Chapter 35 - Rest and Sleep

‭Functions of Rest and Sleep‬ ‭●‬ ‭Rest refers to a condition in which the body is in a decreased state of activity, with the‬ ‭consequent feeling of being refreshed‬ ‭●‬ ‭Sleep is part of what is called the sleep-wake cycle‬ ‭○‬ ‭Wakefulness is a time of mental activity and energy expenditure‬ ‭○‬ ‭Sleep is a state of rest accompanied by altered consciousness and inactivity‬ ‭●‬ ‭Sleep is a period of inactivity and restoration of mental and physical function‬ ‭Stages of Sleep‬ ‭●‬ ‭Non-rapid eye movement (NREM)‬ ‭○‬ ‭Consists of four stages‬ ‭○‬ ‭Stages I and II: Light sleep‬ ‭○‬ ‭Stages III and IV: Deep-sleep states‬ ‭●‬ ‭Rapid eye movement (REM)‬ ‭○‬ ‭Contributes to brain development in infants, learning, and memory‬ ‭○‬ ‭20-25% of a person’s nightly sleep time‬ ‭○‬ ‭Pulse, respiratory rate, blood pressure, metabolic rate, and body temp increase‬ ‭○‬ ‭Skeletal muscle tone and deep tendon reflexes are depressed‬ ‭A Single Normal Sleep Cycle‬ ‭Stages of NREM Sleep‬ ‭●‬ ‭Stage I:‬ ‭○‬ ‭Transitional stage between wakefulness and sleep‬ ‭○‬ ‭Relaxed state but somewhat aware of surroundings‬ ‭○‬ ‭Involuntary muscle jerking may awake the person‬ ‭ ‬ ‭Only lasts minutes‬ ○ ‭○‬ ‭Can be aroused easily‬ ‭○‬ ‭5% of total sleep‬ ‭ ‬ ‭Stage II:‬ ● ‭○‬ ‭Person falls into a stage of sleep‬ ‭○‬ ‭Can be aroused with relative ease‬ ‭○‬ ‭50-55% of sleep‬ ‭●‬ ‭Stage III:‬ ‭○‬ ‭Depth of sleep increases‬ ‭○‬ ‭Arousal becomes increasingly difficult‬ ‭○‬ ‭10% of sleep‬ ‭●‬ ‭Stage IV:‬ ‭○‬ ‭Greatest depth of sleep; delta sleep‬ ‭○‬ ‭Arousal is difficult‬ ‭○‬ ‭Physiologic changes:‬ ‭■‬ ‭Slow brain waves (EEG)‬ ‭■‬ ‭Most vital decrease‬ ‭■‬ ‭Muscle relaxation‬ ‭■‬ ‭Metabolism slows‬ ‭○‬ ‭10% of sleep‬ ‭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-enteres NREM sleep at stage II and moves onto III and IV‬ ‭ uestion:‬‭In which stage of NREM sleep does the person‬‭fall into a stage of sleep but can be‬ Q ‭aroused with relative ease?‬ ‭a.‬ ‭Stage I‬ ‭b.‬ ‭Stage II‬ ‭c.‬ ‭Stage III‬ ‭d.‬ ‭Stage IV‬ ‭Factors Affecting Sleep‬ ‭●‬ ‭Developmental considerations‬ ‭●‬ ‭Motivation‬ ‭●‬ ‭Culture‬ ‭●‬ ‭Lifestyle and habits‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ nvironmental factors‬ E ‭Psychological stress‬ ‭Medications (barbiturates, amphetamines, and antidepressants)‬ ‭Illness‬ ‭Question:‬‭Barbiturates, amphetamines, and antidepressants‬‭increase REM sleep.‬ ‭a.‬ ‭True‬ ‭b.