Chapter 40 Sleep and Rest

40-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Rest and Sleep  Rest refers to a state of relaxation and calmness.  Sleep refers to a state of altered consciousness during which an individual experiences minimal physical activity and a general slowing of the body’s physiological processes.  Sleep and dreaming have a restorative value.

40-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Rest and Sleep  Stages of Sleep NREM Sleep -Four different stages. REM Sleep (stage 5 sleep) -Essential to emotional well being and emotional adaptation. -REM sleep needs are greatest after periods of increased stress and illness.

40-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Rest and Sleep  Sleep Cycle The sequence of sleep begins with the four stages of NREM sleep in order, with a return to stage 3, then 2, then passage into the first REM stage.

40-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Biological Clock  Measures time in a living organism.  Controls daily fluctuations in hundreds of physiological processes.  Chronobiology is a branch of science that studies the rhythms that are controlled by our biological clocks.  Circadian rhythms cycle on a daily basis.

40-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Affecting Rest and Sleep  Comfort Level  Anxiety/Stress  Environment  Lifestyle  Hormones

40-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Affecting Rest and Sleep  Diet/Nutrition  Drugs/Medications  Cultural Norms  Life Span Considerations

40-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Illness or Hospitalization  Factors that Lead to Sleep Impairment Physical or emotional pain Loss of familiar surroundings Loss of routine Fear of the unknown Noise level Loss of privacy

40-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Alteration in Sleep Patterns  Insomnia Chronic inability to sleep or inadequate quality of sleep Due to sleep prematurely ended or interrupted by periods of wakefulness May be a manifestation of many illnesses

40-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Alteration in Sleep Patterns  Insomnia Psychophysiological Idiopathic Sleep-State Misinterpretation

40-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Alteration in Sleep Patterns  Hypersomnia is an alteration in sleep pattern characterized by excessive sleep, especially in the daytime.  Narcolepsy manifests as sudden uncontrollable urges to fall asleep during the daytime.

40-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Alteration in Sleep Patterns  Sleep Apnea and Snoring Periods of sleep during which airflow stops for 10 seconds or more Occurs because the tissue of the soft palate closes off the airway resulting in the person not breathing. Ends with a loud snore as the brain sends the message to breathe more forcefully.

40-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Alteration in Sleep Patterns  Sleep Apnea and Snoring Short term consequences Persons at risk for sleep apnea Continuous Positive Airway Pressure (CPAP)

40-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Alteration in Sleep Patterns  Sleep Deprivation Prolonged, inadequate quality and quantity of sleep, either of the REM or the NREM type

40-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Alteration in Sleep Patterns  Parasomnias Alterations in sleep that result from activation of physiological systems at inappropriate times during the sleep-wake cycle

40-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assessment  Assess to determine sleep routines, sleep alterations, types of disturbances, and impact of sleep problems.  A spouse or partner may add valuable information to client’s report.

40-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  Disturbed Sleep Pattern

40-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Outcome Identification and Planning  Planning should focus on the true cause related to the sleep disturbance or alteration.  Effective outcome identification and planning consider that many sleep disturbances will require extended periods of time to correct.

40-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Create a relaxing environment.  Calm the mind.  Ensure appropriate nutrition.  Promote daytime activity and exercise.  Manage stress.  Initiate pharmacologic interventions.  Promote sleep in the hospitalized client.

40-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation

40-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Complementary Modalities  Acupressure, Acupuncture  Aromatherapy  Guided Imagery  Herbs  Therapeutic Touch  Massage  Meditation

40-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evaluation  Plan of care must be individualized for and negotiated with the client.  Assure that clients understand that there is help for sleep problems and that they are not alone in having difficulty with managing their sleep patterns.