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Nursing Rest and Sleep

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OBJECTIVE 45
DISCUSS INFLUENCES ON REST AND SLEEP
OBJECTIVE 45
DISCUSS INFLUENCES ON REST AND SLEEP
Rest and Sleep Functions
Characterized as being protective and
restorative.
⬢ Restores physical well-being
⬢ Relieves stress and anxiety
⬢ Restores the ability to cope and to
concentrate on activities of daily living.
Rest and Sleep Terminology

⬢ Rest
• Rest
– implies calmness, relaxation without
emotional stress, freedom from anxiety.
Rest and Sleep Terminology

⬢ Sleep
• Sleep
– an altered state of consciousness,
an individual’s perception of and reactions
to the environment are decreased.
-*Necessary for Protein synthesis
Rest and Sleep Terminology

⬢ Biorhythms
• Biorhythms
– rhythmic biologic clocks.
Rest and Sleep Terminology

⬢ Circadian Synchronization
• Circadian Synchronization
– when a person’s biologic clock coincides with
sleepwake patterns.
-begins 3rd week of life
-by 4 mon. infant sleeps thru night
-5-6 mon infant sleep pattern is like adult
Rest and Sleep Terminology

⬢ Electroencephalagram (EEG)
• Electroencephalagram (EEG)
– a graph of the electrical activity of the brain.
-delta slowest of 4 types of waves, low voltage, less activity
-alpha high voltage
-deep sleep waves, dreaming occurs, very hard to arouse
Stages of Sleep

1. Non-rapid eye movement (NREM).
The parasympathetic branch of the
autonomic nervous system dominates
and results in a decrease in:
⬢ Heart rate
⬢ Respiratory rate
⬢ Blood pressure
⬢ Metabolic rate
⬢ Body temperature
⬢ Slow brain waves
NREM STAGE =Four Stages

⬢ Stage I
• Stage I – transitional stage between
wakefulness and sleep. A relaxed state that last
only minutes, eyes roll from side to side, the
person can be aroused easily.
NREM STAGE =Four Stages

⬢ Stage II
• Stage II – a person falls into a stage of light
sleep but can be aroused easily, eyes still, body
temp. falls.
NREM STAGE =Four Stages

⬢ Stage III
• Stage III – arousal becomes difficult, snoring
may occur.
NREM STAGE =Four Stages

⬢ Stage IV
• Stage VI – greatest depth of sleep (delta sleep).
Arousal is difficult, restores the body physically,
eyes roll and dreaming occurs.
Stages of Sleep

2. Rapid eye movement (REM) sleep
–not as restful, dreams are usually remembered, sleep
is characterized by a stage that is more difficult to arouse a person. It consumes 20% to 25% of a normal adult’s nightly sleep.
• General skeletal muscle tone and deep tendon reflexes are depressed
• Increased heart rate
• Increased respiratory rate
• Increased blood pressure
• Increased metabolic rate
• Increased body temperature
• Highly active brain (paradoxical)
REM Sleep

⬢ Believed to be essential to________
• Believed to be essential to mental and emotional
worst survival – < 3 to 4.5 hours or > 8.5 hours.
Influences of Rest and Sleep
Influences of Rest and Sleep
⬢ Age
⬢ Comfort
⬢ Illness
⬢ Drugs
⬢ Life Style
Sedative – Hypnotic Therapy
• Sedatives introduced in the early 1900’s
• First prescribed to reduce tension and
anxiety
• Usually increases total sleep time
• May decrease REM sleep Developmental Patterns
• Infants – REM sleep
• Infants – REM sleep constitutes much of the
sleep cycle. Newborns sleep an average of 16
hours, infants 10-12 hours (can be as much as
22 hours).
⬢ Toddlers
• Toddlers – begin with 12 hours with two naps
during the day and end with 8 hours with one
nap during the daytime. Normal sleep-wake
cycles are established.
• Preschoolers – REM sleep pattern
• Preschoolers – REM sleep pattern is similar to
the adult. Can sleep 11-12 hours at night, the
average is 12. Wake up frequently at night.
Developmental Patterns
• School-age –
• School-age – sleep needs increase when
physical growth peaks. May require 8-12
hours per night.
Developmental Patterns
• Adolescents –
• Adolescents – growth spurts necessitate
the need for more sleep. Restless sleep is
contributed to stress of school, activities,
employment, nocturnal emission (wet dreams). Many adolescents do not get enough sleep.
Developmental Patterns
• Young adults –
• Young adults – average 8 hours of sleep.
Sleep is affected by physical health, type
of occupation, exercise, and lifestyle
demands.
Developmental Patterns
⬢ Middle-age adults
• Middle-age adults – 6-8 hours, decrease in
total sleep time and a decrease in delta
sleep. The total time awake in bed
increases.
Developmental Patterns
• Older adults –
• Older adults – average 5-7hours. Sleep is less sound, stage VI sleep may be absent, periods of REM sleep is shorter. May experience more difficulty falling asleep and c/o of problems
staying asleep. There is a decline in physical activity, psychological factors, effects of drug
therapy, or environmental factors may be implicated as causes of inability to sleep.
Sundowner’s syndrome – confusional state that tends to appear at dusk (R/T change in circadian
rhythms )
Comfort and Sleep Influences
⬢ Illness
⬢ Medication
⬢ Lifestyle
⬢ Diet
⬢ Stimulants and Alcohol
⬢ Smoking
⬢ Environmental factors
Influences of Illness on Rest and Sleep
Illness is a physiologic and psychological stressor.
Influences of Illness on Rest and Sleep

