Basic Human NeedsBasic Human Needs

SleepSleep

SleepSleep Proper rest & sleep are as important to good Proper rest & sleep are as important to good

health as good nutrition and adequate exercisehealth as good nutrition and adequate exercise Amount of sleep required varies among individualsAmount of sleep required varies among individuals Physical & emotional health on the ability to fulfill Physical & emotional health on the ability to fulfill

these basic human needsthese basic human needs

SleepSleep Without proper amounts of rest & sleep, the Without proper amounts of rest & sleep, the

ability to concentrate, make judgments, & ability to concentrate, make judgments, & participate in daily activities decreases & participate in daily activities decreases & irritability increasesirritability increases

Functions of Sleep TheoriesFunctions of Sleep Theories

Associated with healing & restorationAssociated with healing & restoration

Quality of sleep important to health Quality of sleep important to health promotionpromotion

Physiology of SleepPhysiology of Sleep Sleep-cyclical physiological process that Sleep-cyclical physiological process that

alternates with longer periods of alternates with longer periods of wakefulnesswakefulness

Sleep-wake cycle influences & regulates Sleep-wake cycle influences & regulates physiological function & behavioral physiological function & behavioral responsesresponses

Circadian RhythmsCircadian Rhythms Cyclical rhythms are part of everyday lifeCyclical rhythms are part of everyday life Most familiar rhythms is the 24 hr day-night Most familiar rhythms is the 24 hr day-night

cycle known as diurnal or circadian rhythmcycle known as diurnal or circadian rhythm Menstrual cycle-infradian rhythmMenstrual cycle-infradian rhythm

Circadian RhythmCircadian Rhythm Influence the pattern of major biological and Influence the pattern of major biological and

behavioral functionsbehavioral functions Body temperature, heart rate, blood Body temperature, heart rate, blood

pressure, hormone secretion, sensory acuity pressure, hormone secretion, sensory acuity & mood depend on the maintenance of the & mood depend on the maintenance of the 24 hr cycle24 hr cycle

Circadian RhythmsCircadian Rhythms Affected by: light, temperature, external Affected by: light, temperature, external

factors (work schedules, social activities)factors (work schedules, social activities) Biological clock- synchronize sleep cycle, Biological clock- synchronize sleep cycle,

individualized to person, different people individualized to person, different people function best at different times of the dayfunction best at different times of the day

Sleep RegulationSleep Regulation Sleep involves a sequence of physiological Sleep involves a sequence of physiological

states (stages of sleep) maintained by highly states (stages of sleep) maintained by highly integrated central nervous system activity integrated central nervous system activity that is associated with all body systems that is associated with all body systems

(C-V, endocrine, nervous, respiratory)(C-V, endocrine, nervous, respiratory)

Sleep RegulationSleep Regulation Each sequence can be identified by specific Each sequence can be identified by specific

physiological responses and brain activity patternsphysiological responses and brain activity patterns Current theory indicates sleep is thought to be an Current theory indicates sleep is thought to be an

active mutliphase processactive mutliphase process Major sleep center-hypothalamusMajor sleep center-hypothalamus Control & regulation of sleep may depend on the Control & regulation of sleep may depend on the

interrelationship between 2 cerebral mechanisms interrelationship between 2 cerebral mechanisms that intermittently activate & suppress the brain’s that intermittently activate & suppress the brain’s higher centers to control sleep & wakefulnesshigher centers to control sleep & wakefulness

Reticular Activating SystemReticular Activating System

Located in upper brain stemLocated in upper brain stem Believed to contain special cells that maintain Believed to contain special cells that maintain

alertness & wakefulnessalertness & wakefulness RAS receives visual, auditory, pain, and tactile RAS receives visual, auditory, pain, and tactile

sensory stimulisensory stimuli Activity from the cerebral cortex(thoughts, Activity from the cerebral cortex(thoughts,

emotions) also stimulate RASemotions) also stimulate RAS

Reticular Activating SystemReticular Activating System

Wakefulness results from neurons in the Wakefulness results from neurons in the RAS that release catecholamines such as RAS that release catecholamines such as norepinephrinenorepinephrine

