Chapter 40 Rest and Sleep

Physiology of Sleep Reticular activating system (RAS) –Facilitates reflex and voluntary movements –Controls cortical activities related to state of alertness Bulbar synchronizing region Hypothalamus — control center for sleeping and waking

Stages of Sleep Non-rapid eye movement (NREM) –Consists of four stages Stage I and II — 5% to 50 % of sleep, light sleep Stage III and IV — 10% of sleep, deep-sleep states (delta sleep) Rapid eye movement (REM)

Sleep Cycle The person passes consecutively through four stages of NREM sleep. The pattern is then reversed. –Return from stage IV to III to II –Enter REM sleep instead of reentering stage I The person reenters NREM sleep at stage II and moves on to III and IV.

Factors Affecting Sleep Developmental considerations Psychological stress Motivation Culture Lifestyle and habits Physical activity and exercise

Factors Affecting Sleep (continued) Dietary habits Environmental factors Illness Medications

Illnesses Associated With Sleep Disturbances Peptic ulcers Coronary artery diseases Epilepsy Liver failure and encephalitis Hypothyroidism

Classification of Sleep Disorders Dyssomnias Parasomnias Sleep disorders associated with medical or psychiatric disorders Other proposed disorders

Sleep Disorders Dyssomnias — characterized by insomnia or excessive sleepiness Parasomnias — patterns of waking behavior that appear during sleep

Dyssomnias Insomnia Hypersomnia Narcolepsy Sleep apnea Restless leg syndrome Sleep deprivation

Parasomnias Somnambulism Sleep talking Nocturnal erections Bruxism Enuresis Sleep-related eating disorder

Treatment for dyssomnias Pharmologic therapy –Sedatives and hypnotics Nonpharmacologic therapy –Stimulus control –Sleep restriction –Sleep hygiene –Cognitive therapy –Multicomponent therapy –Relaxation therapy

Nursing Interview Identify patient’s sleep-wakefulness patterns Identify effect of these patterns on everyday functioning Assess patient’s use of sleep aids Assess the presence of sleep disturbances and contributing factors

Sleep Disturbance Assessment Parameters Nature and cause of problem Accompanying signs and symptoms Date of occurrence and effect of everyday living Severity of the problem Treatment of problem How the patient is coping with the problem

Information Recorded in a Sleep Diary Time patient retires Time patient tries to fall asleep Approximate time patient falls asleep Time of any awakening during the night and resumption of sleep Time of awakening in morning Presence of any stressors affecting sleep

Information Recorded in a Sleep Diary (continued) Record of food, drink, or medication affecting sleep Record of physical and mental activities Record of activities performed 2 to 3 hours before bedtime Presence of worries or anxieties affecting sleep

Key Findings of Physical Assessment Energy level Facial characteristics Behavioral characteristics Physical data suggestive of sleep problems

Sleep Characteristics to Assess Restlessness Sleep postures Sleep activities Snoring Leg jerking

Common Etiologies for Nursing Diagnoses Physical or emotion discomfort or pain Changes in bedtime rituals or sleep environment Disruption of circadian rhythm Exercise and diet before sleep Drug dependency and withdrawal Symptoms of physical illness

Nursing Interventions to Promote Sleep Prepare a restful environment Promote bedtime rituals Offer appropriate bedtime snacks and beverages Promote relaxation and comfort Respect normal sleep-wake patterns Schedule nursing care to avoid disturbances Use medications to produce sleep Teach about rest and sleep