Sleep and Rest Flashcards
Compare and contrast sleep and rest. How are they different? Alike?
Sleep is a state of rest accompanied by altered consciousness and relative inactivity. Sleep
is characterized by reduced skeletal muscle activity. Blood pressure and pulse rate decrease, and skin vessels dilate. The metabolism falls
by 20% to 30%, so energy is conserved. At rest, the body is disturbed by all exterior noises, whereas in sleep, it is screened from them by altered consciousness. Rest is a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed. Although necessary and beneficial, rest without sleep is inadequate. Sleep restores the normal levels of normal brain activity
and “balance” in the central nervous system; rest alone cannot do this. Many organs that function during rest suspend their activities
in sleep.
Why is promoting sleep an important nursing intervention?
because it enhances wellness and speeds recovery from illness. Sleep and illness are interrelated. Prolonged lack of sleep can result in illness, and illness interferes with sleep. Sleep and rest are both essential to life and for keeping the body, mind, and spirit in excellent physiological shape. Rest and sleep restore energy, improve learning, and strengthen the immune system. Without the proper amount of sleep, the body ceases to function efficiently.
List the five stages of sleep.
Sleep includes the following stages of NREM and REM sleep:
• NREM (non–rapid eye movement, also called slow-wave sleep) is stages I, II, III, and IV
• REM (rapid eye movement) is stage V
What is the stage that must be “made up” if not enough time is spent in it?
REM (stage V) sleep must be made up.
What is the most common dyssomnia?
Insomnia is the most common dyssomnia.
What are the clinical signs of sleep deprivation?
• Daytime drowsiness • Difficulty performing daily tasks • Perceptual disorders • Impaired cognitive functioning, problem-solving, and decision making • Irritability • Slowed reaction time • Somatic (body) complaints • General feeling of malaise If sleep deprivation is severe and prolonged, delusions, paranoia, and other psychotic behaviors may occur.
Why are sleeping pills not recommended for chronic insomnia?
• They are habit forming.
• They become less effective with long-term use.They can have serious side effects.
However, sedative–hypnotic treatment is justified in short-term insomnia to avoid the known consequences of insomnia on mood and performance. Short-term, aggressive treatment may prevent the development of chronic insomnia
Why is snoring significant?
Snoring is a physical sign of obstructive sleep apnea. Snoring can also significantly reduce the quality of sleep for the bed partner.
Sleepwalking (somnambulism) occurs during
stages III and IV of NREM sleep, usually 1 to
2 hours after falling asleep.
Sleeptalking occurs during
NREM sleep, just before the REM stage. It does not usually interfere with the person’s rest. Speech is often nonsensical and garbled.
Bruxism,
grinding and clenching of the teeth,
Bruxism, grinding and clenching of the teeth, usually occurs during
stage II NREM sleep. It can eventually erode tooth enamel, loosen the teeth, and lead to misalignment.
Night terrors are sudden arousals in which the person (usually a child) is physically active and expresses fear or strong emotion. which occur during
REM, night terrors occur during stage IV (deep NREM) sleep.
Nocturnal enuresis (bedwetting) is nighttime incontinence. It has incorrectly been associated with dreaming; however, most incidents occur during
NREM sleep, during the first third of
the night when the child is difficult to rouse.
Describe ways in which depression can affect sleep.
- Difficulty falling asleep
- Less slow-wave (deep) sleep
- Less time in REM sleep
- Awaken early
- Less total sleep time
- Hypersomnia (excessive sleeping)
Sleep Pattern Disturbance
NANDA-I nursing diagnosis defining a time-limited interruption in sleep resulting from external factors, such as room temperature and humidity, noise, lighting, noxious odors, sleep partner, unfamiliar sleep surroundings or bed, interruptions, lack of privacy, and physical restraints.
Sleep Deprivation
is the NANDA-I nursing diag- nosis for a patient who has a decreased amount, consistency, or quality of sleep over prolonged periods of time
Readiness for Enhanced Sleep
NANDA-I diagnosis for a client who has no particular sleep problem but desires improved quality of sleep.
What is the classification of zolpidem tartrate? Why is it an especially desirable medication for sleep?
Zolpidem tartrate is classified as a sedative/hypnotic nonbarbiturate. It is an especially desirable medication for sleep because it is short acting and does not produce a hangover effect.
What are two other classes of medications that are sometimes prescribed for sleep?
Answers may include the following classes of medications (other than sedative/hypnotic, nonbarbiturate) prescribed for sleep:
• Benzodiazepines
• Tricyclic antidepressants • Barbiturates
what is rest?
decreased activity with a feeling of being refreshed
people rest by doing things they find calm and relaxing
what is sleep?
state of rest accompanied by an altered state of consciousness
its is complex and rhythmic with a cyclic nature
where is sleep controlled
the lower part of the brain
What are the functions of sleep
restores normal levels of activity
restores balance among parts of the nervous system
Facilities protein synthesis
restores psychological well-being (how we look, feel, and perform on a daily basis)
The nurse is preparing to teach a client about the important of rest and sleep. Which statement made by the client would indicate the need for further teaching?
