Sleep Basics for Health Promotion
Barbara B. Richardson, PhD
Learning Objectives
1. Describe normal developmental sleep
changes across the lifespan
2. Identify normal sleep patterns and
common sleep disorders
3. Describe potentially adverse health
outcomes associated with inadequate
sleep
Learning Objectives
4. Integrate knowledge of sleep when
completing a health assessment,
nursing care plan, and patient
education.
5. Evaluate environmental factors and
describe nursing interventions to
promote sufficient sleep
What is sleep?
o Sleep is a dynamic and regulated set of
behavioral and physiological states during
which many processes vital to health and
well-being take place.
Why is sleep important?
o Sufficient sleep is essential for
maintaining optimal physical health,
mental and emotional functioning, and
cognitive performance.
o Inadequate sleep time and poor quality
sleep interfere with quality of life and
can be hazardous to health
Current Theory Suggests a 2-Process
Model of Sleep/Wake Regulation
1 Sleep homeostasis or
internal drive, exact
mechanism unknown
o Pressure to sleep
increases throughout the
day until an internal
threshold is crossed
causing sleep to occur
o Waking occurs when
homeostatic drive
decreases sufficiently to
cross opposite threshold
2 Circadian rhythms
o Refers to cyclical
changes that occur over
a 24 hour period driven
by an internal “biological
clock” located in the
brain in the
suprachiasmatic nucleus
(SCN)
o Synchronized to external
physical environment
Sleep Across the Life Span
Developmental Patterns of Sleep
o All aspects of sleep behavior across the
lifespan demonstrate a large degree of
variability among individuals and across
cultures
o Sleep patterns are shaped by intrinsic biological
processes and psycho-social factors such as
cultural norms, family values, school, and
work.
Newborn and Infant Sleep
o Newborn sleep has 2 stages;
50% “quiet or non-rapid eye movement
(NREM) sleep” and
50% “active or rapid eye movement
(REM) sleep”
o Total sleep time = 16 to 17 hours / 24 hour
period with frequent awakenings for feeding
and nurturing
Children Ages 1-5 Years
o Amount of total sleep time decreases
to ~11 to 13 hours / 24 hour period
o Generally sleep through the night
o Nap during the day as needed
Sleep in Middle Childhood
(5-12 years)
o Total sleep time 10-12 hours
o May experience parasomnias
(sleep problems) such as
enuresis (bedwetting),
nightmares,
and sleep walking
Sleep in Adolescents
(12-18 years)
o Need ~9 hours of nightly sleep for optimal
health, emotional well being, and cognitive
functioning
o Often experience delayed sleep phase
syndrome …. can’t go to sleep until late at
night and prefer to sleep later in the morning
o Frequently do not get sufficient sleep
Sleep in Adulthood
o Generally need 7.5 to 8 hours
of nightly sleep
o Increasing frequency of problems sleeping
including common sleep disorders such as
obstructive apnea, insomnia, and restless
leg syndrome
Sleep in Aging Adults
(65+ years)
o Still need ~7 to 8 hours of total sleep time…
may decrease to as little as 6 hours a night
with naps common during the day
o Increased number of nighttime awakenings
o Frequently awaken very early in the morning
o Sleep may be impacted by illness and
medications
Assessing Sleep
o Always include questions about sleep
when assessing health status (except in
emergency situations)
o Inquire about number of hours client
generally sleeps (quantity) and how well
he/she usually sleeps (quality).
o Whenever possible, observe (in a hospital
or care facility) and record client’s sleep
patterns
Use standardized sleep assessment
tool if possible
o Using a survey to inquire about a
client’s normal sleep patterns
encourages a thorough assessment
including:
– Sleep environment
– Quality of sleep
– Amount of sleep
– Problems associated with sleep
If Standardized Assessment is Not
available, use BEARS* Sleep Assessment
as a guide
B - bedtime problems?
E - excessive sleepiness during the day?
A - awakenings at night?
R - regularity of sleep (number of hours)?
S - sleep disorders…including sleep apnea
and snoring
o Also, may inquire about lifestyle factors
impacting sleep such as work schedule,
alcohol use, illness, medications, bed sharing
arrangements, etc….
o
o
o
o
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Sleep problems can be associated
with many conditions including:
o Stress and environmental
factors
o Pregnancy
o Menopause
o Chronic pain
o Major depression
o Chronic illnesses such as
cancer, cardio-pulmonary
disease, and Alzheimer’s
Impaired Sleep and Adverse Health
Outcomes
o Adverse health outcomes resulting from
insufficient sleep include physiological,
behavioral / cognitive, emotional, and/or social
responses.
o Physiological outcomes include increased risk
for obesity, hypertension, and impaired immune
system functioning
Impaired Sleep and Adverse Health
Outcomes
o Inadequate sleep impacts behavior in children
and adults and may result in impaired daytime
functioning, including decreased school or
work place performance due to decreased
alertness, poor memory, and impaired problem
solving.
