Rest and Sleep Chyrel Lynn T. Panlilio MSN, RN Objectives Describe Describe the functions of sleep Identify Identify factors affecting sleep Describe Describe nursing interventions that address age related different sleep cycles Rest and Sleep Rest - a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed. Sleep is a state of rest accompanied by altered consciousness and relative inactivity. Sleep is part of what is called the sleep–wake cycle. Wakefulness is a time of mental activity and energy expenditure. Sleep is a period of inactivity and restoration of mental and physical function. Physiology of Sleep Reticular activating system (RAS) Bulbar synchronizing region Hypothalamus— control center for sleeping and waking Facilitates reflex and voluntary movements Controls cortical activities related to state of alertness Circadian Rhythms • Predictable fluctuations in processes in repeated cycles of time, completing a full cycle every 24 hours • Sleep–wake patterns - inner biologic clock located in the hypothalamus • Physiologic and psychological rhythms- high/most active wakefulness; these rhythms are low - asleep • Night shift chronodisruption Non-rapid eye movement (NREM) • Consists of four stages • Stages I and II: 5% to 50% of sleep, light sleep • Stages III and IV—10% of sleep, deep-sleep states (delta sleep) Stages of Sleep Rapid eye movement (REM) • 20% to 25% of a person’s nightly sleep time • Pulse, respiratory rate, blood pressure, metabolic rate, and body temperature increase; skeletal muscle tone and deep tendon reflexes are depressed. What stage of sleep makes it difficult to arouse the patient? Single Normal Sleep Cycle • The person passes consecutively through four stages of NREM sleep. • The pattern is then reversed. • Return from stage IV to III to II • Enter REM sleep instead of re-entering stage I • The person re-enters NREM sleep at stage II and moves on to III and IV. Comparison of Developmental Differences in Sleep Cycles Function of Sleep Brain Function Metabolism Function Healing and Repair Hormonal Function Growth and development Immunity Productivity Physical & Psychological Effects of Insufficient Sleep • Obesity* • Anxiety, personal conflicts, loneliness, & depression • Gastrointestinal symptoms • Type 2 diabetes • Hypertension • Cardiovascular disease - strokes • Substance abuse • Slow reaction time^ • Fatigue • Decreased alertness • Decreased competence Factors Affecting Sleep Developmental considerations Medications Motivation Illness Culture Psychological stress Lifestyle and habits Environmental factors Illnesses Associated With Sleep Disturbances • Gastroesophageal reflux • Coronary artery diseases • Epilepsy • Liver failure and encephalitis • Hypothyroidism • End-stage renal disease Classification of Sleep Disorders (ICSD) Insomnia Sleep-related breathing disorders Parasomnias Central disorders of hypersomnolence Sleep-related movement disorders Circadian rhythm sleep–wake disorders Other sleep disorders Insomnia • Difficulty falling asleep • Intermittent sleep or difficulty maintaining sleep • 30 to 35 percent of adults in the United States • History of depression • Related to disruptions in circadian rhythms. • Short-term or chronic in nature. Obstructive Sleep Apnea • Characterized by five or more predominantly obstructive respiratory events: • Absence of breathing [apnea] • Diminished breathing efforts [hypopnea] • Respiratory effort-related arousals during sleep, accompanied by sleepiness, fatigue, insomnia, snoring • Subjective nocturnal respiratory disturbance • Observed apnea and associated health disorders • CPAP, Bi-PaP, Central Disorders of Hypersomnolence • Idiopathic hypersomnia • Characterized by excessive sleep, particularly during the day. • Narcolepsy • Characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep. • Up to 70% of people with narcolepsy also experience cataplexy, the sudden, involuntary loss of skeletal muscle tone lasting from seconds to one or two minutes. Circadian Rhythm Sleep-Wake Disorders • Primary causes: • An alteration in the internal circadian timing system or misalignment between the internal circadian rhythm and the sleep–wake schedule desired or required • A sleep–wake disturbance (e.g., insomnia or excessive sleepiness) • Associated distress or impairment, lasting for a period of at least 3 months (except for jet lag disorder). Parasomnias • Somnambulism • REM sleep behavior disorder (RBD) • Sleep terrors • Nightmare disorder • Sleep enuresis • Sleep-related eating disorder TREATMENT 1. Regular sleep schedule 2. Good sleep hygiene 3. Medication to control symptoms True or False Somnambulism is a parasomnia in which the person walks in his or her sleep. Restless Legs Syndrome (RLS) • Restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED) – 15% of older adults • (RLS) • cannot lie still • report unpleasant creeping, crawling, or tingling sensations in the legs. • ESRD, DM, Fe deficiency, pregnant,& peripheral neuropathy • Nonpharmacologic treatments Treatment for Dyssomnias • Pharmacologic therapy • Sedatives • Hypnotics • Nonpharmacologic therapy • Cognitive Behavioral Therapy (CBT) • Progressive muscle relaxation measures • Stimulus control • Sleep restriction; sleep hygiene measures • Biofeedback and relaxation therapy Nature of problem Cause of problem Related signs and symptoms Obtaining a Sleep History When the problem began and how often it occurs How the problem affects everyday living Severity of the problem and how it can be treated How the patient is coping with the problem and success of treatments attempted Screening Tools to Assess Sleep Disturbances • The Epworth Sleepiness Scale • The Pittsburgh Sleep Quality Index (PSQI) • Sleep Disturbance Questionnaire Assess Sleep Disturbances Screening Tools Sleep Characteristics to Assess • Restlessness • Sleep postures • Sleep activities • Snoring • Leg jerking Information Recorded in a Sleep Diary Time patient retires Time patient tries to fall asleep Approximate time patient falls asleep Time of any awakening during the night and resumption of sleep Time of awakening in morning Presence of any stressors affecting sleep Information Recorded in a Sleep Diary Record of food, drink, or medication affecting sleep Record of physical and mental activities Record of activities performed 2 to 3 hours before bedtime Presence of worries or anxieties affecting sleep Key Findings of Physical Assessment • Energy level • Facial characteristics • Behavioral characteristics • Physical data suggestive of sleep problems Common Etiologies for Nursing Diagnoses • Physical or emotional discomfort or pain • Changes in bedtime rituals or sleep environment • Disruption of circadian rhythm • Exercise and diet before sleep • Drug dependency and withdrawal • Symptoms of physical illness DISTURBED SLEEP PATTERN R/T ( SHORT TERM PROBLEM) Nursing Diagnoses SLEEP DEPRAVATION R/T (LONG TERM PROBLEM) READINESS FOR ENHANCED SLEEP INSOMNIA Nursing Interventions to Promote Sleep • Prepare a restful environment. • Promote bedtime rituals. • Offer appropriate bedtime snacks and beverages. • Promote relaxation and comfort. • Respect normal sleep–wake patterns. • Schedule nursing care to avoid disturbances. • Use medications to produce sleep. • Teach about rest and sleep.
