PROMOTING REST & SLEEP
KRISTINE JOY L. RICAFORT-ACERA
REST
Diminished state of activity
Calmness
Relaxation without emotional stress
Freedom from anxiety
SLEEP
State of consciousness in which the individual’s
perception and reaction to the environment are
decreased
Characterized:
Minimal physical activity
Variable level of consciousness
Changes in body’s physiologic processes
Decreased responsiveness to external EV
PHYSIOLOGY OF SLEEP
Biorhythms
Circadian (Circa dies –about a day)
Circadian synchronization
Awake-physiological& psychological rhythms are active
REGULARITY – 3rd week of life
STAGES OF SLEEP
NREM
Slow-wave sleep
Deep, restful sleep
↓ some physiologic functions (↓ VS, metabolism,
U& muscle action)
STAGE I –VERY LIGHT SLEEP
Drowsy & relaxed, eyes roll from side to side, HR &
RR slightly drop, can be readily awakened
STAGE II-LIGHT SLEEP
Eyes are still, HR & RR slightly & body temperature
falls
10-15 but constitute 40-45% of total of sleep
STAGE III –
HR & RR, body processes slows further
More difficult to arouse
Not disturbed by sensory stimuli
Skeletal muscles are very relaxed
Reflexes are diminished
Snoring
STAGE IV DEEP SLEEP
Delta sleep
HR & RR drops 20-30% (Waking hours)
Very relaxed, rarely moves, difficult to arouse
Restore the body physically
Eyes roll * some dreams occur
REM
Occurs every 90 minutes & last 5-30 minutes
Most dreams occur (remember)
Brain- highly active & brain metabolism ↑ 20%
Paradoxical sleep
Difficult to arouse or may awake spontaneously,
muscle tone is depressed, gastric secretions ↑,
HR & RR irregular
SLEEP CYCLES
NREM & REM – lasting 1.5 hours in adults
STAGE I, STAGE II & STAGE III -20-30 minutes
STAGE IV – 30 minutes
Back to NREM STAGE III and II -20 minutes
1st REM occur –10 minutes
4-6 cycles in 7-8 H
Function
To cope with daily stresses
Prevent fatigue
Conserve energy
Restore mind and body (NREM)
Enjoy life fully
Increase in synthetic processes in the brain (REM)
PATTERNS OF SLEEP
Newborn-16-18 H divided into 7 sleep periods
INFANTS- 22H a day (12-14 H in other)
TODDLERS -10-12 hours
PRESCHOOL – 11-12 hours
SCHOOL AGE-8-12 hours
ADOLESCENTS- 8-10 hours
YOUNG ADULTS- 7-8 hours
MIDDLE ADULTS- 6-8 hours
OLD ADULT- 6 hours
FACTORS AFFECTING SLEEP
ILLNESS
ENVIRONMENT
FATIGUE
LIFESTYLE
EMOTIONAL STRESS
STIMULANTS & ALCOHOL
DIET –wt. loss ↓ sleep wt. gain ↑ sleep
SMOKING
MOTIVATION
MEDICATIONS
SLEEP DISORDERS
PARASOMIAS
Behavior that may interfere with sleep and may even occur
during sleep
SOMNAMBOLISM (Sleep walking)
NIGHT TERRORS (after having slept for few hours, one bolts
upright in bed, shakes and screams, appears pale &
terrified)
NOCTURNAL ENURESIS (bedwetting)
SOLILOQUY (sleeptalking)
NOCTURNAL ERECTIONS (wet dreams)
BRUXISM (clenching & grinding of teeth during sleep)
PRIMARY SLEEP DISORDERS
INSOMIA –inability to obtain an adequate amount
or quality of sleep
TYPES:
Difficulty in falling asleep (initial insomnia)
Difficulty in staying asleep due to frequent/prolonged
waking (intermittent or maintenance insomnia)
Early morning/ premature waking (terminal insomnia)
Result of mental overstimulation due to anxiety
PRIMARY SLEEP DISORDERS
HYPERSOMNIA- excessive sleeping (daytime)
Medical condition (CNS damage0
NARCOLEPSY – Greek NARCO (numbness) LEPSIS (seisuze)
“SLEEP ATTACK”
Lack of hypocretin in CNS-regulate sleep
SLEEP APNEA –cessation of breathing during sleep
Obstructive-structures of the pharynx/ oral cavity block the
flow of air
Central –defect in respiratory center of the brain
Mixed – combination
SLEEP DEPRIVATION – prolonged disturbance in
amount, quality, & consistency of sleep
NURSING MANAGEMENT
ASSESSING
Sleep history
When do you usually sleep? Usually wake? Nape? For children, bedtime
rituals
Do you have any problems with sleep? Has anyone told you that you
snore? Are you able to stay awake at work? Driving? Usual activities?
Medications? OTC meds/herbal?
Is there anything I need to know about your sleep?
Health history
Obtained to rule out medical/psychiatric causes of the client’s difficulty
sleeping
P.E.
Facial appearance, behaviors, & energy
Obesity (adults)
Sleep diary
Time of going to bed?
Instances of waking up and duration of periods?
Waking up in the morning
Naps & duration?
Activities 2-3 hours before bedtime
Caffeinated and alcoholic drinks?
Factors that the client believes have a positive or negative effect on
sleep
Diagnostic studies
Polysomnography
Electroencephalogram (EEG)
Electromyogram (EMG)
NURSING DIAGNOSIS
Fatigue related to insufficient sleep
Anxiety related to sleep apnea and or the diagnosis of a
sleep disorder
Activity intolerance related to sleep deprivation or excessive
daytime sleepiness
Risk for injury related to somnambolism
Ineffective coping related to insufficient quality and quantity
of sleep
Risk for impared gas exchange related to sleep apnea
Deficient knowledge (nonprescription remedies for sleep)
related to misinformation
PLANNING
GOAL:
Maintain a sleeping pattern that provides sufficient energy for daily
activities
Enhancing the client’s feeling of well-being
Improving quality and quantity of sleep
IMPLEMENTATION
Adequate exercise -2 hours before bedtime
High protein food (tryptophan)
Observe habits of sleep periodocity and wake-up time
Go to bed when sleepy
Use bed for sleep
SUPPORTIVE BEDTIME RITUALS
Listening to music
Readings soothing bath
Praying
CREATING RESTFUL ENVIRONMENT
Minima; noise
Comfortable room temperature
Appropriate ventilation
Appropriate lighting
PROMOTING COMFORT & RELAXATION
Provide loose-fitting nightwear
Assist client with hygienic routine
Bed linens are smooth & clean & dry
Encourage client to void before bedtime
Offer back massage
Positioning