REST AND SLEEP Flashcards
Rest
A state of mental, physical and spiritual activity that leaves a person feeling refreshed.
Ex. reading, being activate in a way that leaves you aware of the environment and feeling refreshed
Sleep
Rest that is accompanied by altered consciousness and relative inactivity
Restorative process both emotionally and physically. A sense of well being
Naps are beneficial 20-90 mins
hypothalamus
Circadian Rhythm (sleep wake cycles)
hormones, fluctuations in vital, cognitive function, sensitive to changes in our environment (like/dark, warm/cool)
Temp will drop through vasodilation during the night.
Brainstem
important for waking up. Reticular Activating System (RAS) & the Bulbar Synchronizing Region
neurotransmitters
inhibit of the CNS
hormones
Melatonin: released when the eyes see change in light. Dark so its time to sleep
Non-REM
~75% of sleep time
Parasympathetic Nervous System is in control
Divided into four stages
- Stage I & II are light sleep
- Stage III & IV are deep sleep/delta sleep/slow wave sleep
REM
Remaining 25% of sleep
Fluctuation or increase in vital signs
Increase in cerebral
blood flood and oxygen
consumption
Relaxation of skeletal muscles
REM rebound
when you don’t get enough sleep and you finally get a good night’s rest, you spend more time in REM to catch up.
Stage 1 of sleep
Transitional state between wakefulness and sleep. Muscle relaxation, HR slows
Lasts only minutes. May feel like you were never sleeping and just “closing your eyes”
Hypnic Jerk: stage 1
feels like you are falling, or head falls and you jump. Transition from awake to sleep. If we fall asleep too quickly, our brain will startle us to make sure we are okay.
stage 2
Asleep, but a light stage if sleep, easily awakened
Makes up about half of all sleep time
stage 3: slow wave/ delta
Deeper sleep, more difficult to awaken
Increased relaxation → snoring
Stage 4
Deepest stage, brain activity slows (slow wave sleep)
Realistic dreams
EOG
ocular exam.
EEG
brain exam
EMG
muscular exam
Infancy
Newborns sleep approximately 16 hours/24 hours
“Sleeps through the night” between 2-4 months of age
REM constitutes much of the sleep cycle of infants
ABCs of safe sleep
Alone, on their back, in
a crib
Toddlers/ preschoolers
11-14 hours/24 hours
Transition from crib to bed
Establish bedtime routine: helps slow body down and get ready for bed
School-age children
9-12 hours/24 hours
Increased need for sleep related to growth spurts
Adolescents
8-10 hours/24 hours recommended, but rarely achieved
Make poor decisions related to sleep.
Adults
7-9 hours/24 hours
Decrease in Non-REM Stage IV sleep starts in middle age and is absent by older adulthood. Increased time to fall asleep and stay asleep as we age
Insomnia
Adequate time to sleep but can’t sleep. Experience daytime sleepiness and other impairments
most common sleep
disorder. women> men
insomnia acute/chronic
Occur longer than 1 month. 50% of people over 65 experience chronic illness that lasts more than a month.
Tx of insomnia
Non-Pharmacologic first: Cognitive Behavioral Therapy (CBT)
Helps with maladaptive sleep. It helps relax body
Sleep restriction, no naps. Getting out of bed at the same time every day is the best way to improve insomnia
Pharmacologic: z- drugs
OSA (obstructive sleep apnea)
Frequent (100s) mini-arousals during sleep, decreased SWS (slow wave sleep) and REM 10 second-2 minute apneic episodes
Sx of apnea
Sx: Excessive sleepiness, fatigue, depressed mood, difficulty concentrating, poor memory
tx of apnea
CPAP. 46-83% do not use it!
Surgery
Weight loss
Position changes
risks of apnea
Strongly linked to CV disease (HTN, ischemic heart disease, CVA) and to cognitive impairments (attention deficit, impaired concentration, memory problems)
Judicious use of sedatives (hypnotics, ETOH)
hyper-somnolence: hypersomnia
Excessive (daytime) sleep
Naps do not relieve symptoms**
Awaken disoriented, irritated, slowed thoughts and speech
hyper-somnolence: narcolepsy
Excessive daytime sleepiness and frequent overwhelming urges to sleep
Most also experience cataplexy (involuntary loss of skeletal muscle tone)
sx: Hallucinations and sleep paralysis
shift work disorder
working different shifts every week
Tx. of circadian rhythm sleep-wake disorders: shift work
CBT (avoiding naps, maintaining regular sleep-wake times, avoiding stimulants within several hours of bedtime)
Shifting the sleep-wake cycle by an hour or 2 over several weeks is ideal
Parasomnias
REM behavior disorder (RBD): acting out dreams
Sleep terrors: occur in deepest sleep stage
Somnambulism
sleep walking
Bruxism
teeth grinding
enuresis
bed wetting
sleep-related eating disorder
consumes food but has no recollection
Priority is the safety of the pt.
restless leg syndrome: aka Willis-Ekbom disease (WED)
Mostly middle aged and older adults
Cannot lie still
Unpleasant, creeping,
crawling, or tingling
sensation
No known cure
Massage, walking, stretching seems to help
Leads to chronic sleep loss
Assessment/ screening tools
STOP-Bang Questionnaire: further assess the risk for sleep apnea
The Pittsburgh Sleep Quality Index: measures quality of sleep pt gets
The Epworth Sleepiness Scale: measures the sleepiness of the pt.
Interventions: environment
60-67 degrees (fans?)
Dark (or night-light)
Clean linen/Blankets
Privacy
Sleep masks & ear plugs
interventions: bedtime rituals
HS care → warm bath/shower/face cloth
Bedtime stories
Prayer
Blankie/Bear
interventions: snacks
Tryptophan and Complex Carbohydrates
(milk and cookies, peanut butter crackers)
Interventions: nursing care
Cluster care
Provide care when patient is already awake
Manage alarms→ iv pumps going off
Medications to sleep
Use non-pharmacologic first
Usually PRN
Be knowledgeable about onset and duration when considering administration time
