HLTEN504A - INCP

1. HLTEN504A - INCP Comfort Rest Sleep

2. What is sleep • Sleep is a sensory experience. • Perception of and reaction to the surrounding environment decrease during sleep. • The sleeping person can be aroused by tactile, auditory and visual disturbances. • Sleep is influenced by an individual biologic clock that regulates not only sleep but also levels of alertness throughout the day. • Sleep is a cyclic phenomenon. • Within a 24-hour period, individuals have one major sleep period and one major wake period

4. Circadian Rhythms • Relates to the behavioral and biological activity in 24 hrs. • Internal clock synchronized to light / dark cycles and other daily cues. • Circadian clock synchronized to local time. • The human clock is found in a distinct group of cells in the hypothalamus. • These specialized cells have a connection with the pineal gland. • This gland secretes melatonin. • Night time causes melatonin secretion to be increased, day time causes secretion to be inhibited. • Even when night time cues are absent Melatonin is still released in a cyclic manner • The special cells are activated by light hitting the retina of the eyes.

5. Areas of the brain which influence sleep control: The reticular activating system (RAS) and the bulbar synchronising region (BSR) in Pons Varoli. Both work together, alternately activating and suppressing the brain’s higher centres to control sleep. Hinwood, 1987, p. 227

7. Reticular activating system – is localised in upper brain stem • Contain specialised cells that maintain alertness and wakefulness • Receives stimuli from – visual, auditory, pain, tactile, emotions • Wakefulness results from neurons in RAS releasingneurotransmitters such as • Nor adrenaline • Dopamine • Gamma-aminobutyric acid (GABA) • As the person begins to fall asleep and relax, RAS stimuli declines. Further decrease of activation occurs in a quiet , dark room .BSR takes over and sleep occurs

8. Two states of sleep Sleep has two distinct states • Non-rapid eye movement (NREM), which has four stages • Rapid eye movement (REM) These two states occur in approximately 90-minute cycles throughout the sleeping time.

9. Sleep stages

11. Stages of sleep Stage 1 • Is experienced as we fall asleep and is the transition between being awake and asleep – eye and body movements slow down • It lasts between 5 and 10 minutes. • Easily aroused from this state • This will be increased in those people suffering insomnia and disorders that produce frequent arousal patterns e.g. apnoea

12. Stages of sleep Stage 2 • Is the baseline of sleep, last for around 20 mins • Body temp and heart rate begins to slow • Arousal still relatively easy • It occupies approximately 45-60% of sleep

13. Stages of sleep Stage 3 – transitional stage to deep or delta wave sleep • Muscles are completely relaxed, and may last 15-30 minutes. • Very difficult to wake from this stage • Can feel groggy and disorientated for several minutes if woken • In children delta sleep occupies up to 40% of all sleep time.

14. Stages of sleep • Stage 4 – second stage of deep sleep • May last up to 15-30 mins • Very difficult to wake • Both 3 & 4 are important to feeling refreshed when waking • Sleep walking and enuresis may occur

15. Stages of sleep REM sleep • Lasts 5-30 mins, beginning about 70 -90 mins after commencement of sleep • It composes 20-25% of a normal night’s sleep. • Breathing, eye movement, heart rate and brain wave activity increase. • Vivid dreams occur. • There is also a loss of muscle tone (as if paralysed) in skeletal muscles

16. Sleep patterns of older adults • It often takes longer to fall asleep • Beginning in middle age, stages 3and 4 sleep become less prominent • There is a moderate reduction in total REM sleep time • The percentage of sleep time in stages 1 and 2 increases • Nocturnal awakenings increase in frequency and duration. • Because of frequent and longer night-time awakenings, total time spent asleep is shorter • There is a tendency to nap during the day so that total time spent asleep is redistributed in a 24-hour cycle

17. Conditions to promote proper rest Physical comfort • Elimination sources of physical irritation • Controlling sources of pain • Providing warmth • Maintaining hygiene • Maintaining proper anatomical alignment or positioning • Removing environmental distractions • Provide adequate ventilation

18. Conditions to promote proper rest Freedom from; Worry • Making decisions • Participating in personal health care • Gaining an understanding of health problems and their implications • Practicing restful activities regularly • Knowing the environment is safe Sufficient sleep

19. Improving sleep hygiene Regular sleep and waking times • go to bed when sleepy • use relaxation techniques to promote sleep • if unable to sleep within 15-30 minutes get out of bed Avoiding daytime naps • if naps are used, limit to 20 minutes or less twice a day Optimising sleep environments • Use night light if required • Keep path to bathroom free of obstacles • Provide privacy • Provide enough pillows for comfort

20. Improving sleep hygiene Regular sleep and waking times • go to bed when sleepy • use relaxation techniques to promote sleep • if unable to sleep within 15-30 minutes get out of bed Avoiding daytime naps • if naps are used, limit to 20 minutes or less twice a day Optimising sleep environments • Use night light if required • Keep path to toilet free of obstacles • Provide privacy • Provide enough pillows for comfort

21. Improving sleep hygiene Minimise noise and moderate temperature • Sometimes soft music can mask other noise • Control noise in the hospital • Make sure that the heater is on/off, fan on/off, windows open/closed; • Provide enough blankets, socks to promote warmth Eliminate daytime sedation and night time stimulants • Ensure that medications or their interactions are not cause of insomnia

22. Effects of Sleep deprivation • Benefits of power naps • Visitors and other clients • Meditation and relaxation • Pain management • Medications