Chapter 33 Rest and Sleep

Chapter 33Rest and Sleep

Physiology of Sleep • Reticular activating system (RAS) • Facilitates reflex and voluntary movements • Controls cortical activities related to state of alertness • Bulbar synchronizing region • Hypothalamus—control center for sleeping and waking

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Stages of Sleep • Non-rapid eye movement (NREM) • Consists of four stages • Stages I and II: 5% to 50% of sleep, light sleep • Stages III and IV—10% of sleep, deep-sleep states (delta sleep) • Rapid eye movement (REM) • 20% to 25% of a person’s nightly sleep time • Pulse, respiratory rate, blood pressure, metabolic rate, and body temperature increase; skeletal muscle tone and deep tendon reflexes are depressed.

Question In which stage of NREM sleep does the person fall into a stage of sleep but can be aroused with relative ease? A. Stage I B. Stage II C. Stage III D. Stage IV

Answer Answer: B. Stage II Rationale: In stage II of NREM sleep, the person falls into a stage of sleep but can be aroused with ease. In stage I, the person is in a transitional stage between wakefulness and sleep. In stages III and IV, the depth of sleep increases, and arousal becomes increasing difficult.

Sleep Cycle • The person passes consecutively through four stages of NREM sleep. • The pattern is then reversed. • Return from stage IV to III to II • Enter REM sleep instead of re-entering stage I • The person re-enters NREM sleep at stage II and moves on to III and IV.

A Single Normal Sleep Cycle

Factors Affecting Sleep • Developmental considerations • Motivation • Culture • Lifestyle and habits • Environmental factors • Psychological stress • Illness • Medications

Question Tell whether the following statement is true or false. Barbiturates, amphetamines, and antidepressants increase REM sleep. A. True B. False

Answer Answer: B. False Rationale: Barbiturates, amphetamines, and antidepressants decrease REM sleep.

Illnesses Associated With Sleep Disturbances • Gastroesophageal reflux • Coronary artery diseases • Epilepsy • Liver failure and encephalitis • Hypothyroidism • End-stage renal disease

Classification of Sleep Disorders • Dyssomnias • Parasomnias • Sleep disorders associated with medical or psychiatric disorders • Other proposed disorders

Sleep Disorders • Dyssomnias: characterized by insomnia or excessive sleepiness • Parasomnias—patterns of waking behavior that appear during sleep

Dyssomnias • Insomnia • Hypersomnia • Narcolepsy • Sleep apnea • Restless leg syndrome • Sleep deprivation

Question In which of the following sleep disorders does the patient have an uncontrollable desire to sleep? A. Insomnia B. Sleep apnea C. Narcolepsy D. Restless leg syndrome

Answer Answer: C. Narcolepsy Rationale: In narcolepsy, a person can literally fall asleep while performing ADLs. Insomnia is characterized by difficulty falling asleep. Sleep apnea is a condition in which a person experiences the absence of breathing during sleep between snores. Restless leg syndrome is a crawling or tingling sensation in the legs.

Obstructive Sleep Apnea

Parasomnias • Somnambulism • REM behavior disorder (RBD) • Sleep terrors • Nightmares • Bruxism • Enuresis • Sleep-related eating disorder

Question Tell whether the following statement is true or false. Somnambulism is a parasomnia in which the person walks in his or her sleep. A. True B. False

Answer Answer: A. True Rationale: Somnambulism is a parasomnia in which the person walks in his or her sleep.

Treatment for Dyssomnias • Pharmacologic therapy • Sedatives • Hypnotics • Nonpharmacologic therapy • Cognitive Behavioral Therapy (CBT) • Progressive muscle relaxation measures • Stimulus control • Sleep restriction; sleep hygiene measures • Biofeedback and relaxation therapy

Obtaining a Sleep History • Nature of problem • Cause of problem • Related signs and symptoms • When the problem began and how often it occurs • How the problem affects everyday living • Severity of the problem and how it can be treated • How the patient is coping with the problem and success of treatments attempted

Screening Tools to Assess Sleep Disturbances • The Epworth Sleepiness Scale • The Pittsburgh Sleep Quality Index (PSQI) • Sleep Disturbance Questionnaire

Sleep Characteristics to Assess • Restlessness • Sleep postures • Sleep activities • Snoring • Leg jerking

Information Recorded in a Sleep Diary • Time patient retires • Time patient tries to fall asleep • Approximate time patient falls asleep • Time of any awakening during the night and resumption of sleep • Time of awakening in morning • Presence of any stressors affecting sleep

Information Recorded in a Sleep Diary (cont.) • Record of food, drink, or medication affecting sleep • Record of physical and mental activities • Record of activities performed 2 to 3 hours before bedtime • Presence of worries or anxieties affecting sleep

Key Findings of Physical Assessment • Energy level • Facial characteristics • Behavioral characteristics • Physical data suggestive of sleep problems

Common Etiologies for Nursing Diagnoses • Physical or emotional discomfort or pain • Changes in bedtime rituals or sleep environment • Disruption of circadian rhythm • Exercise and diet before sleep • Drug dependency and withdrawal • Symptoms of physical illness

Nursing Interventions to Promote Sleep • Prepare a restful environment. • Promote bedtime rituals. • Offer appropriate bedtime snacks and beverages. • Promote relaxation and comfort. • Respect normal sleep–wake patterns. • Schedule nursing care to avoid disturbances. • Use medications to produce sleep. • Teach about rest and sleep.

Question Which of the following snacks is an appropriate bedtime snack to promote sleep in a patient? A. Candy B. Toast C. Lunchmeat D. Cheese

Answer Answer: B. Toast Rationale: Because carbohydrates seem to promote sleep, there appears to be justification for offering a snack or beverage high in carbohydrates (such as toast or crackers) before bedtime. Candy, lunchmeat, and cheese do not contain carbohydrates.

Chapter 33 Rest and Sleep