Comfort, Rest, and Sleep:
Stages of Sleep:
* NREM-Non-REM sleep
* Stage I- very light sleep (drowsy-relaxed)
* Stage II- body process continue to slow
* Stage III-heart and respiratory rate are slower
* Stage VI-signals deep sleep
* REM-Rapid eye Movement
Sleep Cycles
* NREM (pass the four stages in 1hr)
* Sleeper passes from Stage I NREM through stages II and II to Stage IV in about 20-30 min.
* Stages are followed by Stage III and II, in that order.
Functions of Sleep
* Restores normal levels of activity
* Sympathetic Nervous System (while awake)
* Parasympathetic nervous system increases.
* Regular sleep pattern more important than actual hours slept.
Normal Sleep Patterns and Requirements
* Newborns- sleep 16 to 18 hours a day, usually seven sleep periods.
* Infants- sleep 22 hours a day,20-30% REM sleep.
* Toddlers- 10-12 hours a day, 20-30% REM sleep.
* Preschoolers- 11-12 hours of sleep per night
* School Aged children- 8-12 hours at night.
* Adolescents- 8-10 hours of sleep
* Young adults- 7-8 hours may require less
* Middle Aged Adults- 6-8 hours per night
* Older Adults- 6 hours
Factors Affecting Sleep
* Age- One of the most important factors affecting persons sleep and rest periods.
* Illness- causing pain or physical distress can result in sleep problems.
* Environment-Noise level
* Fatigue- more tired shorter the first (REM) sleep
* Lifestyle-Shift work
* Emotional Stress
* Alcohol and Stimulants
* Diet
* Smoking
* Motivation
* Medications
Common Sleep Disorders
* Primary Sleep disorders- those in which the person’s sleep problem is the main disorder.
* Secondary Sleep disorder- sleep disturbance caused by another clinical disorder, such as thyroid dysfunction, depression , or alcoholism.
Primary Sleep Disorders
* Insomnia- most common sleep disorder, inability to obtain an adequate amount or quality of sleep.
* Hypersomnia- Opposite of insomnia, excessive sleep, especially daytime.
* Narcolepsy- Sudden wave of overwhelming sleepiness that occurs during the day. Referred to as “sleep attack”.
* Sleep Apnea- periodic cessation of breathing during sleep.
* Parasomnias- Behavior that may interfere with sleep. (somnambulism (sleep walking), sleep talking, Nocturnal enuresis, nocturnal erections, bruxism).
* Sleep Deprivation- prolonged disturbance results in decreases amount, quality, consistency of sleep.
Assessment of Sleep
* Assessment relative to a client’s sleep includes a sleep history, sleep diary, a physical examination, and a review of diagnostic studies.
Sleep History
* Usual sleeping pattern, specifically sleeping and waking times, hours of undisturbed sleep, etc.
* Bedtime rituals
* Use of sleep medications
* Sleep environment
* Changes in sleep pattern
Sleep Diary
* Written record to be much more precise
* Total number of sleep hours a day
* Activities performed 2-3 hours before sleep
* Bedtime rituals
* Any worries that may affect client’s sleep
* Factors that client believes to be positive or negative towards sleep
Physical Examination
* Observation of clients facial appearance, behavior, and energy level.
* Darkened areas around the eyes, puffy eyelids, reddened conjunctiva, glazed or dull appearing eyes.
* Irritability, yawning, slumped posture, hand tremor, rubbing of eyes, confusion, fatigued, lethargic, etc.
Planning
* Major goal for clients with sleep disturbances is to maintain a sleeping pattern that provides sufficient energy for daily activities.
* Interventions include- guided imagery, therapeutic message, progressive muscle relaxation, uninterrupted sleep periods.
Implementation
* Nursing interventions to enhance the quantity and quality of sleep involve largely non-pharmacologic measures.
* Client teaching
* Individuals need to learn the importance of rest and sleep in maintaining active and productive lifestyles.
* Supporting bedtime rituals
* Many are accustomed to rituals or pre-sleep routines and if altered can affect sleep.
* Creating Restful Environment
* Promoting Comfort and Relaxation
* Assist client with hygienic routines
* Offer back message
* Administer analgesics 30 min before sleep
* Enhancing Sleep with Medications
* Nurse responsible for making decisions with the client about when to administer sedative hypnotics.
Reducing Environmental Distractions in Hospitals
* Close window curtains if street lights shine through
* Close curtains between client in semiprivate and larger rooms
* Reduce or eliminate overhead lighting: provide night light at the bedside or in the bathroom
* Close the door of the clients room
* Perform only essential noisy activities during sleeping hours
* Ensure that all carts wheels are well oiled
* Wear rubber soled shoes
* Keep required staff conversations at low levels: conduct nursing reports or other discussions in a separate area away from clients rooms