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100 Cards in this Set
- Front
- Back
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Sleep is
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Basic human need
1/3 of our lives are spent sleeping Helps to: Cope with daily stress Prevent fatigue Conserve energy Restore mind and body Enjoy life more fully |
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Sleep enhances
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daytime functioning
Vital for optimal: Psychological functioning Physiological functioning Healing of damaged tissue occurs fastest during sleep |
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Physiology of Sleep
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Sleep is altered state of consciousness where perception of and reaction to environment decreased
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what part of the brain controls sleep
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Cyclic nature of sleep thought to be controlled by lower part of brain
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what does the brain do during sleep?
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Neurons in reticular formation integrate sensory information from PNS and relay to cerebral cortex
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involved in sleep-wake cycle
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RAS
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Neurotransmitters affect
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sleep-wake cycle and seritonin
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serotonin is thought to
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Thought to lessen response to sensory stimulation
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GABA
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Thought to shut off activity in neurons of RAS
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Acetylcholine, dopamine, noradrenaline
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associated with cerebral cortical arousal
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Sleep is altered state of consciousness
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where perception of and reaction to environment decreased
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Cyclic nature of sleep
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thought to be controlled by lower part of brain
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Circadian Rhythm synchronization occurs
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biological clock coincides with sleep-wake cycle
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Person awake when body temp
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highest and asleep when body temp lowest
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Darkness and preparing for sleep cause
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decrease in stimulation of RAS
Pineal gland begins to secrete melatonin and person feels less alert |
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During sleep growth hormone
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is secreted and cortisol inhibited
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Sleep Architecture
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Refers to basic organization of sleep
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Sleep Architecture Two types that alternate in cycles during sleep
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NREM
REM |
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NREM Sleep
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Occurs when activity in RAS inhibited
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NREM Sleep Constitutes
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75% - 80% of sleep
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NREM Sleep Consists
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of 4 stages
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NREM Sleep stage 1
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Very light sleep and lasts only a few minutes
Feels drowsy and relaxed Eyes roll from side to side HR and RR drop slightly Can be readily awakened and may deny sleeping |
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NREM Sleep Stage II
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Light sleep lasts only about 10 to 15 minutes
Body processes continue to slow down Eyes are generally still HR and RR decrease slightly Body temperature falls 44% to 55% of total sleep Requires more intense stimuli to awaken |
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NREM Sleep Stage III and IV
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Deepest stages of sleep (delta sleep or deep sleep)
HR and RR drop 20% to 30% below waking hours Difficult to arouse Not disturbed by sensory stimuli Skeletal muscles very relaxed Reflexes are diminished |
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NREM Sleep Stage III and IV
___________ is likely to occur |
Snoring
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NREM Sleep Stage III and IV
Swallowing and saliva production |
reduced
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NREM Sleep Stage III and IV
Essential for |
for restoring energy and releasing important growth hormones
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Physiologic Changes in NREM Sleep
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BP falls
Pulse rate decreases Peripheral blood vessels dilate CO decreases Skeletal muscles relax BMR decreases 10% - 30% GH levels peak Intracranial pressure decreases |
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Characteristics of REM Sleep
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Occurs every 90 minute
Lasts 5 to 30 minutes Acetylcholine and dopamine increase Most dreams take place |
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May be difficult to arouse or may wake spontaneously
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Characteristics of REM Sleep
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Gastric secretions increase
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Characteristics of REM Sleep
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Characteristics of REM Sleep
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Gastric secretions increase
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Characteristics of REM Sleep
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HR and RR often are irregular
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Regions of brain associated with learning, thinking, organizing information stimula
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Characteristics of REM Sleep
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Functions of Sleep
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Restores normal levels of activity
Restores normal balance among parts of the nervous system Necessary for protein synthesis Psychological well-being |
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Sleep Patterns: The Young Newborns:
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16-18 hours per day
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Sleep Patterns: The Young Infants
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14-15 hours per day
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Sleep Patterns: The Young Toddlers:
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12-14 hours per day
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Sleep Patterns: The Young Preschoolers
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11-13 hours per day
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Sleep Patterns: The Young School-Age:
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10-11 hours per day
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Sleep Patterns: The Young Adolescents:
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9-10 hours per day
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Sleep Patterns: Adults
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Most healthy adults need 7-9 hours of sleep
Individual variations |
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Adults likely to have sleep issues
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students
travelers depressed long work hours shift workers acutely stressed chronic pain multiple jobs and women |
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Sleep Patterns: Older Adults
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Tendency toward earlier bedtime and wake times
May show an increase in disturbed sleep Need to sleep does not decrease with age Health and sleep directly related Sundown syndrome |
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Factors Affecting Sleep
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Illness
Environment Lifestyle Emotional stress Stimulants and alcohol Diet Smoking Motivation Medications |
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Illness Changes sleep requirements
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Respiratory conditions
Ulcers Endocrine disorders Elevated temp Night time voiding |
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Environment
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Relaxation
Stimuli Temperature Ventilation Light Bed |
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Lifestyle
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Irregular schedule
Exercise Night shift |
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Night Shift Workers
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Keep a steady schedule
Prepare your sleeping area Make and keep rules about sleeping hours Watch what you eat and drink Take naps Be aware of your sleep debt If your not getting enough sleep consider changing jobs |
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Additional Factors
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Emotional Stress
Stimulants & Alcohol Diet Smoking Motivation Medications |
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Common Sleep Disorders
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Insomnia
Excessive daytime sleepiness Parasomnias |
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Parasomnias
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•Sleepwalking
•Confusional Arousals •Night Terrors •REM Sleep Behavior Disorder •Nightmare Disorder •Sleep Paralysis •Sleep Talking •Bedwetting (enuresis) •Sleep Related Groaning •Exploding Head Syndrome •Sleep Related Eating Disorder |
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Insomnia
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Difficulty falling asleep
Difficulty staying asleep Waking up frequently Difficulty returning to sleep Waking too early Daytime sleepiness Difficulty concentrating Irritability |
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Insomnia Risk factors
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Older age
Increases sleep loss Female Hormonal change |
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Insomnia Treatment
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Development of new behaviors
Induce sleep Maintain sleep Stimulus control Cognitive therapy Sleep restriction Medications |
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Excessive Daytime Sleepiness
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Hypersomnia
Narcolepsy Sleep apnea Insufficient sleep |
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Hypersomnia
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Sufficient sleep at night but cannot stay awake during day
Caused by medial or psychological disorders |
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Narcolepsy Caused by
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lack of hypocretin in CNS that regulates sleep
Patients have sleep attacks or excessive daytime sleepiness Other associated symptoms |
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Sleep Apnea
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Frequent short breathing pauses during night
More than 5 apneic episodes > 10 sec/hr considered abnormal Symptoms include loud snoring, excessive daytime sleepiness, frequent awakenings, difficulty falling asleep, morning headaches, memory and cognitive problems, irritability |
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Sleep Apnea Types
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obstructive, central, mixed
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OSA
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Structures of pharynx or oral cavity block flow of air
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Central Apnea
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Defect in respiratory center of brain
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Mixed Apnea
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Combination of central and obstructive
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Insufficient Sleep symptoms
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Sleepiness and fatigue
Attention and concentration difficulties Reduced vigilance Distractibility Reduced motivation Fatigue, malaise, diplopia, and dry mouth |
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Parasomnia
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Behavior that may interfere with or occur during sleep
Arousal disorders Sleepwalking, sleep terrors Sleep-wake transition disorders Sleep talking Associated with REM sleep Nightmares |
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Parasomnia signs
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Bruxism
Enuresis Periodic limb movement disorder Sleeptalking Sleepwalking |
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Bruxism
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is excessive grinding of the teeth and/or excessive clenching of the jaw.[1] Bruxism is an oral parafunctional activity;[1] i.e., not an activity related to normal function such as eating or talking. Bruxism is a common problem: reports of prevalence range from 8–31% in the general population.[2] Bruxism may cause minimal symptoms, and therefore people may not be aware of the condition. Several symptoms are commonly associated with bruxism, including hypersensitive teeth, aching jaw muscles, and headaches
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Enuresis
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refers to a repeated
inability to control urination. |
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Assessment
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Sleep history
Health history Physical exam If warranted, a sleep diary and diagnostic studies |
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Sleep History
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When does client usually go to sleep?