Bulbar Synchroninizing Region Bulbar Synchroninizing Region (BSR)(BSR)

Sleep may be produced by the release of Sleep may be produced by the release of seretonin from specialized cells in the Raphe seretonin from specialized cells in the Raphe sleep system of the pons & medulla also known as sleep system of the pons & medulla also known as the BSRthe BSR

Whether a person remains awake or falls asleep Whether a person remains awake or falls asleep depends on a balance of impulses received from depends on a balance of impulses received from higher centers (thoughts), peripheral sensory higher centers (thoughts), peripheral sensory receptors (sound, light) and the Limbic system receptors (sound, light) and the Limbic system (emotions)(emotions)

Falling AsleepFalling Asleep As people try and fall asleep, they close As people try and fall asleep, they close

their eyes and assume a relaxed position, their eyes and assume a relaxed position, stimuli to RAS decline. If the room is quiet & stimuli to RAS decline. If the room is quiet & dark, activation to RAS declines furtherdark, activation to RAS declines further

At some point BSR takes over, causing At some point BSR takes over, causing sleepsleep

Stages of SleepStages of Sleep Measured by EMG, EEG, EOGMeasured by EMG, EEG, EOG Normal sleep involves 2 phases: NREM Normal sleep involves 2 phases: NREM

(Nonrapid eye movement) REM (Rapid eye (Nonrapid eye movement) REM (Rapid eye movement)movement)

NREM SleepNREM Sleep NREM-sleeper progresses through 4 stages NREM-sleeper progresses through 4 stages

during a typical 90 min sleep cycleduring a typical 90 min sleep cycle Progresses from stage 1-4Progresses from stage 1-4 Sleep becomes increasingly deepSleep becomes increasingly deep Lighter sleep- stages 1-2Lighter sleep- stages 1-2 Deeper sleep- stages 3-4Deeper sleep- stages 3-4 REM sleep is the phase at the end of each 90 REM sleep is the phase at the end of each 90

minute cycleminute cycle

REM SleepREM Sleep Vivid, full color dreamingVivid, full color dreaming Typified by autonomic response by rapidly, moving Typified by autonomic response by rapidly, moving

eyes, fluctuating heart & respiratory rates and eyes, fluctuating heart & respiratory rates and increased or fluctuating BPincreased or fluctuating BP

Very difficult to arouse sleeperVery difficult to arouse sleeper Duration of REM sleep increases with each cycle, Duration of REM sleep increases with each cycle,

averages about 20 minaverages about 20 min

SleepSleep Once person falls asleep, person usually passes Once person falls asleep, person usually passes

through 4-6 complete sleep cycles per nightthrough 4-6 complete sleep cycles per night Each cycle consisting of 4 stages of NREM sleep Each cycle consisting of 4 stages of NREM sleep

and a period of REM sleep and a period of REM sleep Pattern- NREM stages 1-4 followed by a reversal Pattern- NREM stages 1-4 followed by a reversal

of stages, 4,3,2, ending with a period of REM of stages, 4,3,2, ending with a period of REM sleepsleep

Reach REM sleep 90 minutes into sleep cycleReach REM sleep 90 minutes into sleep cycle

Functions of SleepFunctions of Sleep Allows body to rest, slows vitals, preserves Allows body to rest, slows vitals, preserves

cardiac function, decrease in muscle tonecardiac function, decrease in muscle tone Sleep restores biological processesSleep restores biological processes Body conserves energy during sleep Body conserves energy during sleep

(Lowers metabolic rate)(Lowers metabolic rate) REM sleep important for cognitive REM sleep important for cognitive

restoration, memory storage, & learning, restoration, memory storage, & learning, during sleep brain filters information about during sleep brain filters information about the day’s activitiesthe day’s activities

