Rest and Sleep

Introduction to the Nature and Importance of Sleep

• Sleep as a Basic Human Need: Sleep is categorized as a fundamental requirement for human life and health.

• Benefits of Sleep:     * Provides a mechanism to cope with daily stresses.     * Enhances daytime functioning and overall quality of life.     * Vital for restoring the mind and the body.

• Biological Functions of Sleep: Sleep is essential for specific physiological and psychological processes, including:     * Protein synthesis.     * Cognitive function.     * Physiological function.     * Psychosocial function.

• Consequences: The presentation notes that there are significant consequences associated with chronic sleep loss.

Healthy People 2030: Sleep Health (SH) Objectives

• SH- 1: Increase the proportion of persons with symptoms of obstructive sleep apnea (OSA) who seek medical evaluation.

• SH- 2: Reduce the rate of vehicular crashes per $100 \times 10^{6}$ miles traveled ($100 \text{ million miles}$) that are attributed to drowsy driving.

• SH- 3: Increase the proportion of students in grades $9$ through $12$ who obtain sufficient sleep.

• SH- 4: Increase the proportion of adults who get sufficient sleep.

Physiology of Sleep

• Definition: Sleep is defined as an altered state of consciousness.

• Physiological Characteristics:     * Variable levels of consciousness.     * Minimal physical activity.     * Significant changes in the body's physiological processes.     * Decreased responsiveness to external stimuli.

Stages and Cycles of Sleep

• The Cyclic Nature of Sleep: Sleep consists of cycles that repeat throughout the night.

• Sleep Cycle Composition:     * A complete sleep cycle lasts approximately $90$ to $110 \text{ minutes}$.     * Sleep is divided into Non-Rapid Eye Movement (NREM) and Rapid Eye Movement (REM) states.     * Distribution: $80\%$ NREM and $20\%$ REM.

• Stages of Sleep (Hierarchy):     * Wake     * REM     * NREM $1$     * NREM $2$     * NREM $3$     * NREM $4$

Characteristics of REM Sleep

• Dreams: This is the stage where dreams take place.

• Metabolic and Systemic Changes:     * Gastric secretions increase.     * Heart and respiratory rates often become irregular.

• Cognitive Stimulation: REM sleep stimulates learning, thinking, and the organization of information.

Physiological Changes during NREM Sleep

• Cardiovascular Changes:     * Arterial blood pressure falls.     * Pulse rates decrease.     * Cardiac output decreases.     * Peripheral blood vessels dilate.

• Respiratory Changes: Respiratory rates decrease.

• Metabolic and Neurological Changes:     * Basal metabolic rate (BMR) decreases by $20\%$ to $30\%$.     * Intracranial pressure decreases.     * Growth hormone levels reach their peak.

• Musculoskeletal Changes: Skeletal muscles undergo relaxation.

Nursing Management and Diagnostic Studies

• Assessment Components:     * Sleep history.     * Health history.     * Polysomnography: Used to measure sleep objectively.

• Diagnostic Tools:     * Electroencephalogram (EEG): Measures electrical activity in the brain.     * Electromyogram (EMG): Measures muscle activity/tension.     * Electrooculogram (EOG): Measures eye movements.

Sleep Requirements Across the Lifespan

• Variables: Sleep requirements vary between individuals based on quantity and quality.

• Developmental Considerations: Sleep patterns change with growth and development.

• Life Span Categories:     * Newborns     * Infants     * Toddlers     * Preschool     * School-age     * Adolescents     * Adults     * Older adults

Biorhythms and Circadian Rhythm

• Biorhythms: The study of the biological rhythms of the body, which are synchronized with environmental factors such as light, darkness, gravity, and electromagnetic activity.

• Circadian Rhythm: The internal $24 \text{-hour}$ clock that regulates synchronization of bodily functions.

• Daily Biological Timeline:     * $00:00$ (Midnight): Start of the cycle.     * $02:00$: Deepest sleep.     * $04:30$: Lowest body temperature.     * $06:45$: Sharpest rise in blood pressure.     * $07:30$: Melatonin secretion stops.     * $08:30$: Bowel movement likely.     * $09:00$: Highest testosterone secretion.     * $10:00$: High alertness.     * $12:00$ (Noon): Mid-day.     * $14:30$: Best coordination.     * $15:30$: Fastest reaction time.     * $17:00$: Greatest cardiovascular efficiency and muscle strength.     * $18:30$: Highest blood pressure.     * $19:00$: Highest body temperature.     * $21:00$: Melatonin secretion starts.     * $22:30$: Bowel movements suppressed.

