rest and sleep

rest and sleep

vital to life and health

used synonymously

deficiencies has effects on person’s mental, physical, and psychological health

synonymously

person can sleep and not feel rested

one can rest w/o resting

rest

body decreased state of activity → refreshed

reduced activity

refresh feeling

sleep

state of rest, altered consciousness, relative inactivity → sleep-wake cycle

person is less aware of surroundings

altered consciousness

fatal familial insomnia FFI

rare genetic degenerative brain disorder

inability to sleep → significant physical/mental deterioration

no known cure

lead to worsening insomnia → hallucination, delirium, confusion

sleep health

multidimensional pattern of sleep-wakefulness, adapted to individual, social, environment demands, promotes physical/mental well-being

healthy, balanced sleep pattern

why sleeps matters

learning and memory

removal waste product

metabolism

immune response

neurotransmitter uptake/mood

why sleeps matters: learning/memory

acquisition → learn new inf, wakefulness

consolidation → memory stable, sleep

recall → access inf consciously or unconsciously, wakefulness

sleep → strengthens neural connections

why sleeps matters: removal waste product

glymphatic system

• clear waste from CNS

• brains waste disposal system

sleep = brain detox

why sleeps matters: metabolism

hormone changes with sleep deprivation

• decrease leptin (satiety) → increase hunger

• increase ghrelin (hunger) → increase appetite

effects:

• insulin resistance

• oxidative stress

risk:

• obesity

• diabetes

why sleeps matters: immune response

innate → first defense

adaptive → long-term defense

during sleep:

• increase cytokine production

• helps fight infection, heals tissues

why sleeps matters: neurotransmitter uptake/mood

effect of sleep deprivation

• irritability

• stress

• anger

• mental exhaustion

poor sleep → bad mood

stress/anxiety → poor sleep

chronic sleep → depression, anxiety

why sleeps matters: neurotransmitters types

excitatory

• acetylcholine

• norepinephrine

• dopamine

• serotonin

• histamine

inhibitory

• GABA

special hormone

• melatonin

melatonin

regulate circadian rhythm

control sleep-wake cycle

brainstem

reticular activating system

bulbar synchronizing region

control the cyclic nature of sleep

control sleep, wake, attention

circadian rhythm

biological clock follows the sleep-wake cycle

non-rapid eye movement sleep

75% sleep consists 4 stages

person can be aroused easily

Parasympathetic NS dominates

decrease pulse, RR, BP, metabolic rate, body temp

rapid-eye movement sleep

difficult to arouse

consume 20-25% nightly sleep time

dream

mental and emotional equilibrium

sleep stage I

dozing off; 5-15 min

awake → sleep

easy to wake

light sleep

5% sleep

sleep stage II

main sleep stage; 50-55%

5-15 min

light sleep but actually asleep

easy to wake

body slow down, HR slow

sleep stage III/IV

slow-wave, delta sleep

body repairs itself

5-15 min; 20%

deepest sleep

sleep stage V

REM, dream

brain is active

muscles are paralyzed

10 min

normal young adult sleep cycle

sleep cycle is repeated about 4 to 5 min each night

sleep cycle as morning gets closer

REM is longer

deep sleep decreases

early night = more deep sleep

later night - more REM sleep

sleep follows predictable cycle

NREM → REM → repeat

sleep cycle stages

normal

• 1 → 2 → 3 → 4 deepest sleep

reverse

• 4 → 3 → 2 → REM

sleep cycle time

each cycle = 90-100 min

total cycle per night = 4-5 cycles

sleep changes throughout night

first half of night

• more deep sleep → stage 3-4

later (morning)

• cycle longer

• REM sleep

age and developmental affecting sleep/rest

sleep patterns changes across lifespan

age and developmental affecting sleep/rest: older adults

sleep lighter

wake often

↓ deep sleep (Stage IV ↓/absent)

↓ REM sleep

Difficulty falling/staying asleep

age and developmental affecting sleep/rest: newborns

16 hr sleep/day

age and developmental affecting sleep/rest: childhood/adolescence

varies

age and developmental affecting sleep/rest: adults

need 7-9 hrs

age and developmental affecting sleep/rest: culture

affect sleep routine

bedtime rituals

nappings

affects

• bedtime rituals, sleep location, noise tolerance

age and developmental affecting sleep/rest: motivation

person values sleep habits

high interest → stay awake despite fatigue

low interest → fall asleep easily

age and developmental affecting sleep/rest: lifestyle

shift work, school schedule, screen time, social activities

can disrupt circadian rhythm

lead to insomnia

age and developmental affecting sleep/rest: physical activity

exercise helps sleep

promotes sleep

exercising 3 hrs before sleep can disrupt sleep

age and developmental affecting sleep/rest: dietary habits

heavy meal

caffeine

stimulating food

food closer to bedtime → impairs sleep

tryptophan food with carbs → sleep-promoting

age and developmental affecting sleep/rest: smoking

interfere with sleep

difficult falling asleep, light sleep, easily awakened

can become a stimulant

age and developmental affecting sleep/rest: environment

noise

light

temp

age and developmental affecting sleep/rest: physiological stress

anxiety, grief, depression, stress

decrease total sleep

decrease REM sleep → increase anxiety

age and developmental affecting sleep/rest: illness

pain

breathing problem

urinary frequency

reflux

age and developmental affecting sleep/rest: medication

promote sleep and can interfere with sleep

medication decrease REM sleep

barbiturates

amphetamines

antidepressants

medications that can cause sleep problems

diuretics

steroids

decongestants

caffeine

asthma

antihypertensives

chronotherapeutics

timings meds based on circadian rhythm

improve effectiveness and reduce SE

right drug + right time = better effect

insomnia types and causes

onset: difficulty falling asleep

maintenance: difficult staying asleep

causes:

