Sleep Basics for Health Promotion Barbara B. Richardson, PhD

1. Sleep Basics for Health Promotion Barbara B. Richardson, PhD

2. Learning Objectives • Describe normal developmental sleep changes across the lifespan • Identify normal sleep patterns and common sleep disorders • Describe potentially adverse health outcomes associated with inadequate sleep

3. Learning Objectives • Integrate knowledge of sleep when completing a health assessment, nursing care plan, and patient education. • Evaluate environmental factors and describe nursing interventions to promote sufficient sleep

4. What is sleep? • Sleep is a dynamic and regulated set of behavioral and physiological states during which many processes vital to health and well-being take place.

5. Why is sleep important? • Sufficient sleep is essential for maintaining optimal physical health, mental and emotional functioning, and cognitive performance. • Inadequate sleep time and poor quality sleep interfere with quality of life and can be hazardous to health

6. 1Sleep homeostasis or internal drive, exact mechanism unknown Pressure to sleep increases throughout the day until an internal threshold is crossed causing sleep to occur Waking occurs when homeostatic drive decreases sufficiently to cross opposite threshold 2Circadian rhythms Refers to cyclical changes that occur over a 24 hour period driven by an internal “biological clock” located in the brain in the suprachiasmatic nucleus (SCN) Synchronized to external physical environment Current Theory Suggests a 2-Process Model of Sleep/Wake Regulation

7. Sleep Across the Life Span

8. Developmental Patterns of Sleep • All aspects of sleep behavior across the lifespan demonstrate a large degree of variability among individuals and across cultures • Sleep patterns are shaped by intrinsic biological processes and psycho-social factors such as cultural norms, family values, school, and work.

9. NewbornandInfant Sleep • Newborn sleep has 2 stages;50% “quiet or non-rapid eye movement (NREM) sleep” and 50% “active or rapid eye movement (REM) sleep” • Total sleep time = 16 to 17 hours / 24 hour period with frequent awakenings for feeding and nurturing

10. Children Ages1-5 Years • Amount of total sleep time decreases to ~11 to 13 hours / 24 hour period • Generally sleep through the night • Nap during the day as needed

11. Sleep in Middle Childhood (5-12 years) • Total sleep time 10-12 hours • May experience parasomnias(sleep problems) such as enuresis (bedwetting), nightmares, and sleep walking

12. Sleep in Adolescents(12-18 years) • Need ~9 hours of nightly sleep for optimal health, emotional well being, and cognitive functioning • Often experience delayed sleep phase syndrome …. can’t go to sleep until late at night and prefer to sleep later in the morning • Frequently do not get sufficient sleep

13. Sleep in Adulthood • Generally need 7.5 to 8 hours of nightly sleep • Increasing frequency of problems sleeping including common sleep disorders such as obstructive apnea, insomnia, and restless leg syndrome

14. Sleep in Aging Adults(65+ years) • Still need ~7 to 8 hours of total sleep time… may decrease to as little as 6 hours a night with naps common during the day • Increased number of nighttime awakenings • Frequently awaken very early in the morning • Sleep may be impacted by illness and medications

15. Assessing Sleep • Always include questions about sleep when assessing health status (except in emergency situations) • Inquire about number of hours client generally sleeps (quantity) and how well he/she usually sleeps (quality). • Whenever possible, observe (in a hospital or care facility) and record client’s sleep patterns

16. Use standardized sleep assessment tool if possible • Using a survey to inquire about a client’s normal sleep patterns encourages a thorough assessment including: • Sleep environment • Quality of sleep • Amount of sleep • Problems associated with sleep

17. If Standardized Assessment is Not available, use BEARS* Sleep Assessment as a guide • B - bedtime problems? • E - excessive sleepiness during the day? • A - awakenings at night? • R - regularity of sleep (number of hours)? • S - sleep disorders…including sleep apnea and snoring • Also, may inquire about lifestyle factors impacting sleep such as work schedule, alcohol use, illness, medications, bed sharing arrangements, etc….