Factors Contributing to Sleep and Common Disorders

• Contributing Factors: Chemical, developmental, microbiological, physiological, physical, and psycho/socio/cultural-spiritual factors.

• Common Sleep Disorders:     * Parasomnia: Includes behaviors such as somnambulism (sleepwalking).     * Insomnia: Divided into initial, intermittent/frequent, and terminal insomnia.     * Hypersomnia: Excessive sleep.     * Narcolepsy: Characterized by excessive daytime sleepiness (EDS).     * Obstructive Sleep Apnea (OSA): Disruption of breathing during sleep.     * Sleep Deprivation: Prolonged lack of sufficient sleep.

Clinical Manifestations of Sleep Disorders

• General Psychological/Physical Symptoms: Fatigue, irritability, restlessness.

• Ocular Signs: Darkened circles around eyes, puffy eyelids, reddened conjunctiva, glazed or dull eyes.

• Cognitive and Behavioral Signs:     * Inattentiveness and slowed speech.     * Distorted perceptions and hallucinations.     * Slumped posture, hand tremors, and poor coordination.     * Withdrawal and frequent yawning.     * Medical Risk: Decreased seizure threshold.

Nursing Diagnoses and Interventions

• Sample Nursing Diagnoses:     * Disturbed Sleep Pattern R/T (Related To) anticipated surgery.     * Insomnia R/T parental responsibilities.     * Readiness for Enhanced Sleep R/T expressed willingness to improve sleep.     * Fatigue R/T lack of sleep.

• General Goals of Intervention: Create a restful environment, provide a safe environment, and provide comfort and relaxation.

• Interventions for the Hospital Environment:     * Privacy/Physical Control: Close the door, pull the bed curtain, shut off the phone, TV, and radio. Provide soft music and limit lighting.     * Social Control: Provide a compatible roommate.     * Environmental Control: Set appropriate room temperature, provide ear plugs and eye pads.

• Sleep Hygiene in Hospitals:     * Decrease the amount and type of stimuli.     * Prioritize uninterrupted blocks of sleep and organize care to ensure fewest possible disturbances.     * Clinical Rule: Do not give a sleeping pill and then wake the patient.

• Safety Interventions:     * Use night lights.     * Place bed in the lowest position with side rails as appropriate.     * Ensure call bell is within reach and instruct the patient on its use; answer prompts promptly.     * Make purposeful rounds using the $5 \text{ Ps}$.     * Instruct patient on movement with IVs and drainage tubes.     * Keep essential objects within reach.

• Comfort and Relaxation Interventions:     * Support established bedtime rituals.     * Provide loose-fitting nightwear and assist with hygiene routines.     * Ensure bed linens are clean, dry, and smooth; provide extra blankets if needed.     * Encourage voiding before bedtime; advise against excessive fluid intake close to bedtime.     * Dietary/Physical: Avoid caffeine; give warm milk. Offer a back massage.     * Physical alignment: Position patient in functional alignment and provide pain management.     * Diversional: Provide for diversional activities.     * Pharmacological: Assess for medications that affect sleep.

• Sleep Medications:     * Sedatives used to promote relaxation and decrease anxiety.     * Use with extreme caution in older adults.     * Ensure safety measures are in place after sedative administration.     * Prioritize non-pharmacological approaches; use medications only as a last resort or as a PRN (pro re nata/as needed).

Patient Teaching and Evaluation

• Promoting Sleep through Education: Teach patients about sleep patterns, bedtime rituals, diet, exercise, and medications.

• Evaluation: Regularly monitor the effectiveness of sleep medications and nursing interventions aimed at promoting sleep.

Questions & Discussion

• Question: A college student was referred to the campus health service because of difficulty staying awake in class. What should be included in the nurse's assessment? (Select all that apply.)     * Options:         1. Amount of sleep they usually obtain during the week and on weekends.         2. How much alcohol they usually consume.         3. Onset and duration of symptoms.         4. Whether or not their classes are boring.         5. What medications, including herbal remedies, they are taking.     * Correct Response: $1, 3, \text{ and } 5$.

• Question: Which should the nurse do to best promote rest and sleep in the hospital for all patients?     * Options:         1. Provide a backrub at bedtime.         2. Turn the lights off at night.         3. Encourage usual routines.         4. Administer a sedative.     * Correct Response: $3$. Usual routines meet self-attributed needs and reduce anxiety by providing a familiar pattern.