Functions of SleepFunctions of Sleep Loss of REM sleep can lead to feelings of Loss of REM sleep can lead to feelings of

confusion & suspicionconfusion & suspicion Prolonged sleep loss affects mood, motor Prolonged sleep loss affects mood, motor

performance, memory & equilibriumperformance, memory & equilibrium Sleep deprivation-results in traffic accidents, Sleep deprivation-results in traffic accidents,

home, work related accidentshome, work related accidents

DreamsDreams Dreams occur in NREM & REMDreams occur in NREM & REM More vivid & elaborate in REM More vivid & elaborate in REM Important to the consolidation of long-term Important to the consolidation of long-term

memory memory

Physical Illness Affect on SleepPhysical Illness Affect on Sleep

Any illness resulting in pain, physical Any illness resulting in pain, physical discomfort(SOB) or mood problems (anxiety, discomfort(SOB) or mood problems (anxiety, depression) can result in sleep problemsdepression) can result in sleep problems

Respiratory disease often interferes with sleep Respiratory disease often interferes with sleep (COPD & orthopnea)(COPD & orthopnea)

Nocturia disrupts sleep cycleNocturia disrupts sleep cycle Restless leg syndromeRestless leg syndrome

Sleep DisordersSleep Disorders InsomniaInsomnia ParasomniasParasomnias Sleep Disorders Associated with Medical or Sleep Disorders Associated with Medical or

Psychiatric DisorderPsychiatric Disorder HypersomniasHypersomnias Circadian Rhythm Sleep DisordersCircadian Rhythm Sleep Disorders Sleep-Related Movement DisordersSleep-Related Movement Disorders Refer to P &P pg. 1032 Box 42-3 Refer to P &P pg. 1032 Box 42-3

ParasomniasParasomnias Undesirable behaviors that occur Undesirable behaviors that occur

predominately during sleeppredominately during sleep More common in childrenMore common in children Arousal disordersArousal disorders Sleep-wake transition disorderSleep-wake transition disorder Parasomnia associated with REM sleepParasomnia associated with REM sleep Other ParasomniasOther Parasomnias

InsomniaInsomnia Symptom experienced by clients who have Symptom experienced by clients who have

a chronic difficulty falling asleep, frequent a chronic difficulty falling asleep, frequent awakenings from sleep and/or a short sleep awakenings from sleep and/or a short sleep or non-restorative sleepor non-restorative sleep

C/O excessive daytime sleepinessC/O excessive daytime sleepiness

InsomniaInsomnia May be transient due to emotional stress, May be transient due to emotional stress,

family, work, or school problem, or loss of a family, work, or school problem, or loss of a loved oneloved one

May be associated with poor sleep hygiene, May be associated with poor sleep hygiene, habits and practices associated with sleephabits and practices associated with sleep

Sleep ApneaSleep Apnea Lack of airflow through nose & mouth for Lack of airflow through nose & mouth for

periods of 10 seconds or longer during sleepperiods of 10 seconds or longer during sleep 3 Types- Central, Obstructive, Mixed 3 Types- Central, Obstructive, Mixed Most common type-Obstructive Sleep Most common type-Obstructive Sleep

Apnea (OSA)Apnea (OSA)

Obstructive Sleep ApneaObstructive Sleep Apnea Relaxation of muscles & structures of oral cavity Relaxation of muscles & structures of oral cavity

during sleepduring sleep Upper airway becomes obstructedUpper airway becomes obstructed Person still attempts to breathe resulting in loud Person still attempts to breathe resulting in loud

snorting & snoring soundssnorting & snoring sounds Deviated septum, nasal polyps, enlarged tonsils Deviated septum, nasal polyps, enlarged tonsils

can predispose you to OSAcan predispose you to OSA Results in severe interference with deep sleep and Results in severe interference with deep sleep and

EDSEDS www.sleepeducation.com/Disorder.aspx?id=7

Obstructive Sleep ApneaObstructive Sleep Apnea 18 million in U.S.18 million in U.S. Causes a serious decline in oxygen levelCauses a serious decline in oxygen level Risk for cardiac dysrythmias, heart failure, Risk for cardiac dysrythmias, heart failure,

pulmonary hypertension, stroke, HTNpulmonary hypertension, stroke, HTN Most common im men, the obese, and Most common im men, the obese, and

postmenopausal womenpostmenopausal women

Sleep Apnea TreatmentSleep Apnea Treatment

Weight lossWeight loss

Sleeping on sideSleeping on side

CPAPCPAP

Bi-PAPBi-PAP

Central Sleep Apnea Central Sleep Apnea Involves dysfunction in the brains respiratory Involves dysfunction in the brains respiratory

