rest and sleep

Question 1

tell me a bit about sleep

Answer 1

it is a basic necessity of life and is as important as air, food, water.

Individuals are sleeping less, chronic sleep loss may have adverse outcomes for health and well-being.

Insufficient sleep alters mood and decreases the
ability to concentrate, make decisions, and participate in daily activities.

Question 2

explain physiology of sleep

Answer 2

*A cyclical physiological and behavioral process that alternates with longer periods of wakefulness

Question 3

the physiology of sleep is controlled by three distinct processes, what are they?

Answer 3

1) Ultradian process: non–rapid eye movement (NREM) and rapid eye movement (REM)

2) Homeostatic process (process S): sleep–wake cycle

3) Circadian process (process C): maintaining wakefulness

Question 4

explain circadian rhythms

Answer 4

• 24-hour circadian rhythm
• Factors include light, temperature, social activities, and work routines
• Biological clock
  *Synchronizes sleep–wake cycles (e.g., bedtime)
  *Affects individual’s optimal time of day

Question 5

do hospital routines interrupt sleep?

Answer 5

yes

Question 6

name the stages of sleep

Answer 6

• awake
• rem sleep
• nrem sleep

Question 7

explain sleep regulation

Answer 7

Sleep is regulated by a sequence of physiological states integrated by central
nervous system activity (e.g., hypothalamus, anterior pituitary)

Question 8

what does reticular activation system (RAS) affect

Answer 8

wakefulness and sleep–wake
transitions.

Question 9

what does bulbar synchronizing region cause

Answer 9

sleep

Question 10

name some benefits of sleep

Answer 10

Sleep is restorative => necessary for health
* During sleep (NREM), biological functions slow down = e.g. HR, RR, BP, muscle tone, urine production, hormone secretion => all
decrease

• Preserves cardiac function
• our heart rate (HR) slows down→ beating 10-26 times fewer each minute
• There is evidence that sleep improves immune function and ability to
  fight disease
• Cell and tissue repair
• Brain filters stored information
  about the day’s activities
• Without sleep, we become irritable, anxious and stressed

Question 11

draw the stages of sleep

Question 12

name the stages of sleep

Answer 12

Stage 1: Non–rapid eye movement = lightest level of sleep (2–5% of adult sleep time)
* Stage 2: Non–rapid eye movement = sound sleep (45–55% of adult sleep time)
* Stage 3: Non–rapid eye movement = deepest sleep (10% of adult sleep time)
*Rapid eye movement sleep= dreams (25% of adult sleep time)

Question 13

explain sleep cycle

Answer 13

Presleep period (10–30 min)

• Four to five complete cycles (stages 1, 2, 3 NREM and REM) each lasting 90–120 minutes/cycle in a night

Question 14

true or false Newborns and children spend more time in stage 3 NREM sleep

Answer 14

true

Question 15

when do dreams occur

Answer 15

while we sleep

Question 16

explain dreams

Answer 16

• A mental activity that occurs while individuals are asleep
• Occurs mostly during REM sleep but can also occur in NREM sleep
• Important for learning, memory, and adaptation to stress

Question 17

explain the sleep requirements through the lifespan

Answer 17

Newborns (neonates)
* sleep cycle is strongly determined by hunger
* sleep ~16 hours per day

• Infants (3-12 months old) to Toddler (1-3 years old)
• cycle follows the day-night schedule more closely
• sleep ~ 10-12 hours per day with several daytime naps (12-14
  hours total) need for naps decrease with age.
• Pre School aged child (3-5years old)= ~13 hours of sleep per day, with need for naps decreasing
• School aged child (5-12 years old) = require ~ 9-10 hours of sleep per night
• Adolescents (12 and up)=> varies (shorter during the school week) “sleep debt”
• Young adults= most adults average 6-8.5 hours per night
• Middle aged to Older adults =changes in sleep patterns occur-decline in total number of hours

Question 18

explain sleep requirements in the older adult

Answer 18

Approximately 50% of older adults report
difficulty with sleep
* Increased frequency of spontaneous awaking
* Increased frequency of daytime napping

• The elderly may be in bed longer but sleep
  less
• Women are often affected due to hormonal
  changes (menopause)