A. The client verbalizes that circadian rhythms do indeed influence sleep
B. The client suggests that their Reticular Activating System is responsible for maintaining restfulness
C. The client verbalizes that they may be less likely to develop an infection if they sleep less than 5 hours per day
D. The client suggests they it may be easier to gain weight if they do not get enough regular sleep
C. The client verbalizes that they may be less likely to develop an infection if they sleep less than 5 hours per day
When adequate sleep is not maintained the bodies ability to maintain glucose is lessened therefore responds with insulin resistance. This leads to reduced energy expenditure, all of which can lead to obesity and type 2 diabetes
All of the other options suggests adequate information
Reticular Activating System route in the brain
Medula –> Pons –> Midbrain –> Hypothalamus
what does the Reticular Activating System do?
facilitates reflex and voluntary movement and cortical activity related to state of alertness
also relays impulses into the cerebral cortex and spinal cord
Wakefullness occurs when the ______ is activated
RAS (reticular activating system) by cerebral cortex and periphery organs/cells (pain or noise)
what is the Bulbar Synchronizing Region
plays a part in releasing neurotransmitters which either cause excitation or inhabitation
What does the pineal gland do for sleep/wake cycle
secretes melatonin which is a hormone that helps control your sleep/wake cycle
NREM (non-rapid eye movement) Stage 1
the Pre-sleep stage lasts only a few minutes 5% of total sleep times easily awakened from stage 1 drift in and out of sleep eyes move very slowly involuntary muscle jerking
NREM (non-rapid eye movement) Stage 2
person falls into a light sleep but can be aroused with relative ease
50-55% of total sleep
NREM (non-rapid eye movement) Stage 3
the depth of sleep continues and arousal becomes increasingly difficult
composes about 10% of sleep
NREM (non-rapid eye movement) Stage 4
person reaches greatest depth of sleep ( delta sleep)
arousal is very difficult - if awaken they dont adjust immediately and feel groggy and disoriented
Body changes in NREM (non-rapid eye movement) Stage 4
Pulse and respiration drops 20-30 %
B/P decreases
metabolism and body temp decreases
Characteristics of REM Sleep
eyes dart back and forth twitching of small muscles in the face immobile of large muscles respirations irregular pulse is rapid/irregular metabolism and body temp increases gastric secretions increase
The nurse is performing parent teaching to the parent of a client recently diagnoses with somnambulism. The nurse knows that teaching has occurred when the parent verbalizes the following: Select all that apply
A. A complete cycle is 90-100 minutes
B. It may be harder for my child to wake up when she is in stage 4 of sleep
C. Muscles in the face are likely to twitch during REM Sleep
D. If my child were to sleep walk, it will most likely occur during NREM sleep stage 3
All of the Above
Normal sleep patterns for newborns
sleep 16 or more hours/day usually in 4 hour increments
50/50 NREM and REM
normal sleep patterns for Infants
10-12 hours night 2-3 during the day
usually sleep through the night by 6 months
problems for infants when sleeping
used to parental assistance at bedtime and may signal their parents to help them return to sleep at night
putting infants to bed when drowsy - helps them to become self-soother
normal sleep patterns for Toddlers
12 hours per night decreasing to 8-10 as they reach preschool age
the need for midmorning naps gradually decrease
moving to crip to bed may be difficult
Normal sleep patterns for Preschoolers
9-16 - having a relaxing bedtime routine will promote a good sleep schedule and decrease nightmares
Normal sleep patterns for Elementary/ School-age
8-12 hours per night - may increase when physical growth peaks
less sleep because of homework, sports, activities
good time to teach the importance of a healthy sleeping habit
sleep patterns for adolescents
vary widely but average 9-10 hours
changes in circadian rhythm
sleep deprivation from staying up later (video games)
sleep patterns for older adults
may sleep 7-9 hours
considerably less or absent stage 4 NREM
What is Sundowning Syndrome
seen in older patients with Alzheimer’s disease
not asleep disorder directly to a pattern of symptoms that occurs late afternoon and can last through the night disrupting sleep
Environment factors for sleeping
familiar surroundings Noise Temperatures Ventilation Light levels Comfort and size of the bed a person partner
lifestyle factors affecting sleep
routines/schedules substances (alcohol, caffeine, medications) exercise/activities before bed shift at work stress TV viewing diet smoking motivation
medications that interpret sleep
Hyponicts Beta-blockers narcotics tranquilizers antidepressants
Medications that promote sleep
zaleplon (sonata)
Zolpidem (ambien)
Eszopiclone (lunesta)
What is insomnia
associated with sleep hygiene, stress, and or mental health issues
What is hypersomnia
sufficient sleep at night but cannot stay awake during the day
caused by a medical or psychological disorder
What is narcolepsy
excessive daytime sleepiness, sudden episodes of falling asleep, sleep paralysis sleep attacks hypotonia hallucinations nighttime wakefulness no cure
what is sleep apnea
lack of airflow through the nose and mouth
abnormal is considered when there are more than 5 apneic episodes or 5 breathing pauses longer than 10seconds per hour
what is polysomnography?
a test overnight while the patient is sleeping measuring multiple sleep-related signals EEG EMG ECG Respiration
what is parasomnia? and some examples
behavior that may interfere with or occur during sleep more common in children Examples: night or sleep terrors nightmares sleepwalking (somnambulism) nocturnal enuresis bruxism (teeth grinding)
what is night or sleep terror?
partial arousal from deep, non-dreaming sleep
what is a nightmare
frightening dreams followed by full arousal
what is dyssomnia
difficulty falling asleep, overstimulation, bedtime fears
what is nocturnal enuresis?
bedwetting
simple interventions for nocturnal enuresis
fluid restriction near bedtime scheduled wakening reward system bladder training enuresis training
what is restless leg syndrome?
condition in which the client cannot lay still - unpleasant creeping, crawling, or tingling sensation in the legs, making the legs move
what are the components of a sleep history?
age nature of the problem signs and symptoms severity onset and duration predisposing factors or stressors medications effect on client what has been done to help it
