Professional Documents
Culture Documents
rest – condition in which the body is in a decreased state of activity, with the
consequent feeling of being refreshed
I. PHYSIOLOGY OF SLEEP
A. CIRCADIAN RHYTHMS - complete a full cycle every 24 hours
- fluctuations in a person’s heart rate, blood pressure, body temperature,
hormone secretions,
metabolism, and performance and mood depend in part on
circadian rhythms
- synchronization exists when an individual’s sleep wake patterns follow
the inner biologic clock
- rhythms are most active when person is awake - rhythms are low
when person is sleeping
- regulating mechanism is person’s individual biologic clock
B. STAGES OF SLEEP
1. NREM Sleep
a. Stage I – transitional stage (5% of total sleep)
- person is in relaxed state but still somewhat aware and can
be aroused easily
- involuntary muscle jerking may occur
C. SLEEP CYCLE – person passes consecutively through four stages, reverses pattern
and enters REM on return
- if person is awakened from sleep at any time, he/she returns to sleep
again by starting at Stage I of
NREM
- most go through 4 or 5 cycles of sleep each night - cycles tend to
become longer as morning nears
- more sleep occurs in delta stage in 1st half of night, especially if one is
tired or has lost sleep
D. SLEEP REQUIREMENTS AND PATTERNS – 8 hrs a night has been accepted standard for
adults; however, each
person follows a pattern of rest that maintains well-being
- on average, infants sleep 14 – 20 hrs ea. day - growing children require
10 – 14 hrs
- those who are able to relax and rest easily, even while awake, find that
less sleep is needed
- fatigue can be considered a normal, protective body mechanism and
nature’s warning that sleep is
necessary
- chronic fatigue is abnormal and often a symptom of illness
- older people often need more time to fall asleep, wake earlier and more
frequently during the night,
and are less able to cope with changes in sleep patterns
- many take a nap during the day resulting in fewer hours of sleep
at night
6. Young Adults – average amt of sleep required 8 hrs, many require less
- sleep is affected by many factors (physical health, type of
occupation, exercise, lifestyle
demands)
- REM sleep averages about 20% of sleep
B. PSYCHOLOGICAL STRESS
- generally affect sleep in two ways:
person experiencing stress may find it difficult to obtain amount of
sleep he/she needs
REM sleep decreases in amount, adding to anxiety and stress
C. MOTIVATION
- a desire to be wakeful and alert helps overcome sleepiness and sleep
- minimal motivation to be awake, sleep generally follows
E. ENVIRONMENTAL FACTORS
- most people sleep best in their usual home environments
- sleeping in a strange or new environment tends to influence both REM
and NREM
- people accustomed to sleeping in a noisy environment have a hard time
falling asleep in an area that
is extremely quiet (visa versa)
F. ILLNESS
- gastric secretions increase during REM sleep
- many with peptic ulcers wake at night with pain
- eating a snack or using antacids to neutralize acidity relieves
discomfort and promotes sleep
- pain associated with coronary artery disease and MI is more likely with
REM sleep
- epilepsy seizures are more likely to occur during NREM and appear to be
depressed by REM
- liver failure and encephalitis tend to cause reversal in day-night
sleeping habits
- hypothyroidism tends to decrease amt of NREM, especially Stages II and
IV
- certain treatments for disease are more effective when body rhythms
are taken into account
- larger midafternoon dose of asthma med may be more effective in
preventing attacks commonly
occurring during sleep
- antihypertensive med administration may need to be adjusted to
provide peak protection during early
morning hours
- cancer chemotherapy appears less toxic when administered at certain
times of day
- biologic rhythms may influence drug tolerance and med effectiveness
G. MEDICATIONS
- drugs that decrease REM include barbiturates, amphetamines, and
antidepressants
- drugs that cause sleep problems include diurtetics, antiparkinsonian
drugs, some antidepressants
and antihypertensives, steroids, decongestants, caffeine, and
asthma meds
- chloral hydrate and zolpidem tartrate (Ambian) appear to influence
quality of sleep and promote
normal sleep
Common Features:
sleep attacks = irresistible urge to sleep regardless of type of
activity person is engaged
cataplexy = sudden loss of motor tone
hypnagogic hallucinations = nightmares or vivid hallucinations
sleep-onset REM periods = during a sleep attack, person moves
directly into REM
sleep paralysis = skeletal paralysis that occurs during transition
from wakefulness to sleep
3. Physical Assessment
a. Snoring – caused by obstruction to airflow through nose and mouth
- not ordinarily a sleeping disorder but accompanied by
apnea can present a problem
- changes from characteristic sawing-wood sound to more
irregular silence followed
by a snort indicates obstructive apnea
B. DIAGNOSING / ANALYSIS
- sleep data indicate problem, contribute to different problem or are signs
or symptoms of problem
- no diagnoses is more correct than the other
- with each patient, nurse must review each cluster of significant data
and identify the key problem,
contributing factors, and related signs and symptoms
C. PLANNING
- rest and sleep are essential components of well-being
- planning with patient suitable measures to promote rest and sleep
D. IMPLEMENTING
- in most cases, sleep problems are not primary reason for healthcare
- communicating with patient while displaying nonjudgmental caring
attitude is key to detecting sleep
problem
E. EVALUATION
- care is considered effective if patient is able to
• verbalize feeling rested or having had a restful night’s sleep
• identify factors that interfere with or disrupt normal sleep pattern
• use techniques that promote sleep and provide a restful
environment
• concentrate and function effectively during waking hours
• eliminate behaviors related to sleep deprivation