Chapter 40Rest and Sleep

Physiology of SleepPhysiology 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 SleepStages 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 CycleSleep 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 SleepFactors Affecting Sleep

• Developmental considerations

• Psychological stress

• Motivation

• Culture

• Lifestyle and habits

• Physical activity and exercise

Factors Affecting Sleep (continued)Factors Affecting Sleep (continued)

• Dietary habits

• Environmental factors

• Illness

• Medications

Illnesses Associated With Sleep DisturbancesIllnesses Associated With Sleep Disturbances

• Peptic ulcers

• Coronary artery diseases

• Epilepsy

• Liver failure and encephalitis

• Hypothyroidism

Classification of Sleep DisordersClassification of Sleep Disorders

• Dyssomnias

• Parasomnias

• Sleep disorders associated with medical or psychiatric disorders

• Other proposed disorders

Sleep DisordersSleep Disorders

• Dyssomnias — characterized by insomnia or excessive sleepiness

• Parasomnias — patterns of waking behavior that appear during sleep

DyssomniasDyssomnias

• Insomnia

• Hypersomnia

• Narcolepsy

• Sleep apnea

• Restless leg syndrome

• Sleep deprivation

ParasomniasParasomnias

• Somnambulism

• Sleep talking

• Nocturnal erections

• Bruxism

• Enuresis

• Sleep-related eating disorder

Treatment for dyssomniasTreatment for dyssomnias

• Pharmologic therapy

– Sedatives and hypnotics

• Nonpharmacologic therapy

– Stimulus control

– Sleep restriction

– Sleep hygiene

– Cognitive therapy

– Multicomponent therapy

– Relaxation therapy

Nursing InterviewNursing 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 ParametersSleep 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 DiaryInformation 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)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 AssessmentKey Findings of Physical Assessment

• Energy level

• Facial characteristics

• Behavioral characteristics

• Physical data suggestive of sleep problems

Sleep Characteristics to AssessSleep Characteristics to Assess

• Restlessness

• Sleep postures

• Sleep activities

• Snoring

• Leg jerking

Common Etiologies for Nursing DiagnosesCommon 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 SleepNursing 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