NURS 171: Week 12: Sleep and Rest Flashcards
Rest
- inactive with mild to no activity
- relaxation; stress-free
- leads to feeling refreshed
ex: reading, listening to music, surfing the internet, praying or meditating, gardening, playing golf
Sleep
- cyclical states/ altered consciousness
- decreased motor activity/ perception
- selective response to external stimuli
- metabolism decreases
ex: unaware of environment and responds selectively to external stimuli (alarm clock, bright light)
Why Do We Need Sleep?
-essential for physical, mental, and spiritual well being
-sleep, rest, and illness are interrelated
-increases mental performance
>improves learning
>helps the storage of long-term memory
-restores energy
-improves ability to cope
-strengthens immune system
How Much Sleep Do We Need?
- older adults: need less (5-7 hrs) plus naps
- newborns: 16-20
- adolescents: 8-9
- young adults: 7-8
Circadian Rhythm
- internal clock affected by light
- 24-hour-day-night sleep/wake pattern
- affects overall level of functioning
- people who work evening and night can suffer significant sleep deprivation until body adjusts to shift
- changing time zones and hospitalization can lead to disrupted sleep wake cycles
How is Sleep Regulated?
-reticular activating system (nerve pathways affecting consciousness)
-stages of sleep
-cycles average of 90 to 120 minutes
>NREM (restful place)
>REM (brain highly active)
What Factors Affect Sleep?
- total amount of sleep
- how well the person slept
- whether the needed amounts of NREM and REM were achieved
- sleep amounts and sleep patterns vary
- seep quality has both subjective and objective components
Factors Affecting Sleep In Older Adults
- nocturia
- side effects of medications
- discomfort or pain
- partners sleep habits (snoring, restlessness)
Factors Affecting Sleep In Young Adults
- studying all night
- driven to succeed
- late work nights
- stress
- parents of young children with sleep disturbances
Factors Affecting Sleep
- Lifestyle Factors
- Illness
- Environmental Factors
Factors Affecting Sleep: Lifestyle Factors
-Physical Activity: exercise more than 2 hours before bedtime
-Food: can promote or interfere with sleep
>saturated fat, L tryptophan, carbohydrates
-Alcohol: go to sleep easier but disrupts REM sleep
-Medications: promotes or interrupts sleep
-Nicotine + Caffeine: stimulants
Saturated Fat Vs Effects on Sleep
interferes with sleep
L. tryptophan vs Sleep
(milk + cheese)
-may induce sleep
Carbohydrates Vs Sleep
seem to promote relaxation
Factors Affecting Sleep: Illness
- increases need for sleep + rest
- associated with mental + physical distress that disturb sleep
Factors Affecting Sleep: Environmental Factors
promote or inhibit sleep
- temperature + humidity
- noise + light
- odors or allergies
- comfort of bedding
Common Sleep Disorders
-Insomnia
-Circadian Disorders
-Restless Leg Syndrome
Dyssomnias:
>hypersomnia
>sleep apnea
Parasomnias:
>sleepwalking, sleep-talking, bruxism, night terrors, REM sleep behavior disturbances, Enuresis (bedwetting)
Insomnia
inability to fall or remain asleep or go back to sleep
Insomnia Treatment
a combination of behavioral and pharmacological therapy may be effective
-some sleep aids are habit forming
Circadian Disorders
abnormality in sleep/wake times
e.g. jet lag, working night shift, rotating shifts
S + S of Circadian Disorders
- decreased ability to perform psycho-motor tasks
- short sleep episodes person is not aware of (dozing off)
Treatment of Circadian Disorders
need several days to adjust sleep wake schedule
Restless Leg Syndrome
disorder of the CNS with overwhelming urge to move the legs while resting or before sleep onset
S + S of Restless Leg Syndrome
-unpleasant creeping, crawling, itching, or tingling sensation in the legs
Treatment for Restless Leg Syndrome
- relieved only by moving the legs
- may include neuroleptic agents and medication used to treat parkinsons disease
- avoid caffeine + other stimulants
- walking
- massage
- stretching
- heat or cold compresses
- medication vibration
- acupressure
Dyssomnias
trouble falling or staying asleep
- hypersomnia
- sleep apnea
Dyssomnia: Hypersomnia