• circadian rhythm

• stress

• shift work

• pain/discomfort

• limited mobility

• medication

insomnia medication, acute vs chronic

medication causing insomnia

• antihypertensive

• CV

• cold/allergy

• ADHD

• antidepressants

acute: short-term, temporary

chronic: more than 3 times per week, last longer than 3 mo

insomnia risk factors

depression

over 60 yo

women

stress

illness

job

insomnia treatment

sleep hygiene

• avoid caffeine/alcohol

• consistent sleep schedule

• relax bedtime routine

cognitive behavioral therapy

• fix thought patterns about sleep

medication: induce/maintain sleep

• sedative-hypnotics

• zolpidem

• eszopiclone

• zaleplon

hypersomnolence: idiopathic hypersomnia

excessive daytime sleepiness

treatment:

• med stimulants

• antidepressants

affected:

• adolescent

• young adult

• genetic link

hypersomnolence: narcolepsy

neurological disorder

cataplexy

sleep is sudden w/o warning

cause: decreased hypocretin

hypersomnolence: narcolepsy symptoms, diagnosis, treatment

symptoms

• cataplexy → sudden loss muscle tone

• sleep paralysis → awake but unable to move

• hallucination

  • hypnagogic → falling asleep

  • hypnopompic → waking up

diagnosis

• sleep study req

treatment

• CNS stimulant → methylphenidate

• wake-promoting → modafinil

• sedative → sodium oxybate

circadian rhythm disorder

mismatch between persons schedule and body clock

circadian rhythm disorder shift work disorder

people working night shifts

• insomnia

• somnolence

• accident

• mood disorder

circadian rhythm disorder jet lag

new time zone conflicts with body internal sleep-wake cycle

S/S

• fatigue

• somnolence

• malaise

• GI issues

treatment

• sleep hygiene

• light therapy

  • red light

  • exposure to sunlight

parasomnias

abnormal behavior during sleep

somnambulism → sleep walk

enuresis → bedwetting

sleep eating

sleep terrors → NREM, fear, scream, autonomic signs

parasomnias treatment

sleep hygiene

• reg sleep schedule

• good sleep hygiene

medication

• only risk for injuries

• severe disruption

Sleep-related movement disorders: restless leg syndrome

uncomfortable urge/movement issue

common in middle-aged to older

genetic

treatment:

• ropinirole

• pramipexole

• gabapentin

sleep-related movement disorders: periodic limb movement disorder

repeated sleep movement

repetitive limb movement during sleep

“triple flexion” → knee, ankle, hallux

multiple times per hour during NREM

sleep-related movement disorders: sleep bruxism

teeth grinding

sleep stage 1-2

unnoticed → dental trauma

associated:

• stress

• OSA

• genetics

can lead to:

• TMJ pain

• HA, neck pain

• trauma

obstructive sleep apnea

repeat airway obstruction during sleep

decreased oxygen

freq awakenings

poor sleep quality

obstructive sleep apnea apneic period during sleep

hypoxia

arrhythmias

hypertension

obstructive sleep apnea what happens, risk factors

what happens

• sympathetic NS activated

• person briefly awakens → may/not remember

risk factors

• age, weight

• neck circumference

• gender, fam hx

• smoke, ETOH

obstructive sleep apnea symptoms, diagnosis

daytime fatigue.somnolence

mood disorder

decreased mental activity

diagnosis:

• polysomnography

obstructive sleep apnea treatment

modify risk factors

continuous positive airway pressure

• keep airway open with constant airflow

mandibular advancement device

• move jaw/tongue forward

• decrease throat obstruction, snoring/apnea episodes

• increase airway space

sleep disorder assessment/diagnosis

sleep diary

physical assessment

screen tool

sleep study

measures

sleep disorder assessment/diagnosis sleep diary

record sleep pattern/behavior

1-2 wks

bedtime, wake time, night awakenings, sleep habits

sleep disorder assessment/diagnosis screen tool

pittsburgh sleep quality index

• measure quality, sleep disturbance

epworth sleepiness scale

• measure daytime sleepiness

sleep disorder assessment/diagnosis sleep study

polysomnogram

overnight test

sleep disorder assessment/diagnosis measures

EEG

• brain activity

EOG

• eye movement

EMG

• muscle tone

NANDA sleep-related disorder

insomnia

sleep deprivation

readiness for enhanced sleep

disturbed sleep pattern

fatigue

risk injury

impaired sleep

risk impaired sleep

sleep nurse assessment

ask about

• bedtime, wake time

• naps

• nighttime awakening

• snore, apnea

• caffeine, alcohol, nicotine

• exercise habits

• stress

• medication

• daytime fatigue

• safety concern

• sleep env

sleep intervention sleep hygiene

Maintain sleep pattern within 30 min, even on weekends 

Avoid napping

Begin preparing for sleep 1-2 hr bf bedtime 

Avoid caffeine or food before sleep 

Avoid alcohol/nicotine 

Used bedroom for sleep 

Keep room quiet, dark, cool 

Exercise, but not before bed 

Consider sleep diary if problem continues 

Pharmacologic intervention is needed  

evaluation question

did intervention work

did we reach goal

do we need to reassess and revise

documentation

 if it wasn't documented, it wasn't done

What was done 

How it was taught 

Pt response to teaching and treatment 

Whether it worked or needed revision

hours of sleep

total hour per night

uninterrupted sleep?

normal 7-9 hr

pharmacologic aids

sleep medication

effectiveness

watch for:

• sedation

• fall risk

• confusion

priority assessment

aiway

breathing