Nurs 215 Rest and Sleep

Factors affecting sleep

-age

-food/alcohol/caffiene

-meds

-sleep habits

-physical activity

-illness

-environmental factors

Insomnia

-inability to fall/remain asleep

-low sleep quantity

-sleep disturbances cause distress or impairments in social, occupational, academic, behavorial, and functioning

-occurs at lest 3 nights per week for at least 3 months

-may be short term or chronic (less than a month)

Circadian disorder

abnormal wake/sleep times (ex: jet lag or working nights)

Restless leg syndrome

-uncontrollable leg movements

-moderate management: decrease alcohol/tobacco, avoid caffiene, stretch/exercise routine, massage, hot/cold compress, acupressure, foot wraps with vibration to apply pressure

-SEVERE management: iron supplement, dopaminergic agents (increase dopamine ex: Parkinson’s), anticonvulsants, benzodiazepines (side effects sleep apnea, daytime sleepiness)

Hypersomnia

excessive sleep (related to disease or depression)

Sleep apnea

cessation of breathing, approx. 10 secs

Narcolepsy

-chronic, brain unable to regulate sleep cycle, uncontrollable

Parasomnias (disruptive sleep disorders)

-Sleepwalking/talking: occurs in stages 3, 4, or NREM 1-2 hrs after falling asleep, person has no memory of this

-Bruxism: grinding/clenching of teeth, stage 2 or NREM sleep

-Night terrors: often children, strong emotions cause hallucinations while sleeping, hard to wake up, episodes last 10-30 mins, no memory

-Enuresis: nighttime incotinence past toilet training age, occurs in NREM

Assessment

ask pt about sleep patterns, environment, routine, what helps sleep, have you seen any changes in your sleep

Rest/Sleep interventions

-cluster care: AVOID unnecessary interruptions

-restful environment (ex: fixing linens, help situate bedding, dim lights, no TV, adjust temperature

-promote comfort (ex: pain meds at scheduled time, massage, fluids)

-help with bedtime routine/rituals (ex: warm milk, blankets, dolls, oral care, no smoking after a meal)

NREM 1

-non-rapid eye movement

-restful stage of sleep where everything slows down (LIGHT SLEEP) relaxed but aware

-deep of slow wave sleep (SWS)

NREM 2

-muscles, temp., HR, BP decrease

-still easily roused, still light sleep

NREM 3

-deep sleep

-if roused during stage maybe confused

-slow vital signs

-snoring stage

-dreams occur but not vivid

-IMPORTANT stage for tissue repair

REM

-rapid eye movement

-brain in highly active, resembles fully awake person

-more spontaneous awakenings occur in this stage (if roused will react normal)

-ESSENTIAL for mental/emotional restoration

-metabolism and vitals increase (pulse rapid/irregular)

-apnea may be seen in this stage

-dreaming occurs

Poor sleep leads to

-drowsy, malaise, restless, irritable

-difficulty doing tasks

-impaired cognition

-somatic complaints (ex: tremors)

-delusions/paranoia/psychotic episodes

-decreased protection against infection

NREM/REM cycle occurence

-about 4-6 times thorughout the night

-each cycle lasts about 90-100 minutes

-FIRST REM lasts only 20 minutes but last cycle can be 8 hrs

-REM can last up to 60 minutes

-time spent in each stage varies over a lifespan

Unhealthy sleep habits

-do not “catch up” on sleep

-limit screen time, blue light is bad

-do not depend on sleep aids

-avoid caffiene, alcohol, tobacco, heavy meals, black tea, chocolate, cola

-avoid carbs, glucose will wake you up

-do not overhydrate

-avoid going to bed angry or frustrated, avoid emotional discussions before sleep

MC symptom of lack of slees

excess drowsiness

Nicotine affects sleep pattern

True

Ages 18+ require how many hours of sleep?

at least 7

Sleep apnea

periodic breath cessation for at least 10 seconds, best to sleep in high fowler’s, pt wakes up SOB

Sleep deprivation

not enough sleep can cause cognitive problems, impair judgement, decrease response time, trigger seizures, migraines, tension headaches