sleep and rest

1. Sleep and Rest George Ann Daniels, MS, RN

2. Sleep Stages Stage 1 Transition Stage 2 Light Sleep Stage 3 & 4 Slow wave Stage 5 REM sleep Transition –between drowsiness and sleep, muscle relax, respirations even, pulse decreases. If awaken during this stage, client will not thing they have been asleep Light Sleep- easily awaken, rolling eye movement and snoring may occur Slow wave- deep sleep, need a strong stimuli to awakenTransition –between drowsiness and sleep, muscle relax, respirations even, pulse decreases. If awaken during this stage, client will not thing they have been asleep Light Sleep- easily awaken, rolling eye movement and snoring may occur Slow wave- deep sleep, need a strong stimuli to awaken

3. REM Sleep REM-Rapid eye movement Vital signs fluctuate 02 consumption increases Thermoregulations lost Vaginal secretion increase Erections Dreams-vivid

4. Sleep Rhythm 90 minute cycles during which people pass through the sleep stages

5. Characteristics of normal sleep and rest Awareness of the need for sleep Sleepiness Urge to go to sleep Fatigue State of weariness Restoration and Protection Conserves energy Synthesis of cells (anabolism)

6. Normal sleep and rest patterns Short sleepers 6 hours or less Efficient, hardworking Long sleepers 9 hours or more Creative Sleep latency period Change of position 20-40 time/ night One to two awakenings per noc normal for young adults Should awake well rested, refreshed, and energized Cultural habits Circadian Rhythms Sleep latency period- the time required to fall asleep. Varies usually 10-30 minutes 5 minutes = excessive sleepiness longer than 30 minutes= sense of frustration preventing sleep Cultural habits siesta in the afternoons Circadian rhythm based on cycle of 24 hoursSleep latency period- the time required to fall asleep. Varies usually 10-30 minutes 5 minutes = excessive sleepiness longer than 30 minutes= sense of frustration preventing sleep Cultural habits siesta in the afternoons Circadian rhythm based on cycle of 24 hours

7. Lifespan Newborns/infants Quiet sleep and active sleep 3 waking states Quiet awake, active awake, and crying Newborns sleep 16-17 hours per day Divided into seven sleep periods between the day and night Infants have a shorter sleep cycle ( 50-60 minutes) Quiet sleep- closed eyes, regular respirations, and absence of eye or body movement Active sleep- eye movement through closed lids and body movements, irregular respirationsQuiet sleep- closed eyes, regular respirations, and absence of eye or body movement Active sleep- eye movement through closed lids and body movements, irregular respirations

8. Adaptive task for the infant Establish sleep-wake patterns compatible with the environment Most infants sleep through the night be 3 months Total sleep times continue to drop as the infant gets older Toddler/Preschooler 1 year naps once or twice per day Total sleep time drops to 13-14 hours at age 2 12 hours by age 5

9. Child Sleep needs are in relationship to growth spurts and activity patterns Adolescents Require more sleep than before puberty Growth and hormone Adults Vary Middle adults Increase in nocturnal awakenings Sleep satisfaction decreases Middle adult variable: job- related stress, parenting responsibilities, and illnessMiddle adult variable: job- related stress, parenting responsibilities, and illness

10. Older adults Stage 4 sleep decreases Difficulty remaining asleep Shorter nocturnal period with increase in daytime naps Total time in bed increases Napping, longer sleep latency, increased number and length of awakenings, and general fatigue Educate elderly about normal sleep pattern changes

11. Factors Affecting Sleep and Rest Need Morning people/evening people Environment New environment Sleep room doubles with work area Objects of play may interrupt a child sleep Reduction of environmental stimuli Light , noise, and temperature Total sleep needed to maintaining functioning ability. Need to analyze self or client to identify the amount of sleep needed.Total sleep needed to maintaining functioning ability. Need to analyze self or client to identify the amount of sleep needed.

12. Relationships Parenting, bereaved,homesick, critical care units. Shift Work Nutrition and Metabolism Hunger or difficulty sleeping after a large meal, ingestion of certain foods decrease sleep latency and increase stage 4 sleep. Elimination Patterns Need to void Limit fluids=decrease nocturnal stimulation Exercise and Thermoregulation Physically fit people have decreased sleep latency Warmth increases slow-wave sleep

13. Lifestyle and habits Bedtime rituals Lifestyle patterns Up at 5 and asleep by 8 Illness Acute or chronic Loss of stage 3 sleep Pain, dyspnea, hormone changes (hyperthyroidism), skin conditions, anxiety from illness Medications and Chemicals Hypnotics, alcohol, caffeine Mood states Mood states- anxiety, stress, depressionMood states- anxiety, stress, depression

14. Alterations in sleep Insomnia Perceived difficulty in sleeping Months to years 3 types Onset insomnia Maintenance insomnia Early-awakening insomnia Onset- prolonged sleep latency Maintenance- multiple awakenings Early-up too earlyOnset- prolonged sleep latency Maintenance- multiple awakenings Early-up too early

15. Narcolepsy Disorder of excessive daytime sleepiness characterized by short, sleep attacks Last 10 –15 minutes Onset usually in adolescents Sleep apnea Recurrent periods of absence of breathing for 10 seconds or longer, occurring at least 5 times per hour Obstructive sleep apnea Central apnea Mixed apnea Obstructive- collapse of the upper airway in spite of respiratory effort. 4 % males 2% women Central- neurogenic failure to trigger respiratory effort. Stroke, brain stem involvement, usually requires vents Mixed- combination of obstructive and centralObstructive- collapse of the upper airway in spite of respiratory effort. 4 % males 2% women Central- neurogenic failure to trigger respiratory effort. Stroke, brain stem involvement, usually requires vents Mixed- combination of obstructive and central

16. Periodic limb movement Repetitive dorsiflexion of the foot and flexion of the knee Once every 15-20 seconds Restless legs syndrome Crawling, itching sensations in the legs at rest Circadian rhythm disruptions Jet lag Parasomnias Normal activities in the day that is abnormal during sleep Sleepwalking, talking, bed wetting

17. Impact on ADL’s Decreased energy Impaired coping and cognitive responses Role performance Social interactions Irritability Impaired concentration

18. Assessment Subjective How many hours of sleep do you usually get? What time do you usually go to bed? What time do you usually get up? What helps you sleep? How do feel when you wake up? How much sleep do you believe you need? What helps you relax? What are your sleep rituals?

19. How often do you take naps or rest periods? Do you take anything to help you sleep? Assess caffeine, nicotine, and alcohol intake. Assess work hours Identify dysfunctions Sleep apnea, snoring, stress Objective Data Circles under eyes, yawning, nodding, slow responses, irritability, impaired concentration, word-finding difficulties, VS Diagnostic test Sleep studies, 02 levels

20. NDX Sleep pattern Disturbance R/T Internal sensory alterations Illness, stress External sensory alterations Light, noise, social stimulation, strange environment

21. EO Client will report fewer problems falling asleep. Client will have an increase sleep time to 6 hours per night. Client will report feeling more rested.

22. Interventions Environment modifications Privacy and security Sleep rituals Managing individual sleep needs Medication Concept MapConcept Map