Sleep and Sleep Disorders: Professional Nursing I

Introduction to Sleep

  • Definition: Sleep is a natural necessity involving a shift in physiological and neurological activity, designed to be restorative (Giddens, 2025).
  • Scope:
    • Restorative sleep: Results in an individual feeling rested and refreshed.
    • Impaired sleep: Leaves the individual feeling unrested or unrefreshed. This can be intermittent or chronic.
    • Chronic impaired sleep: Is associated with significant physical, cognitive, and social challenges (Giddens, 2025).

Physiology of Sleep

Circadian Rhythm

  • An internal process that controls the sleep-wake cycle (ATI, 2023).
  • Occurs approximately every 24 hours.
  • Regulates a person's biological clock.
  • Synchronizes with environmental cues.

Measuring Brain Activity

  • The stages of sleep are determined by monitoring brain waves and frequencies, eye and muscle movements, and vital signs (ATI, 2023; Giddens, 2025; Pearson, 2023).
  • Key terms:
    • Electroencephalogram (EEG): A test that detects electrical activity in your brain using small, flat metal discs (electrodes) attached to your scalp.
    • Polysomnography (sleep study): A comprehensive test that monitors multiple physiological parameters during sleep, including brain activity (EEG), eye movement, muscle movement, heart rate (HR), oxygen levels, and breathing patterns.
  • Sleep stages: Divided into Non-Rapid Eye Movement (NREM) and Rapid Eye Movement (REM).

NREM Sleep Stages

  • NREM: Stage 1 (Giddens, 2025)
    • Lightest stage of sleep.
    • Breathing is normal.
    • Skeletal muscle tone is present.
    • Can last from 1-5 minutes.
  • NREM: Stage 2 (ATI, 2023; Giddens, 2025)
    • A person can wake up easily from this stage.
    • Heart rate, respiration, and temperature decrease.
    • Consumes approximately 50\% of the total sleep cycle.
  • NREM: Stages 3 & 4 (ATI, 2023; Giddens, 2025)
    • Represents deeper sleep.
    • If awoken, the person may experience mental cloudiness for 30 to 60 minutes.
    • The immune system strengthens during these stages.
    • Muscles, tissues, and bones repair and regenerate.

Rapid Eye Movement (REM) Sleep

  • Most dreams occur during REM sleep.
  • Eyes dart back and forth quickly.
  • Small muscle twitching may be observed on the face.
  • Muscle atonia: A temporary paralysis of the voluntary muscles, preventing individuals from acting out their dreams.
  • Metabolism increases.
  • Respirations are irregular.
  • Pulse rate and blood pressure increase.

Sleep Patterns Across the Lifespan (Taylor et al., 2023)

  • Newborns & Infants:
    • Position the baby on their back to sleep to prevent Sudden Infant Death Syndrome (SIDS).
    • Provide the baby with their own sleep space.
    • Avoid placing pillows, crib bumpers, or stuffed animals in the crib with the baby.
  • Toddlers:
    • Establish a consistent bedtime routine.
    • Transition from a crib to a youth bed occurs around age 2. Parents/caregivers need education on safety as the toddler can wander out of bed and out of the room.
  • Preschool (3-6 years):
    • Require 10-13 hours of sleep at night.
    • Most children no longer take naps by age 5.
  • School-aged children (6-12 years):
    • Require 9-11 hours of sleep at night.
    • Sleep needs increase during growth spurts.
  • Adolescents (12-20 years):
    • Require 8-10 hours of sleep.
    • Tend to go to bed later due to biological shifts.
    • Many adolescents do not get enough sleep.
  • Adults:
    • Young adults (20-35 years) & middle-aged adults (35-65 years): Require 7-9 hours of sleep.
  • Older Adult (age 65+): (ATI, 2023; Taylor et al., 2023)
    • Requires 7-8 hours of sleep.
    • Wake up more frequently and take longer to fall asleep.
    • Exhibits an increase in sleep complaints.

Factors Influencing Sleep (Giddens, 2025)

  • Age: Middle-aged and older adults.
  • Gender: Women, particularly pregnant and perimenopausal women.
  • Physiological conditions: Obesity.
  • Genetics: Family history of sleep disorders.
  • Individual behavior: Shift work, daily routines affecting sleep schedule.
  • Dietary behavior: Caffeine intake.
  • Environmental factors: Noise, light, temperature.

Assessment of Sleep (Giddens, 2025)

History

  • Question the individual about how they feel upon awakening.
  • Identify underlying sleep problems.
  • Gather family history related to sleep disorders.
  • Obtain social history, including lifestyle and routine factors.

