REST AND SLEEPREST AND SLEEP

Rest is a state of mental and Rest is a state of mental and physical relaxation and calmness. physical relaxation and calmness. body activities continue..body activities continue..

Sleep is a state of altered Sleep is a state of altered consciousness (non-voluntary) consciousness (non-voluntary) during which a person has minimal during which a person has minimal physical activity, changes in level of physical activity, changes in level of consciousness, and a slowing of consciousness, and a slowing of physiologic processes.physiologic processes.

Rest SleepRest Sleep

Lying DownLying Down Reading a bookReading a book Taking a walkTaking a walk Playing a board Playing a board

gamegame TVTV cookingcooking

CyclicalCyclical RestorativeRestorative Decreased motor Decreased motor

activityactivity

PHYSIOLOGY OF SLEEPPHYSIOLOGY OF SLEEP

The stages of sleep are identified The stages of sleep are identified by EEG patterns, eye movements, by EEG patterns, eye movements, and muscle activity.and muscle activity.

Sleep phases are classified as non-Sleep phases are classified as non-rapid eye movement (NREM) and rapid eye movement (NREM) and rapid eye movement (REM) sleep.rapid eye movement (REM) sleep.

Note: if sleep cycle is broken a new Note: if sleep cycle is broken a new cycle starts with non-remcycle starts with non-rem

THE SLEEP CYCLETHE SLEEP CYCLE The sequence of sleep begins with The sequence of sleep begins with

the four stages of NREM the four stages of NREM sleep,followed by sleep,followed by the first REM sleep.the first REM sleep.

The duration of a sleep cycle is The duration of a sleep cycle is usually usually 60 to 90 minutes.60 to 90 minutes.

Sleeper generally goes through 4–6 Sleeper generally goes through 4–6 cycles during sleep period of 7–8 cycles during sleep period of 7–8 hours. hours.

BIOLOGICAL CLOCKBIOLOGICAL CLOCK

An internal mechanism in a living An internal mechanism in a living organism capable of measuring organism capable of measuring time.time.

It controls the daily variations in It controls the daily variations in hundreds of physiologic processes.hundreds of physiologic processes.

FACTORS AFFECTING FACTORS AFFECTING REST AND SLEEPREST AND SLEEP

Physical comfortPhysical comfort Psychological factorsPsychological factors EnvironmentEnvironment Lifestyle stressorsLifestyle stressors DietDiet Medications and other substancesMedications and other substances Age/agingAge/aging

Things That Affect SleepThings That Affect Sleep

PositivePositive– ComfortComfort– WorkoutWorkout– TryptophanTryptophan– drugsdrugs

NegativeNegative– PainPain– HospitalHospital– Cola, caffeineCola, caffeine– Heavy meal/hungryHeavy meal/hungry– DrugsDrugs– IllnessIllness– PregnancyPregnancy– AgeAge

SLEEP PATTERN ALTERATIONSSLEEP PATTERN ALTERATIONS

InsomniaInsomnia HypersomniaHypersomnia NarcolepsyNarcolepsy Sleep Sleep

apnea/snoringapnea/snoring Sleep Sleep

deprivationdeprivation

ParasomniasParasomnias Restless leg Restless leg

syndromesyndrome Periodic limb Periodic limb

movement disordermovement disorder Nocturnal sleep-Nocturnal sleep-

related eating related eating disorderdisorder

INSOMNIAINSOMNIA

Difficulty falling asleep or staying asleep.Difficulty falling asleep or staying asleep. Causes include stress, depression, medical Causes include stress, depression, medical

problems, caffeine, alcohol, pain, poor sleep problems, caffeine, alcohol, pain, poor sleep habits, smoking, or changes in sleep patterns habits, smoking, or changes in sleep patterns related to travel or shift work.related to travel or shift work.

Treatment is best focused on modifying the Treatment is best focused on modifying the factors or behaviors causing it. Involves family factors or behaviors causing it. Involves family solutions.solutions.

NX Dx sleep deprivation M/B irritability and NX Dx sleep deprivation M/B irritability and confusion.confusion.

HYPERSOMNIA HYPERSOMNIA

Characterized by excessive sleep, Characterized by excessive sleep, especially in the day time.especially in the day time.

Causes can be physical or Causes can be physical or psychological.psychological.

Treat to address the underlying Treat to address the underlying cause.cause.

NARCOLEPSYNARCOLEPSY

Sudden, irresistible urge to fall Sudden, irresistible urge to fall asleep during the daytime.asleep during the daytime.

Can occur during conversation or Can occur during conversation or while driving.while driving.

Lasts few seconds or 30 minutes or Lasts few seconds or 30 minutes or more.more.

