Rest and Sleep Teresa V. Hurley, MSN, RN

Sleep Physiology Circadian Rhythm –Sleep-wake cycle or biological clocks –Early birds and night owls –Interruption of cycle Anxiety Restlessness Irritability Impaired judgment

Sleep Physiology Sleep Regulation by CNS, peripheral nervous, endocrine, respiratory, muscular and cardiovascular systems Stages of Sleep –Non-rapid eye movement (NREM) 4 stages during a 90 minute cycle from light to deep sleep (harder to arouse) Body tissue restoration HR decreases to 60/min or less Interruption (confusion, suspicion, mood changes, immune suppression, accidents) –Rapid eye movement (REM) End of each sleep cycle Dreams more vivid and elaborate Learning, memory processing, stress adaptation

Factors Affecting Sleep Examples –Pain –Physical Discomfort –Difficulty Breathing (COPD, Asthma, Colds etc.) –Mood (anxiety or depression) –Nocturia –Restless legs syndrome prior to sleep (rhythmic movements and itching) –GERDS

Sleep Disorders Dyssomnias –Intrinsic (initiate and maintain sleep due to psychophysiological) Narcolepsy Obstructive sleep apnea –Extrinsic (external factors) –Circadian (sleep time/preference) Time zone change Shift work Parasomnias –Sleepwalking –Sleep terrors –Sleep talking –Noctural leg cramps –Nightmares –Sleep paralysis –Teethgrinding –Bedwetting –SIDS

Factors Affecting Sleep Age: less time as age Drugs (L-trytophan in cheese, milk and meats promote sleep) Lifestyle (shift work, changing meal time) Emotional Stress Environment (temperature, sound, lighting) Exercise (less than 2 hours before bedtime)

Factors Affecting Sleep Food and Caloric Intake (caffeine, alcohol, spicy, large meal, milk allergies in infants and food allergies as corn, chocolate, yeast, food dyes, wheat, eggs; wtg loss and gain

Nursing Interventions Promote bed time rituals and routines Adjust environment Back rub if not contra-indicated Provide Pain relief measures Do not interrupt sleep unless absolutely necessary Establish periods of rest and sleep

Pharmocolgic Hypnotics produce sleep Sedatives produce calming effect