Fundamentals: Sleep & Rest

Sleep

Rest that helps the body restore energy and function.

Benefits of Sleep

Helps with memory, tissue repair, immunity, and energy conservation.

Sleep-Wake Cycle

The body's natural pattern of being awake and sleeping.

Melatonin

Hormone that helps prepare the body for sleep.

Pineal Gland

Gland that produces melatonin.

Darkness and Melatonin

Darkness causes melatonin release, which promotes sleep.

Circadian Rhythm

The body's natural 24-hour sleep-wake clock.

Factors Affecting Sleep-Wake Rhythm

Light, medications, caffeine, food, environment, stress, and irregular sleep schedules.

Caffeine and Sleep

Caffeine is a stimulant that can delay/disrupt sleep.

Alcohol and Sleep

Alcohol can interrupt sleep cycles and decrease sleep quality.

Stress and Sleep

Stress can cause worry and difficulty sleeping.

Regular Sleep Schedule

Going to bed and waking at the same time each day helps regulate sleep.

Healthy Sleep Environment

Keep the room dark, quiet, comfortable, and cool.

Exercise and Sleep

Exercise regularly, but avoid exercise within 2 hours of bedtime.

Naps

Keep naps short, less than 30 minutes.

Bedtime Routine

A regular relaxing activity, such as a warm shower or bath, can promote sleep.

NREM Sleep

Sleep stage when the body slows down and restores itself.

NREM Vital Signs

HR, BP, RR, temperature, and metabolic rate decrease.

REM Sleep

Sleep stage associated with vivid dreaming.

REM Muscle Tone

Skeletal muscles become very relaxed/atonic.

REM Breathing

Breathing can become irregular.

REM Heart Rate

Heart rate can increase or vary.

REM Onset

Usually begins about 90 minutes after falling asleep.

Sleep Deprivation

Not getting enough sleep to meet the body's biological sleep needs.

Effects of Sleep Deprivation

Impaired judgment, slower response time, headaches, and decreased thinking ability.

Hospital Sleep Disruption

Noise, bright lights, procedures, pain, medications, and stress can interrupt sleep.

Sensory Overload

Receiving more sensory stimulation than the person can process.

Sensory Overload Nursing Interventions

Lower noise, dim lights, manage pain, and decrease interruptions.

Cluster Nursing Care

Perform care together to reduce interruptions and allow longer rest periods.

Priority for Hospitalized Client Who Cannot Sleep

Create a calm environment and protect uninterrupted sleep.

Apnea

Breathing/airflow stops for at least 10 seconds.

Hypopnea

Reduced airflow for at least 10 seconds with decreased oxygen saturation.

Obstructive Sleep Apnea (OSA)

Upper airway becomes blocked during sleep.

OSA Risk Factors

Obesity, enlarged tonsils, and relaxed/inactive tongue can contribute.

OSA Common Finding

Snoring is common.

Effects of OSA

Interrupted sleep can cause daytime sleepiness, low energy, and decreased motivation.

Central Sleep Apnea (CSA)

The brain does not adequately signal the respiratory muscles to breathe.

CSA Causes

Can occur with opioid overdose or heart failure.

OSA vs. CSA

OSA = airway problem. CSA = brain signaling problem.

Polysomnography

A sleep study used to diagnose sleep disorders.

Polysomnography Monitors

HR, BP, breathing, O₂ saturation, brain waves, movement, and snoring.

Promoting Sleep: Stimulants

Avoid caffeine, alcohol, and nicotine 4-6 hours before bedtime.

Promoting Sleep: Light and Noise

Remove unnecessary light and noise.

Promoting Sleep: Consistency

Go to bed and wake up at the same time every day.

Promoting Sleep: Bedroom Use

Remove work and television; use the bedroom mainly for sleep and sex.

Promoting Sleep: Meals

Avoid large meals close to bedtime.

Hospitalized Client Sleep Priority

Reduce nighttime light, noise, and avoidable interruptions.

Benzodiazepines

Medications that can cause drowsiness, muscle relaxation, and decreased anxiety.

Nonbenzodiazepine Hypnotics

Medications commonly prescribed to help a client sleep.

Zolpidem (Ambien)

A nonbenzodiazepine sleep medication.

Diphenhydramine (Benadryl)

OTC medication that can cause drowsiness.

Diphenhydramine Side Effects

Daytime drowsiness, dry mouth, blurred/visual problems, constipation, and difficulty urinating.

Nonpharmacologic Sleep Interventions

Methods such as massage, guided imagery, mindfulness, meditation, music, and yoga.

Massage

Helps relax muscles and improve comfort.

Massage Precaution

Use caution with blood clots, injuries, skin conditions, or open wounds.

A hospitalized client cannot sleep because staff frequently enter the room. What should the nurse do?

Cluster nursing care to allow uninterrupted sleep.

A client is experiencing sensory overload. What is the priority nursing action?

Decrease environmental stimulation such as noise and light.

A client who has obesity snores loudly and repeatedly stops breathing while asleep. What should the nurse suspect?

Obstructive sleep apnea (OSA).

A client stops breathing during sleep because the brain does not signal the respiratory muscles. What disorder is this?

Central sleep apnea (CSA).

A client develops apnea after an opioid overdose. What type of sleep apnea should the nurse suspect?

Central sleep apnea (CSA).

Which test should the nurse expect for a client suspected of having sleep apnea?

Polysomnography.

A sleep-deprived client has impaired judgment and a slower response time. What is the nurse's biggest concern?

Risk for injury/accidents.

Which statement shows correct understanding of healthy sleep habits?

I will go to bed and wake up at the same time every day.

Which statement shows a client needs more teaching about sleep?

I will exercise right before bedtime.

A hospitalized client is having trouble sleeping because of bright lights and noise. What should the nurse do first?

Dim the lights and reduce noise.