o Insufficient sleep may be a factor in sports
related and automobile accidents.
o Not enough sleep may lead to use of caffeine
and other stimulants to maintain wakefulness
Common Sleep Problems
o Parasomnias – include sleepwalking, bed
wetting, nightmares and night terrors (all
common in children), nocturnal sleep related
eating disorders, and bruxism (teeth grinding)
o Sleep disorders – include insomnia, obstructive
sleep apnea, restless leg syndrome, and
narcolepsy
Insomnia
o Defined as trouble falling asleep or staying
asleep
o May be due to stress, anxiety, hormonal
changes, lifestyle, environmental factors,
physical ailments, or psychiatric illness
o May be transient (lasting less than 4 weeks),
short term (1-6 months) or chronic (> 6 months)
Obstructive Sleep Apnea (OSA)
o During sleep, breathing pauses or stops for 1020 seconds or more, 20-30 times an hour.
Oxygen levels in blood drop, normal breathing
starts again with a loud snort.
o Results in excessive daytime sleepiness
o Often associated with overweight / obesity
o Can be treated with continuous positive airway
pressure (CPAP)
Restless Leg Syndrome
o Neurological disorder characterized by
unpleasant sensations in the legs and an
uncontrollable urge to move when resting
as an attempt to relieve these feelings.
o Causes difficulty falling asleep
o Cause unknown, difficult to treat
Narcolepsy
o Chronic neurological disorder caused by the
brain’s inability to regulate sleep-wake
cycles normally. Cause unknown.
o Characterized by frequent urges to sleep
occurring anytime.
o Can be disabling due to involuntarily falling
asleep at school, work, or anywhere.
o Cannot be cured, may be treated with
various medications
Treatment of Sleep Problems
o Behavior modification programs, hypnosis,
or meditation may be effective
o Self-prescribed over-the-counter sleep aids
o Prescription medications
Sleep Medications
Over the counter medications include:
1. antihistamines or drugs containing
diphenhydramamine hydrochloride
2. diphenhydramine citrate
3. doxylamine succinate
OTC Sleeping Aids
o Not intended for long term use
o May interfere with alertness during the day
so should avoid driving or other potentially
dangerous activities
o Reduce the quality of sleep by decreasing
the amount of time spent in deep sleep
Prescription Medications
o Must be used at the direction of a physician
o Often do not cure the cause of sleeping
problems, just help alleviate the symptoms
o Can be addictive / become drug dependent
o May cause physical side effects
o May interact with other medications or alcohol
Prescription Medications
Primary classes include:
o Short acting sedatives; hypnotics (Ambien,
Sonata, Lunesta)
o Melatonin receptor agonists (Rozerem)
o Benzodiazepines; tranquilizers (Dalmane,
Restoril, ProSom)
o Sedating anti-depressants (Desyrel)
To Get a Good Night’s Sleep –
Practice Good Sleep Hygiene!
o Maintain a regular sleep / wake schedule
whenever possible … even on weekends and
vacations
o Avoid napping during the day, especially after
3pm. Limit naps to < 1 hour.
o Establish a regular, relaxing bed time routine
Guidelines For Better Sleep
o Exercise regularly – but not within 2 hours
of sleep
o Avoid eating large meals just before
going to sleep
o Avoid caffeinated beverages, particularly
after lunch
o Avoid the use of alcohol and nicotine as
these substances can disrupt sleep
Environmental Factors Impacting
Sleep
o Light – exposure to light inhibits ability to fall
asleep and bright light in the morning can
shorten sleep
o Noise – traffic, TV, music, phones, and
computers can disturb sleep
o Bed sharing
o Room temperature (too hot or too cold can
inhibit sleep)
Good sleep promotes good health
o Assess sleep patterns and
sleeping environment
o Implement nursing interventions
to promote adequate sleep
Resources
o www.sleepfoundation.org
o www.aasmnet.org
o www.bettersleep.org
o www.sleepresearchsociety.org
o www.sleepandhealth.com
o www.kidzzzsleep.org
Books
o Bellenir, K. (Ed.).(2008). Sleep information for
teens. Detroit, MI: Omnigraphics.
o Mindell JA, Owens JA. (2003). A clinical guide
to pediatric sleep: diagnosis and management
of sleep problems. Philadelphia, PA: Lippincott
Williams & Wilkins.
Books
o Sleep Research Society Basics of Sleep Guide.
2005. Sleep Research Society, Westchester, IL.
o Yager, J. & Thorpy, M. (2001). Sleeping well:
The sourcebook for sleep and sleep sisorders.
Publisher: Facts on File. ISBN: 9780816040902
Contact Information
Barbara B. Richardson, PhD
barbrichardson@comcast.net