Sleep and Rest

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Sleep and Rest

• George Ann Daniels, MS, RN

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Sleep Stages

• Stage 1 Transition
• Stage 2 Light Sleep
• Stage 3 4 Slow wave
• Stage 5 REM sleep

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REM Sleep

• REM-Rapid eye movement
• Vital signs fluctuate
• 02 consumption increases
• Thermoregulations lost
• Vaginal secretion increase
• Erections
• Dreams-vivid

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Sleep Rhythm

• 90 minute cycles during which people pass through
  the sleep stages

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Characteristics of normal sleep and rest

• Awareness of the need for sleep
• Sleepiness
• Urge to go to sleep
• Fatigue
• State of weariness
• Restoration and Protection
• Conserves energy
• Synthesis of cells (anabolism)

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Normal sleep and rest patterns

• Short sleepers
• 6 hours or less
• Efficient, hardworking
• Long sleepers
• 9 hours or more
• Creative
• Sleep latency period
• Change of position
• 20-40 time/ night

• One to two awakenings per noc normal for young
  adults
• Should awake well rested, refreshed, and
  energized
• Cultural habits
• Circadian Rhythms

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Lifespan

• Newborns/infants
• Quiet sleep and active sleep
• 3 waking states
• Quiet awake, active awake, and crying
• Newborns sleep 16-17 hours per day
• Divided into seven sleep periods between the day
  and night
• Infants have a shorter sleep cycle ( 50-60
  minutes)

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• Adaptive task for the infant
• Establish sleep-wake patterns compatible with the
  environment
• Most infants sleep through the night be 3 months
• Total sleep times continue to drop as the infant
  gets older
• Toddler/Preschooler
• 1 year naps once or twice per day
• Total sleep time drops to 13-14 hours at age 2
• 12 hours by age 5

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• Child
• Sleep needs are in relationship to growth spurts
  and activity patterns
• Adolescents
• Require more sleep than before puberty
• Growth and hormone
• Adults
• Vary
• Middle adults
• Increase in nocturnal awakenings
• Sleep satisfaction decreases

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• Older adults
• Stage 4 sleep decreases
• Difficulty remaining asleep
• Shorter nocturnal period with increase in daytime
  naps
• Total time in bed increases
• Napping, longer sleep latency, increased number
  and length of awakenings, and general fatigue
• Educate elderly about normal sleep pattern
  changes

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Factors Affecting Sleep and Rest

• Need
• Morning people/evening people
• Environment
• New environment
• Sleep room doubles with work area
• Objects of play may interrupt a child sleep
• Reduction of environmental stimuli
• Light , noise, and temperature

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• Relationships
• Parenting, bereaved,homesick, critical care
  units.
• Shift Work
• Nutrition and Metabolism
• Hunger or difficulty sleeping after a large meal,
  ingestion of certain foods decrease sleep latency
  and increase stage 4 sleep.
• Elimination Patterns
• Need to void
• Limit fluidsdecrease nocturnal stimulation
• Exercise and Thermoregulation
• Physically fit people have decreased sleep
  latency
• Warmth increases slow-wave sleep

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• Lifestyle and habits
• Bedtime rituals
• Lifestyle patterns
• Up at 5 and asleep by 8
• Illness
• Acute or chronic
• Loss of stage 3 sleep
• Pain, dyspnea, hormone changes (hyperthyroidism),
  skin conditions, anxiety from illness
• Medications and Chemicals
• Hypnotics, alcohol, caffeine
• Mood states

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Alterations in sleep

• Insomnia
• Perceived difficulty in sleeping
• Months to years
• 3 types
• Onset insomnia
• Maintenance insomnia
• Early-awakening insomnia

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• Narcolepsy
• Disorder of excessive daytime sleepiness
  characterized by short, sleep attacks
• Last 10 15 minutes
• Onset usually in adolescents
• Sleep apnea
• Recurrent periods of absence of breathing for 10
  seconds or longer, occurring at least 5 times per
  hour
• Obstructive sleep apnea
• Central apnea
• Mixed apnea

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• Periodic limb movement
• Repetitive dorsiflexion of the foot and flexion
  of the knee
• Once every 15-20 seconds
• Restless legs syndrome
• Crawling, itching sensations in the legs at rest
• Circadian rhythm disruptions
• Jet lag
• Parasomnias
• Normal activities in the day that is abnormal
  during sleep
• Sleepwalking, talking, bed wetting

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Impact on ADLs

• Decreased energy
• Impaired coping and cognitive responses
• Role performance
• Social interactions
• Irritability
• Impaired concentration

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Assessment

• Subjective
• How many hours of sleep do you usually get?
• What time do you usually go to bed?
• What time do you usually get up?
• What helps you sleep?
• How do feel when you wake up?
• How much sleep do you believe you need?
• What helps you relax?
• What are your sleep rituals?

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• How often do you take naps or rest periods?
• Do you take anything to help you sleep?
• Assess caffeine, nicotine, and alcohol intake.
• Assess work hours
• Identify dysfunctions
• Sleep apnea, snoring, stress
• Objective Data
• Circles under eyes, yawning, nodding, slow
  responses, irritability, impaired concentration,
  word-finding difficulties, VS
• Diagnostic test
• Sleep studies, 02 levels

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NDX

• Sleep pattern Disturbance R/T
• Internal sensory alterations
• Illness, stress
• External sensory alterations
• Light, noise, social stimulation, strange
  environment

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EO

• Client will report fewer problems falling asleep.
• Client will have an increase sleep time to 6
  hours per night.
• Client will report feeling more rested.

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Interventions

• Environment modifications
• Privacy and security
• Sleep rituals
• Managing individual sleep needs
• Medication