Physical Examination

  • Assess respiratory and cardiac functions if relevant.
  • Observe for neurological changes that may impact sleep.

Diagnostic Tests

  • Polysomnography (sleep study): Often used for definitive diagnosis of sleep disorders.
  • Sleep Journal: A diary kept by the individual to record sleep patterns, behaviors, and environmental factors over a period, providing valuable subjective data.

Promoting Sleep

General Strategies (ATI, 2023; Pearson, 2023)

  • Avoid stimulants (e.g., caffeine, nicotine) at least 4-6 hours before bedtime.
  • Remove unnecessary light and noise from the sleep environment.
  • Establish a consistent bedtime routine.
  • Keep the room dark, quiet, and cool.
  • Go to bed only when feeling tired.

Promoting Sleep in the Healthcare Setting (Ignatavicius et al., 2024; Pearson, 2023)

  • Observe for restlessness behaviors in patients.
  • Administer appropriate analgesics before bedtime if pain is a factor.
  • Attempt to keep the patient awake during the day to consolidate nighttime sleep.
  • Keep staff conversations as quiet as possible near patient rooms.
  • Postpone non-essential treatments until waking hours or early morning.
  • Place a “Do Not Disturb” sign on the patient’s door to minimize interruptions.

Sleep Disorders (Giddens, 2025)

  • Primary Sleep Disorders: Conditions that exist as an independent entity (e.g., insomnia, and parasomnias like sleepwalking and sleep terrors).
  • Secondary Sleep Disorders: Conditions that are often caused by underlying medical conditions, mental health conditions, or side effects of medical treatments.

Night Terrors (Giddens, 2025; Pearson, 2023)

  • Description: Sudden episodes of intense fear, screaming, panic, and confusion while the individual is still asleep.
  • Duration & Recall: Can last between a few seconds to several minutes. The person usually does not recall the episode upon waking.
  • Physiological responses: Respiratory rate and heart rate increase, pupils are dilated, and diaphoresis (sweating) occurs.
  • Demographics: Preschool and school-age children are more likely to experience night terrors.

Sleepwalking (Somnambulism) (Giddens, 2025; Suni & Vyas, 2022)

  • Description: Characterized by getting out of bed and engaging in various activities while still asleep.
  • Sleep Stage: Occurs during NREM sleep.
  • Activity: The activity is often goal-directed (e.g., walking, getting dressed, moving objects).
  • Recall: The person typically has no recall of the episode.
  • Demographics: Occurs most frequently among children.

Insomnia (Pearson, 2023; Giddens, 2025)

  • Definition: An inability to fall asleep or stay asleep, leading to impaired daytime functioning.
  • Symptoms:
    • Drowsiness
    • Fatigue
    • Irritability
    • Cognitive deficits (e.g., difficulty concentrating, impaired memory)
  • Risk Factors:
    • Women
    • Individuals over 60 years old
    • Presence of a mental health disorder (e.g., depression, anxiety)

Treatment for Insomnia (Pearson, 2023)

Nonpharmacological Treatments
  • Cognitive Behavioral Therapy (CBT): Considered the first line of treatment. It addresses the thoughts and behaviors that interfere with sleep.
  • Good sleep hygiene: Implementing consistent sleep habits and environmental conditions conducive to sleep.
  • Physical exercise: Regular moderate exercise, avoiding strenuous activity close to bedtime.
  • Relaxation techniques:
    • Breathing exercises
    • Progressive muscle relaxation
    • Meditation
Medications Used to Treat Sleep Disorders (Giddens, 2025; Lilley et al., 2023)
  • Antihistamines:
    • Example: Diphenhydramine (Benadryl).
    • Can cause drowsiness as a side effect, which can be useful for sleep induction.
  • Benzodiazepines:
    • Examples: Diazepam (Valium), Lorazepam (Ativan).
    • Are central nervous system depressants that enhance the effect of the neurotransmitter GABA, promoting sedation.
    • Generally used for short-term treatment due to potential for dependency and side effects.
  • Benzodiazepine Receptor-Like Agents (Z-drugs):
    • Example: Zolpidem (Ambien).
    • Selectively target GABA-A receptors, leading to sedative effects with a different chemical structure than benzodiazepines.
    • Tend to have fewer side effects related to muscle relaxation and anxiety relief compared to traditional benzodiazepines.
  • Melatonin:
    • A natural hormone that regulates the sleep-wake cycle.
    • Can be used, particularly in cases of circadian rhythm problems or jet lag, to help reset the body’s internal clock.