No cure; scheduled, daytime naps No cure; scheduled, daytime naps help.help.

SLEEP APNEA/SNORINGSLEEP APNEA/SNORING

Sleep apnea is a period, during Sleep apnea is a period, during sleep, of not breathing following sleep, of not breathing following a period of loud snoring, which a period of loud snoring, which may cause excessive daytime may cause excessive daytime sleepiness and can increase the sleepiness and can increase the risk of heart attack or stroke.risk of heart attack or stroke.

SLEEP SLEEP APNEA/SNORING APNEA/SNORING (continued)(continued)

Treatment includes: Treatment includes: Nasal continuous positive airway Nasal continuous positive airway

pressure device (CPAP), .pressure device (CPAP), . Dental appliances that reposition Dental appliances that reposition

the tongue.the tongue. Surgery.Surgery.

SLEEP DEPRIVATIONSLEEP DEPRIVATION

Term used for prolonged inadequate Term used for prolonged inadequate quality and quantity of sleep.quality and quantity of sleep.

Can result from age, hospitalization, Can result from age, hospitalization, drug and substance use, illness, and drug and substance use, illness, and frequent changes in lifestyle patterns.frequent changes in lifestyle patterns.

Most effective intervention is to treat Most effective intervention is to treat or minimize factors causing or minimize factors causing deprivation.deprivation.

PARASOMNIAPARASOMNIA

Disorders that intrude on sleep in Disorders that intrude on sleep in very active ways.very active ways.

Somnambulism (sleepwalking), Somnambulism (sleepwalking), sleeptalking, sleep terrors, REM sleeptalking, sleep terrors, REM movement disorder, bed wetting, movement disorder, bed wetting, bruxism (teeth grinding) are most bruxism (teeth grinding) are most common.common.

Treatment varies.Treatment varies.

RESTLESS LEG SYNDROMERESTLESS LEG SYNDROME

Tingling or crawling in muscles; Tingling or crawling in muscles; twitching, burning, prickling, or deep twitching, burning, prickling, or deep aching in the foot, calf or upper leg aching in the foot, calf or upper leg when at rest.when at rest.

Only relieved by walking, standing, Only relieved by walking, standing, or moving or rubbing the legs.or moving or rubbing the legs.

Symptoms may be relieved by Symptoms may be relieved by opiates, benzodiazepines, or L-dopa.opiates, benzodiazepines, or L-dopa.

PERIODIC LIMB PERIODIC LIMB MOVEMENTS IN SLEEPMOVEMENTS IN SLEEP

Repetitive leg movements every Repetitive leg movements every 20 to 40 seconds throughout the 20 to 40 seconds throughout the night.night.

Multiple sleep interruptions occur, Multiple sleep interruptions occur, leading to daytime sleepiness and leading to daytime sleepiness and night-time insomnianight-time insomnia

NOCTURNAL SLEEP-RELATED NOCTURNAL SLEEP-RELATED EATING DISORDER (NSRED)EATING DISORDER (NSRED)

Rapid and chaotic eating when Rapid and chaotic eating when partially or fully awake with partially or fully awake with variable recall of the episode.variable recall of the episode.

Clients gain weight with only Clients gain weight with only moderate daytime eating, are not moderate daytime eating, are not hungry in the morning, and are hungry in the morning, and are chronically tired.chronically tired.

NURSING NURSING PROCESS–ASSESSMENTPROCESS–ASSESSMENT

Nature of sleepNature of sleep Quality of sleepQuality of sleep Sleep environmentSleep environment Associated factorsAssociated factors Opinion of sleepOpinion of sleep

NURSING DIAGNOSISNURSING DIAGNOSIS

Disturbed sleep patternDisturbed sleep pattern Sleep deprivationSleep deprivation Activity intolerance/related to lack Activity intolerance/related to lack

of sleep as evidenced by verbal of sleep as evidenced by verbal complaint, extreme fatigue, complaint, extreme fatigue, disorientation, confusion, and lack disorientation, confusion, and lack of energyof energy

PLANNING/OUTCOME PLANNING/OUTCOME IDENTIFICATIONIDENTIFICATION

Client input should be incorporated Client input should be incorporated into the plan and goals.into the plan and goals.

Must focus on the true cause of the Must focus on the true cause of the sleep alteration or disturbance.sleep alteration or disturbance.

IMPLEMENTATIONIMPLEMENTATION

A trusting nurse-client relationshipA trusting nurse-client relationship Relaxing environmentRelaxing environment Relaxation techniquesRelaxation techniques Nutritional considerationsNutritional considerations Pharmacological interventionsPharmacological interventions Client educationClient education

QuestionsQuestions