Sleep Notes
Learning Outcomes
Explain the physiology and functions of sleep.
Identify the characteristics of NREM and REM sleep states.
Describe variations in sleep patterns throughout the life span.
Identify factors that affect sleep.
Describe common sleep disorders.
Identify the components of a sleep pattern assessment.
Develop nursing diagnoses, outcomes, and nursing interventions related to sleep problems.
Describe interventions that promote sleep.
Why Sleep Matters
Sleep is a basic human need and a universal biologic process.
Humans spend about one-third of their lives asleep.
Sleep is needed to cope with daily stresses, prevent fatigue, conserve energy, restore the mind and body, and enjoy life more fully.
Sleep enhances daytime functioning and is vital for cognitive, physiological, and psychosocial function.
Sleep disorders and sleep deprivation are an unmet public health problem.
Sleep is an important factor in a person’s quality of life
Physiology of Sleep
Sleep is considered an altered state of consciousness where perception of and reaction to the environment are decreased.
Biological Rhythm: Biologic rhythms are controlled from within the body and synchronized with environmental factors, such as light and darkness.
Circadian Rhythm: The most familiar biologic rhythm is the circadian rhythm. It is a sort of 24-hour internal biologic clock. The term circadian is from the Latin circa dies, meaning “about a day.” Your body’s internal clock regulates sleep-wake cycles.
Melatonin: Hormone that signals your body it’s time to sleep.
Types of Sleep
REM (Rapid Eye Movement): Dreaming, memory consolidation.
Non-REM: Deep sleep, physical restoration.
Sleep Cycles
The healthy adult sleeper usually experiences four to six cycles of sleep during 7 to 8 hours.
The sleeper who is awakened during any stage must begin anew at stage 1 NREM sleep and proceed through all stages to REM sleep.
During a sleep cycle, people typically pass through NREM and REM sleep; the complete cycle usually lasts about 90 to 110 minutes in adults.
Time spent in REM and NREM stages of sleep in an
Normal Sleep Patterns and Requirements
Newborns: 12 to 18 hours a day, on an irregular schedule with periods of 1 to 3 hours spent awake.
Infants awaken every 3 or 4 hours, 12 to 16 hours of sleep in 24 hours.
Toddlers (1 to 3 years of age): 12 - 14 hours of sleep in 24 hours.
Preschoolers (3 to 5 years of age): 11 to 13 hours of sleep per night.
School-Age Children (5 to 12 years of age): 10 to 11 hours of sleep per night.
Adolescents (12 to 18 years of age): 9 to 10 hours of sleep each night.
Adults: 7 to 8 hours of sleep per night.
Older Adults (65 to 75 years): 5 to 6 hours of sleep per night.
Factors Affecting Sleep
Illness: Illness that causes pain or physical distress (e.g., arthritis, back pain) can result in sleep problems
Environment: Environment can promote or hinder sleep.
Lifestyle: Following an irregular morning and nighttime schedule can affect sleep.
Emotional Stress: Stress is considered one of the greatest causes of difficulties in falling asleep
Stimulants and Alcohol: Caffeine-containing beverages act as stimulants of the central nervous system (CNS).
Diet: Dietary l-tryptophan—found, for example, in cheese and milk—may induce sleep.
Smoking: Nicotine has a stimulating effect on the body, and smokers often have more difficulty falling asleep than nonsmokers.
Motivation
Medication: Some medications affect the quality of sleep.
Most hypnotics can interfere with deep sleep and suppress REM sleep.
Beta-blockers have been known to cause insomnia and nightmares.
Narcotics, such as morphine, are known to suppress REM sleep and to cause frequent awakenings and drowsiness.
Tranquilizers interfere with REM sleep.
Although antidepressants suppress REM
Common Sleep Disorders
Insomnia: Difficulty falling or staying asleep.
Examples of behavioral treatments include the following:
Stimulus control: creating a sleep environment that promotes sleep
Cognitive therapy: learning to develop positive thoughts and beliefs about sleep
Sleep restriction: following a program that limits time in bed in order to get to sleep and stay asleep throughout the night (National Sleep
Excessive Daytime Sleepiness: Clients may experience excessive daytime sleepiness as a result of hypersomnia, narcolepsy, sleep apnea, and insufficient sleep.
