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Chapter 40
Rest and Sleep
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
Stages of Sleep
• Non-rapid eye movement (NREM)
– Consists of four stages
• Stage I and II — 5% to 50 % of sleep, light sleep
• Stage III and IV — 10% of sleep, deep-sleep
states (delta sleep)
• Rapid eye movement (REM)
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 reentering stage I
• The person reenters NREM sleep at stage II and moves
on to III and IV.
Factors Affecting Sleep
• Developmental considerations
• Psychological stress
• Motivation
• Culture
• Lifestyle and habits
• Physical activity and exercise
Factors Affecting Sleep (continued)
• Dietary habits
• Environmental factors
• Illness
• Medications
Illnesses Associated With
Sleep Disturbances
• Peptic ulcers
• Coronary artery diseases
• Epilepsy
• Liver failure and encephalitis
• Hypothyroidism
Classification of Sleep Disorders
• Dyssomnias
• Parasomnias
• Sleep disorders associated with medical or psychiatric
disorders
• Other proposed disorders
Sleep Disorders
• Dyssomnias — characterized by insomnia or excessive
sleepiness
• Parasomnias — patterns of waking behavior that appear
during sleep
Dyssomnias
• Insomnia
• Hypersomnia
• Narcolepsy
• Sleep apnea
• Restless leg syndrome
• Sleep deprivation
Parasomnias
• Somnambulism
• Sleep talking
• Nocturnal erections
• Bruxism
• Enuresis
• Sleep-related eating disorder
Treatment for dyssomnias
• Pharmologic therapy
– Sedatives and hypnotics
• Nonpharmacologic therapy
– Stimulus control
– Sleep restriction
– Sleep hygiene
– Cognitive therapy
– Multicomponent therapy
– Relaxation therapy
Nursing Interview
• Identify patient’s sleep-wakefulness patterns
• Identify effect of these patterns on everyday functioning
• Assess patient’s use of sleep aids
• Assess the presence of sleep disturbances and
contributing factors
Sleep Disturbance
Assessment Parameters
• Nature and cause of problem
• Accompanying signs and symptoms
• Date of occurrence and effect of everyday living
• Severity of the problem
• Treatment of problem
• How the patient is coping with the problem
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
Information Recorded in a Sleep Diary
(continued)
• 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
Key Findings of Physical Assessment
• Energy level
• Facial characteristics
• Behavioral characteristics
• Physical data suggestive of sleep problems
Sleep Characteristics to Assess
• Restlessness
• Sleep postures
• Sleep activities
• Snoring
• Leg jerking
Common Etiologies for Nursing Diagnoses
• Physical or emotion 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
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