promoting sleep and rest

rest

A condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed

sleep

A state of rest accompanied by altered consciousness and relative inactivity

NREM-non rapid eye movement

75 % of total sleep time

light sleep stage 1

deep sleep stage 3

REM-rapid eye movement

About 25 % of sleep time

Difficult to arouse

Dreaming occurs *Key

Mental & emotional equilibrium (balance)

Role in learning, memory, & adaptation

Eyes are moving but body is paralyzed

Need to have enough rem sleep to be functional

Factors affecting sleep

• Developmental Considerations

• Motivation to be awake

• Culture

• Bedtime rituals

  • people with diabetes usually have a bed time snack

• Physical activity

  • don’t work our 2hr before sleep

• Shift work

• Stimulating activities

  • working out

  • caffeine

• Dietary habits

  • promotes digestion rather than sleep

• Tobacco use/nicotine

• Alcohol use

  • can miss some REM sleep

• Environment

• Psychological

• Health Conditions

• Medications

  • can keep you up lime steroids

Effects of insufficient sleep: Children

• Affects normal growth & development

• Contributing factor in performance deficits & behavioral problems

• Increased risk of obesity during childhood or later in life

Effects of insufficient sleep: Adult

• Anxiety, personal conflicts, loneliness, depression

• GI symptoms increase

• risk for breast & colorectal cancer

• type II diabetes, HTN

• cardiovascular disease – including strokes

• sleep related MVCs & substance abuse

Types of Insomnia

Transient insomnia

Short-term insomnia

Chronic insomnia

Transient insomnia

Less than one month.

go to provider to get temporary sleeping pill

Short-term insomnia

Between one and six months.

can’t get to sleep

Chronic insomnia

More than six months.

Wake up in the middle of the night and can't get back to sleep

Common sleep disorders

Dyssomnias

parasomnias

Dyssomnias characterized by

• insomnia or excessive sleepiness

• Hypersomnia

• Narcolepsy

• Sleep apnea

• Sleep deprivation

Parasomnias characterized by

patterns of waking behavior that appear during sleep

Assessment: sleeping history

• Usual sleep-wakefulness pattern: recent changes

• Effect of sleep pattern on everyday life

• Sleep aids

• Sleep disturbances & contributing factors

Assessment: sleeping diary

• 14 days

• Times

• Presence of stressors

• Food, drink, or medication

• Physical activities

• Mental activities

• Bedtime rituals

Assessment: physical

• Energy level

• Facial characteristics

• Behavioral characteristics

• Physical data (vitals)

• Observations

Sleep as the Problem

difficulty falling asleep related to worries about family & lack of de-stressing rituals

altered sleep-wake patterns related to frequent rotations of shift & overtime

Sleep as the Etiology

Activity Intolerance related to sleep deprivation

Impaired Gas Exchange related to sleep apnea

Implementing for good sleep

• Prepare a restful environment

• Promote bedtime rituals

• Offer appropriate bedtime snacks & beverages

• Promote relaxation

• Promote comfort

• Respect normal sleep-wake patterns

• Schedule nursing care to avoid disturbances

• Minimize sleep disturbances

• Use medications when necessary

Medications to promote and maintain sleep

• Benzodiazepine-like drugs:

  • zaliplon (Sonata)

  • eszopiclone (Lunesta):

    • often used in older adults due to less residual sleepiness

  • zolpidem tartrate (Ambien)

    • must take right before bed

    • has an amegisic effect

• Melatonin receptor activator

  • amelteon (Rozerem)

• Over the counter (OTC) sleep meds

Patient education about rest and sleep

A well-informed person has better coping skills

• Decreased sleep linked to obesity in U.S.

• Measures to promote relaxation & sleep hygiene

• Daily activity & diet

Whatever the plan is to promote sleep & rest – make sure the patient deems it acceptable or it will not work

Evaluating the patients rest

• Verbalizes feeling rested

• Identifies factors that interfere with their sleep

• Uses techniques to promote sleep & provide a restful environment

• Concentrates & functions effectively during waking hours

• Eliminates behaviors related to sleep deprivation