Hypersomia obtains sufficient sleep at night but still cannot stay awake during the day.
Narcolepsy: a disorder of excessive daytime sleepiness caused by the lack of the chemical hypocretin in the area of the CNS that regulates sleep.
Sleep apnea: Breathing interruptions during sleep.
Parasomnia: A parasomnia is behavior that may interfere with sleep and may even occur during sleep. It is characterized by physical events such as movements or experiences that are displayed as emotions, perceptions, or dreams.
The International Classification of Sleep Disorders subdivides parasomnias into three classes: non–rapid eye movement, rapid eye movement, and miscellaneous with no specific stage of sleep (Judd & Sateia, 2014)
Sleep Diary
Time of (a) going to bed, (b) trying to fall asleep, (c) falling asleep (approximate time), (d) any instances of waking up and duration of these periods, (e) waking up in the morning, and (f) any naps and their duration
Activities performed 2 to 3 hours before bedtime (type, duration, and time)
Consumption of caffeinated beverages and alcohol and amounts of those beverages
Any prescribed medications, OTC medications, and herbal remedies taken during the day
Bedtime rituals before sleep
Any difficulties remaining awake during the day and times when difficulties occurred
Any worries that the client believes may affect sleep
Tips for Better Sleep
Stick to a Schedule: Go to bed and wake up at the same time daily.
Create a Sleep-Friendly Environment: Cool, dark, and quiet room. Comfortable mattress and pillows.
Limit Screen Time: Avoid screens 1 hour before bed (blue light disrupts melatonin).
Watch Your Diet: Avoid caffeine, alcohol, and heavy meals before bed.
Relax Before Bed: Try reading, meditation, or gentle stretching.
The Role of Exercise: Regular exercise improves sleep quality and duration. Avoid intense workouts close to bedtime. Aim for 30 minutes of moderate exercise daily.
Sleep Myths Debunked
Myth: You can "catch up" on sleep during the weekend. Fact: Irregular sleep patterns disrupt your circadian rhythm.
Myth: Snoring is harmless. Fact: It can be a sign of sleep apnea.
MytLearning Outcomes
Explain the physiology and functions of sleep.
Identify the characteristics of NREM and REM sleep states.
Describe variations in sleep patterns throughout the life span.
Identify factors that affect sleep.
Describe common sleep disorders.
Identify the components of a sleep pattern assessment.
Develop nursing diagnoses, outcomes, and nursing interventions related to sleep problems.
Describe interventions that promote sleep.
Why Sleep Matters
Sleep is a basic human need and a universal biologic process.
Humans spend about one-third of their lives asleep.
Sleep is needed to cope with daily stresses, prevent fatigue, conserve energy, restore the mind and body, and enjoy life more fully.
Sleep enhances daytime functioning and is vital for cognitive, physiological, and psychosocial function.
Sleep disorders and sleep deprivation are an unmet public health problem.
Sleep is an important factor in a person’s quality of life
Physiology of Sleep
Sleep is considered an altered state of consciousness where perception of and reaction to the environment are decreased.
Biological Rhythm: Biologic rhythms are controlled from within the body and synchronized with environmental factors, such as light and darkness.
Circadian Rhythm: The most familiar biologic rhythm is the circadian rhythm. It is a sort of 24-hour internal biologic clock. The term circadian is from the Latin circa dies, meaning “about a day.” Your body’s internal clock regulates sleep-wake cycles.
Melatonin: Hormone that signals your body it’s time to sleep.
Types of Sleep
REM (Rapid Eye Movement): Dreaming, memory consolidation.
Non-REM: Deep sleep, physical restoration.
Sleep Cycles
The healthy adult sleeper usually experiences four to six cycles of sleep during 7 to 8 hours.
The sleeper who is awakened during any stage must begin anew at stage 1 NREM sleep and proceed through all stages to REM sleep.
During a sleep cycle, people typically pass through NREM and REM sleep; the complete cycle usually lasts about 90 to 110 minutes in adults.
Time spent in REM and NREM stages of sleep in an
Normal Sleep Patterns and Requirements
Newborns: 12 to 18 hours a day, on an irregular schedule with periods of 1 to 3 hours spent awake.
Infants awaken every 3 or 4 hours, 12 to 16 hours of sleep in 24 hours.
