Unit 13 Rest and Sleep

REM Sleep » 20% more active

• Recurs about every 90 minutes and lasts 5 to 30 minutes

• Dreams take place » brain is highly active

  • You won’t remember unless you wake up right after REM sleep

    • Usually nightmares or oddities

• Gastric secretions increase » body relaxes and digestion increases

• Heart and respiratory rates often are irregular

  • Chemical mediators are highest during REM Sleep

  • Feeling of being “high”

• learning, thinking, and organizing information stimulated

  • Difficult to arose

  • May wake spontaneously

    • Depending what is occurring in dream

Dreams take place » brain is highly active

• You won’t remember unless you wake up right after REM sleep

  • Usually nightmares or oddities

Heart and respiratory rates are often irregular

• Chemical mediators are highest during REM sleep

• Feeling of being “high”

Learning, thinking, and organizing information stimulated

• Difficult to arouse

• May wake spontaneously

  • Depending what is occurring in dream

Non-REM Sleep » Less Active

• 70-80% of your sleep cycle

• Arterial blood pressure falls

• Pulse rate decreases

• Peripheral blood vessels dilate

• Cardiac output decreases

• Skeletal muscles relax

• Basal metabolic rate decreases 10% to 30%

• Growth hormone levels peak

• Intracranial pressure decreases

• Increases susceptibility to infection

Everything decreases, except hormone levels

Factors that Affect Sleep

Chemical, Developmental, Physical, Physiological, Psychological, Microbiological

Chemical

• Alcohol, smoking, and opioids

• Medication

  • Ex) Benadryl makes you more sleepy

  • Ex) Adderall makes you more alert

  • Ex) Diuretics make you have to go to the bathroom more often, may disturb sleep patterns

  • Sedatives promote relaxation, decrease anxiety

  • Use with caution in the older adult

  • Provide safety after administration of sedatives

  • Use non-pharmacological approach

Developmental

• Babies require the most sleep and rest

• Older Adult have shorter sleep periods generally

Physical

Noise, temperature, electromagnetic fields, blue light, phone

Physiological

Inflammation, sickness, obesity (any disease)

Psychological

Stress, anxiety, depression, dementia, mental/neurological disorders

Microbiological

Pneumonia- coughing is associated — may interfere with rest and sleep

Functions of Sleep

• Restores normal levels of activity

• Restores normal balance among parts of the nervous system!!

• Necessary for protein synthesis!!

No Sleep and Psychological Well Being

• Decrease in the ability to make cognitive decision

• Decrease motor ability

Sleep Requirements

• Changes with growth and development

  • Ex) infants need more sleep » 16-18 hours of sleep

• Decreases with age

• Varies between individuals

  • Average adult needs 7-9 hours of sleep

• Quantity of sleep » amount of hours

• Quality of sleep » uninterrupted hours of sleep

  • Older adult may wake up more frequently throughout the night

  • Naps should be limited to 20-30 min/ a day

Quality of sleep » uninterrupted hours of sleep

• Older adult may wake up more frequently throughout the night

• Naps should be limited to 20-30 min/ a day

Biorhythms- Study of the biological rhythms of the body

• Synchronized with environmental factors such as light, darkness, gravity and electromagnetic activity

• Circadian rhythm (24 hours)

