chapter 34 Rest and sleep Flashcards
describe physiology of sleep
Reticular Activating System (RAS)-facilitates reflex and voluntary movements related to state of alertness.
Wakefulness: RAS activated with stimuli from the cerebral cortex and periphery sensory organs and cells (pain, pressure, noise).
what are the neurotransmitters involved in the sleep process?
Excitation: norepinephrine, acetylcholine, dopamine, serotonin, histamine.
Inhibition: Gamma-aminobutyric acid (GABA)
Circadian Rhythms: 24 hour cycles that involve an individual’s sleep-wake cycle.
fluctuations in a person’s HR, BP, body temperature, mood, hormones, metabolism, and performance depends on?
circadian rhythms
What are the two stages of sleep?
Non-rapid eye movement (NREM)
Rapid eye movement (REM)
what are the different stages of NREM?
stage I
stage II
stage III
stage IV
describe the characteristics of NREM sleep stage I
falling to sleep, light sleep, arouse with relative ease
transitional stage between wakefulness and sleep
relaxed but still somewhat aware of the surroundings
involuntary muscle jerking may occur and waken the person
what are the characteristics of NREM sleep stage II
the “baseline” of sleep, 90 minute cycle
aroused with relative ease
What are some characteristics of NREM sleep stage III
depth of sleep increases; deep-sleep (delta sleep) or slow wave sleep
arousal starts to be more difficult
what are the characteristics of NREM sleep stage IV?
The arousal threshold (intensity of stimulus required to awaken) is greatest (delta sleep)
arousal is difficult
physiologic changes in the body:
slow brain waves, decrease HR, BP, RR, low body temperature, muscles are relaxed, slow metabolism
wakefulness occurs when —is activated with stimuli from the cerebral cortex and peripheral sensory organs
Reticular activating system (RAS)
The arousal threshold is usually greatest in which of the following stages of NREM sleep?
Stage IV
describe the phenomenon, termed REM rebound.
when a person who is deprived of REM sleep for several nights spends more time in REM on successive nights.
what are some characteristics of REM Sleep?
Eyes dart back and forth quickly
small muscle twitching
large muscle immobility (resembles paralysis)
irregular RR, rapid or irregular HR, increase or fluctuates BP, increase gastric secretions, increase metabolism, increase body temperature
enters and reenters NREM stage 2 sleep
arousal is difficult
reports of dreaming
Which of the body systems dominates during NREM sleep?
Parasympathetic Nervous system
what is “sleep architecture” ?
alternating between REM and NREM
what happens during a normal sleep cycle
passes consecutively through the 4 stages of NREM sleep
pattern is then reversed, return from 4 to 3 to 2
enter REM sleep
Than reenters NREM sleep stage 2 to 3 to 4
if awakened from sleep at any time, start at NREM stage I
4-5 cycles each night
each cycle lasts about 90-100 minutes
identify factors affecting sleep
developmental considerations motivation culture lifestyle and habits environmental factors psychological stress illness medications
what is the average hours of sleep adequate for the older adults?
5 to 7 hours
what are some patterns of sleep of the older adults
need more time to fall asleep
awake earlier and more frequently during the night (REM shorten)
less able to cope with changes in usual sleep patterns
nap during the day
illnesses, psychological factors, drug therapy
stage IV sleep is absent or considerable decreased.
environmental factors
describe nursing implications that address older adults sleep cycle
A comprehensive assessment and individualized interventions
emphasize concern for a safe environment (restful environment)
use sedatives with extreme caution
encourage patient in this group to discuss sleep concerns with physicians
promote bedtime rituals (eg. reading, listening to radio, watching TV, praying)
offer bedtime appropriate snacks and beverages (carbohydrates: toast, crackers, glass of fruit juice)
promoting relaxation( backrub, warm bath, washing face)
promoting comfort (eg. caring presence and touch, back massage, extra blanket, administering an analgesic)
respect normal sleep-wake patterns
scheduling nursing care to avoid unnecessary disturbances
identify appropriate interview questions for sleep assessment
use open-ended questions
The nature of the problem, its cause, SxS
when it began and how often it occurs
how it affects everyday living
how the patient is coping with the problem and the success of any Tx attempted
identify the appropriate use for sleep diary and what should be included in one.
a sleep diary provides more specific data on sleep-wakefulness patterns over a long period
kept for 14 days
it includes a graph of # of hours per day, time, stressors, food, medications, physical activities, mental activities, environmental factors
worries or anxieties
what are the more common sleep disorders?
