Rest and Sleep

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Rest and Sleep

• ZZZZZZZZ
• ZZZZZZZZZZZZZZ

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Circadian Rhythms

• Biorhythms are controlled in body
• Synchronized with environmental factors, ie
  light, darkness, gravity, electromagnetic stimuli

• Circadian synchronization
• When the biologic clock coincides with sleepwake
  patterns

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Circadian Regularity

• Begins by third week of life and may be inherited
• 4 month olds begin 24 hr cycle and sleep mostly
  during the night

By 5-6 months, most sleep wake patterns resemble
adults
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Stages of Sleep

• Non-REM (NREM)
• REM (rapid eye movement)

Electroencephalogram (EEG)
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NREM Sleep

• Stage 1 lasts a few minutes
• Very light sleep, person is drowsy, relaxed, eyes
  roll from side to side, heart and resp rates drop
  slightly

• Stage 2 lasts 10-15 min, but equals 40-45 of
  total
• Body processes slow down, eyes generally still,
  heart and resp rates decrease and body temp falls

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NREM Sleep

• Stage 3 sleeper is more difficult to arouse
• Domination of parasympathetic nervous system,
  reflexes diminished, very relaxed, may snore

• Stage 4 delta sleep is very deep
• Heart and resp rate both drop 20-30 below waking
  hours, sleeper rarely moves, body restored
  physically

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REM Sleep

• Recurs every 90 min, lasts 5-30 min
• Dreaming occurs, brain activity increases by as
  much as 20

• Also called paradoxical sleep
• May be difficult to arouse, may wake
  spontaneously, muscle tone depressed, gastric
  juices increase, heart and resp rates often irreg

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Sleep Cycles

• Cycles begin with NREM sleep and move to REM
  sleep
• Usual sleeper experiences 4-6 cycles of sleep
  during 7-8 hours

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Sleep Functions

• Restores normal levels of activity
• Normal balance of nervous system
• Necessary for protein synthesis and repair
  processes

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Sleep Loss

• Emotionally irritable
• Poor concentration
• Decreased mental functioning
• Difficulty making decisions

What about test-taking???
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Newborns

• Sleep 16-18 hours/day
• Most time spent in stages 3 4 NREM
• Nearly 50 is REM

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Infants

• Sleep 12-14 hrs/day up to 22 hrs/day
• 20-30 is REM, awaken every 3-4 hrs to eat
• Most sleep thru night by 4 months

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Toddlers

• Sleep 10-12 hrs/day
• 20-30 is REM
• Afternoon naps
• Need consistent approach to bedtime

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Preschoolers

• Need 11-12 hrs sleep per night
• Often resist bedtime
• Stage 1 sleep is less, REM sleep is 20-30 higher
  than adults

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School-Age Children

• Sleep 8-12 hrs/night
• REM sleep reduced to about 20
• Some children may have nightmares

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Young Adults

• Most require 7-8 hrs sleep each night
• Others may do well on less sleep
• Have active lifestyle

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Middle-Aged Adults

• Usually sleep 6-8 hours per night
• About 20 is REM
• Stage 4 sleep begins to decrease
• of arousals increases

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Elders

• Usually sleep about 6 hours per night
• Stage 4 sleep markedly less
• First REM period is longer

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Sundowners Syndrome

• Confusional state that appears at dusk
• May be due to change in circadian rhythms,
  decreases sensory stimulation at end of day, or
  to a mental condition such as Alzheimers Disease

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Factors Affecting Sleep

• Illness
• Environment
• Fatigue
• Lifestyle
• Emotional stress

• Stimulants/alcohol
• Diet
• Smoking
• Motivation
• Medications

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Parasomnias

• Bruxism
• Nocturnal enuresis
• Nocturnal erections

• Periodic limb movements disorder
• Sleeptalking
• Somnambulism

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Primary Sleep Disorders

• Insomnia
• Hypersomnia
• Narcolepsy

• Sleep apnea
• Sleep deprivation

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Secondary Sleep Disorders

• Caused by other conditons
• Depression
• Alcoholism
• Parkinsonism

• Thyroid dysfunction
• COPD
• Peptic ulcer disease

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Polysomnography

• Electroencephalo-gram
• Electromyogram
• Electro-oculogram

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Nursing Diagnosis

• Disturbed Sleep Pattern/Time limited disruption
  of sleep amount and quality
• Sleep deprivation/Prolonged periods of time
  without sleep

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Nursing Interventions

• Client teaching
• Supporting bedtime rituals
• Creating a restful environment
• Promoting comfort and relaxation

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Figure 43.2 One suggested pattern for a back
massage.
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Table 43-2 Selected Sedative-Hypnotic
Medications Used for Insomnia
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Box 43-1 Physiologic Changes During NREM Sleep
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Box 43-2 Drugs that Disrupt Sleep
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Box 43-3 Parasomnias
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Box 43-4 Reducing Environmental Distractions in
Hospitals
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Unnum Box 43-3 Assessment Interview Sleep
Disturbances
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Unnum Box 43-6 Teaching Wellness Care
Promoting Rest and Sleep
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Chapter 43, Discussion Point 1
How do REM and NREM sleep differ?
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Chapter 43, Discussion Point 2
What stage of sleep is thought to restore the
body physically?
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Chapter 43, Discussion Point 3
What impact do the sympathetic nervous system and
parasympathetic nervous system have on sleep?
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Chapter 43, Discussion Point 4
What are some signs and symptoms that indicate a
person may have a sleep problem?
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Chapter 43, Discussion Point 5
How are hypersomnia and narcolepsy different?
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Chapter 43, Discussion Point 6
What is the etiology of the different types of
sleep apnea?
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Chapter 43, Discussion Point 7
Which parasomnias might be considered health
problems?
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Chapter 43, Discussion Point 8
What information should a client include in a
sleep diary?