Sleep and Rest

Sleep and Rest George Ann Daniels, MS, RN Sleep Stages • • • • Stage 1 Transition Stage 2 Light Sleep Stage 3 & 4 Slow wave Stage 5 REM sleep REM Sleep • • • • • • • REM-Rapid eye movement Vital signs fluctuate 02 consumption increases Thermoregulations lost Vaginal secretion increase Erections Dreams-vivid Sleep Rhythm • 90 minute cycles during which people pass through the sleep stages Characteristics of normal sleep and rest • Awareness of the need for sleep • Sleepiness • Urge to go to sleep • Fatigue • State of weariness • Restoration and Protection • Conserves energy • Synthesis of cells (anabolism) Normal sleep and rest patterns • Short sleepers • 6 hours or less • Efficient, hardworking • One to two awakenings per noc normal for young adults • Should awake well rested, refreshed, and energized • Cultural habits • Circadian Rhythms • Long sleepers • 9 hours or more • Creative • Sleep latency period • Change of position • 20-40 time/ night Lifespan • Newborns/infants • Quiet sleep and active sleep • 3 waking states • Quiet awake, active awake, and crying • Newborns sleep 16-17 hours per day • Divided into seven sleep periods between the day and night • Infants have a shorter sleep cycle ( 50-60 minutes) • Adaptive task for the infant • Establish sleep-wake patterns compatible with the environment • Most infants sleep through the night be 3 months • Total sleep times continue to drop as the infant gets older • Toddler/Preschooler • 1 year naps once or twice per day • Total sleep time drops to 13-14 hours at age 2 • 12 hours by age 5 • Child • Sleep needs are in relationship to growth spurts and activity patterns • Adolescents • Require more sleep than before puberty • Growth and hormone • Adults • Vary • Middle adults • Increase in nocturnal awakenings • Sleep satisfaction decreases • Older adults • Stage 4 sleep decreases • Difficulty remaining asleep • Shorter nocturnal period with increase in daytime naps • Total time in bed increases • Napping, longer sleep latency, increased number and length of awakenings, and general fatigue • Educate elderly about normal sleep pattern changes Factors Affecting Sleep and Rest • Need • Morning people/evening people • Environment • New environment • Sleep room doubles with work area • Objects of play may interrupt a child sleep • Reduction of environmental stimuli • Light , noise, and temperature • Relationships • Parenting, bereaved,homesick, critical care units. • Shift Work • Nutrition and Metabolism • Hunger or difficulty sleeping after a large meal, ingestion of certain foods decrease sleep latency and increase stage 4 sleep. • Elimination Patterns • Need to void • Limit fluids=decrease nocturnal stimulation • Exercise and Thermoregulation • Physically fit people have decreased sleep latency • Warmth increases slow-wave sleep • Lifestyle and habits • Bedtime rituals • Lifestyle patterns • Up at 5 and asleep by 8 • Illness • Acute or chronic • Loss of stage 3 sleep • Pain, dyspnea, hormone changes (hyperthyroidism), skin conditions, anxiety from illness • Medications and Chemicals • Hypnotics, alcohol, caffeine • Mood states Alterations in sleep • Insomnia • Perceived difficulty in sleeping • Months to years • 3 types • Onset insomnia • Maintenance insomnia • Early-awakening insomnia • Narcolepsy • Disorder of excessive daytime sleepiness characterized by short, sleep attacks • Last 10 –15 minutes • Onset usually in adolescents • Sleep apnea • Recurrent periods of absence of breathing for 10 seconds or longer, occurring at least 5 times per hour • Obstructive sleep apnea • Central apnea • Mixed apnea • Periodic limb movement • Repetitive dorsiflexion of the foot and flexion of the knee • Once every 15-20 seconds • Restless legs syndrome • Crawling, itching sensations in the legs at rest • Circadian rhythm disruptions • Jet lag • Parasomnias • Normal activities in the day that is abnormal during sleep • Sleepwalking, talking, bed wetting Impact on ADL’s • • • • • • Decreased energy Impaired coping and cognitive responses Role performance Social interactions Irritability Impaired concentration • Subjective • • • • • • • • Assessment How many hours of sleep do you usually get? What time do you usually go to bed? What time do you usually get up? What helps you sleep? How do feel when you wake up? How much sleep do you believe you need? What helps you relax? What are your sleep rituals? • • • • • How often do you take naps or rest periods? Do you take anything to help you sleep? Assess caffeine, nicotine, and alcohol intake. Assess work hours Identify dysfunctions • Sleep apnea, snoring, stress • Objective Data • Circles under eyes, yawning, nodding, slow responses, irritability, impaired concentration, word-finding difficulties, VS • Diagnostic test • Sleep studies, 02 levels NDX • Sleep pattern Disturbance R/T • Internal sensory alterations • Illness, stress • External sensory alterations • Light, noise, social stimulation, strange environment EO • Client will report fewer problems falling asleep. • Client will have an increase sleep time to 6 hours per night. • Client will report feeling more rested. Interventions • • • • • Environment modifications Privacy and security Sleep rituals Managing individual sleep needs Medication