18. Sleep problems can be associated with many conditions including: • Stress and environmental factors • Pregnancy • Menopause • Chronic pain • Major depression • Chronic illnesses such as cancer, cardio-pulmonary disease, and Alzheimer’s

19. Impaired Sleep and Adverse Health Outcomes • Adverse health outcomes resulting from insufficient sleep include physiological, behavioral / cognitive, emotional, and/or social responses. • Physiological outcomes include increased risk for obesity, hypertension, and impaired immune system functioning

20. Impaired Sleep and Adverse Health Outcomes • Inadequate sleep impacts behavior in children and adults and may result in impaired daytime functioning, including decreased school or work place performance due to decreased alertness, poor memory, and impaired problem solving. • Insufficient sleep may be a factor in sports related and automobile accidents. • Not enough sleep may lead to use of caffeine and other stimulants to maintain wakefulness

21. Common Sleep Problems • Parasomnias – include sleepwalking, bed wetting, nightmares and night terrors (all common in children), nocturnal sleep related eating disorders, and bruxism (teeth grinding) • Sleep disorders – include insomnia, obstructive sleep apnea, restless leg syndrome, and narcolepsy

22. Insomnia • Defined as trouble falling asleep or staying asleep • May be due to stress, anxiety, hormonal changes, lifestyle, environmental factors, physical ailments, or psychiatric illness • May be transient (lasting less than 4 weeks), short term (1-6 months) or chronic (> 6 months)

23. Obstructive Sleep Apnea (OSA) • During sleep, breathing pauses or stops for 10-20 seconds or more, 20-30 times an hour. Oxygen levels in blood drop, normal breathing starts again with a loud snort. • Results in excessive daytime sleepiness • Often associated with overweight / obesity • Can be treated with continuous positive airway pressure (CPAP)

24. Restless Leg Syndrome • Neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move when resting as an attempt to relieve these feelings. • Causes difficulty falling asleep • Cause unknown, difficult to treat

25. Narcolepsy • Chronic neurological disorder caused by the brain’s inability to regulate sleep-wake cycles normally. Cause unknown. • Characterized by frequent urges to sleep occurring anytime. • Can be disabling due to involuntarily falling asleep at school, work, or anywhere. • Cannot be cured, may be treated with various medications

26. Treatment of Sleep Problems • Behavior modification programs, hypnosis, or meditation may be effective • Self-prescribed over-the-counter sleep aids • Prescription medications

27. Sleep Medications Over the counter medications include: • antihistamines or drugs containing diphenhydramamine hydrochloride • diphenhydramine citrate • doxylamine succinate

28. OTC Sleeping Aids • Not intended for long term use • May interfere with alertness during the day so should avoid driving or other potentially dangerous activities • Reduce the quality of sleep by decreasing the amount of time spent in deep sleep

29. Prescription Medications • Must be used at the direction of a physician • Often do not cure the cause of sleeping problems, just help alleviate the symptoms • Can be addictive / become drug dependent • May cause physical side effects • May interact with other medications or alcohol

30. Prescription Medications Primary classes include: • Short acting sedatives; hypnotics (Ambien, Sonata, Lunesta) • Melatonin receptor agonists (Rozerem) • Benzodiazepines; tranquilizers (Dalmane, Restoril, ProSom) • Sedating anti-depressants (Desyrel)

31. To Get a Good Night’s Sleep – Practice Good Sleep Hygiene! • Maintain a regular sleep / wake schedule whenever possible … even on weekends and vacations • Avoid napping during the day, especially after 3pm. Limit naps to < 1 hour. • Establish a regular, relaxing bed time routine

32. Guidelines For Better Sleep • Exercise regularly – but not within 2 hours of sleep • Avoid eating large meals just before going to sleep • Avoid caffeinated beverages, particularly after lunch • Avoid the use of alcohol and nicotine as these substances can disrupt sleep

33. Environmental Factors Impacting Sleep • Light – exposure to light inhibits ability to fall asleep and bright light in the morning can shorten sleep • Noise – traffic, TV, music, phones, and computers can disturb sleep • Bed sharing • Room temperature (too hot or too cold can inhibit sleep)

34. Good sleep promotes good health • Assess sleep patterns and sleeping environment • Implement nursing interventions to promote adequate sleep

35. Resources • www.sleepfoundation.org • www.aasmnet.org • www.bettersleep.org • www.sleepresearchsociety.org • www.sleepandhealth.com • www.kidzzzsleep.org

36. Books • Bellenir, K. (Ed.).(2008). Sleep information for teens. Detroit, MI: Omnigraphics. • Mindell JA, Owens JA. (2003). A clinical guide to pediatric sleep: diagnosis and management of sleep problems. Philadelphia, PA: Lippincott Williams & Wilkins.

37. Books • Sleep Research Society Basics of Sleep Guide. 2005. Sleep Research Society, Westchester, IL. • Yager, J. & Thorpy, M. (2001). Sleeping well: The sourcebook for sleep and sleep sisorders. Publisher: Facts on File. ISBN: 9780816040902

38. ContactInformation Barbara B. Richardson, PhD barbrichardson@comcast.net