Ch. 43 Sleep

Page 1: Chapter Overview

Title: Chapter 43 SleepCopyright: © 2023, Elsevier Inc. All Rights Reserved.

Page 2: Physiology of Sleep

Circadian Rhythm

• Definition: This is a natural cycle that lasts about 24 hours and helps control when we sleep and when we wake up like a natural clock.

• Importance: It helps our body know when it is daytime and when it is nighttime, influencing our sleep.

Sleep Regulation

• Key Area: The hypothalamus, a small area in the brain, acts as the main control center for sleep. It tells the body when to feel sleepy or alert.

Stages of Sleep

1. Nonrapid Eye Movement (NREM): This stage has four parts, and it's important for helping the body recover and feel rested.

   • Stage 1: Light sleep, easy to wake up from.

   • Stage 2: Deeper sleep where body temperature drops and heart rate slows.

   • Stage 3: Deep sleep needed for physical recovery.

   • Stage 4: Deepest sleep; it's very hard to wake someone in this stage.

2. Rapid Eye Movement (REM): This stage is where most dreaming occurs. It is crucial for our brain functions, such as learning and memory.

Sleep Cycle Individual Variability

• Personal Differences: Everyone has their own sleep style. Some people may prefer going to bed early, while others might like staying up late.

• Unique Patterns: Each person has different times when they feel most awake or tired during the day, which can affect their sleep patterns.

• Sleep Regulation: The hypothalamus is the primary sleep center in the brain.

• Stages of Sleep:

  • Nonrapid Eye Movement (NREM): Consists of four stages for restorative sleep.

  • Rapid Eye Movement (REM): Characterized by vivid dreams; essential for cognitive functions.

• Sleep Cycle Individual Variability: Different individuals have unique sleep patterns, with preferences for bedtimes and functioning at various times of the day.

Page 3: Functions of Sleep

• Importance of Sleep: Crucial for restoring biological processes.

• Consequences of Sleep Deprivation: Impairs immune function and metabolism.

• Physical Illness Impact: Various illnesses can disrupt sleep, including:

  • Injury: Painful conditions or those with physical immobilization.

  • Respiratory Disease: Conditions like COPD or CHF leading to shortness of breath and difficulty relaxing due to sleep disturbances.

  • Nocturia: Frequent urination at night can lead to sleep interruptions, especially in conditions like BPH or diabetes.

  • Restless Legs Syndrome: Causes uncomfortable sensations prompting leg movements, disrupting sleep.

Page 4: Sleep Disorders

Sleep Disorders

• Insomnia: Trouble falling asleep or staying asleep, often because of stress or life situations.

• Sleep Apnea: A condition that causes breathing problems while sleeping; the most common kind makes loud snoring sounds and can lower oxygen levels.

• Narcolepsy: A condition where a person suddenly falls asleep during the day, at unexpected times.

• Sleep Deprivation: Not getting enough sleep, which can happen due to sickness, stress, medication side effects, or surroundings.

• Parasomnias: Unusual actions during sleep, like sleepwalking or having scary dreams (night terrors).

• Sleep Apnea: Characterized by breathing interruptions during sleep; obstructive sleep apnea is the most common form, associated with loud snoring and decreased oxygen saturation.

• Narcolepsy: Uncontrollable episodes of sleep throughout the day.

• Sleep Deprivation: Caused by illness, emotional stress, medications, or environmental factors.

• Parasomnias: Abnormal behaviors during sleep, such as sleepwalking or night terrors.

Page 5: Sleep Requirements by Age

• Neonates: 16 hours

• Infants: 15 hours including naps

• Toddlers: 12 hours with napping

• Preschoolers: 12 hours

• School-aged children: 9-12 hours

• Adolescents: Recommended 8-10 hours

• Young Adults: 6-8.5 hours

• Middle Adults: 7-9 hours

• Older Adults: Varying sleep needs with increased difficulty in sleeping.

Page 6: Factors Influencing Sleep

Factors That Affect Sleep Quality

• Caffeine and Alcohol: Drinking caffeine (like coffee or energy drinks) or alcohol can make it harder to sleep well at night. Caffeine keeps you awake, and alcohol can disturb your sleep patterns.

• Opiates: These are strong pain medications that can make you feel sleepy during the day. They can increase tiredness and drowsiness, making it hard to stay awake when you need to.

• Diuretics: These medications can make you wake up often at night to go to the bathroom. This can disrupt your sleep because you’re getting up too much.

• Antidepressants and Benzodiazepines: These medications can affect how long you sleep and how alert you feel. They might make you feel sleepy during the day or affect your nighttime rest.

• Lifestyle Factors: If you work long hours or have jobs with strange hours (like night shifts), this can mess up your sleep patterns. Your body might not know when it's time to rest.

• Technology Use: Spending too much time on screens before bedtime can make it hard for your brain to relax. The bright lights from phones and TVs can keep you awake longer.

• Emotional Stress: Worries, stress, or personal troubles can keep your mind busy at night, making it tough to sleep.

• Environmental Factors: If your sleeping area is too noisy, too bright, or not the right temperature, it can be hard to sleep well.

