Rest & Sleep

Question 1

what is rest

Answer 1

body in decreased state of activity and result is we feel refreshed

Question 2

what is sleep

Answer 2

state of rest accompanied by an altered LOC & relative inactivity
-we need unfragmented sleep
-insufficient sleep leads to serious physical and psychological health issues

Question 3

Stages of sleep

Answer 3

-non-rapid eye movement (nrem)
-rapid eye movement (rem)

Question 4

nrem

Answer 4

consists of four stages
I. transition stage between wakefulness and sleep (5% of sleep) (twilight sleep; easy to arouse; b/w wakefulness and sleep; still aware of surroundings)
II. light sleep (50% of sleep)(easily aroused)
III. deep sleep (10%)
IV. very deep sleep state (10% of sleep)(hard to wake up)

**physical renewal (all about body); growth <–stages 3 & 4; restorative function

Question 5

rem

Answer 5

20-25% of a person’s nightly sleep time
-INCREASED pulse, respiratory rate, blood pressure, metabolic rate, & body temp
-skeletal muscle tone and deep tendon reflexes are depressed

**hormonal regulation; store memories; brain processes learning and mood

Question 6

a single normal sleep cycle
**see slide 3

Answer 6

in and out of REM through stage 2 all night long

Question 7

sleep requirements and patterns

Answer 7

-acceptable standard for adults s 7-9 hours of sleep
-older adult:
-sleep 6-7 hours per night
-sleep is less sound
-stage 4 is absent or decreased
-decreased rem sleep
-will wake up more often

Question 8

illnesses associated with sleep disturbances

Answer 8

-gastroesophageal reflux (increased gastric secretions during rem)
-coronary artery disease (angina)
-epilepsy (seizures happen more in orem)
-liver failure and encephalitis
-end stage renal disease (disruptive sleep; excessive daytime sleep)

Question 9

factors affecting sleep in acute care settings

Answer 9

-environmental factors (new environment; impacts rem/nrem; noisy; lights; alarms)
-psychological stress
-illness
-medications (decrease sleep; disrupt sleep)
-dietary habits (alcohol, caffeine, smokers)

Question 10

physical and physiological effects of insufficient sleep

Answer 10

-can’t concentrate
-fatigue
-anxiety and depression
-obesity
-increased risk of:
-DM2
-MI
-CVA
-breast cancer
-colon cancer

Question 11

common sleep disorders previously classified as DYSSOMNIAS (anything that will cause someone problems with sleeping)

Answer 11

-insomnia
-sleep related breathing disorders
-narcolepsy
-circadian rhythm sleep-wake disorders

Question 12

insomnia

Answer 12

-difficulty falling sleep, intermittent sleep, early wakefulness
-most common sleep disorder (30-35%)
-common in people >60, women after menopause, depression
-often due to disruptions in circadian rhythms or medications (anti htn; adhd; cold meds)
-tx: behavior modification, medications, education

**acute if brief and due to life circumstance; chronic=3+ times/week for over 3 months

Question 13

sleep related breathing disorders

Answer 13

OSA
-obstructive sleep apnea
-obesity and/or anatomical causes (large neck sizes)
-S&S
-excess daytime sleepiness (fall asleep @ dinner table, at work, etc.)
-snoring
-abnormal sleep study
-treatment
-weight reduction
-CPAP/BIPAP

Question 14

narcolepsy

Answer 14

-uncontrollable desire to sleep
-S&S
-sleep attacks
-cataplexy (suddenly loss of muscle tone; full body paralysis)
-nightmares and hallucinations
-sleep onset rem
-tx
-medication (ritalin)

Question 15

circadian rhythm sleep-wake disorders

Answer 15

any disruption in sleep-wake
-chronic or recurrent pattern of sleep-wake rhythm disruption
-misalignment between circadian rhythm and sleep wake cycle
-shift work
-jet lag

Question 16

parasomnias (a wakeful period that occurs during rem or nrem sleep)

Answer 16

-somnambulism (sleep walking)
-sleep terrors (deep stages of sleep; wake up screaming)
-nightmares (frightening dreams)
-bruxism (grinding teeth)
-enuresis (nocturnal bed wetting)

**common with children

Question 17

sleep-related movement disorders

Answer 17

restless leg syndrome (15% of population)
-unpleasant creeping, crawling or tingling sensations in the legs while sleeping (in calf mostly; irresistible urge to move legs)
-treatment: walking, massage to area, stretching

Question 18

obtaining a sleep history

Answer 18

interview
-description of disturbance (what is the problem? how long? you ADL?)
-sleep-wake patterns
-sleep habits/rituals
-sleep aides
-physical assessment-energy level

Question 19

nursing interventions to promote sleep

Answer 19

-promote a restful sleep environment
-promote bedtime rituals (pray, tv, shower)
-offer appropriate bedtime snacks and beverages
-promote relaxation and comfort (back rub, clean gown)
-respect normal sleep-wake patterns
-schedule nursing care to avoid disturbances
-use medications to produce sleep (use PRN orders)
-teach about rest and sleep
-avoid alcohol, caffeine, nicotine
-no exercise 3 hours before bedtime
-no daytime naps
-avoid high fluid in the evenings
-avoid disruptions in circadian rhythms