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Tangela Hales

on 27 October 2014

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Transcript of SLEEP-REST

Circadian Rhythm
Sleep is one of the body's most complex biological rhythms.
Circadian Rhythm-completes a full cycle every 24 hours.
Circadian synchronization exists when an individual's sleep-wake patterns follow the inner biologic clock.
Person is awake when physiologic and psychological rhythms are high or most active.
Person is sleep when rhythms are low.
Light and darkness are powerful regulators of sleep.
Stages of Sleep
NREM Stage I
The person is in a transitional stage between wakefulness and sleep.
The person is in a relaxed state but still somewhat aware of the surroundings.
The stage normally lasts only minutes.
The person can be aroused easily.
The person can be aroused with relative ease.
This stage constitutes 50% to 55% of sleep.
The depth of sleep increases, and arousal becomes increasingly different.
This stage composes about 10% of sleeps.
The person reaches the greatest depth of sleep, which is called delta sleep (slow-wave,deep).
Arousal from sleep is difficult.
Physiologic changes in the body include the following:
Slow brain waves are recorded on an EEG.
Pulse and respiratory rates decrease.
Blood pressure decreases.
Muscles are relaxed.
Metabolism slows and the body temperature is low. This constitutes about 10% of sleep.
Factors Affecting Sleep
Alcohol intake
Caffeine-containing beverages
Emotional State
Environmental Factors
Exercise and Fatigue
Caloric Intake
Sleep Requirements and Patterns
8 hours of sleep accepted standard for adults
*Important that each person follows a pattern of rest that maintains well-being*
*Box 34-2 Developmental Patterns of Sleep pg. 1085-1086*
School-Aged Children
Young adults
Middle-aged adults
Older adults
Common Sleep Disorders
Dyssomnias- sleep disorders characterized by insomnia or excessive sleepiness.
Parasommnias-patterns of waking behavior that appear during sleep.
Characterized by difficulty falling asleep, intermittent sleep, or early awakening from sleep.
most common of all sleep disorders.
People usually over the age of 60, women, hx of depression are more likely to have insomnia.
Stressful periods, change in environment.
usually feel tired, lethargic, and irritable during the day; difficulty concentrating.
Sleep hygiene practices
Sleep Hygiene
Restrict the intake o caffeine, nicotine, and alcohol.
Avoid activities after 5 p.m. that are stimulating.
Avoid naps.
Eat a light meal before bedtime.
Sleep in a cool, dark room.
Eliminate the use of a bedroom clock.
Take a warm bath before bedtime.
Try to to keep the sleep environment as quiet as possible.

Characterized by excessive sleep, particularly during the day.
Person may fall asleep for intervals during work, while eating, or even during conversations.
When they are awake, they are often disoriented, irritated, restless, and have slower speech and thinking processes.
Drug or alcohol abuse
CNS injury or head trauma
Effects of certain medications
other medical conditions
A condition characterized by an uncontrollable desire to sleep.
Considered a neurologic disorders.
About 2.4 million people in the U.S. have this disorder.
Sleepiness during the day is often the first symptom.
Common features:
Sleep attacks: irresistible urge to sleep, regardless of activity in which you are engaged in.
Cataplexy: sudden loss of motor tone that may cause the person to fall asleep; usually experienced during a period of strong emotion.
Hypnagogic hallucinations: nightmares or vivid hallucinations.
Sleep-onset REM periods: during sleep attack, the person moves directly to REM sleep.
Sleep paralysis: skeletal paralysis that occurs during the transition from wakefulness to sleep.
Sleep Apnea
A condition in which a person experiences the absence of breathing (apnea) or diminished breathing effors (hypoapnea) during sleep between snoring intervals.
Breathing may cease for 10-20 seconds, possibly as long as 2 minutes.
During long periods of apnea, the oxygen level drops, the pulse becomes irregular, and the bp often increases.
More common in obesity, and middle-aged men that have short necks.
Obstructive sleep apnea (OSA)- when the airway is occluded.
Restless Leg Syndrome
Condition in which people cannot lie still and report unpleasant, creeping, crawling, or tingling sensations in the legs.
Usually felt in the calf, but can may occur anywhere from the ankle to the thigh.
Clients describe an irresistible urge to move legs when these symptoms occur, usually during the evening and the night.
URGE-Urge to move legs, Rest-induced, Gets better with activity, Evening symptoms more severe.
TREATMENT: eliminate caffeine, tobacco, and alcohol; take a mild analgesic, apply heat or cold to extremities, use relaxation techniques.
Ropinirole (requip) has been approved by the FDA to treat restless leg syndrome.
Sleep Deprivation
Refers to a decrease in the amount, consistency or quality of sleep.
Many causes.........
Progress from irritability, impaired mental abilities, to total personality change.
The effects are increasingly apparent after 30 hours of continual wakefulness.
The strange environment of a hospital, physical discomfort and pain, the effects of medication, and the need for 24 -hour nursing care may also contribute to sleep deprivation in hospitalized clients.
Patterns of waking behavior that appear during REM or NREM stages of sleep.
Common examples:
Somnambulism (sleepwalking)
Sleep talking
Night terrors (screaming upon awakening due to a perceived threat).
Bruxism-grinding of teeth during sleep.
Enuresis-urinating during sleep.
The Nursing Process for Rest and Sleep
Sleep history
Observation for behaviors of sleep deprivation.
Nursing Diagnosis
Sleep Pattern Disturbances
Risk for Injury
Altered Thought Processes
Ineffective Coping
Goal will be made to promote normal, restful sleep for clients having sleep disturbances and /or difficulties.
Prepare a restful environment.
Promoting bedtime rituals or routines.
Offering appropriate bedtime snacks and beverages.
Promoting relaxation.
Promoting relaxation.
Promoting comfort.
Respecting normal sleep-wake patterns.
Schedule nursing care to avoid unnecessary disturbances.
Teaching about rest and sleep.
Determines whether the interventions have promoted a normal sleep pattern, minimized sleep deprivation symptoms, and improved client understanding of how to promote sleep.
Sweet Dreams!
REM Sleep
Eyes dart back and forth quickly.
Metabolism increases; body temperature increases.
Rapid or irregular pulse.
Metabolism increases; body temperature increases.
Arousal from sleep difficult.
Constitutes about 20% to 25% of sleep.
People awakened from REM sleep report that they have been dreaming and can vividly recall their dreams.
Stages of Sleep
Two major stages of sleep:
Non-rapid eye movement (NREM)
Rapid eye movement (REM)
These stages have been studied and analyzed by the:
electroencephalograph (EEG)-receives and records electrical currents from the brain.
electrooculogram (EOG)-records eye movements.
Electromyograph-records muscle tone.
Sleep Medications
Commonly used for patients.
Often ordered p.r.n.
When used to induce sleep, the drugs have the potential to induce daytime drowsiness, a morning hangover effect, and physical and psychological dependence.
Tangela Hales, PhDc, RN
Rest-a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed.
Many factors influence a person's rest:
juggling job and family responsibilities
nursing school
environment, etc.
Sleep- a state of rest accompanied by altered consciousness and relative inactivity.
a complex rhythmic state involving a progression of repeated cycles, each representing a phase of body and brain activity.
Physiology of Sleep
Reticular activating system (RAS)
Facilitates reflex and voluntary movements
Controls cortical activities related to state of alertness
Two systems in the brain stem that work together to control the cyclic nature of sleep.
Hypothalamus-control center for sleeping and waking.
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