Rest and Sleep: Foundations of Nursing

Nursing 111Foundations of Nursing

Nancy Duphily

Rest and Sleep

• Rest: state in which motor/cognitive response decreased, awareness of environment maintained

• Sleep: naturally occurring altered state of consciousness characterized by decreased awareness

and responsiveness to stimuli

Functions of Sleep

• Returns the body to its physiological and psychological state

• Slows the functions of the body• Repairs epithelial and brain cells• Increases protein synthesis, cell division,

tissue renewal

Functions of Sleep

• Helps the body to conserve energy (BMR decreases)

• Increases oxygen, leading to increased cerebral blood flow, improved memory,

increased learning Moral: Get sleep before a test!

Sleep Regulation

• Reticular Activating System (RAS)

• Bulbar Synchronizing Region

Sleep Deprivation Symptoms

• Decreased reflexes,response time,judgment, hearing and sight, motivation

• Cardiac Arrhythmias• Irritability• Confusion• Agitation

Sleep Cycle Changes

• Stage I NREM :light sleep, short stage, decreased vital signs, noise awakens one easily; “daydreaming”

• Stage II NREM : Sound sleep; 10-20 minutes; increased relaxation

• Stage III NREM: Begins deep sleep; decreased movement; decreased vital signs; last 15-30 minutes

Sleep Cycle Stages

• Stage IV NREM: Deepest sleep; difficult to awaken; 15-30 minutes; sleepwalking and bedwetting can happen here

• REM Sleep: dreams (color); changes in vital signs; begins ninety minutes after the start of sleep; difficult to awaken; averages 20 minutes

• 1-2-3-4-3-2-REM typical cycle

Diagnostic Sleep Tests

• Polysomnogram• EEG: electroencephalogram• EMG: electromyogram• EOG: electrooculogram

Factors Affecting Sleep

• Excessive Daytime Sleepiness (EDS)• Exercise and Fatigue• Food and Caloric Intake• Physical Environment• Illnesses• Substances• Stress

Conditions For Proper Rest

• Physical Comfort• Freedom from worry• Sufficient sleep

Sleep Requirements Across the Life Span

• Newborns/Infants• Toddlers• Preschool• School age

Sleep Requirements Across the Life span

• Adolescents

• Adults

• Elderly

Sleep Assessment

• Daily exercise• Sleep Cycle• Sleep Environment• Food and Fluids• Relaxation /Exercise• Coping, stress• Vocation

Nursing Diagnosis:Disturbed Sleep Pattern

• PLAN,IMPLEMENTATION:• Client Teaching( sleep hygiene,medication• Support Bedtime Rituals• Creating a Restful Environment• Promote Comfort and Relaxation• EVALUATION: client describes measures to

induce sleep

Sleep Medications

• Sedative- Hypnotic Medications• Antianxiety Medications• Onset and Duration• Effect on NREM,REM Sleep• Dosing• Medication Dependency

Common Sleep Disorders

• Parasomnia: behavior interfering with sleep or that occurs with sleep

• Primary disorders: the client’s sleep problem is the main disorder

• Secondary disorders; sleep disturbances caused by other clinical conditions

Parasomnias

• Arousal disorders: sleepwalking, sleep terrors• Sleep wake transition disorders: sleep talking• REM sleep disorders: nightmares• Other: bruxism,nocturnal enuresis, periodic

limb movements

Primary Sleep Disorders

• Insomnia• Hypersomina• Narcolepsy• Sleep Apnea• Sleep Deprivation

Secondary Sleep Disorders

• Depression• Alcoholism• Dementia• Parkinson’s disease• COPD• Thyroid disease

Question: What is Sleep?

Sri Ramana Maharishi: “How can you know sleep when you are awake? The answer is to go to sleep and find out what it is.”

Q: “But I cannot know it in this way.”Maharishi: “This question must be raised in sleep.” Q: “But I cannot raise the question then.”Maharishi: “So that is sleep”.