Sleep

Question 1

Why do we need sleep

Answer 1

Think RESTORATION

Question 2

What are the purposes/benefits of sleep?

Answer 2

1. Physiologic/metabolic
   - Protein synthesis and cell division increases (growth and repair of tissues)
   - Strengthened immune system
   - Cardiopulmonary function
   During NREM sleep, a person HR can fall to 60bpm
   Decreased respirations and BP allow the heart to rest
2. Cognitive/memory and learning
   - REM sleep is necessary for brain tissue restoration
   - Assists with memory storage and learning
3. Psychological
   - Stress, anxiety, pain response lessened
   - Relaxed muscle tone - allows musculoskeletal system to rest

Question 3

What happens without sleep?

Answer 3

• Glucose metabolism changes; insulin resistance increases and glucose intolerance
• The hormones regulating appetite change, encouraging obesity (increased appetite)
• Sensitivity to pain worsens
• Impaired/compromised tissue repair

Question 4

How much sleep do we need?

Answer 4

• Different age groups have their own sleep patterns so there really is NO definitive amount of sleep that is best for everyone
• Infants 12-16 hrs/day (including naps)
• Toddlers 11-14 hrs/day (including naps)
• Preschoolers 10-13 hrs/day (including naps)
• School aged (6-12 yo) 9-12 hrs/day
• Teenagers 8-10 hrs/day
• Young and middle adults 7+ hrs/day
• Older adults
  Wake more often at night
  Harder to return to sleep (due to discomfort and chronic illness)
  Napping increases

Question 5

What are some common causes of poor sleep?

Answer 5

• Age related - adolescents, middle adult, older adults
• Lifestyle
• Illness/disease
• Environmental

Question 6

Risks due to poor sleep

Answer 6

• Cardiac
• Asthma
• Chronic lung disease (COPD)
• Diabetes
• GI Ulcers

Question 7

What are clinical manifestations of inadequate sleep?

Answer 7

• Excessive daytime sleepiness or EDS(extremeley drowsy during the day
• Malaise
• Difficulty performing tasks
• Difficulty concentrating, problem solving, and decision making
• Decreases reasoning and judgement
• Confused and disoriented (can progress to agitation, hyperactivity, and paranoia especially as sleep deprivation continues)
• Paranoia
• Poor balance and coordination
• Decreased reflexes
• Slowed response time (ex: braking for a red light; responding to a patient emergency) –> for anything that demands us to act quickly
• Ptosis (eyelid drooping) and blurred vision
• Withdrawn and apathetic to agitated and hyperactive (behavior)
• Increased sensitivity to pain
• Irritable, depressed, and anxious…about sleeping!

Question 8

Nursing Interventions - Sleep Hygiene

Answer 8

1. Establish a routine
   - go to bed when sleepy
   - advise patient to get out of bed and do a quiet activity if they do not fall asleep within 30 minutes until they feel sleepy enough to go back to bed (this prevents the danger of the bed becoming a stressful place)
   - caution patients against sleeping long hours during weekends or holidays to prevent disturbance of normal sleep-wake cycle
2. Environment
   - Temperature - cool
   - Air moving - maintain some ventilation - maybe a fan running
   - Lighting - not too much
   - Noise - minimize it
   - Associated bed and the bedroom with sleep, not thinking, working, or studying; avoid using this space for intensive studying, snacking, television watching, or similar non sleep activities
   - Don’t spend time looking at bright light (computer screen, technology) before trying to sleep
3. Exercise
   - Exercise daily preferably in the morning or afternoon and ry to avoid vigorous exercise in the evening within 2 hours of bedtime
4. PM Care
   - Manage, progressive relaxation, and/or restful music of the patient’s choice
5. Bedtime snacks/nutrition
   Encourage:
   - L-tryptophan - a natural protein found in foods such as milk, cheese, and meats
   - Carbohydrates make tryptophan more available to the brain, which is why carbohydrate heavy meals can make you drowsy
   - Proteins are the building blocks of tryptophan, which is why THE BEST BEDTIME SNACK IS ONE THAT CONTAINS CARBOHYDRATES AND PROTEIN such as cereal with milk, peanut butter on toast, or cheese and crackers
   - Warm milk or decaf/herbal teas (chamomile tea)

Discourage:
- Caffeine
- Alcohol - limit it to 1 or 2 a day (alcohol is a diuretic)
- Chocolate contains xanthins which may keep people awake, but contains l-tryptophan which may help sleep –> effects people differently
- LARGE meals - avoid eating heavy meals 3 hours before bedtime; a light snack may help

Question 9

Nursing interventions that can be considered for patients in healthcare facilities:

Answer 9

• Provide PM care - fresh linens, wash face, provide oral care at bedtime
• Administer sleep medications when client is ready to sleep rather than later when they may have just fallen asleep
• Maintain the client’s home sleep routine if possible; alter nursing routine to avoid waking the patient if possible
• Take client through progressive relaxation exercises
• Provide pillows for body alignment during sleep
• Give patient a back massage

Question 10

Sleep Aids

Question 11

What are some common sleep disorders?