Module I Sleep Fall 2025

Define terms associated with comfort, pain, and rest.
Define the stages of sleep and their significance in patient care.
Explain the physiological and psychological benefits of sleep.
Analyze factors affecting sleep.
Explain techniques to promote comfort.
Explain the process of promoting sleep.
Explain the process of promoting rest.
Discuss common barriers to sleep in various patient populations.
Explain the application of the nursing process in managing comfort, pain, sleep, and rest.

Circadian Rhythm
- Regulates the sleep-wake cycle.
- Occurs every 24 hours.
- Controls a person’s biological clock.
- Synchronizes with environmental cues such as light and temperature.
Sleep-wake Homeostasis
- Assists the body in remembering to sleep after a certain period of wakefulness.
- Plays a role in transferring memory from short-term to long-term storage during sleep.
- During REM sleep, the thalamus transmits sensory aspects (images, sounds, and sensations) which influence dreams.
Melatonin
- A natural substance that helps the body prepare for sleep.

Definition
- Occurs when a client cannot achieve adequate REM sleep due to insufficient or disrupted sleep.
Signs and Symptoms
- Confusion.
- Disorientation.
Treatment
- Depends on the cause and severity.
- Recommendations:
- Eliminate caffeine, nicotine, and alcohol.
- Develop a plan for regular exercise (20-30 mins/day can help promote sleep).
- Medications and therapy may be prescribed.
Implications
- Impairs higher-order cognitive processes, affects judgment, slows response times, and can trigger conditions such as seizure disorders, migraines, and tension headaches.

Recommendation for Improving Sleep Hygiene:
- A 23-year-old student presenting with difficulty falling asleep and daytime fatigue may best be advised to limit caffeine intake, especially in the afternoon and evening, as this greatly improves sleep quality.
- Incorrect Suggestions:
- Taking daytime naps (can hinder nighttime sleep).
- Intense exercise before bed (may disrupt sleep).
- Using electronic devices before bed (can interfere with sleep).

NREM Sleep (75% total sleep time)
- Stages:
- N1 (formerly Stage 1)
- N2 (formerly Stage 2)
- N3 (formerly Stage 3 and 4)
REM Sleep (25% total sleep time)
- ATI refers to these as the 4th stages of sleep.

Lightest stage of sleep lasting a few minutes.
Breathing is normal, and skeletal muscle tone is present.
Physiological activity decreases - gradual decline in vital signs and metabolism occurs.
Body temperature begins to fall.
Lasts approximately 1-5 minutes, making up about 5% of total sleep cycle.
Easily aroused by sensory stimuli, with waking experience feeling like daydreaming.

Represents the deepest level of sleep where arousing is difficult, and movement is rare.
Mental cloudiness may appear if woken during this stage that lasts for 30-60 minutes.
Significant decrease in brain and muscle activity; vital signs drop below waking hours.
Immune system strengthens here, promoting repair, regeneration of muscles, tissues, and bones.
Number of cycles decline with aging.

Includes the dreaming stage, characterized by muscle atonia (loss of muscle tone).
Cognitive restoration occurs; breathing is irregular and erratic with potential elevated heart rate.
Typically begins roughly 90 minutes after falling asleep, with the first cycle lasting around 10 minutes but increasing as the night continues (up to 1 hour).

Assessment Question: What commonly contributes to sleep deprivation?
Factors include working night shifts, irregular sleep patterns, high caffeine intake, and age. The greatest risk factors related to inadequate sleep are:
- C: Working the night shift and having irregular patterns.

Normal sleep requirements vary by age:
- Neonates: 16 hours
- Infants: 15 hours total (inclusive of naps)
- Toddlers: 12 hours total (inclusive of a nap)
- Preschoolers: 12 hours per night
- School-age children: 9-12 hours
- Adolescents: 8-10 hours recommended
- Young adults: 6-8.5 hours per night
- Middle adults: 7-9 hours per night
- Older adults: Sleep difficulties often increase with age.

Insomnia: Ongoing inability to sleep despite having the opportunity, characterized by difficulties falling or staying asleep, waking early, and feeling fatigued upon waking.
Apnea: Absence of inspiratory airflow for at least 10 seconds.
Hypopnea: Associated with decreased oxygen saturation, lasting 10 seconds or longer.
Obstructive Sleep Apnea (OSA): Characterized by recurrent episodes of upper airway collapse and obstruction during sleep, combining with waking episodes.

Narcolepsy: Chronic sleep disorder marked by sudden daytime sleepiness and episodes of sleep, alongside features such as nocturnal hallucinations, paralysis while asleep, and vivid dreams.
Hypersomnia: Excessive daytime fatigue despite adequate sleep, not linked to poor nighttime sleep, displaying symptoms of memory issues, depression, short attention span, and irritability.
Restless Leg Syndrome (RLS): An uncontrollable urge to move legs during sleep, known as Willis-Ekbom disease.