⬢ Gastric secretions
• Gastric secretions – increase during REM sleep.
People with peptic ulcers wake at night with pain.
Eating a snack or using antacids can help neutralize
stomach acidity.
Influences of Illness on Rest and Sleep

⬢ Coronary artery disease
• Coronary artery disease – myocardial infarcts are
more likely during REM sleep.
Influences of Illness on Rest and Sleep

⬢ Elevated Body Temp.
• Elevated Body Temp. – may cause reduction in
stages III, IV and REM
Influences of Illness on Rest and Sleep
Influences of Illness on Rest and Sleep

⬢ Epilepsy seizures
• Epilepsy seizures – are more likely to occur during
NREM sleep.
Influences of Illness on Rest and Sleep

⬢ Liver failure and encephalitis
• Liver failure and encephalitis – tend to cause a
reversal in day-night sleeping habits.
Influences of Illness on Rest and Sleep

• Hyperthyroidism –
• Hyperthyroidism – lengthens presleep time, making
it difficult to fall asleep.
Influences of Illness on Rest and Sleep

⬢ Hypothyroidism
• Hypothyroidism – decreases stage IV sleep.
Influences of Illness on Rest and Sleep

⬢ Estrogens levels
• Estrogens levels – low levels cause hot flashes and
night sweats that disturb sleep and causes fatigue.
Influences of Drug Therapy on Rest and Sleep

⬢ Asthma medications
• Asthma medications – administration of larger
mid-afternoon doses may more effectively
prevent attacks that commonly occur at night
during sleep.
Influences of Drug Therapy on Rest and Sleep
⬢ Anti-hypertensive medications
• Anti-hypertensive medications – may need
adjustment to provide peak protection during
early-morning hours, when heart attacks are
more common. Beta-blockers have been know
to cause insomnia and nightmares.
Influences of Drug Therapy on Rest and Sleep

• Chemotherapy –
• Chemotherapy – appears to be less toxic when
administered at certain times during the day.
Note: A client withdrawing from narcotics,
tranquilizers, amphetamines and antidepressants gets more REM sleep and may experience nightmares.
Influences of Drug Therapy on Rest and Sleep

Sedative – Hypnotic Therapy
Sedative – Hypnotic Therapy
• Sedatives introduced in the early 1900’s
• First prescribed to reduce tension and anxiety
• Usually increases total sleep time
• May decrease REM sleep
Influences of Life Style on
Sleep and Rest
⬢ Shift work
⬢ Work related pressures
⬢ Home stress
⬢ Educational goals
Factors Affecting Comfort and Sleep, Continued

• Diet –
• Diet – weight loss reduces total sleep time,
weight gain increases total sleep time, Ltryptophan
may induce sleep.
Factors Affecting Comfort and Sleep, Continued

⬢ Stimulants and Alcohol
• Stimulants and Alcohol – caffeine= stimulant,
alcohol=decrease in REM sleep.
Factors Affecting Comfort and Sleep, Continued

• Smoking –
• Smoking – more difficulty falling asleep, easily
aroused.
Factors Affecting Comfort and Sleep, Continued

⬢ Environment
• Environment – noise level, environmental temperatures, levels of light.
Sleep Disorders