Bedtime rituals? Does client snore? Can client stay awake during day? Taking any prescribed or OTC medications? Anything else I need to know |
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Health History
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Obtain information about medical or psychiatric problems that may influence sleep
Medication history Obtain information about medical or psychiatric problems that may influence sleep Medication history |
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Physical Examination
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Rarely yields information unless client has obstructive sleep apnea
Enlarged and reddened uvula and soft palate Enlarged adenoids and tonsils (children) Obesity (adults) Neck circumference > 17.5 inches (men) Deviated septum (occasionally) |
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Sleep Diary
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Patient may be asked to keep track of
Time factors associated with sleep Activities performed 2-3 hours prior to sleep Consumption of caffeine, alcohol Medications Bedtime rituals Difficulty remaining awake during day Any worries or fears that may be contributing |
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Diagnostic Studies
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Polysomnography
EEG EMG EOG |
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NANDA Nursing Diagnoses
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Insomnia (delayed onset of sleep) R/T overstimulation prior to bedtime
Risk for Injury R/T sleepwalking Ineffective coping R/T insufficient sleep Fatigue R/T insufficient sleep Impaired Gas R/T sleep apnea Anxiety R/T diagnosis of sleep disorder Activity Intolerance R/T sleep deprivation |
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Planning
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Goals:
Maintain (or develop) a sleeping pattern that provides sufficient energy for daily activities Enhance feeling of well being Improve the quality and quantity of the patient’s sleep |
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Implementing: Sleep Hygiene
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Used to promote sleep
Patient education Supporting bedtime rituals Creating a restful environment Promoting comfort and relaxation Sleep medications, if appropriate |
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Patient Education
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The importance of sleep
Conditions that promote sleep Conditions that interfere with sleep Safe use of sleep medications Effects of prescribed medications on sleep Effects of disease states on sleep |
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Bedtime Rituals
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Altering or eliminating routines can affect sleep
Adults Listening to music Reading Soothing bath Praying |
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Bedtime Rituals Children
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Need to be socialized into presleep routine
Usually preceded by hygienic ritual |
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Creating a Restful Environment
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Minimal noise
Comfortable room temperature Appropriate ventilation Appropriate lighting |
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Promoting Comfort and Relaxation
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Ensure a safe environment
Concerned, caring attitude Relaxation techniques |
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Medications
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Sedative-hypnotics (induce sleep)
Anti-anxiety or tranquilizers Be aware of actions, effects, risks of specific medications |
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sleep medication side effects
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Sleep medications interfere with normal sleep patterns
Can cause drowsiness and morning hangovers so can cause risk for injury Can cause dependency Elderly are susceptible to side effects because of their changes in metabolism and need to be monitored closely for mental alertness and coordination |
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Sedative-Hypnotics
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Depress or slow down bodily functions
Are often referred to as tranquilizers and sleeping pills Can cause dependency, unconsciousness or death |
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Sedative-Hypnotics-types
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Barbiturates
Phenobarbital Pentobarbital Benzodiazepines Diazepam (Valium) Chlordiazepoxide (Librium) Chlorazepate (Tranxene) |
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Ambien
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Non-benzodiazepine hypnotic
Should be taken short-term Should be taken when you will be able to have 7-8 hour uninterrupted sleep May cause blackout amnesia |
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Evaluating
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Using data collected during care and the desired outcomes developed during the planning stage as a guide, the nurse judges whether client goals and outcomes have been achieved
If the desired outcomes are not achieved, the nurse and client should explore the reasons |
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sleep is needed for
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optimal psychological and physiological functioning
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insufficeint sleep is wide spread amoung
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all age groups 50-70 million
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sleep is a naturally occuring and altered
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state of consciousness which a person's perception and reaction to the environment is decreased
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the sleep cycle is
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controlled by specialized areas in the brainstem and is affected by the individual's circdian rhtythm
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__________ consists of four stages. progressing from stage 1 very light sleep to stage IV , deep sleep
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NREM
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__________ occurs about evey 90 minutes and is often associated with dreaming. it is essential for psychosocial and mental equilibrium
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REM
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during a normal nights sleep and adult has ____ to ___ sleep cycles
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4,6
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each sleep cycle has
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NREM (quiet sleep) and REM (rapid eye movement)
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the ratio of NREM and REM
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varies with age
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many factors affect sleep
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illness, enviroment, life style, emotional stress, diet, smoking, stimulants, alcohol, motivation and medication
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assessment of a clients sleep includes a
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sleep history, health history, physcial exam to detect signs that may include sleep apnea
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Nursing responsibilites to help clients sleep include
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teaching clients ways to enhance sleep, supporting bed time rituals, creating a restful enviroment, promoting comfort and relaxation
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