‬ ‭False‬ ‭Sleep Disorders‬ ‭●‬ ‭Dyssomnias: Characterized by insomnia or excessive sleepiness‬ ‭●‬ ‭Parasomnias: Patterns of waking behavior that appear during sleep‬ ‭Dyssomnias‬ ‭●‬ ‭Insomnia‬ ‭●‬ ‭Hypersomnia‬ ‭●‬ ‭Narcolepsy‬ ‭●‬ ‭Sleep apnea‬ ‭●‬ ‭Restless leg syndrome‬ ‭●‬ ‭Sleep deprivation‬ ‭Obstructive Sleep Apnea‬ ‭●‬ ‭Treated with a CPAP (continuous positive air pressure)‬ ‭Parasomnias‬ ‭●‬ ‭Somnambulism‬ ‭●‬ ‭REM behavior disorder (RBD)‬ ‭●‬ ‭Sleep terrors‬ ‭●‬ ‭Nightmares‬ ‭●‬ ‭Bruxism‬ ‭●‬ ‭Enuresis‬ ‭●‬ ‭Sleep-related eating disorder‬ ‭ uestion:‬‭In which of the following sleep disorders‬‭does the patient have‬ Q ‭an uncontrollable desire to sleep?‬ ‭a.‬ ‭Insomnia‬ ‭b.‬ ‭Sleep apnea‬ ‭c.‬ ‭Narcolepsy‬ ‭d.‬ ‭Restless leg syndrome‬ ‭Obtaining a Sleep History‬ ‭●‬ ‭Nature of problem‬ ‭●‬ ‭Cause of problem‬ ‭●‬ ‭Related S/S‬ ‭●‬ ‭When the problem began‬ ‭●‬ ‭Frequency of problem‬ ‭●‬ ‭How problem affects everyday living‬ ‭●‬ ‭Severity of the problem‬ ‭●‬ ‭How the problem can be treated‬ ‭●‬ ‭How the patient is coping with the problem‬ ‭●‬ ‭Success of attempted treatments‬ ‭Sleep Characteristics to Assess‬ ‭●‬ ‭Restlessness‬ ‭●‬ ‭Sleep postures‬ ‭●‬ ‭Sleep activities‬ ‭●‬ ‭Snoring‬ ‭●‬ ‭Leg jerking‬ ‭Screening Tools to Assess Sleep Disturbances‬ ‭●‬ ‭The Epworth Sleepiness Scale‬ ‭●‬ ‭The Pittsburgh Sleep Quality Index (PSQI)‬ ‭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 the morning‬ ‭●‬ ‭Presence of any stressors affecting sleep‬ ‭●‬ ‭Record of food, drink, or medication affecting sleep‬ ‭●‬ ‭Record of physical and mental activities‬ ‭●‬ ‭Record of activities performed 2-3 hours before bedtime‬ ‭●‬ ‭Presence of worries or anxieties affecting sleep‬ ‭Key Findings of Physical Assessment‬ ‭●‬ ‭Energy level‬ ‭●‬ ‭Facial characteristics‬ ‭●‬ ‭Behavior characteristics‬ ‭●‬ ‭Physical data suggestive of sleep problems‬ ‭Treatment for Dyssomnias‬ ‭●‬ ‭Pharmacologic therapy‬ ‭○‬ ‭Sedativess‬ ‭○‬ ‭Hypnotics‬ ‭●‬ ‭Nonpharmacologic therapy‬ ‭○‬ ‭Cognitive behavioral therapy (CBT)‬ ‭○‬ ‭Progressive muscle relaxation measures‬ ‭○‬ ‭Biofeedback and relaxation therapy‬ ‭○‬ ‭Sleep restriction‬ ‭○‬ ‭Sleep hygiene measures‬ ‭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 ‭Teaching About Rest and Sleep‬ ‭●‬ ‭Restricting the intake of caffeine, nicotine, and alcohol, especially later in the day‬ ‭●‬ ‭Eating a light carbohydrate and protein snack before bedtime‬ ‭●‬ ‭Taking a warm bath before bedtime‬ ‭●‬ ‭Avoiding mental and physical activities after 5 pm that are stimulating‬ ‭●‬ ‭Avoiding daytime naps‬ ‭●‬ ‭Avoiding high fluid intake in the evening‬ ‭●‬ ‭Eliminating use of a bedroom clock‬ ‭●‬ ‭Sleeping in a cool, dark room‬ ‭●‬ ‭Trying to keep the sleep environment as quiet and stress-free as possible‬