  • Sleep / wake cycle

• Infradian rhythm

  • Cycle longer than 24 hours

  • Ex) menstruation cycle

Primary Sleep Disorders

• Parasomnia

• Insomnia

• Hypersomnia

• Narcolepsy

• Sleep apnea

• Sleep deprivation

Parasomnia

• Behaviors affecting sleep

• Abnormal sleep disorders

  • Ex; Somnambulism- sleep walking

  • Ex; Bruxism- habitual grinding of teeth during sleep

Insomnia

• Inability to achieve quality/quantity of sleep

• 3 types

  • Initial » can’t fall asleep

  • Intermittent/frequent » can’t stay asleep

  • Terminal » wake up early

Hypersomnia

• Sufficient/excessive sleep

• Can’t stay awake during the day

• Usually patients with tumors or hypothyroid

• Predisposing factors

  • Psychological disorders], CNS depression, Liver/Kidney/metabolic disorder

Narcolepsy

• Sleep attacks

• Day time sleepiness

• Readily falls asleep during the day » falls asleep mid-sentence

Sleep Apnea

• Periods of sleep where there is no breathing for at least 10 seconds

• Choking sound » may need a CPAP machine

Sleep Deprivation

• Long/consistent lack of sleep

• Disturbances in quality of sleep and quantity

Clinical Manifestations

• Fatigue, irritability

• Restlessness

• Darkened circles around eyes

• Puffy eyelids

• Reddened conjunctiva

• Glazed or dull eyes

• Distorted perceptions / hallucinations

• Inattentiveness

• Slowed Speech

• Slumped postures

• Hand tremors

• Poor coordination

• Withdrawal / yawning

• Decreased seizure threshold

Nursing Role w/ Sleep

Assessment, Physical Exam, Interventions, Patient Teaching, Evaluation

Assessment

Sleep patterns, sleep history, diagnostic tests

Sleep patterns

• Sleep diary

• Nocturnal myoclonic- muscle jerking

• Do you take naps

• Bedtime ritual

• Chance in sleep cycle

• How many times did you wake up?

• What is your usual amount of sleep

  • Quality of sleep? (amount of hours)

• Do you feel rested?

Sleep History

Any recent life changes

Diagnostic Tests

• Polysomnography (measures sleep objectively)

• Electroencephalogram (EEG)

• Electromyogram (EMG)

• Electrooculogram (EOG)

Physical Exam

• Facial expressions

• Behaviors

  • Yawning

  • Restless

• Energy level (fatigue, physical weakness, lethargy)

• Weight/BMI

  • Obese patients

    • Decrease quality of sleep

    • More pressure on the lungs (less O2 intake)

    • Increase risk for sleep apnea

Interventions

• Create a restful environment

• Provide a safe environment

• Provide comfort and relaxation

Create a Restful Environment

• Close the door of the room

• Pull the curtain around the bed

• Shut off the TV, telephone, radio

• Provide soft music

• Reduce or limit lighting

• Provide a compatible roommate

• Set appropriate room temperature (can be cold)

• Don’t give a sleeping pill and then wake up the patient

• Implement sleep hygiene

• Decreases the stimuli

• Organize care

• Uninterrupted blocks of sleep

Provide a Safe Environment » Prevent Falls

• Use a night light

• Place bed in lowest position

• Use side rails if appropriate

• Place call bell within reach

• Answer call bell promptly

• Keep urinal, bed pan, belongings within reach » be careful with fluids

• Support bedtime rituals

Provide comfort and relaxation

• Provide loose fitting night wear

• Assist with hygiene routines

• Provide clean, dry smooth bed linens

• Provide additional blankets

• Encourage patient to void before bed time

• Courage not to drink too much fluids close to bedtime

Other Interventions

• Avoid caffeine – give warm milk

• Offer back massage

• Provide pain relief

• Provide for diversional activities

Patient Teaching

• Exercise

  • We want the patient up and OOB unless prescribed bedrest

• Diet » light snacks, not heavy meals

• Bedtime Ritual

  • Only have the patient stay in bed if bed rest

  • Want to associate bed with sleep

• Sleep Pattern » ask about normal sleep patterns

• Medication » only take when it’s time to sleep

Evaluation

• Monitor the effectiveness of medication for sleep and the interventions

• Ask the patient if they feel rested

• How they feel after waking

Medications and Sleep

• Use with caution in the older adult  last resort

• Provide safety after administration of sedatives

• Use non-pharmacological approach

Sedatives promote relaxation and decreases anxiety