Comfort, Rest, and Sleep

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Comfort, Rest, and Sleep
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Objectives

• Identify the characteristics of NREM and REM
  sleep
• Identify the four stages of NREM sleep
• Describe variations in sleep patterns throughout
  the life span
• Identify factors that affect normal sleep
• Describe common sleep disorders

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Objectives

• Identify the components of a sleep pattern
  assessment
• Develop nursing diagnosis, outcomes, and nursing
  interventions related to sleep problems
• Describe interventions that promote normal sleep

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Physiology of Sleep

• Biorhythms
• Circadian Rhythms
• about a day
• Circadian Synchronization

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Stages of Sleep

• NREM-Non-REM sleep
• Stage I- very light sleep (drowsy-relaxed)
• Stage II- body process continue to slow
• Stage III-heart and respiratory rate are slower
• Stage VI-signals deep sleep
• REM-Rapid eye Movement

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Sleep Cycles

• NREM (pass the four stages in 1hr)
• Sleeper passes from Stage I NREM through stages
  II and II to Stage IV in about 20-30 min.
• Stages are followed by Stage III and II, in that
  order.

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Functions of Sleep

• Restores normal levels of activity
• Sympathetic Nervous System (while awake)
• Parasympathetic nervous system increases.
• Regular sleep pattern more important than actual
  hours slept.

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Normal Sleep Patterns and Requirements

• Newborns- sleep 16 to 18 hours a day, usually
  seven sleep periods.
• Infants- sleep 22 hours a day,20-30 REM sleep.
• Toddlers- 10-12 hours a day, 20-30 REM sleep.
• Preschoolers- 11-12 hours of sleep per night
• School Aged children- 8-12 hours at night.

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Continued

• Adolescents- 8-10 hours of sleep
• Young adults- 7-8 hours may require less
• Middle Aged Adults- 6-8 hours per night
• Older Adults- 6 hours

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Factors Affecting Sleep

• Age- One of the most important factors affecting
  persons sleep and rest periods.
• Illness- causing pain or physical distress can
  result in sleep problems.
• Environment-Noise level
• Fatigue- more tired shorter the first (REM) sleep
• Lifestyle-Shift work

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Continued

• Emotional Stress
• Alcohol and Stimulants
• Diet
• Smoking
• Motivation
• Medications

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Common Sleep Disorders

• Primary Sleep disorders- those in which the
  persons sleep problem is the main disorder.
• Secondary Sleep disorder- sleep disturbance
  caused by another clinical disorder, such as
  thyroid dysfunction, depression , or alcoholism.

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Primary Sleep Disorders

• Insomnia- most common sleep disorder, inability
  to obtain an adequate amount or quality of sleep.
• Hypersomnia- Opposite of insomnia, excessive
  sleep, especially daytime.
• Narcolepsy- Sudden wave of overwhelming
  sleepiness that occurs during the day. Referred
  to as sleep attack.

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Continued

• Sleep Apnea- periodic cessation of breathing
  during sleep.
• Parasomnias- Behavior that may interfere with
  sleep. (somnambulism (sleep walking), sleep
  talking, Nocturnal enuresis, nocturnal erections,
  bruxism).
• Sleep Deprivation- prolonged disturbance results
  in decreases amount, quality, consistency of
  sleep.

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Assessment of Sleep

• Assessment relative to a clients sleep includes
  a sleep history, sleep diary, a physical
  examination, and a review of diagnostic studies.

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Sleep History

• Usual sleeping pattern, specifically sleeping and
  waking times, hours of undisturbed sleep, etc.
• Bedtime rituals
• Use of sleep medications
• Sleep environment
• Changes in sleep pattern

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Sleep Diary

• Written record to be much more precise
• Total number of sleep hours a day
• Activities performed 2-3 hours before sleep
• Bedtime rituals
• Any worries that may affect clients sleep
• Factors that client believes to be positive or
  negative towards sleep

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Physical Examination

• Observation of clients facial appearance,
  behavior, and energy level.
• Darkened areas around the eyes, puffy eyelids,
  reddened conjunctiva, glazed or dull appearing
  eyes.
• Irritability, yawning, slumped posture, hand
  tremor, rubbing of eyes, confusion, fatigued,
  lethargic, etc.

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Planning

• Major goal for clients with sleep disturbances
  is to maintain a sleeping pattern that provides
  sufficient energy for daily activities.
• Interventions include- guided imagery,
  therapeutic message, progressive muscle
  relaxation, uninterrupted sleep periods.

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Implementation

• Nursing interventions to enhance the quantity and
  quality of sleep involve largely
  non-pharmacologic measures.

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Continued

• Client teaching
• Individuals need to learn the importance of rest
  and sleep in maintaining active and productive
  lifestyles.
• Supporting bedtime rituals
• Many are accustomed to rituals or pre-sleep
  routines and if altered can affect sleep.
• Creating Restful Environment

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Continued

• Promoting Comfort and Relaxation
• Assist client with hygienic routines
• Offer back message
• Administer analgesics 30 min before sleep
• Enhancing Sleep with Medications
• Nurse responsible for making decisions with the
  client about when to administer sedative
  hypnotics.

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Reducing Environmental Distractions in Hospitals

• Close window curtains if street lights shine
  through
• Close curtains between client in semiprivate and
  larger rooms
• Reduce or eliminate overhead lighting provide
  night light at the bedside or in the bathroom
• Close the door of the clients room

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Continue

• Perform only essential noisy activities during
  sleeping hours
• Ensure that all carts wheels are well oiled
• Wear rubber soled shoes
• Keep required staff conversations at low levels
  conduct nursing reports or other discussions in a
  separate area away from clients rooms