Toddlers (1 to 3 years of age): 12 - 14 hours of sleep in 24 hours.
Preschoolers (3 to 5 years of age): 11 to 13 hours of sleep per night.
School-Age Children (5 to 12 years of age): 10 to 11 hours of sleep per night.
Adolescents (12 to 18 years of age): 9 to 10 hours of sleep each night.
Adults: 7 to 8 hours of sleep per night.
Older Adults (65 to 75 years): 5 to 6 hours of sleep per night.
Factors Affecting Sleep
Illness: Illness that causes pain or physical distress (e.g., arthritis, back pain) can result in sleep problems
Environment: Environment can promote or hinder sleep.
Lifestyle: Following an irregular morning and nighttime schedule can affect sleep.
Emotional Stress: Stress is considered one of the greatest causes of difficulties in falling asleep
Stimulants and Alcohol: Caffeine-containing beverages act as stimulants of the central nervous system (CNS).
Diet: Dietary l-tryptophan—found, for example, in cheese and milk—may induce sleep.
Smoking: Nicotine has a stimulating effect on the body, and smokers often have more difficulty falling asleep than nonsmokers.
Motivation
Medication: Some medications affect the quality of sleep.
Most hypnotics can interfere with deep sleep and suppress REM sleep.
Beta-blockers have been known to cause insomnia and nightmares.
Narcotics, such as morphine, are known to suppress REM sleep and to cause frequent awakenings and drowsiness.
Tranquilizers interfere with REM sleep.
Although antidepressants suppress REM
Common Sleep Disorders
Insomnia: Difficulty falling or staying asleep.
Examples of behavioral treatments include the following:
Stimulus control: creating a sleep environment that promotes sleep
Cognitive therapy: learning to develop positive thoughts and beliefs about sleep
Sleep restriction: following a program that limits time in bed in order to get to sleep and stay asleep throughout the night (National Sleep
Excessive Daytime Sleepiness: Clients may experience excessive daytime sleepiness as a result of hypersomnia, narcolepsy, sleep apnea, and insufficient sleep.
Hypersomia obtains sufficient sleep at night but still cannot stay awake during the day.
Narcolepsy: a disorder of excessive daytime sleepiness caused by the lack of the chemical hypocretin in the area of the CNS that regulates sleep.
Sleep apnea: Breathing interruptions during sleep.
Parasomnia: A parasomnia is behavior that may interfere with sleep and may even occur during sleep. It is characterized by physical events such as movements or experiences that are displayed as emotions, perceptions, or dreams.
The International Classification of Sleep Disorders subdivides parasomnias into three classes: non–rapid eye movement, rapid eye movement, and miscellaneous with no specific stage of sleep (Judd & Sateia, 2014)
Sleep Diary
Time of (a) going to bed, (b) trying to fall asleep, (c) falling asleep (approximate time), (d) any instances of waking up and duration of these periods, (e) waking up in the morning, and (f) any naps and their duration
Activities performed 2 to 3 hours before bedtime (type, duration, and time)
Consumption of caffeinated beverages and alcohol and amounts of those beverages
Any prescribed medications, OTC medications, and herbal remedies taken during the day
Bedtime rituals before sleep
Any difficulties remaining awake during the day and times when difficulties occurred
Any worries that the client believes may affect sleep
Tips for Better Sleep
Stick to a Schedule: Go to bed and wake up at the same time daily.
Create a Sleep-Friendly Environment: Cool, dark, and quiet room. Comfortable mattress and pillows.
Limit Screen Time: Avoid screens 1 hour before bed (blue light disrupts melatonin).
Watch Your Diet: Avoid caffeine, alcohol, and heavy meals before bed.
Relax Before Bed: Try reading, meditation, or gentle stretching.
The Role of Exercise: Regular exercise improves sleep quality and duration. Avoid intense workouts close to bedtime. Aim for 30 minutes of moderate exercise daily.
Sleep Myths Debunked
Myth: You can "catch up" on sleep during the weekend. Fact: Irregular sleep patterns disrupt your circadian rhythm.
Myth: Snoring is harmless. Fact: It can be a sign of sleep apnea.
Myth: Older adults need less sleep. Fact: Sleep needs remain consistent with age.
h: Older adults need less sleep. Fact: Sleep needs remain consistent with age.