Download Sleep

Chapter 33
Rest and Sleep
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physiology of Sleep
• Reticular activating system (RAS)
– Facilitates reflex and voluntary movements
– Controls cortical activities related to state of
alertness
• Bulbar synchronizing region
• Hypothalamus—control center for sleeping and waking
Copyright © 2015 Wolters Kluwer • All Rights Reserved
SCN
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Stages of Sleep
• Non-rapid eye movement (NREM)
– Consists of four stages
• Stages I and II: 5% to 50% of sleep, light sleep
• Stages III and IV—10% of sleep, deep-sleep
states (delta sleep)
• Rapid eye movement (REM)
– 20% to 25% of a person’s nightly sleep time
– Pulse, respiratory rate, blood pressure, metabolic
rate, and body temperature increase; skeletal muscle
tone and deep tendon reflexes are depressed.
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Question
In which stage of NREM sleep does the person fall into a
stage of sleep but can be aroused with relative ease?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Answer
Answer: B. Stage II
Rationale: In stage II of NREM sleep, the person falls into
a stage of sleep but can be aroused with ease. In stage I,
the person is in a transitional stage between wakefulness
and sleep.
In stages III and IV, the depth of sleep
increases, and arousal becomes increasing difficult.
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Sleep Cycle
• The person passes consecutively through four stages of
NREM sleep.
• The pattern is then reversed.
– Return from stage IV to III to II
– Enter REM sleep instead of re-entering stage I
• The person re-enters NREM sleep at stage II and moves
on to III and IV.
Copyright © 2015 Wolters Kluwer • All Rights Reserved
A Single Normal Sleep Cycle
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Factors Affecting Sleep
• Developmental considerations
• Motivation
• Culture
• Lifestyle and habits
• Environmental factors
• Psychological stress
• Illness
• Medications
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Question
Tell whether the following statement is true or false.
Barbiturates, amphetamines, and antidepressants
increase REM sleep.
A. True
B. False
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Answer
Answer: B. False
Rationale: Barbiturates, amphetamines, and
antidepressants decrease REM sleep.
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Illnesses Associated With
Sleep Disturbances
• Gastroesophageal reflux
• Coronary artery diseases
• Epilepsy
• Liver failure and encephalitis
• Hypothyroidism
• End-stage renal disease
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Classification of Sleep Disorders
• Dyssomnias
• Parasomnias
• Sleep disorders associated with medical or psychiatric
disorders
• Other proposed disorders
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Sleep Disorders
• Dyssomnias: characterized by insomnia or excessive
sleepiness
• Parasomnias—patterns of waking behavior that appear
during sleep
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Dyssomnias
• Insomnia
• Hypersomnia
• Narcolepsy
• Sleep apnea
• Restless leg syndrome
• Sleep deprivation
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Question
In which of the following sleep disorders does the patient
have an uncontrollable desire to sleep?
A. Insomnia
B. Sleep apnea
C. Narcolepsy
D. Restless leg syndrome
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Answer
Answer: C. Narcolepsy
Rationale: In narcolepsy, a person can literally fall asleep
while performing ADLs. Insomnia is characterized by
difficulty falling asleep. Sleep apnea is a condition in
which a person experiences the absence of breathing
during sleep between snores. Restless leg syndrome is a
crawling or tingling sensation in the legs.
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Obstructive Sleep Apnea
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Parasomnias
• Somnambulism
• REM behavior disorder (RBD)
• Sleep terrors
• Nightmares
• Bruxism
• Enuresis
• Sleep-related eating disorder
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Question
Tell whether the following statement is true or false.
Somnambulism is a parasomnia in which the person
walks in his or her sleep.
A. True
B. False
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Answer
Answer: A. True
Rationale: Somnambulism is a parasomnia in which the
person walks in his or her sleep.
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Treatment for Dyssomnias
• Pharmacologic therapy
– Sedatives
– Hypnotics
• Nonpharmacologic therapy
– Cognitive Behavioral Therapy (CBT)
• Progressive muscle relaxation measures
• Stimulus control
• Sleep restriction; sleep hygiene measures
• Biofeedback and relaxation therapy
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Obtaining a Sleep History
• Nature of problem
• Cause of problem
• Related signs and symptoms
• When the problem began and how often it occurs
• How the problem affects everyday living
• Severity of the problem and how it can be treated
• How the patient is coping with the problem and success
of treatments attempted
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Screening Tools to Assess Sleep
Disturbances
• The Epworth Sleepiness Scale
• The Pittsburgh Sleep Quality Index (PSQI)
• Sleep Disturbance Questionnaire
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Sleep Characteristics to Assess
• Restlessness
• Sleep postures
• Sleep activities
• Snoring
• Leg jerking
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Information Recorded in a Sleep Diary
• Time patient retires
• Time patient tries to fall asleep
• Approximate time patient falls asleep
• Time of any awakening during the night and resumption
of sleep
• Time of awakening in morning
• Presence of any stressors affecting sleep
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Information Recorded in a Sleep Diary
(cont.)
• Record of food, drink, or medication affecting sleep
• Record of physical and mental activities
• Record of activities performed 2 to 3 hours before
bedtime
• Presence of worries or anxieties affecting sleep
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Key Findings of Physical Assessment
• Energy level
• Facial characteristics
• Behavioral characteristics
• Physical data suggestive of sleep problems
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Common Etiologies for Nursing Diagnoses
• Physical or emotional discomfort or pain
• Changes in bedtime rituals or sleep environment
• Disruption of circadian rhythm
• Exercise and diet before sleep
• Drug dependency and withdrawal
• Symptoms of physical illness
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Nursing Interventions to Promote Sleep
• Prepare a restful environment.
• Promote bedtime rituals.
• Offer appropriate bedtime snacks and beverages.
• Promote relaxation and comfort.
• Respect normal sleep–wake patterns.
• Schedule nursing care to avoid disturbances.
• Use medications to produce sleep.
• Teach about rest and sleep.
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Question
Which of the following snacks is an appropriate bedtime
snack to promote sleep in a patient?
A. Candy
B. Toast
C. Lunchmeat
D. Cheese
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Answer
Answer: B. Toast
Rationale: Because carbohydrates seem to promote
sleep, there appears to be justification for offering a
snack or beverage high in carbohydrates (such as toast
or crackers) before bedtime. Candy, lunchmeat, and
cheese do not contain carbohydrates.
Copyright © 2015 Wolters Kluwer • All Rights Reserved