Sleep Rest

VCS When You Have to Be Right: Rest and Sleep

Objectives

• Identify variables that influence rest and sleep.

• Describe age-related differences in the sleep cycle.

• Describe nursing strategies to promote sleep and rest.

Sleep Cycle

• The sleep cycle consists of four consecutive stages of non-rapid eye movement (NREM) sleep, which are reversed before entering REM sleep.

  • Stages of NREM:

    • The person returns from Stage IV to III to II.

    • After reaching the end of Stage II, REM sleep is entered instead of returning to Stage I.

    • Re-entering NREM starts at Stage II then moves through stages III and IV.

Single Normal Sleep Cycle

• Wakefulness transitions into NREM and then REM:

  • NREM stages include:

    • Stage I

    • Stage II

    • Stage III

    • Stage IV

• After completing cycle, the pattern starts over with wakefulness.

Stages of Sleep

• Non-Rapid Eye Movement (NREM) Sleep:

  • Four stages characterized as follows:

    • Stages I and II: Light sleep (5% to 50% of total sleep time)

    • Stages III and IV: Deep sleep states (delta sleep, approx. 10% of total sleep time)

• Rapid Eye Movement (REM) Sleep:

  • Represents about 20% to 25% of total sleep time.

  • Physiological changes occur, including increased pulse, respiratory rate, blood pressure, metabolic rate, and body temperature; skeletal muscle tone and reflexes are depressed during this stage.

Factors Affecting Sleep

• Various factors can impact sleep:

  • Developmental considerations

  • Lifestyle and habits

  • Environmental factors

  • Psychological stress

  • Illnesses

  • Medications

Developmental Considerations

• The amount of sleep needed varies by age group:

  • Newborns, infants, toddlers

  • Preschoolers

  • School-aged children

  • Adolescents

  • Young adults and adults

  • Elderly adults

• Review strategies to promote sleep and rest across these age groups.

Illnesses Associated with Chronic Sleep Disturbances

• Chronic sleep disturbances are often linked to:

  • Depression

  • Increased risk of obesity

  • Hypertension

  • Diabetes

  • Heart attacks

  • Strokes

Sleep Disorders

• Dyssomnias: Characterized by insomnia or excessive sleepiness.

• Parasomnias: Involves patterns of waking behavior appearing during sleep.

Types of Dyssomnias

• Includes several specific conditions:

  • Insomnia

  • Hypersomnia

  • Narcolepsy

  • Sleep apnea

  • Restless leg syndrome

  • Sleep deprivation

Obstructive Sleep Apnea

• A physical condition characterized by:

  • Normal unoccluded airway versus an occluded airway (tongue, soft palate, uvula).

Types of Parasomnias

• Disorders include:

  • Somnambulism

  • REM behavior disorder (RBD)

  • Sleep terrors

  • Nightmares

  • Bruxism

  • Enuresis

  • Sleep-related eating disorder

Obtaining a Sleep History

• Essential questions to ask include:

  • Nature and cause of the sleep problem

  • Related signs and symptoms

  • Duration and frequency of the problem

  • Impact of the problem on daily living

  • Severity of the problem and treatment options

  • Coping mechanisms and treatment success

Sleep Characteristics to Assess

• Indications to observe and assess:

  • Restlessness

  • Sleep postures

  • Sleep activities

  • Snoring

  • Leg jerking

Information Recorded in a Sleep Diary

• Important details to include:

  • Time patient retires

  • Time attempting to fall asleep

  • Approximate time patient falls asleep

  • Times of awakening during the night

  • Morning awakening time

  • Presence of stressors affecting sleep

  • Food, drink, or medication affecting sleep

  • Physical and mental activities prior to bedtime

  • Worries or anxieties impacting sleep

Key Findings of Physical Assessment

• Aspects to look for:

  • Energy level

  • Facial characteristics

  • Behavioral attributes

  • Physical data suggesting sleep problems

Common Etiologies for Nursing Diagnoses

• Factors leading to sleep issues include:

  • Physical/emotional discomfort or pain

  • Changes in bedtime rituals or sleeping environment

  • Disruption of circadian rhythm

  • Pre-bedtime exercise and diet

  • Drug dependency and withdrawal

  • Symptoms of physical illness

Nursing Interventions to Promote Sleep

• Strategies to enhance sleep include:

  • Create a restful environment

  • Establish bedtime rituals

  • Offer appropriate snacks and beverages

  • Encourage relaxation and comfort

  • Respect normal sleep-wake patterns

  • Schedule nursing care to minimize disturbances

  • Employ medication when necessary

  • Educate about the importance of rest and sleep