SLEEP

Sleep

Sleep

Considered an altered state of consciousness in which the individual's perception of and reaction to the environment are decreased.

Sleep

Cyclical physiological process that alternates with longer periods of wakefulness; sleep-wake cycle influences and regulates physiological function and behavioral responses

Sleep-Wake Cycle

influences and regulates physiological function and behavioral responses

Circadian Rhythm

24-hour, day-night cycle

Hypothalamus

secretes hypocretins that promote wakefulness and REM

RAS

receives visual, auditory, and tactile sensory stimuli.

cerebral cortex

Activity from the ___________________ affects sleep.

Stage 1 NREM

Stage lasts a few minutes.
It includes the lightest level of sleep.
Decreased physiological activity begins with a gradual fall in vital signs and metabolism.
Sensory stimuli such as noise easily arouse a person.
When awakened, the person feels as though daydreaming has occurred.

Stage 2 NREM

Stage lasts 10 to 20 minutes.
It is a period of sound sleep.
Relaxation progresses.
Body functions continue to slow.
Arousal remains relatively easy.

Stage 3 NREM

Stage lasts 15 to 30 minutes.
It involves initial stages of deep sleep.
Muscles are completely relaxed.
Vital signs decline but remain regular.
Sleeper is difficult to arouse and rarely moves.

Stage 4 NREM

Stage lasts approximately 15 to 30 minutes.
It is the deepest stage of sleep.
If sleep loss has occurred, the sleeper spends a considerable part of the night in this stage.
Vital signs are significantly lower than during waking hours.
Sleepwalking sometimes occurs. and enuresis (bed-wetting)
It is very difficult to arouse a sleeper.

REM Sleep

Stage usually begins about 90 minutes after sleep has begun.

REM Sleep

Stage is typified by rapidly moving eyes, fluctuating heart and respiratory rates, increased or fluctuating blood pressure, loss of skeletal muscle tone, and increase of gastric secretions.

NREM Sleep

contributes to body tissue restoration

REM Sleep

is necessary for brain tissue restoration & appears important for cognitive restoration & memory

Physical Illness

Any illness that causes pain, physical discomfort, or mood problems such as anxiety or depression often results in sleep problems.

Environment

can promote or hinder sleep. The person must be able to achieve a state of relaxation prior to entering a period of sleep.

Lifestyle

Following an irregular morning and nighttime schedule can affect sleep.

Moderate Exercise

in the morning or early afternoon usually is conducive to sleep, but exercise late in the day can delay sleep.

Stress

is considered by most sleep experts to be the one the greatest cause of difficulties in falling asleep or staying asleep.

Emotional Stress

Stress is considered by most sleep experts to be the one the greatest cause of difficulties in falling asleep or staying asleep.

Stimulants and Alcohol

Drinking beverages containing caffeine in the afternoon or evening may interfere with sleep. People who drink an excessive amount of alcohol often find their sleep disturbed.

Weight Gain

has been associated with reduced total sleep time as well as broken sleep and earlier awakening

Diet

Weight gain has been associated with reduced total sleep time as well as broken sleep and earlier awakening.

Nicotine

has a stimulating effect on the body and smokers often have more difficulty falling asleep than nonsmokers.

Smoking

Nicotine has a stimulating effect on the body and smokers often have more difficulty falling asleep than nonsmokers.

Motivation

can increase alertness in some situations.

hypnotics

Most _____________ can interfere with deep sleep and suppress REM sleep.

morphine

Narcotics such as ____________ are known to suppress REM sleep and to cause frequent awakenings and drowsiness.

Insomnia

The inability to fall asleep or remain asleep.

Sleep Apnea

Sudden cessation of breathing during sleep.

Obstructive Apnea

There is a blockage of the flow of air in the pharynx or oral cavity.

Central Apnea

Involve a defect in the respiratory center of the brain.

Mixed Apnea

a combination of central apnea and obstructive apnea

Narcolepsy

A disorder of excessive daytime sleepiness caused by the lack of chemical hypocretin in the area of the CNS that regulates sleep.

narcolepsy

People with __________________ have uncontrollable sleep at inappropriate times.

Sleep Deprivation

Occurs when you don’t get enough sleep

Parasomnias

behavior that may interfere with sleep and may even occur during sleep.

Parasomnias

Characterized by physical events such as movements or experiences that are displayed as emotions, perceptions, or dreams.

16 hours

Neonate up to the age of 3 months averages about _____________________ of sleep a day, sleeping almost constantly during the first week.

Infants

usually develop a nighttime pattern of sleep by 3 months of age.