• Exercise and Food Intake: When you exercise at the right times and eat healthy food, it can help you sleep better. Be careful about when and what you eat before bed; heavy meals can disrupt sleep.

• Lifestyle Factors: Long work hours and non-traditional shifts can disrupt sleep patterns.

• Technology Use: Screen time before bed can hinder sleep onset.

• Emotional Stress: Anxiety or personal issues contributing to sleep difficulties.

• Environmental Factors: Noisy settings, bright light, and temperature issues impacting sleep.

• Exercise and Food Intake: Proper timing of exercise and diet can promote better sleep quality.

Page 7: Critical Thinking in Sleep Management

• Use Knowledge: Apply information from nursing and other fields to help with sleep problems.
  Personal Experience: Think about your experiences to better understand common sleep difficulties.
  Professional Guidelines: Follow the agreed-upon rules for dealing with sleep issues in patients.

Page 8: Nursing Process Assessment

Subjectivity of Sleep

• Individual Differences: People experience sleep in different ways. What helps one person sleep well may not work for another. It's important to understand these differences when assessing sleep.

Sources for Sleep Assessment

• Questions for Patients: Ask patients directly about their sleep problems, like how they feel when they try to sleep and whether they wake up during the night.

• Partner Observations: Get insights from family members or partners about the patient's sleeping habits. They can notice patterns that the patient might not remember or see themselves.

• Sources for Sleep Assessment:

  • Direct inquiries to patients about their sleep challenges

  • Observations from bed partners on patient's sleeping patterns.

Page 9: Sleep History Assessment

Components of Sleep History:

• Problem Description: Details about what sleep problems someone has and how often they happen.

• Usual Sleep Patterns: Regular and unusual things about how someone sleeps.

• Health Status: Look at both body health and mental health.

• Important Life Events: How recent changes or stress affect sleep.

• Home Environment: How the bedroom setting and daily habits affect sleep.

• Deprivation Behaviors: Signs or actions that show a person isn’t getting enough sleep.

Page 10: Analysis and Nursing Diagnosis

Potential Sleep Diagnoses

1. Adequate Sleep: This means the person is getting enough sleep to feel rested and alert.

2. Fatigue: This is when a person feels very tired and low on energy, even after sleeping. It can affect daily activities and make it hard to focus.

3. Impaired Sleep: This refers to trouble sleeping, such as frequently waking up during the night or having a hard time falling asleep. It can impact how rested someone feels.

4. Impaired Alertness: This means the person finds it hard to stay awake and alert during the day, possibly due to not getting enough good-quality sleep.

5. Sleep Deprivation: This occurs when a person does not get enough sleep, which can lead to feeling tired, having trouble concentrating, and various health issues.

Page 11: Planning and Outcomes Identification

• Setting Sleep Goals: Create simple, reachable sleep goals that fit what the patient needs.
  Working Together: Team up with other healthcare workers to combine sleep plans and make schedules that allow patients to rest properly.

Page 12: Implementation of Sleep Nursing Interventions

Health Promotion Strategies:

• Make your sleeping area better (like reducing noise or light).

• Create a bedtime routine to help you relax before sleeping.

• Make sure you are safe and comfortable

Page 13: Focus on Older Adults in Sleep Promotion

Sleep-Wake Pattern

• Keep a Regular Sleep Schedule: Try to go to bed and wake up at the same time every day. This helps your body know when it is time to sleep and when it is time to be awake.

• Limit and Time Naps: If you need to nap during the day, keep it short (about 20-30 minutes) and time it well so that it doesn't interfere with your nighttime sleep.

• Encourage Relaxation Before Bed: Do calming things like reading a book or taking a warm bath before sleeping. This can help your body and mind feel ready for sleep.

• Adapt Evening Activities: Change what you do before bed to support good sleep. Try to avoid stimulating activities like using screens or exercising too close to bedtime.

Environmental Factors

• Create a Comfortable Sleep Environment: Make your bedroom a nice place to sleep by reducing noise and making sure the room isn’t too hot or too cold. This can help you fall asleep easier.

Diet and Medications

• Adjust Food Intake and Review Medications: Be careful about what and when you eat. Eating heavy meals right before bed can make it hard to sleep. Also, check with your doctor about any medications you are taking to see if they might affect your sleep.

Physiological Factors

• Ensure Comfort: Make sure you are comfortable while you sleep. This means adjusting your pillow and blankets and finding a relaxing sleeping position. If you have pain, talk to your doctor about how to manage it to help you sleep better.

• Environmental Factors: Create a conducive environment for sleep with reduced noise and appropriate temperatures.

• Diet and Medications: Adjust food intake and review medications to minimize insomnia risk.

• Physiological Factors: Ensure comfort by adjusting positions, pillow heights, and pain management strategies.

Page 14: Acute Care Nursing Implementation

• Managing Hospital Environments: Focus on reducing disturbances, ensuring patient comfort, and optimizing rest opportunities.

Page 15: Restorative Care and Continuing Care Implementation

• Maintaining Patient Activity: Engage patients in gradual physical activities to promote better sleep.

• Control Physiological Factors: Prepare for regular care routines while addressing sleep needs.

Page 16: Evaluation of Nursing Interventions

• Assessing Effectiveness: Measure patient outcomes against set sleep goals and interventions.