excessive sleeping (especially during daytime)
- sleep-related or disease-related
- can be related to depression
- can be related to sleep apnea or narcolepsy or disorders of CNS, kidney, liver or metabolic disorders (diabetic acidosis and hypothyroidism)
Dyssomnia: Sleep Apnea
- snoring is the biggest sign of obstructive sleep apnea
- soft tissue of pharynx and soft palate collapse + obstruct airway for at least 10 seconds during sleep cycles
- oxygen level in blood drops and carbon dioxide level rises causing person to wake up
- complain of fatigue and morning headache
- diagnosed with sleep study
Narcolepsy
genetic defect of the CNS in which REM sleep can not be controlled
- chronic disorder caused by the brains ineffectiveness in regulating sleep-wake cycles normally
- sudden, uncontrollable episodes of sleep during the day
S + S of Narcolepsy
- sleepiness
- slurred speech
- slackening of facial muscles
- feeling of impending weakness of knees
- paralysis + hallucinations
- performance is impaired
- awaken feeling refreshed
- do not tolerate irregular sleep-wake patterns such as shift work
Treatment for Narcolepsy
-CNS stimulants such as methylphenidate (Ritalin)
Parasomnias
common sleep disorders that happen during sleep
- sleepwalking
- sleep-talking
- bruxism
- night terrors
- REM sleep behavior disturbances
- Enuresis (bedwetting)
Parasomnia: Sleepwalking
- In NREM sleep 1 to 2 hours after person falls asleep
- if dangerous, given medication to suppress the deepest stage III NREM sleep
- can be triggered by stress, fatigue, and some drugs
Parasomnia: Sleep-talking
in NREM sleep just before REM
Parasomnia: Bruxism
grinding and clenching of the teeth in NREM sleep
-can erode tooth enamel and loosen the teeth
Parasomnia: Night Terrors
sudden arousal (usually children) with activity, hallucinations, and expression of terror with no memory of event
Parasomnias: REM Sleep Behavior Disturbances
violently acts out dream
Parasomnias: Enuresis
(bedwetting)
- most during NREM sleep early in night
- most outgrow, patients
Disorders that are Provoked by Sleep
- Coronary Artery Disease
- Asthma
- COPD
- Diabetes
- Gastric + Intestinal Ulcers
- Peptic Ulcers
Disorder Provoked by Sleep: Coronary Artery Disease
- during REM sleep
- dreams may increase heart rate, and provoke angina and ECG changes
Disorder Provoked by Sleep: Asthma
- may experience bronchospasm during REM sleep
- asthma attacks at night as esophageal sphincter relaxes and reflux results
Disorder Provoked by Sleep: COPD
-experience lower oxygen tension and increased carbon dioxide retention during sleep, especially during REM sleep
Disorder Provoked by Sleep: Diabetes
blood glucose levels vary during the night
Disorder Provoked by Sleep: Gastric and Intestinal Ulcers
during REM sleep people with duodenal ulcers secrete up to 20 times more gastric acid
Disorders Provoked by Sleep: Peptic Ulcers
also contributes to increased acid producing nocturnal epigastric pain and sleep loss
Planning Interventions/ Implementation
- cluster/schedule nursing care to avoid interrupting sleep
- create a comfortable/ restful environment
- promote comfort/ relaxation
- support bedtime rituals/ routine
- offer foods that promote sleep
- teach about sleep hygiene
- administer/ complete client teaching about sleep-inducing medications
- “iCare”
- “quiet heals” (Nsg Units have certain quiet times of the day)
Prescription Medications
- Nonbenzodiazepines
- Benzodiazepines
- Barbiturates
Nonbenzodiazepines
- sedative/ hypnotic
- short half life, eliminated from the body quickly and do not cause “hangover” (daytime sleepiness)
- Ambien, Sonata, Lunesta
Benzodiazepines
- sedative/ hypnotic
- both long-acting and short-acting drugs
- long-acting medications linger in the body and potentially cause daytime drowsiness
- Valium, Xanax, Ativan
Barbiturates
- sedative/ hypnotic
- anticonvulsants
- rarely prescribed for insomnia because of risk of addiction, abuse and overdose
- Nembutal, Seconal
Non Prescription OTC Sleep Medications
sleep medications usually contain an antihistamine, which may induce drowsiness that lasts into the next day
- Benadryl, any “pm” meds
- Melatonin, Herbal sleep aids
