1. REST, COMFORT, SLEEP NUR 102 Module H Dianne Watts

2. REST When people are at rest, they usually feel mentally relaxed, free from anxiety, and physically calm Rest does not imply inactivity

3. SLEEP Sleep is a recurrent, altered state of consciousness that occurs for sustained periods Sleep is a cyclical physiological process –Circadian rhythm –Biological clocks

4. Sleep Regulation Sleep involves a sequence of physiological states maintained by the CNS RAS ( reticular activating system) = wakefulness & BSR (bulbar synchronizing region) = sleep

5. STAGES OF SLEEP NREM sleep = nonrapid eye movement - involves 4 stages REM sleep = rapid eye movement

6. Stage 1: NREM Lightest level of sleep Lasts a few minutes Easily aroused by sensory stimuli Waken, person feels as though daydreaming has occurred

7. Stage 2: NREM Period of sound sleep Relaxation progresses Arousal is still relatively easy Stage lasts 10-20 minutes Body functions, vital signs & metabolism, slow

8. Stage 3: NREM Involves initial stages of deep sleep Sleeper is difficult to arouse and rarely moves Muscles are completely relaxed Lasts 15-30 minutes

9. Stage 4: NREM Very difficult to arouse sleeper Deepest stage of sleep If sleep loss has occurred, sleeper will spend considerable portion of night in this stage Vital signs are significantly lower than during waking hours Lasts approximately 15-30 minutes Sleepwalking and enuresis may occur

10. REM SLEEP Vivid, full-color dreaming may occur in REM. Usually begins about 90 minutes after sleep has begun Typified by autonomic response of rapidly moving eyes, fluctuating heart and resp rates, increased BP Loss of skeletal muscle tone occurs Gastric secretions increase Very difficult to arouse Duration of REM sleep increased with each cycle and averages 20 minutes

11. Functions/Purpose of Sleep Restoration –Psychological –Physiological Biological Cognitive Conservation of energy

12. FACTORS THAT AFFECT SLEEP Physical illness Drugs and substances Lifestyle Emotional stress Environment Exercise and fatigue Food and caloric intake

13. SLEEP DISORDERS INSOMNIA SLEEP APNEA NARCOLEPSY SLEEP DEPRIVATION PARASOMNIAS

14. INSOMNIA Chronic difficulty falling asleep Frequent awakenings from sleep Short sleep or nonrestorative sleep

15. SLEEP APNEA Disorder in which the individual cannot breath and sleep at the same time Lack of airflow through the nose and mouth for periods from 10 seconds to 1-2 minutes, there can be 10 or 15 to more than 100 respiratory events per hour of sleep Three types: central, obstructive, and mixed

16. CENTRAL SLEEP APNEA Caused by cessation of diaphragmatic and intercostal respiratory effort as a result of dysfunction of the brains respiratory control center Impulse to breath fails, temporarily Least common form

17. OBSTRUCTIVE APNEA Most common form Characterized by cessation of airflow despite the effort to breath Occurs when muscles or structures of the oral cavity or throat relax during sleep Usually have loud snoring

18. NARCOLEPSY A CNS dysfunction of mechanisms that regulate the sleep and wake states Falls asleep uncontrollably at inappropriate times Treated with stimulants

19. SLEEP DEPRIVATION S/S: blurred vision, fine motor clumsiness, decreased reflexes, slowed response time, decreased reasoning and judgment, cardiac arrhythmias Psychological S/S: confusion, disorientation, increased sensitivity to pain, irritable, withdrawn, agitation, decreased motivation

20. PARASOMNIAS Sleep problems that are more common in children, one common exception is bruxism (tooth grinding) SIDS Somnambulism(sleepwalking) Nightmares Nocturnal enuresis (bedwetting)

21. ASSESSMENT Normal sleep pattern, restful? sufficient? Self- reported Sleep log Bedtime routines Bedtime environment Client expectations

22. Pain Physical sensation Involves physical, emotional and cognitive components Stimulus

23. Physiology of Pain Transduction Transmission Perception Modulation

24. Types of Pain Acute Chronic Idiopatic Inferred –nociceptive –neuropatic

25. Pain Assessment Scales Nonverbal pain indicators Behavioral indicators

26. Pain Management Pharmacological interventions Non-pharmacological interventions Barriers Cultural considerations Reassessment

27. Environmental factors affecting common and sleep Comfortable room temperature Proper ventilation Minimal noise Comfortable bed Proper lighting

28. Promoting Bedtime Routines Help client to relax in preparation for sleep Avoid mental stimulation before bedtime Relaxation exercises Guided imagery Good sleep hygiene

29. Sleep Hygiene Avoid sleeping long hours during weekend or holiday Bedroom should not be used for intensive studying, snacking, TV watching, or other nonsleep activity Avoid worrisome thinking when going to bed Avoid heavy meals for 3 hours before bedtime

30. Promoting comfort Encourage client to wear loose-fitting nightwear Instruct family on ways to position client and support dependent body parts to aid in muscle relaxation Have client void before going to bed Back massage Keep bed linens dry

31. Activity If client is at home, encourage physical activity during daytime Avoid rigorous exercise at least several hours before bedtime

32. Control of noise in hospital Close doors to clients room Keep doors to work areas closed Reduce volume of nearby telephones and paging equipment Avoid abrupt loud noises Keep necessary conversations at low levels