HLTEN504A - INCP

ComfortRestSleep

What is sleep

Sleep is a sensory experience.

Perception of and reaction to the surrounding environment decrease during sleep.

The sleeping person can be aroused by tactile, auditory and visual disturbances.

Sleep is influenced by an individual biologic clock that regulates not only sleep but also levels of alertness throughout the day.

Sleep is a cyclic phenomenon. • Within a 24-hour period, individuals have one major

sleep period and one major wake period

Circadian Rhythms Relates to the behavioral and biological activity in 24 hrs.Internal clock synchronized to light / dark cycles and other daily cues.Circadian clock synchronized to local time.The human clock is found in a distinct group of cells in the hypothalamus.These specialized cells have a connection with the pineal gland.This gland secretes melatonin.Night time causes melatonin secretion to be increased, day time causes secretion to be inhibited.Even when night time cues are absent Melatonin is still released in a cyclic mannerThe special cells are activated by light hitting the retina of the eyes.

Areas of the brain which influence sleep control:

The reticular activating system (RAS) and the bulbar synchronising region (BSR) in Pons Varoli. Both work together, alternately activating and suppressing the brain’s higher centres to control sleep.

Hinwood, 1987, p. 227

Reticular activating system – is localised in upper brain stem• Contain specialised cells that maintain alertness and

wakefulness• Receives stimuli from – visual, auditory, pain, tactile,

emotions• Wakefulness results from neurons in RAS releasing

neurotransmitters such as~ Nor adrenaline~ Dopamine~ Gamma-aminobutyric acid (GABA)~ As the person begins to fall asleep and relax,

RAS stimuli declines. Further decrease of activation occurs in a quiet , dark room .BSR takes over and sleep occurs

Two states of sleep

Sleep has two distinct states • Non-rapid eye movement (NREM), which has four

stages• Rapid eye movement (REM)

These two states occur in approximately 90-minute cycles throughout the sleeping time.

Sleep stages

Stages of sleep

Stage 1 Is experienced as we fall asleep and is the transition

between being awake and asleep – eye and body movements slow down

It lasts between 5 and 10 minutes. Easily aroused from this state This will be increased in those people suffering

insomnia and disorders that produce frequent arousal patterns e.g. apnoea

Stages of sleepStage 2• Is the baseline of sleep, last for around 20 mins• Body temp and heart rate begins to slow• Arousal still relatively easy• It occupies approximately 45-60% of sleep

Stages of sleep

Stage 3 – transitional stage to deep or delta wave sleep

• Muscles are completely relaxed, and may last 15-30 minutes.

• Very difficult to wake from this stage• Can feel groggy and disorientated for

several minutes if woken• In children delta sleep occupies up to 40%

of all sleep time.

Stages of sleep

Stage 4 – second stage of deep sleep• May last up to 15-30 mins• Very difficult to wake• Both 3 & 4 are important to feeling refreshed when

waking• Sleep walking and enuresis may occur

Stages of sleep

REM sleep• Lasts 5-30 mins, beginning about 70 -90 mins after

commencement of sleep• It composes 20-25% of a normal night’s sleep.• Breathing, eye movement, heart rate and brain

wave activity increase.• Vivid dreams occur.• There is also a loss of muscle tone (as if paralysed)

in skeletal muscles

Sleep patterns of older adults

•It often takes longer to fall asleep•Beginning in middle age, stages 3and 4 sleep become less prominent•There is a moderate reduction in total REM sleep time•The percentage of sleep time in stages 1 and 2 increases•Nocturnal awakenings increase in frequency and duration.•Because of frequent and longer night-time awakenings, total time spent asleep is shorter •There is a tendency to nap during the day so that total time spent asleep is redistributed in a 24-hour cycle

Conditions to promote proper rest

Physical comfort• Elimination sources of physical irritation• Controlling sources of pain • Providing warmth• Maintaining hygiene• Maintaining proper anatomical alignment or

positioning • Removing environmental distractions • Provide adequate ventilation

Conditions to promote proper rest

Freedom from;

Worry • Making decisions• Participating in personal health care• Gaining an understanding of health problems and their

implications• Practicing restful activities regularly• Knowing the environment is safeSufficient sleep

Improving sleep hygieneRegular sleep and waking times• go to bed when sleepy• use relaxation techniques to

promote sleep • if unable to sleep within 15-30

minutes get out of bedAvoiding daytime naps • if naps are used, limit to 20

minutes or less twice a dayOptimising sleep environments• Use night light if required• Keep path to bathroom free of

obstacles • Provide privacy• Provide enough pillows for comfort

Improving sleep hygiene

Regular sleep and waking times• go to bed when sleepy• use relaxation techniques to promote sleep • if unable to sleep within 15-30 minutes get out of bedAvoiding daytime naps • if naps are used, limit to 20 minutes or less twice a dayOptimising sleep environments• Use night light if required• Keep path to toilet free of obstacles • Provide privacy• Provide enough pillows for comfort

Improving sleep hygieneMinimise noise and moderate temperature• Sometimes soft music can mask other noise • Control noise in the hospital• Make sure that the heater is on/off, fan on/off,

windows open/closed;• Provide enough blankets, socks to promote warmth

Eliminate daytime sedation and night time stimulants• Ensure that medications or their interactions are not

cause of insomnia

Effects of Sleep deprivation

Benefits of power naps

Visitors and other clients

Meditation and relaxation

Pain management

Medications