Sleep & Rest Flashcards
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A decreased state of activity, with the consequent feeling of being refreshed
Rest
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Is a state of rest accompanied by altered consciousness and relative inactivity
Restores the normal levels of brain activity and brain balance in the CNS
Sleep
Poor quality or insufficient length of sleep for even one night can reduce mental performance, and long periods of sleep deprivation can result in stress-related illnesses and injuries
How much sleep do we need? Varies upon person
Young and middle adults: 7-8 hours
Older adults: 7-9 hours
Sleep affects learning, memory, body weight, the ability to fight infection, and mental wellbeing
Helps the brain rest while improving retention of information
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Is a biorhythm (i.e. biological clock)
Based on day/night pattern in a 24 hour cycle
Regulated by cells in the ___ that respond to changing levels of light
Circadian rhythms
hypothalamus
What Affects Circadian Rhythms?
Shift work (out of sink with Circadian rhythm)
Changing time zones (disruption of normal sleep-wake cycle)
Hospitalization (can cause sleep deprivation)
Fatigue and Sleep Deprivation Amongst Shift Workers
Lapses in attention and memory
Poor concentration
Irritability
Reduced motivation, apathy, indifference
Diminished reaction time
Impaired judgment and decision-making
Altered communication (miscommunication as a common issue)
More errors, needlestick and sharps-related injuries, and adverse events to clients
One of the biggest factors that affects sleep regulation is the amount of ___ filtered through the eyes
light
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Stage of sleep in which the brain is highly active
Where most spontaneous awakenings occur; when dreams occur
The entire sleep cycle repeats 4-6 times/night; it skips stage I when it does repeat
REM sleep
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Is the restful phase of sleep
Physiologic function slows down and cortisol is at its lowest
Muscles relax, body temperature lowers, heart rate, respirations, and BP all decrease
Supports memory consolidation
NREM sleep
Each cycle of sleep lasts about 90-100 minutes
REM rebound - occurs when the body spends extra time in REM sleep
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Relates to the total amount of sleep, how well the person slept, and whether the person obtained the needed amounts of NREM and REM sleep
Sleep quality
What affects our quality of sleep?
Age
* Students
* Parents of young children
* Older adults - due to medication side effects, underlying illness, depression, discomfort, nocturia, pain, declining melatonin levels
What affects our quality of sleep?
Lifestyle
* Physical activity
* Diet - amino acids and complex carbohydrates can help promote sleep
* Nicotine/caffeine - blocks adenosine, an amino acid that induces sleep; converts into serotonin
* Alcohol - disrupts REM sleep; can lead to nocturia as is a diuretic
* Medications
> Opioids can suppress REM sleep cycles, leading to frequent awakening
> Zolpidem tartrate (Ambien) - can promote normal REM sleep cycles
> Beta blockers can cause sleep disorders as well as nightmares
What affects our quality of sleep?
Illness
- Symptoms
- Specific conditions - allergies, hyperthyroidism, Parkinson’s disease
- Anxiety - increase gastric secretions and intestinal motility, HR, respirations
- Depression
What affects our quality of sleep?
Environmental factors
- Noise
- Light
- Temperature
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Are patterns of waking behavior that appear during sleep
Parasomnias
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Involve having insomnia or excessive sleepiness
Dyssomnias
Dyssomnias
Insomnia
Circadian disorders
Restless Leg Syndrome
Sleep deprivation
Hypersomnia
Sleep apnea
Narcolepsy
Parasomnias
Sleepwalking
Sleeptalking
Bruxism
Night terrors
REM sleep behavior disorders
Nocturnal enuresis
Sleep Provoked Disorders
Coronary artery disease (dreams cause an increase in heart rate and provoke angina [chest pain] and EKG changes)
Asthma (bronchospasms)
Chronic obstructive pulmonary disease (lowered O2 tension and increased CO2 retention)
Sleep Provoked Disorders cont’d
Diabetes (blood glucose levels vary)
Gastric and intestinal ulcers
Epilepsy (sleep deprivation triggers seizures; increase seizure intensity, causes seizures to last longer)
Applying the Nursing Process
Assessment
Assess usual sleep patterns and rituals for all clients being admitted to the hospital OR seeking help for a sleep problem
Assessment should include:
* Usual sleeping pattern
* Usual sleep environment
* Bedtime routines/rituals
* Sleep aids
* Sleep changes or problems
Assessment cont’d
* Sleep history
* Sleep log (is more specific than a sleep history; identify trends)
* Social history (alcohol/drug/caffeine use)
* Actigraph
* Sleep study
Diagnosis
Problem
Insomnia
Sleep deprivation
Disturbed sleep patterns
Diagnosis
Etiology
- Risk for injury r/t sleepwalking
- Fatigue r/t chronic insufficient quality of sleep
Outcomes
- Falls asleep within 30 minutes
- Sleeps six hours without awakening
- Demonstrates self-care behaviors that provide a healthy balance between rest and activity
- Verbalizes feeling less fatigued
* Ensure SMART outcome goals
Nursing Interventions
Schedule nursing care to avoid interrupting sleep
Create a restful environment
Promote comfort
Support bedtime routines and rituals
Offer appropriate bedtime snacks and beverages
Promote relaxation
Maintain client safety
Teach about sleep hygiene
Administer and teach about sleep medications
Prescription Sleep Medications
Nonbenzodiazepines (Zolpidem tartrate [Ambien])
Benzodiazepines*
Selective Melatonin Antagonists
Barbiturates*
Tricyclic Antidepressants
* Can appear on a drug screen
! Are not recommended for long term use !
Nonbenzodiazepines
- Target specific receptors that are thought to be associated with sleep, rather than depressing the entire CNS
- Are short-acting
- No associated grogginess or next-day hangover effects
- Can cause drowsiness, dizziness, fatigue, headache, unpleasant taste
- Is an increased risk of fatal overdose (by taking too much than what is prescribed)
Non-Prescription Sleep Aids
Antihistamines
* Diphenhydramine (Benadryl)
* Have grogginess; impair memory over time
Melatonin
* Supplements can interfere with anticoagulants, birth control pills, anti-diabetic medications and others
Non-Prescription Sleep Aids cont’d
Herbal remedies
- Have not undergone any extensive, formal testing for their benefits or safety
* Chamomile
* Valerian root
* Hops
* Lavender
* Passionflower
Teaching Your Client About Sleep Hygiene
* Use your bedroom only for sleep
* If you do not fall asleep within 30 minutes, get up and do something
* Nap the right amount at the right time
* Follow a regular sleep and wake routine
* Use relaxation methods
* Warm bath before going to sleep
* Avoid cold medications with stimulant ingredients (pseudoephedrine)
Teaching Your Client About Sleep Hygiene cont’d
* Go to bed at the same time each night
* Utilize aromatherapy
* Utilize pilows as support for best sleep positions
* Keep your bedroom dark, cool, and as quiet as possible
* Exercise at the right time
* Use a sleep tracker
* Avoid over-hydrating
* Avoid caffeine, alcohol, tobacco, heavy meals before bed