Dyssomnias: insomnia or excessive sleepiness
Parasomnias: patterns of waking behavior that appear during sleep
Name some common Dyssomnias
Insomnia, Hypersomnia, Narcolepsy,sleep apnea,Obstructive sleep apnea (OSA), Central sleep apnea, Restless leg syndrome, sleep deprivation
Insomnia
difficult falling asleep, intermittent sleep, or early awakening from sleep
hypersomnia
excessive sleep, particularly during the day
Narcolepsy
uncontrollable desire to sleep. Literally sleep standing up. Dangerous if driving, swimming, welding.
sleep apnea
The absence of breathing (apnea) or diminished breathing efforts (hypopnea) during sleep between snoring intervals.
Obstructive sleep apnea (OSA)
blockage of the airway, when the soft tissue; hypopharynx in the rear of the throat collapses and closes during sleep or from other structural abnormalities such as enlarged tonsils and adenoids, a deviated nasal septum and thyroid enlargement. Narrowing of nasal passageways caused by allergic rhinitis or nasal polyps.
Central sleep apnea
The brain fails to signal the muscles to breathe
Restless leg syndrome (RLS)
neurological disorder, unpleasant sensations of the legs and an urge to move them for relief.
sleep deprivation
A decrease in amount, consistency or quality of sleep.
Patterns of waking behavior that appear during sleep
parasomnias
name some common parasomnias
somnambulism (sleepwalking)
bruxmis (grinding of teeth during sleep)
enuresis( urinating during sleep)
nursing interventions (concerns) for parasomnias
promote safety and prevent injury
sleep-related eating disorder
patient eats but does not remember eating in the morning. weight gain, injuries, sleep disruption.
involves marked muscle contractions that result in the jerking of one or both legs during sleep. contributes to insomnia. lasts about 28 seconds on average, may arouse the sleeper
nocturnal myoclonus
what are some physiological effects of sleep deprivation
decrease growth hormone level
increase corticosteroid level
decrease leptin level
increase grehlin level
impaired glucose lowering effects of insulin despite normal insulin level
alter insulin secreting by pancreas
may affect body’s ability to metabolize glucose which can lead to early-stage Diabetes Type 2
decrease thyroid stimulating hormone
memory loss, intellectual impairments, behavioral changes, depression, low self-esteem and emotional health
decrease growth hormone level
maturation and growth
increase corticosteroid level physiological effects of sleep deprivation
increase BP, weaken bones, decrease resistance to infection and wound healing, increase risk of kidney stones and diabetes, mental disturbances, irritability, slower reaction
Increase grehlin leve
hormone that stimulates appetite lead to significant weight changes
decrease TSH
potentially significant effects on growth, glucose and fat metabolism, immune function and cognition.
Nursing Assessment to promote rest and sleep
- sleep history to ascertain sleep pattern
- sleep diary (time, stressors, food, medications, physical activities, mental activities, environmental factors)
- physical assessment (energy level; fatigue, lethargy, facial and behavioral characteristics; glazing eyes, swelling of eyelids, yawning, rubbing eyes, slow speech, slumped posture)
- obesity, enlarged neck, deviated nasal septum
- nocturnal myoclonus
Nursing Dx for rest and sleep
Disturbed sleep pattern as the problem
- physical discomfort, pain
- Anxiety, stress, exercise just before sleep
- drug dependency and withdrawal
- symptoms of physical illness
- caffeine, nicotine, or alcohol intake after dinner
Nursing Dx: Disturbed sleep patterns as the Etiology
Anxiety
Activity intolerance
risk for injury r/t somnambulism, narcolepsy, sleep apnea
disturbed thought process r/t chronic insomnia, sleep deprivation
Teaching about Rest and sleep
Sleep-weight link hormones (leptin and ghrelin)
normal variations in sleep patterns and common measures to promote relaxation and sleep.
Nursing evaluation for effective rest and sleep
patient will..
- verbalizes feeling rested
- identifies factors that interfere/disrupt sleep
- knows techniques that promote sleep
- increases concentrations and function
- Eliminate behaviors related to sleep deprivation
is characterized by difficulty falling asleep, intermittent sleep, or early awakening from sleep
insomnia
is a condition characterized by excessive sleep, particularly during the day
Hypersonmnia
A condition characterized by an uncontrollable desire to sleep
narcolepsy
periods of no breathing between snoring intervals
sleep apnea
List three benefits of sleep
restores physical well-being
Relieves stress and anxiety
restores the ability to cope and to concentrate on ADLs
describe physical findings that either confirm that a patient is getting sufficient rest or validate the existence of a sleep disturbance.
energy level
facial characteristics
behavioral characteristics
data suggestive off potential sleep problems
list three measures a nurse can take to help alleviate a patient’s sleep problem
prepare a restful environment
offer appropriate bedtime snacks and beverages
promote comfort and relaxation