⬢ Dyssomnias
• Dyssomnias – sleep disorder characterized by insomnia or excessive sleepiness.
1. Insomnia –
1. Insomnia – difficulty falling asleep (initial), difficulty staying
asleep (intermittent), premature waking (terminal).
2. Narcolepsy
2. Narcolepsy –overwhelming sleepiness that occurs during the day, starts in REM. Tx of choice -modafinil
3. Sleep Apnea
3. Sleep Apnea – periodic cessation of breathing during sleep.
(p.1119)
4. Restless leg syndrome
4. Restless leg syndrome – (dyssomnia) can occur when awake or asleep.
5. Periodic limb movements disorder
5. Periodic limb movements disorder – legs can jerk 2 or 3X per
min., only when asleep.
6. Sleep deprivation
6. Sleep deprivation
⬢ Patasomnias
• Patasomnias – patterns of waking behaviors that appear during sleep.
1. Somnambulism
1. Somnambulism –sleepwalking
2. Sleep-talking
2. Sleep-talking
3. Nocturnal erections
3. Nocturnal erections
4. Bruxism
4. Bruxism – grinding of teeth
5. Nocturnal Enuresis
5. Nocturnal Enuresis -bedwetting
OBJECTIVE 46
ASSESS REST AND SLEEP
NEEDS OF CLIENTS
OBJECTIVE 46
ASSESS REST AND SLEEP
NEEDS OF CLIENTS
Sleep History
. Interview questions help identify the patient’s sleep-wake-fullness patterns, the
effect of these patterns on everyday functioning, the patient’s use of sleep aids,
and the presence of sleep disturbances and
contributing factors.
. Use open ended questions if you suspect potential problems.
Sleep history
When a sleep disturbance is noted, the history
should include: (significant other)
. The nature of the problem
. Its cause
. The related S/S
. When it first began
. How it affects everyday living
. The severity of the problem (consult may be
indicated)
. How the patient is coping
Sleep Diary
. Any food, drink, or medication patient believes has positive or negatively influenced their sleep
. Record of physical activities
. Record of mental activities
. Record of activities performed 2-3 hours
before bedtime
. Presence of any worries or anxieties
Diagnostic Studies
. Electroencephalogram – EEG,
. Electroencephalogram – EEG, a graph of the
electrical activity of the brain
. Electromyogram – EMG,
. Electromyogram – EMG, measuement of muscle
activity.
. Electro-oculogram –
. Electro-oculogram – EOG, eye movement
. Polysomnograghy
. Polysomnograghy – recording of EEG, EMG, and
EOG simultaneously.
. Electrocardiogram – ECG
. Electrocardiogram – ECG, visualizes structures of
the heart and evaluate left ventricular function.
. Respiratory effort
. Airflow
. Oxygen saturation
. Leg movement
. Respiratory effort
. Airflow
. Oxygen saturation
. Leg movement
Sleep Rest Facts

. Snoring
. Snoring is not ordinarily a sleeping disorder.
Snoring accompanied by apnea can present
a problem.
. Nocturnal Myoclonus
. Nocturnal Myoclonus – marked muscle contraction that results in the jerking of one or both legs during sleep. The jerking lasts about 28 seconds on the average, may arouse the sleeper, and contribute toinsomnia.
. Insomnia
. Insomnia – difficulty falling asleep and/or staying asleep. It is more common in females, people with a history of depression, and people older than 60.
Temporary insomnia can be caused by noise or a
stressful event like the loss of a job or a death in
the family. Certain medication can keep you
awake, those that treat colds and allergies, heart
disease, blood pressure, and pain. Habits that sabotage our sleep include ingestion of alcohol and eating too close to bed time.
Insomnia
. Additional Medications Affecting Sleep.
1. Anti-Parkinson drugs
2. Beta-blocking agents
3. Nonprescription drugs containing caffeine
4. Barbiturate use in the elderly – can cause
the side effect of paradoxical excitement.
Higher doses will not produce sedation. A
non-barbiturate sedative or hypnotic may
be prescribed in its place.
Insomnia
. Short term
. Short term insomnia lasts only a few days and is usually not a cause for concern.
Insomnia
. Short term Treatment with MD advice
Treatment with MD advice – Nytol and
Unisom Nighttime. Insomnia is considered
chronic when it lasts for a few weeks or more. Underlying illness that can cause or contribute to insomnia include, thyroid
disorder, anxiety, depression, arthritis and
asthma and restless leg syndrome.
. Melatonin
. Melatonin – two forms, natural and synthetic.
Natural not recommended. It is from the pineal
gland of animals and may be contaminated with a
virus. Used to treat insomnia. Sold OTC. Not
regulated by government agency, their purity,
safety and effectiveness cannot be assured.
Should consult with MD before taking.
. Valerian –
. Valerian – extract from plant material and
prepared as teas, tinctures, pills or tablets as a
herbal preparation.
Goals
. Has your client met the goal?
Goals:
Client will experience relaxed undisturbed
sleep as evidence by verbalizations of:
Client will not experience injury from falls or
other adverse effects from medication
regime.
Client will verbalize understanding of sleep
process and medication regimen.
Evaluation
. Client has undisturbed, restful sleep for 8 hours.
. Client does not experience falls or other adverse effects of sedative/hypnotic
medications.
. Client verbalizes understanding of sleep
process, medical regimen, adverse effects of sedatives/hypnotics, and need to be compliant with therapy.
Evaluation of Medications
. The use of all sedative and hypnotic drugs
should be subject to routine periodic
review.
1. The clients condition
2. The necessity or advisability of continuing
the drug
3. The development of dependency
4. The effectiveness of the drug
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