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REST AND SLEEP Rest is a state of mental and physical relaxation and calmness. body activities continue.. Sleep is a state of altered consciousness (non-voluntary) during which a person has minimal physical activity, changes in level of consciousness, and a slowing of physiologic processes. Rest Lying Down Reading a book Taking a walk Playing a board game TV cooking Sleep Cyclical Restorative Decreased motor activity PHYSIOLOGY OF SLEEP The stages of sleep are identified by EEG patterns, eye movements, and muscle activity. Sleep phases are classified as nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. Note: if sleep cycle is broken a new cycle starts with non-rem THE SLEEP CYCLE The sequence of sleep begins with the four stages of NREM sleep,followed by the first REM sleep. The duration of a sleep cycle is usually 60 to 90 minutes. Sleeper generally goes through 4–6 cycles during sleep period of 7–8 hours. BIOLOGICAL CLOCK An internal mechanism in a living organism capable of measuring time. It controls the daily variations in hundreds of physiologic processes. FACTORS AFFECTING REST AND SLEEP Physical comfort Psychological factors Environment Lifestyle stressors Diet Medications and other substances Age/aging Things That Affect Sleep Positive – – – – Comfort Workout Tryptophan drugs Negative – – – – – – – – Pain Hospital Cola, caffeine Heavy meal/hungry Drugs Illness Pregnancy Age SLEEP PATTERN ALTERATIONS Insomnia Hypersomnia Narcolepsy Sleep apnea/snoring Sleep deprivation Parasomnias Restless leg syndrome Periodic limb movement disorder Nocturnal sleeprelated eating disorder INSOMNIA Difficulty falling asleep or staying asleep. Causes include stress, depression, medical problems, caffeine, alcohol, pain, poor sleep habits, smoking, or changes in sleep patterns related to travel or shift work. Treatment is best focused on modifying the factors or behaviors causing it. Involves family solutions. NX Dx sleep deprivation M/B irritability and confusion. HYPERSOMNIA Characterized by excessive sleep, especially in the day time. Causes can be physical or psychological. Treat to address the underlying cause. NARCOLEPSY Sudden, irresistible urge to fall asleep during the daytime. Can occur during conversation or while driving. Lasts few seconds or 30 minutes or more. No cure; scheduled, daytime naps help. SLEEP APNEA/SNORING Sleep apnea is a period, during sleep, of not breathing following a period of loud snoring, which may cause excessive daytime sleepiness and can increase the risk of heart attack or stroke. SLEEP APNEA/SNORING (continued) Treatment includes: Nasal continuous positive airway pressure device (CPAP), . Dental appliances that reposition the tongue. Surgery. SLEEP DEPRIVATION Term used for prolonged inadequate quality and quantity of sleep. Can result from age, hospitalization, drug and substance use, illness, and frequent changes in lifestyle patterns. Most effective intervention is to treat or minimize factors causing deprivation. PARASOMNIA Disorders that intrude on sleep in very active ways. Somnambulism (sleepwalking), sleeptalking, sleep terrors, REM movement disorder, bed wetting, bruxism (teeth grinding) are most common. Treatment varies. RESTLESS LEG SYNDROME Tingling or crawling in muscles; twitching, burning, prickling, or deep aching in the foot, calf or upper leg when at rest. Only relieved by walking, standing, or moving or rubbing the legs. Symptoms may be relieved by opiates, benzodiazepines, or L-dopa. PERIODIC LIMB MOVEMENTS IN SLEEP Repetitive leg movements every 20 to 40 seconds throughout the night. Multiple sleep interruptions occur, leading to daytime sleepiness and night-time insomnia NOCTURNAL SLEEP-RELATED EATING DISORDER (NSRED) Rapid and chaotic eating when partially or fully awake with variable recall of the episode. Clients gain weight with only moderate daytime eating, are not hungry in the morning, and are chronically tired. NURSING PROCESS–ASSESSMENT Nature of sleep Quality of sleep Sleep environment Associated factors Opinion of sleep NURSING DIAGNOSIS Disturbed sleep pattern Sleep deprivation Activity intolerance/related to lack of sleep as evidenced by verbal complaint, extreme fatigue, disorientation, confusion, and lack of energy PLANNING/OUTCOME IDENTIFICATION Client input should be incorporated into the plan and goals. Must focus on the true cause of the sleep alteration or disturbance. IMPLEMENTATION A trusting nurse-client relationship Relaxing environment Relaxation techniques Nutritional considerations Pharmacological interventions Client education Questions