Rest and Sleep Study Guide
 Sleep
 Physical and emotional health depends on adequate sleep and rest.
 To help a patient gain needed sleep and rest, you need to understand the nature of sleep, the factors
influencing it and interventions you can provide to promote sleep and rest.
 You also need to understand how to promote optimal sleep and rest for you!
 Physiology of Sleep
 ____________________________ Rhythms
 24 hour day/night cycle affected by light and temperature
 External factors like stress, activities affect it
 Melatonin supports it
 Everyone has a biological clock that is synchronized by light and activity
 Different people function best at different times of the day (ex: early bird vs night owl)
 Sleep Wake Regulation
 Depends on interrelationship between 2 parts of brain that either activate or suppress the brain’s higher
centers to control sleep or wakefulness
 When you try to fall asleep, the stimuli to the RAS (Reticular Activating System) decline; Gradually the
BSR (Bulbar Synchronizing Region) takes over, causing sleep. You will not reawaken until you finish
your normal sleep cycle or are awakened by stimuli in the environment
 Stages of Sleep
 2 phases:
 NREM: 4 stages through a 90 minute sleep cycle
 ____________ is the phase at the end of the sleep cycle with increased brain activity and rapid eye
movements; this is when vivid dreaming occurs
 Understand Figure 29-2 and Box 29-1
 People who have difficulty falling asleep remain in NREM Stage 1 for an hour or more (instead of
normal 10-30 mins)
 NREM Stage 4 is deepest level of sleep; person is very difficult to arouse; VS are lower; sleepwalking
and ____________________ sometimes occur
 Sleep Cycle Graph
 Functions of sleep
 Sleep is a time of restoration and preparation
 Sleep is a part of maintaining normal biological processes and optimal immune performance (repair and
renewal of cells)
 REM sleep is important for cognitive restoration and assists with memory storage and learning; loss of
REM sleep leads to feelings of confusion
 Dreams
 Researchers believe dreams are important for the consolidation of long-term memory and emotional
healing
 This is why it is important to:
 Review coursework right before bedtime
 Get a good night’s sleep before an exam
 Sleep Patterns across the Lifespan
 Newborns/Infants: sleep 16 hrs/day
 By age 2 sleep through night and take daily naps; often unwilling to go to bed. (Bedtime routines are
helpful)
 School age does not nap; needs quiet activities before bedtime
 Teens often experience excessive daytime sleepiness due to lifestyle demands
 By middle adulthood total time sleeping begins to decline and Stage 4 decreases. This continues with
advancing age
 Sleeping difficulties increase with age (50%). They awaken more often then have difficulties getting
back to sleep. Sleep efficiency is decreased.
 Factors Affecting Sleep
 Illness: pain, difficulty breathing, nausea or mood problems cause sleep problems
 Medications affect sleep. Tryptophan may help sleep
 Lifestyle: shift changes, unaccustomed heavy work, late night activities
 Usual sleep patterns and EDS
 Emotional Stress
 Environment is important: ventilation, light, temp, bed
 Noise decreases REM
 Fatigue: moderate=more restful
 Food: lg meal within 3-4 hrs interferes; ________ and caffeine interfere; weight loss and gain can
interfere
 Sleep Disorders
 Insomnia
 Sleep Apnea
 Narcolepsy
 Sleep Deprivation
 Parasomnias
 Routine Sleep Assessment
 From patient, bed partner, or parent of child
 Sleep history: usual bedtime, normal bedtime rituals, preferred environment, what time arises.
 Sleep Problem Assessment
 If there is a problem, assess in greater depth
 Usual Sleep pattern
 Description of Sleeping Problems
 Sleep Log
 Physical Illness and Meds
 Current Life Events
 Emotional and Mental Status
 Bedtime Routines
 Bedtime Environment
 Behaviors of Sleep Deprivation
 Patient Expectations
 Plan of Care
 See Care Plan: Disturbed Sleep Pattern
 Review Assessment, Nursing Diagnosis, Goals, Interventions and Evaluation
 Natural Interventions for Sleep
 Environmental Controls
 Promoting Bedtime Routines
 research shows listening to relaxing music is helpful
 Promote comfort
 Promote activity during the day
 ______________________________________
 Beneficial bedtime snacks
 Pharmacologic approaches
 Review meds with HCP re: insomnia
 Use sleeping meds as last resort and for limited time
 Managing Sleep Disturbances
 In acute care:
 Manage noise; Plan to avoid awakening patients
 Safety precautions if up at night or excessive daytime sleepiness
 Bring _____________________- if use at home
 Comfort measures: personal hygiene before bed; removal of irritating stimuli
 In Continuing Care:
 Previous interventions plus:
 Increase daily activities
 Limit time spent in bed
 Reduce sleep disruptions
 Patients with dementia: shortened activities and use soothing techniques at night
 Evaluation
 Individualized goals and interventions: check shortly after trying and ask after awakening.