Assessment in Sleep and Rest Needs

The nurse should inquire if the client feels he is getting enough sleep and rest.

Questions should focus on specific sleep patterns, such as how many hours a night the

person sleeps, interruptions, whether the client feels rested, any problems sleeping

(e.g., insomnia), what ritual the client uses to promote sleep, and any concerns the

client may have regarding sleep habits. Some of this information may have already

been presented by the client, but it is useful to gather data in a more systematic and

thorough manner at this time. Inquiries about sleep can bring out problems, such as

anxiety, which manifests as sleeplessness, or inadequate sleep time, which can

predispose the client to accidents. Compare the client’s answers with the normal sleep

requirement for adults, which is usually between 5 and 8 hours a night. However,

sleep requirements vary depending on age, health, and stress levels.

Focus Assessment Criteria on Sleep Disturbance

Subjective Data

A. Assess Characteristic Limitation

1. Sleep pattern (now, past)

Mention sleep on 1-10 scale (10=can take a rest, be fresh)

Usual sleep time and wake up time

Difficulty to sleep and wake up

2. Sleep need

To decide total sleep that is needed, let him sleep until wake up in the morning

(without alarm). This must be done for few days. After that, calculate total sleep

time (minus 20-30 minutes). The result is the time that he needs to sleep for usual.

3. Existence of symptoms history

Complains: lack of sleeping, anxiety, sensitivity, depression, scare (bad

dream, dark, maturational situation)

Onset and duration

Location

Description (dicetuskan oleh? Diperberat oleh? Decreased by?)

B. Assess Related Factors

1. Interruption

Noise

Journey schedule

Elimination need

2. Usage of sleeping aid or sleep ritual

Taking a bath with warm water

Pillow

Toys, books

Eat, drink

Positions

Medicines

3. Take a nap (frequency, duration)

Objective Data

A. Assess Characteristic Limitation

1. Physical characteristic

Appearance (pale, dark around eyes circle, concave eyes)

Menguap

Feels sleepy all day long

Decrease of vision range

Sensitivity

Assessment Questions about Sleep Disturbances

How would you describe your sleeping problem? What changes have occurred

in your sleeping pattern? How often does this happen?

Do you have difficulty falling asleep?

Do you wake up often during the night? If so, how often?

Do you wake up earlier in the morning than you would like and have difficulty

falling back to sleep?

How do you feel when you wake up in the morning?

Do you sleep more than usual? If so, how often do you sleep?

Do you have periods of overwhelming tiredness? If so, when does this

happen?

Have you ever suddenly fallen asleep in the middle of a daytime activity? If

so, has any muscle weakness or paralysis occurred?

Has anyone ever told you that you snore, walk in your sleep, talk in your

sleep, or stop breathing for a while when sleeping?

What have you been doing to deal with this sleeping problem? Does it help?

What do you think might be causing this problem? Do you have any medical

condition that might be causing you to sleep more (or less)? Are you receiving

medications for an illness that might alter your sleeping pattern? Are you

experiencing any stressful or upsetting events or conflicts that may be

affecting your sleep?

How is your sleeping problem affecting you?

Assessing

Assessment relative to a client’s sleep includes a sleep history, a sleep diary, a

physical examination, and a review of diagnostic studies.

Sleep history

Usual sleeping pattern, specifically sleeping and waking times; hours or

undisturbed sleep; quality of or satisfaction with sleep (e.g., effect on energy

level for daily functioning); and time and duration of naps.

Bedtime rituals performed to help the person fall asleep (e.g., a glass of hot

fluid, reading or other method of relaxing, and special equipment or

positioning aids).

Use of sleep medication and other drugs. Sleep can be disturbed by a variety

of drugs, such as stimulants or steroids, if they are taken close to bedtime.

Hypnotics and sedating antidepressants may cause excessive daytime

sleepiness.

Sleep environment (e.g., dark room, cool or warm temperature, noise level,

night-light).

Recent changes in sleep patterns or difficulties in sleeping.

If the client indicates a recent pattern change or difficulties in sleeping, a more

detailed history is required. This detailed history should explore the exact nature of

the problem and its cause, when it first began and its frequency, how it affects daily

living, what the client is doing to cope with the problem, and whether these methods

have been effective.

Sleep Diary

Sometimes clients with a sleeping problem can provide more precise

information if they keep a written record of their sleep pattern and the habits

associated with it. Such a sleep diary or log can be kept by clients who are sleeping at

home and should b maintained for at least 1 week. A sleep diary may include all or

selected aspects of the following information that pertain to the client’s specific

problem:

Total number of sleep hours per day

Activities performed 2 to 3 hours before bedtime (type, duration, and time)

Bedtime rituals (e.g., ingestion of food, fluid, or medication) before going to

bed

Time of (a) going to bed, (b) trying to fall asleep, (c) falling asleep

(approximate), (d) any instances of waking up and duration of these periods,

and (e) waking up in the morning

Any worries that the client believes have a positive or negative effect on sleep

Keeping such a diary may become stressful for some clients and further affect

their sleep. The nurse needs to advise the client to obtain the assistance of a bed

partner in keeping the diary or to discontinue the diary if it presents a problem. When

a diary is completed, the nurse and client can develop flowcharts or graphs that will

assist in organizing the data and identifying the specific problem.

Physical Examination

Examination of the client includes observation of the client’s facial

appearance, behavior, and energy level. Darkened areas around the eyes, puffy

eyelids, reddened conjunctiva, glazed or dull-appearing eyes, and limited facial

expression are indicative of sleep insufficiency. Behaviors such as irritability,

restlessness, inattentiveness, slowed speech, slumped posture, hand tremor, yawning,

rubbing the eyes, withdrawal, confusion, and incoordination are also suggestive of

sleep problems. Lack of energy may be noted by observing whether the client appears

physically weak, lethargic, or fatigued.

In addition, the nurse assesses whether the client has a deviated nasal septum,

enlarged neck, or is obese. These findings may be associated with obstructive sleep

apnea or snoring.

Diagnostic Studies

Sleep is measured objectively in a sleep disorder laboratory by

polysomnography: an electroencephalogram (EEG), electromyogram (EMG), and

electro-oculogram (EOG) are recorded simultaneously. Electrodes are placed on the

center of the scalp to record brain waves (EEG), on the outer canthus of each eye to

record eye movement (EOG), and on the chin muscles to record the structural

electromyogram (EMG). The following may also be monitored, depending on

findings of the initial interview; respiratory effect and airflow, ECG, leg movements,

and oxygen saturarin. Oxygen saturation is determined by monitoring with a pulse

oximeter, a light-sensitive electric cell that attaches to the ear or a finger. Oxygen

saturation and ECG assessments are of particular importance if sleep apnea is

suspected. Through polysomnography, the client’s activity (movements, struggling,

noisy respirations) during sleep can be assessed. Such activity of which the client is

unaware may be the cause of arousal during sleep.