1. Chapter 18 Comfort, Rest, and Sleep

2. Comfort, Rest, and Sleep
Comfort : ) state is which a person is relieved of distress ) that facilitates rest and sleep
Rest : (waking state characterized by reduced activity and mental stimulation)
Sleep:(state of arousable unconsciousness)
Safe, clean, and attractive environment contributes to comfort.
Environment : refers to room where the client receives nursing care and its furnishing
LIGHTING—adequate lighting, both natural and artificial is important to the comfort of clients and nursing personnel.

3. The Client Environment
Environment: client’s room & furnishings
Client rooms
Wall: relaxing color schemes, wallpapers
Floor: carpeted or linoleum (جلدي) surface
Lighting: adequate lighting, both natural and artificial is important to the comfort of clients and nursing personnel.
Climate control:
Temperature :most clients are comfortable if temp is 20-23˚C
Humidity: Amount of moisture in the air (30-60% comfortable).
Ventilation: Movement of air
WALLS---blue and colors with tints such as mauve and light green promote relaxation.
FLOORS---noise interferes with comfort—most agencies, the hallways and work stations are carpeted.
LIGHTING—adequate lighting, both natural and artificial is important to the comfort of clients and nursing personnel.
CLIMATE CONTROL—most clients are comfortable if temp is degrees F.
VENTILATION—poor ventilation leads to smells. Can open windows at home, not here.

4. The Client Environment (cont’d)
Room furnishings
Bed
Mattress
Pillows
Linen
Privacy curtain
Overbed table
Bedside stand
Chairs
Mattress overlays—layers foam or other devices placed on top of the mattress. Used to promote comfort and keep the skin intact.
PRIVACY CURTAIN—to be drawn completely around the clients bed (HIPAA)
PILLOW CASES—open end of pillow away from door. Germs can get into case if turned the other way..

5. Sleep and Rest Functions of sleep Reduces fatigue Stabilizes mood
Improves blood flow to brain
Enhances various physiologic processes (Increasing protein synthesis.)
Improves immune system
Promotes emotional well-being
Improves capacity for learning and memory storage

6. Sleep and Rest (cont’d)
Sleep phases
Non rapid eye movement (NREM)
Quiet sleep (نوم خفيف)
Precedes REM
Rapid eye movement (REM)
Active or deepest stage of sleep (نوم عميق)
Most dreams occur
SLEEP DIVIDED INTO 2 PHASES—
PHASE 1—nonrapid eye movement (NREM)—progress through 4 stages-also called slow wave sleep. The electroencephalographic (EEG) waves appear as progressively slower oscillations. CHARATERIZED BY QUIET SLEEP.
PHASE 2 rapid eye movement (REM)—Also called PARADOXICAL SLEEP—the brain waves appear similar to those produced during periods of wakefulness—DEEPEST STAGE OF SLEEP—CHARACTERIZED BY ACTIVE SLEEP. This is where we dream the most.

7. Sleep and Rest (cont’d)
Effect of chronic sleep deprivation
Altered comfort.
Impaired coordination.
Loss of muscle mass and weight.
Increased susceptibility to infection.
Slower wound healing.
Decreased pain tolerance.
Poor circulation.
Unstable moods.
Impaired judgment.
SLEEP DIVIDED INTO 2 PHASES—
PHASE 1—nonrapid eye movement (NREM)—progress through 4 stages-also called slow wave sleep. The electroencephalographic (EEG) waves appear as progressively slower oscillations. CHARATERIZED BY QUIET SLEEP.
PHASE 2 rapid eye movement (REM)—Also called PARADOXICAL SLEEP—the brain waves appear similar to those produced during periods of wakefulness—DEEPEST STAGE OF SLEEP—CHARACTERIZED BY ACTIVE SLEEP. This is where we dream the most.

8. Sleep and Rest (cont’d)
Sleep cycles
Alternate through NREM and REM phases
4-6 times / night
Sleep requirements
Vary among different age groups
Decreases from birth to adulthood (table 18-2)
SLEEP DIVIDED INTO 2 PHASES—
PHASE 1—nonrapid eye movement (NREM)—progress through 4 stages-also called slow wave sleep. The electroencephalographic (EEG) waves appear as progressively slower oscillations. CHARATERIZED BY QUIET SLEEP.
PHASE 2 rapid eye movement (REM)—Also called PARADOXICAL SLEEP—the brain waves appear similar to those produced during periods of wakefulness—DEEPEST STAGE OF SLEEP—CHARACTERIZED BY ACTIVE SLEEP. This is where we dream the most.
We alternate between NREM and REM sleep.
NREM precedes REM sleep.

9. Factors affecting sleep P 380+81
Old age
Light
Activity
Environment
Motivation
Emotions and moods
Food and beverages
Illness
Drugs
Sedatives and tranquilizers
Hypnotics
stimulants
CIRCADIAN RHYTHM—sleep/wake cycle—a phenomena that cycle on a 24 hr basis
ACTIVITY—especially exercise increases fatigue and the need for sleep. Activity appears to increase both REM and NREM sleep.
ENVIRONMENT—we are use to our own bed and pillow and surroundings at home. Vacations are examples.
SLEEP RITUALS—habitual activities performed before retiring. These induce sleep. Examples: eating a snack, watch TV, reading and performing hygiene.

10. Sleep Disorders
INSOMNIA: difficulty falling asleep, awakening frequently during the night or awakening early.
HYPERSOMINA: characterized by feeling sleepy despite getting normal sleep.
SLEEP APNEA: cessation of breathing.
HYPOPNEA: hypoventilation
PARASOMNIA: conditions associated with activities that cause arousal or partial arousal (P 385, Column II).
INSOMNIA—difficulty falling asleep, awakening frequently during the night or awakening early.
HYPERSOMINA—CHARACTERIZED BY FEELING SLEEPY DESPITE GETTING NORMAL SLEEP.
NARCOLEPSY—CHARACTERIZED BY SUDDEN ONSET IF DAY-TIME SLEEP , SHORT NREM PERIOD BEFORE REM PHASE.
HYPERSOMNOLENCE—EXCESSIVE SLEEPING FOR LONG PERIODS OF TIME.
SLEEP APNEA—CESSATION OF BREATHING—OBESE CLIENT WHO SNORE-CPAP-BIPAP-SURGERY
HYPOPNEA--HYPOVENTILATION

11. Nursing Implications Sleep-promoting nursing measures
Maintaining sleep rituals
Reducing intake of stimulating chemicals
Promoting daytime exercise
Adhering to regular schedule for retiring and waking
Progressive relaxation
Back massage