8 to 10 hours

The infant normally takes several naps during the day but usually sleeps an average of _______________ during the night for a total daily sleep time of 15 hours.

Toddlers

Total sleep averages 12 hours a day. After 3 years of age children often give up daytime naps.

Preschoolers

Average sleep about 11-13 hours a night (about 20% is REM).

School Age Children

A 6-year-old averages 11 to 12 hours of sleep nightly, whereas an 11-year-old sleeps about 9 to 10 hours.

Adolescents

On average the majority of teenagers get about 7 hours or less of sloop per night.

Young Adults

Most young adults average 6 to hours of sleep a night. Approximately 20% of sleep time is REM sleep, which remains consistent throughout life.

Middle Adults

The total time spent sleeping at night begins to decline. The amount of stage 4 sleep begins to fall, a decline that continues with advancing age.

Older Adults

Complaints of sleeping difficulties increase with age. Older adults experience weakening, desynchronized circadian rhythms that alter the sleep-wake cycle

polysomnography

Sleep is measured objectively in a sleep disorder laboratory by _____________________ in which an electroencephalogram (EEG), electromyogram (EMG), and electrooculogram (EOG) are recorded simultaneously.

Insomnia

The diagnosis given to clients with sleep problems is usually made more explicit with descriptions such as "difficulty falling asleep" or "difficulty staying asleep.

Brief Sleep History

which is usually part of the comprehensive nursing history, should be obtained for all clients entering a health care facility.

Health History

is obtained to rule out medical or psychiatric causes of the client’s difficulty sleeping.

Sleep Diary

A sleep specialist may ask clients to keep a sleep diary or log for 1 to 2 weeks in order to get a more complete picture of their sleep complaints.

Sleep Pattern Disturbances

may also be stated as the etiology of another diagnosis, in which case the nursing interventions are directed toward the sleep disturbance itself.

Bruxism

Usually occurring during Stage 2 NREM sleep, this clenching or grinding of teeth can eventually erode dental crown, cause teeth to come loose, and lead to deterioration of temporomandibular joint (TMJ), called TMJ Syndrome.

Enuresis

Bed Wetting

Sleep Hygiene

refers to interventions used to promote sleep.

EBC EPB

Client Teaching (Health Promotion):

insomnia

The most common type of sleep disorder is _______________.

(1) assess and manage client’s risks for falls, (2) implement interventions to reduce falls based on the client’s assessed risks

The Joint Commission added two required standards relating to client safety and hospital falls (Jorgensen, 2011): The hospital must:

2-5 minute

The nurse can complete a _______________ assessment tool called the "Timed Up and Go" (TUG) test in a hospital, long-term care, or home setting.

Timed Up and Go

This assessment requires the person to complete a series of tasks that are important for independent mobility: standing, walking, turning and sitting (Picone, 2013, p. 57).

Scheduled Rounding

This is where the nurse conducts hourly visits between 6 am and 10 pm and visits every 2 hours between 10 pm and 6 am. The hourly rounding can be alternated between the nurse and unlicensed assistive personnel.

Awareness

the ability to perceive environmental stimuli and body reactions and to respond appropriately through thought and action.

Extreme Emotional States

can alter the ability to perceive environmental hazards.

Stressful Situations

can reduce a client's level of concentration, cause errors of judgment, and decrease awareness of external stimuli.

depression

Clients with ___________________ may think and react to environmental stimuli more slowly than usual.

injury

Individuals with diminished ability to receive and

convey information are at risk for _______________.

Information

crucial to safety.

Injuries

a major cause of death among individuals of all ages.

Side Rails

do not protect hospitalized clients from falls.

Falls

a common cause of injury among older adults.

Bruxism

Usually occurring during Stage 2 NREM sleep, this clenching and grinding of the teeth can eventually erode dental crowns, cause teeth to come loose and lead to deterioration of the temporomandibular joint called TMJ syndrome.

Enuresis

Occur in children over 3 years old. More males than females are affected it. Often occurs 1 to 2 hours after falling asleep when rousing from NREM Stage 3.

PLMD

In this condition the legs jerk twice or three times per minute during sleep. It is most common among older adults. This kicking motion can make the client and result in poor sleep.

RLS

Occurs whenever the person is at rest not just at night when sleeping it may occur during pregnancy or video to other medical problems that can be treated.

Sleeptalking

It rarely presents a problem to the person unless it becomes troublesome to others.

Sleepwalking

Occurs during Stage 3 of NREM Sleep. It is episodic and usually 1 to 2 hours after falling asleep.