rest and sleep Flashcards
tell me a bit about sleep
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.
explain physiology of sleep
*A cyclical physiological and behavioral process that alternates with longer periods of wakefulness
the physiology of sleep is controlled by three distinct processes, what are they?
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
explain circadian rhythms
- 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
do hospital routines interrupt sleep?
yes
name the stages of sleep
- awake
- rem sleep
- nrem sleep
explain sleep regulation
Sleep is regulated by a sequence of physiological states integrated by central
nervous system activity (e.g., hypothalamus, anterior pituitary)
what does reticular activation system (RAS) affect
wakefulness and sleep–wake
transitions.
what does bulbar synchronizing region cause
sleep
name some benefits of sleep
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
draw the stages of sleep
name the stages of sleep
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)
explain sleep cycle
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
true or false Newborns and children spend more time in stage 3 NREM sleep
true
when do dreams occur
while we sleep
explain dreams
- 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
explain the sleep requirements through the lifespan
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
explain sleep requirements in the older adult
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)
name some sleep disorders
*Insomnias
*Circadian rhythm sleep disorders
* Sleep related breathing disorders
*Excessive sleepiness
* Parasomnias
* Sleep related movement disorders
name some factors affecting sleep (physical illness)
*Illness, disease, and other physical disorders can affect sleep
* Pain
* Anxiety and depression
* Respiratory disease
* Cardiovascular disease
* Musculoskeletal (pain)
* Nocturia
name factors affecting sleep
*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
explain nursing assessment
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
questions u could ask them
- 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
questions for sleeping problems
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?
signs of sleep deprivation
Irritability
* Inability to concentrate
* Forgetfulness
* Confusion
* Frequent yawning
* Increased sensitivity to pain
* Agitation
name factors that can affect sleep
*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
promoting good sleep hygiene
*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)
nursing interventions
- 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
interventions for the HOSPITALIZED client
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