Question 19

name some sleep disorders

Answer 19

*Insomnias
*Circadian rhythm sleep disorders
* Sleep related breathing disorders
*Excessive sleepiness
* Parasomnias
* Sleep related movement disorders

Question 20

name some factors affecting sleep (physical illness)

Answer 20

*Illness, disease, and other physical disorders can affect sleep
* Pain
* Anxiety and depression
* Respiratory disease
* Cardiovascular disease
* Musculoskeletal (pain)
* Nocturia

Question 21

name factors affecting sleep

Answer 21

*Drugs and substances
* Hypnotics, diuretics, antidepressants, alcohol, caffeine, narcotics,
-blockers, benzodiazepines, anticonvulsants, anti-parkinsonians

*Lifestyle
* Work schedule (shift work), social activities, routines

*Usual sleep pattern
* May be disrupted by social activity or work schedule, travel (e.g., jetlag)

*Emotional stress
* Worries, physical health, death, losses

*Environment
* Noise, routines

*Exercise and fatigue
* Restful sleep enabled by moderate exercise and fatigue

• Food and caloric intake
• Time of day, caffeine, nicotine, alcohol, spicy foods

Question 22

explain nursing assessment

Answer 22

1)The client is usually the best source of information

2) sleep history= quantity and quality of daily rest and sleep

3)Usual sleep pattern
* Description of sleeping problems
* Signs of sleep deprivation

Question 23

questions u could ask them

Answer 23

• Ask the client about the number of hours of sleep per night
• Number of daily rest periods throughout the day
• Ask the client about the quality of sleep per night; hours of
  continuous sleep
• Has there been a recent change in sleep habit?
  daily rest and sleep
  *Does the client experience restlessness during the night?
  *Number of arousals during the night?
  *What time does the client wake up?
  *Does the client experience sleepiness during the day?
  *Number of naps during the day and for how long?
  *Refer to sleep log

Question 24

questions for sleeping problems

Answer 24

Do you have difficulty falling asleep?
* When did you first notice have problems sleeping?
* Do you snore or have you been told you snore?
* Do you feel excessively tired or sleepy during the day?

Question 25

signs of sleep deprivation

Answer 25

Irritability
* Inability to concentrate
* Forgetfulness
* Confusion
* Frequent yawning
* Increased sensitivity to pain
* Agitation

Question 26

name factors that can affect sleep

Answer 26

*Lifestyle and current life events
*Bedtime routines
*Environment e.g. temperature, the hospital
environment
*Physical stress; e.g. illness, pain
*Developmental stages; e.g. rest and sleep
requirements change with age
*Psychological condition; anxiety

Question 27

promoting good sleep hygiene

Answer 27

*Daily exercise
*Try to keep routines similar on weekdays and weekends
*Avoid snacking, studying , TV watching in bedroom area
*If you cannot fall asleep in 30 minutes get up and do a quiet activity
*Limit consumption of caffeine and ETOH
*Is environment noisy or too bright
*Avoid eating heavy meals prior to bedtime (up to 3hours before
bedtime)

Question 28

nursing interventions

Answer 28

• Environmental Controls (most difficult in the hospital environment)-we often do not control the room temp in a pts room
• Promoting bedtime routines
• Promoting safety
• Promoting comfort
• Establishing periods of rest and sleep
• Stress reduction
• Heavy bedtime snacks to be avoided, but it is ok to have a light
  snack
• Pharmacological approaches- sleep aids

Question 29

interventions for the HOSPITALIZED client

Answer 29

Control the environment
* volume control on pumps and monitors- keep low
* noise level at the nursing station-be aware
* limiting visitors during rest periods
* group nursing tasks => avoid non essential tasks
during rest periods

Promote comfort:
* positioning the client to promote comfort; maximize use of pillows
* extra blanket
* void before sleep
* back rub

Promote safety:
*safety re: falls
*careful monitoring of clients under the use of
anesthetics and opioids=> these medications
put clients at risk for sleep apnea and airway
obstruction

Pharmacological approaches to aid sleep:
*appropriate use of hypnotics, sedatives, and
benzodiazepines => for selective situations

Pharmacological approaches for pain