or sleepy. They are regulated by chemicals released in your brain in response to a stimulus, such as light. For example, you wake up in the morning because of chemicals that are released as your brain reacts to sunlight. The opposite occurs with a reduction in light, so in the evening your brain responds by making you feel drowsy.Circadian sleep disordersDisrupting your circadian rhythm can lead to problems with sleep. Two examples are jet lag, which can happen when you travel across time zones, and shift work sleep disorder, which affects people who work at night and sleep during the day. These disorders occur because your natural sleep-wake cycles are interrupted.Delayed sleep phase syndrome (DSPS)is the most common type of circadian sleep disorder. People with DSPS tend to stay up late at night and wake up late in the day. Delayed sleep phase syndrome can interfere with work and school because the sufferer is unable to fall asleep at regular "normal" sleep times.HypersomniaHypersomnia causes you to sleep too much or feel extremely sleepy during the day, even though you aren't sleep deprived. It can be hard to wake up in the morning, and you may feel confused at first. An overwhelming need to nap, even in the middle of talking or eating, is another symptom of hypersomnia. But napping may not relieve the sleepiness. Hypersomnia may be caused by a health condition or certain medicines. Conditions that can cause hypersomnia include other sleep disorders such as sleep apnea or narcolepsy.SomnambulismKnown best as sleepwalking, this is a type of sleep disorder that causes people to engage in complex activities while in a deep sleep. People who sleepwalk may stay in the house, wander outside, or even drive a car, all without waking. Sleepwalking is usually spontaneous, but can be induced by alcohol, some medicines, or insufficient sleep.NightmaresNightmares are unpleasant, even frightening, dreams that usually occur during REM sleep. Nightmares will cause waking, and people typically remember their nightmares.Sleep terrorsSleep terrors most often occur in children. Unlike nightmares, sleep terrors occur during non-REM slow-wave sleep. People who experience sleep terrors are aroused from sleep and become agitated or may cry or scream and be inconsolable. The sleep terror stops suddenly after a few minutes, followed by a return to sleep. Sleep terrors are usually short but can last as long as 45 minutes. Typically, people have no memory of the episode.Limit-setting sleep disorderThis disorder occurs when children test the limits of bedtime by trying to postpone going to sleep. They may ask for more books to be read or more water to drink, or they may simply get out of bed to delay sleep. Parents should set firm limits, especially bedtime, and not give in to their child's demands.Insufficient sleep syndromeInsufficient sleep syndrome is characterized by extreme fatigue and drowsiness. It's caused by sleep deprivation. It's usually the result of habits and behaviors that prevent adequate sleep, such as regularly waking early and then staying up late because of other activities.BruxismBruxism is a condition in which you grind your teeth or clench your jaw during sleep. Bruxism can cause headaches and jaw discomfort and may even result in tooth fractures.

Checklist for surgeryThe decision to have surgery is a very important one. You will need to be fully informed and prepared for the surgery. You will also need to be ready for any special needs that you may have after the surgery. How well you prepare will affect the outcome and the results. The following is a checklist to help you get ready for surgery.Make a list of questions to ask your healthcare provider or surgeon about the type of surgery you are to have.Bring a trusted family member or friend with you to any visits before surgery. This person can help make sure all your questions get asked and answered. They also can give you emotional support.Talk with your provider to find out if the surgery is right for you.Get a second opinion if you want to. If you have any concerns, a second opinion can be helpful.Check with your healthcare plan about what costs of the surgery you will be responsible for.Get a list of costs from your providers and the hospital or outpatient facility.Schedule the surgery.Make a list of all medicines you take. This includes all prescription and over-the-counter medicines, and all herbal supplements. Also include any recreational drugs. Go over this list with the anesthesiologist and surgeons.Schedule any labs tests you need to have before the surgery.Meet with the anesthesiologist before the surgery.Follow all instructions during the weeks and days before the surgery.Stop taking any medicines or supplements that your surgeon tells you to before the surgery. Find out when they should be stopped.Arrange for any home care or equipment you will need at home after the surgery.Sign all informed consent and other legal forms before surgery.Quit smoking several weeks before the surgery. This will help you recover faster. It will also help your incision heal more quickly.Remove all jewelry before the surgery and leave it home.Plan to have an adult drive you to and from your appointment.What is an informed consent form?The medical staff will carefully explain the surgery to you before