control centercontrol center Impulse to breathe temporarily failsImpulse to breathe temporarily fails Nasal airflow & chest wall movement cease, O2 Nasal airflow & chest wall movement cease, O2

sat fallssat falls Seen in brain stem injury, muscular dystrophy, Seen in brain stem injury, muscular dystrophy,

encephalitisencephalitis Bipap maskBipap mask

NarcolepsyNarcolepsy Dysfunction of the mechanisms that regulate Dysfunction of the mechanisms that regulate

sleep & wake statessleep & wake states Excessive daytime sleepinessExcessive daytime sleepiness Fall asleep uncontrollably during day at Fall asleep uncontrollably during day at

inappropriate timesinappropriate times REM sleep within 15 minutesREM sleep within 15 minutes May be geneticMay be genetic

Sleep DeprivationSleep Deprivation Occurs as a result of dyssomniasOccurs as a result of dyssomnias Causes include: illness, emotional stress, Causes include: illness, emotional stress,

medications, environmental disturbances, medications, environmental disturbances, shift workshift work

Nurses at risk, patients at riskNurses at risk, patients at risk

Symptoms of Sleep DeprivationSymptoms of Sleep Deprivation

Blurred visionBlurred vision ClumsinessClumsiness Slow responseSlow response Decreased reasoningDecreased reasoning Decreased visual Decreased visual

alertnessalertness ArrhythmiasArrhythmias

ConfusionConfusion DisorientationDisorientation IrritabilityIrritability Sleepiness Sleepiness AgitationAgitation Decreased motivationDecreased motivation

Normal Sleep RequirementsNormal Sleep Requirements

NeonatesNeonates InfantsInfants ToddlersToddlers PreschoolPreschool School ageSchool age TeensTeens Young adultsYoung adults Middle AdultsMiddle Adults Older AdultsOlder Adults

Factors Affecting SleepFactors Affecting Sleep Drugs & SubstancesDrugs & Substances LifestyleLifestyle Usual sleep patterns & excessive daytime Usual sleep patterns & excessive daytime

sleepinesssleepiness Emotional stressEmotional stress EnvironmentEnvironment Exercise & fatigueExercise & fatigue DietDiet

Nursing ProcessNursing ProcessAssessmentAssessment

Sleep assessmentSleep assessment Description of sleep problemsDescription of sleep problems Usual sleep patternUsual sleep pattern Current life eventsCurrent life events Emotional & mental statusEmotional & mental status Bedtime routines & environmentBedtime routines & environment Behaviors of sleep deprivation: “ICU Behaviors of sleep deprivation: “ICU

Syndrome”Syndrome”

Nursing DiagnosisNursing Diagnosis AnxietyAnxiety Ineffective Breathing PatternIneffective Breathing Pattern Sleep Pattern DisturbanceSleep Pattern Disturbance Alteration in Sensory PerceptionAlteration in Sensory Perception Ineffective CopingIneffective Coping Acute ConfusionAcute Confusion FatigueFatigue

ImplementationImplementation Environmental controlsEnvironmental controls Promoting bedtime routinesPromoting bedtime routines Promoting ComfortPromoting Comfort Establishing periods of rest & sleepEstablishing periods of rest & sleep Stress ReductionStress Reduction Bedtime snacksBedtime snacks Pharmacological agentsPharmacological agents

Pharmacological AgentsPharmacological Agents Hypnotics-induce sleepHypnotics-induce sleep Sedatives- produce a calming effectSedatives- produce a calming effect Long term use can disrupt sleepLong term use can disrupt sleep Benzodiazepines- Xanax, Valium, Ativan, Benzodiazepines- Xanax, Valium, Ativan,

Dalmane, Restoril, Halcion, Versed, Librium, Dalmane, Restoril, Halcion, Versed, Librium, SeraxSerax

Non-Benzo Hypnotics: Ambien, Lunesta, Non-Benzo Hypnotics: Ambien, Lunesta, RozeremRozerem

Barbiturates: Seconal, NembutalBarbiturates: Seconal, Nembutal OTC Sleep aidsOTC Sleep aids