Sleep, Stress, & Coping

Sleep

• Definition: A state of rest characterized by altered consciousness and reduced activity. It's an essential part of the sleep-wake cycle.

• Physiology: Involves a natural, necessary shift in physiological and neurologic activity intended for restoration.

Effects of Insufficient Sleep

• Physical and Psychological Outcomes: Includes anxiety, personal conflicts, loneliness, depression, gastrointestinal issues, increased risk of type 2 diabetes, hypertension, cardiovascular diseases (including strokes), and substance misuse.

  • Ex. People who have sleep issues increases physiological or psychological effect & can increase risk for these issues.

• Statistics: One-third of U.S. adults report getting insufficient sleep (CDC).

Health History Questions for Sleep Assessment

• Do you feel you are getting enough sleep?

• Do you feel rested upon waking?

• How many hours do you sleep each night?

• What aids do you use to help you fall asleep?

• Do you find it difficult to stay awake during the day?

• Ask Open-ended questions

• Sleep diary: time before bed, what they did today, caffeine and/or nicotine intake, time asleep, etc.

• When sleep disturbance is noted, ask:

  • Nature of sleep disturbances

  • The cause

  • Related symptoms & signs

  • Frequency and impact on daily life

  • The severity of the issue and treatment needs

Physical Assessment for Sleep Issues

• Energy Level: Assess for signs of fatigue, weakness, or lethargy. How much sleep you get?

• Facial Inspection: Observe for narrowing of eyes, swollen eyelids, and reduced facial expressiveness. Flat affect?

• Behavioral Signs: Look for yawning, rubbing eyes, changes in speech speed, or posture.

• Physical Indicators: Check for obesity, enlarged neck (increases the risk for sleep apnea), nasal septum deviation, and snoring (also a sign of sleep apnea)

• Sleep study tells us how the brain works at night

Factors Altering Sleep/Rest

• Age: Sleep disturbances are common in those aged 65 and older, including difficulty falling asleep and waking frequently.Napping or not feeling rested after a night's sleep.

• Chronic illnesses and sleep disorders (Discomfort or restless leg can make you have issues sleeping) COPD- Like recliners or a lot of pillows to be able to breathe, nocturia, pregnancy, anxiety, etc.

• Environmental factors- Night shifters, cars, neighbors, kids, etc.

• lifestyle choices - Partiers, substance abuse, new parents, etc.

• physical activity - do not do close to bedtime because it can keep you up

• diet- heartburn, eating close to bed, caffeine, etc.

• Smoking- stimulant

• Stress- cannot fall asleep

Health Promotion for Sleep

• Environment- cluster care, minimize noise, lights off, etc.

• Bedtime rituals- try to maintain rituals

• Relaxation & comfort

• Sleep & rest disturbances- silence alarms ASAP

• Medications- can promote sleep

• Education- teach about good sleep hygiene

Stress and Coping Mechanisms

• A condition in which the human system responds to changes in its normal balanced state.

• Change in a person’s external or internal environment:

  • Challenge

  • Threat

  • Danger

• Stressor: The change or stimulus that evokes this state.

Stressors

Neither positive nor negative but can have the short or long-term effects.

• Physical: Cold/heat, chemical agents

• Physiologic: alteration to normal body structure or function. Nutritional imbalances, hypoxia, genetic or immune disorders.

• Psychosocial: Fear (failing a test, losing job, etc.) Anxiety.

  • Daily life stressors that build up until we notice

• Adaptation: adjustment to change

  • Coping response

  • The goal is to adjust and cope with new stressors

• Coping strategies:

  • Fanning yourself if too hot

  • Going to the gym after work

Local Adaptation Syndrome (LAS)

• Localized response of the body to stress

• Involves only a specific body part (such as a tissue or organ) instead of whole body

• Stress precipitating the LAS may be traumatic or pathologic

• Primarily homeostatic short-term adaptive response

• Two Types: Reflex pain response & inflammatory response

• Ex. stepping in hot water and pulling leg back

General Adaptation Syndrome (GAS)

• Biochemical model of stress

• Stages:

  • Alarm Reaction: fight-or-flight response

  • Resistance Stage: The body attempts to adapt

  • Exhaustion Stage: Body rests or returns to normal (can die)

Effects of Stress

• Healthy person: may promote health and prevent illness

  • Makes smokers want to not smoke

• Sick or injured person: stress can make illness worse, and illness can cause stress

Effects of Long-Term stress

• As intensity, duration, and stressors increase, adaptability is lessened

• High levels of ongoing stress are associated with multiple health disorders

Nursing History

• Questions & leading statements to identify stress and anxiety

• Have you noticed that you feel your heart beating or have difficulty breathing?

• Describe how you are feeling.

• Sexual desire change

• How does your body feel when you are upset?

Physical Assessment

• No specific guidelines

  • Inspect skin

  • Do vitals

  • Note general effect

• Dry mouth

• Increased sweating

• Tremors

• Tachycardia

• Increased BP

• Dilated pupils

• Crying

• Restlessness

• Rapid speech

• Pacing

• Lack of facial expression

Physiologic Stress Response

• Each person reacts in their own way to prolonged stress

• Body systems react in various ways

Coping Mechanisms

• Crying, laughing, sleeping, cursing

• Physical activity, exercise

• Smoking, drinking

• Lack of eye contact, withdrawal

• Limiting relationships

• Rest and sleep

• Nutrition

• Encourage support systems

• Encourage the use of stress management techniques

• Providing crisis intervention