you have it. This includes why you are having it, any risks the surgery has, and what you can expect afterward. You will also be asked to sign an informed consent form that explains the procedure and its risks and benefits. This form states that you understand everything about your surgery and have had the opportunity to ask any questions and receive satisfactory answers. It also explains that you have the right to refuse the procedure. You should read through the consent form carefully before signing it. Ask your surgeon if you have any questions or need more information.What are advance directives?When you are admitted to the hospital, hospital staff may encourage you to make an "advance directive." Advance directives are legal documents that state your preference in treatment and resuscitation if you arent able to speak for yourself. There are two types of advance directives:Living will.This document gives your wishes about withholding or withdrawing life support if you have an incurable and terminal condition and cant make decisions about your treatment.Durable power of attorney for healthcare.This document gives the name of the person who will make decisions for you if you are no longer able to make them. This designated person is called a healthcare proxy. This proxy also has the power to make the final decision about stopping treatment.What about a childs consent to medical care?A child must have a parents consent before any surgery or procedure can be done. But an "emancipated" or "mature" adolescent may consent to their own medical care. Laws may vary from state to state. It's important to know your own state's law about emancipated and mature minors.An emancipated or mature minoris usually someone who:Is marriedAttends college away from homeHas a childIs in the military serviceWhat happens when you cant give consent for your own surgery?In some cases, you may not be able make a decision about your medical care. This might be because you are unconscious, or because you have a mental disability or severe illness. In that case, a family member or your healthcare proxy will be asked to make any needed medical decisions.Insurance informationIf your healthcare provider recommends elective surgery, your insurance company may ask for "precertification" from your provider before you can have the surgery. Check with your insurance company on what you should do. You may need to pay a copayment for the hospital stay.

Hospice is not a place, but a philosophy of end-of-life care. Hospice does not hasten nor prolong death but uses symptom management such as pain control to allow for the highest quality of life possible. The goal of hospice is to maintain dignity and peace for the patient and family for as long as life continues. Hospice treats the person rather than the disease or illness. Hospice is ordered by the patients physician when cure is no longer possible but there continues to be a need for comfort care. Comfort care is also known as palliative care.. The hospice team can care for a patient anywhere they call home; i.e.: private home, skilled nursing facility, assisted living, or independent living. The hospice team consists of the Medical Director, RNs, LPNs, Certified Nurses Aides, Social workers, Spiritual care coordinators, volunteers and bereavement counselors as well as the complimentary services such as massage, music, pet, and aroma therapies .The hospice bereavement counselor will offer support to the survivors for up to 13 months after the death.All hospices that are Medicare and Medicaid certified must operate using the same regulations. There is no difference between for- profit and not-for-profit hospices as far as following the Medicare/Medicaid guidelines and caring for the patient/ family. Medicare, Medicaid and most insurance will pay for the hospice benefits which include medication, equipment, supplies, nursing and other services that are used for the comfort of the patient.All hospice care is developed around the physicians orders, patient needs, family involvement and the living environment. The patient is qualified for hospice with a physicians certification of life expectancy of 6 months or less. The RN will prepare a plan of care with the patient, family/caregiver, physician, hospice team and the Medical Director of Hospice. This plan will determine the needed pain control, symptom management, personal care (bathing, linen change, skin care, meal preparation when needed. Hospice care also includes medication management, medical equipment, nursing visits, counseling, spiritual care and social worker as requested. Volunteers are trained to sit with patients, provide comfort and companionship as desired by the patient and family/caregivers. Other services such as the music and massage therapy are offered to the patients through out their care.Hospice staff members are available 24/7 for questions, problem solving and crisis management. Hospice can assist your family/caregiver with the sometimes daunting challenges of your loved ones final passage.Editors Note: This article was written by Pamela Farrell RN, PHN, BSN, MSHA, Administrator of Mountain Valley HealthCare and Hospice, an AccentCare company serving northern Colorado to northern DenverFor questions concerning Home Health or Hospice, please call 970-346-9700