@ Wolters Kluwer Rest, Sleep, and Wakefulness “Rest refers toa condition in which the body is In 2 ‘decreased state of activity, with the consequent feeling of being refreshed ‘Sleep is a state of rest accompanied by altered ‘consciousness and relative inactivity ‘Sleep is part of what is called the sleep-wake cycle ‘Sleep is a period of inactivity and restoration of mental and physical function “Wakefulness is a time of mental activity and eneray ‘expenditure 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 anc wakingStages of Sleep + Non-rapld eye movement (NREM) Consists of four stages «Stages I and Il: 5% to 50% of sleep, light sleep * Stages Il and IV—10% of sleep, deep-sleep states Galt sleep) “© Rapid eye movement (REM) © 20% to 25% of a person's rightly sleep time Pulse, respiratory rate, blood pressure, metabolic rate, ‘and body temperature Increase; skeletal muscle tone ond Seep tendon reflexes are depressed Question #1 In which stage of NREM sleep does the person fall into a stage of sleep but can be aroused with relative ease? A, Stage 1 B. Stage II C. Stage 111 D. Stage IvAnswer to Question #1 Answer: B. Stage I 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 ina transitional stage between wakefuiness and sleep. In stages III and 1V, the depth of sleep increases, and arousal becomes increasingly 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 I © Enter REM sleep instead of re-entering stage I ‘The person re-enters NREM sleep at stage II and moves on to Ill and 1V. A Single Normal Sleep CycleQuestion #2 Tell whether the following statement is true or false. Barbiturates, amphetamines, and antidepressants Increase REM sleep. A True 8. False Answer to Question #2 Answer: B. False Rationale: Barbiturates, amphetamines, and antidepressants decrease REM sleep. Effects of Insufficient Sleep “May affect normal growth and development in children “May increase obesity risk in both children and adults ‘Lowers leptin levels and elevates ghrelin levels, © Leptin: hormone that tells the brain to stop eating Ghrelin: promotes continued eatingDevelopmental Patterns of Sleep “Newborns and infants Toddlers “Preschoolers “#School-aged children Teenagers Young adults Middle-aged adults Older adults Factors Affecting Rest and Sleep ‘Developmental considerations ‘Motivation Culture “Lifestyle and habits ‘Environmental factors “Psychological stress elllness “Medications Lifestyle and Habits “© Activity and exercise increase fatigue and can promote Falaxation followed by sleep; increases both REM and NREM Sleep; contributes to'a more restul sleep “© Dietary habits: © Amino acd L-tryptophan promotes sleep © Small protein snack combined with healthy complex Carbohysrate bofore bea improves sleep Large quantities of alecho! limit REM and dela sleep Galen backs the ait of adenosine to cause rowsiness “© Smoking and nicotine are associated with poorer sleepQuestion #3 Which of the following snacks is an appropriate bedtime snack to promote sleep in a patient? A. Candy B. Toast C. Lunchmeat D. Cheese _AnswertoQuestion #3 0 Answi 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. Psychological Stress “Can be caused by illness or life situations “Disturbs sleep Difficult to obtain the amount of sleep needed REM sleep decreases, leading to anxiety and stressinesses Associated With Sleep Disturbances “Gastroesophageal reflux “Coronary artery diseases “Epilepsy seizures “iver failure and encephalitis “Hypothyroidism ‘End-stage renal disease Medications that Affect Sleep “Benzodiazepines “Decongestants “Amphetamines Caffeine “Antidepressants, Asthma medications “Diuretics “© Antiparkinsonian drugs Antidepressants ‘Antihypertensives ‘Steroids ICSD Classification of Sleep Disorders “Insomnia Sleep-related breathing disorders “© Central disorders of hypersomnolence “Circadian rhythm sleep-wake disorders “Parasomnias Sleep-related movement disorders ‘Other sleep disordersInsomnia “Characterized by difficulty falling asleep, intermittent sleep or difficulty maintaining sleep, despite adequate opportunity and circumstances to sleep “As many as 30% to 35% of adults in the United States complain of insomnia ‘People with a history of depression are more likely to experience insomnia ‘Many cases of insomnia are related to disruptions in circadian rhythms “Tnsomnia may be short term or chronic in nature Question #4 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 to Question #4 “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 Ungling sensation in the legs,Obstructive Sleep Apnea 25 Sleep-Related Breathing Disorder: Obstructive Sleep Apnea (OSA) “Characterized by five or more predominantly obstructive respiratory events © The absence of breathing (apnea) © Diminished breathing efforts (hypopnea) © Respiratory effort-related arousals during sleep, accompanied by sleepiness, fatigue, insomnia, snoring = Subjective nocturnal respiratory disturbance © Observed apnea and associated health disorders © Gasping for air during sleep Central Disorders of Hypersomnolence “Idiopathic hypersomnia © Characterized by excessive sleep, particularly during the day ‘Narcolepsy © Characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep © Up to 70% of people with narcolepsy also experience cataplexy, the sudden, involuntary loss of skeletal muscle tone lasting from seconds to one or two minutesCharacteristics of Circadian Rhythm Sleep-Wake Disorders “Chronic or recurrent pattern of sleep-wake rhythm disruption ‘Primary causes: © An alteration in the internal circadian timing system or misalignment between the Internal Circadian rhythm and the sleep-wake schedule desired or required A sleep-wake disturbance (e. excessive sleepiness) Associated distress or impairment, lasting for a Beriod of atleast 3 months (except for Jet lag disorder Parasomnias ©Somnambulism “REM sleep behavior disorder (RBD) ‘Sleep terrors “Nightmare disorder “Sleep enuresis ‘Sleep-related eating disorder Question #5 Tell whether the following statement is true or false, ‘Somnambulism is @ parasomnia in which the person walks in their sleep. A. True B. FalseAnswer to Question #5 Answer: A. True Rationale: Somnambulism is a parasomnia in which the person walks in their sleep. Sleep-Related Movement Disorders/Restless Legs Syndrome (RLS) “Restless legs syndrome (RLS), also known as Willis Ekbom disease (WED), is a common sleep-related movement disorder that affects up to 15% of the population, most often middle-aged and older adults “People with RLS cannot le still and report unpleasant creeping, crawling, or tingling sensations in the legs Nonpharmacologic treatments 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 “Sleep Diary “The Epworth Sleepiness Scale “©The Pittsburgh Sleep Quality Index (PSQI) “®STOP-Bang Questionnaire (OSA) “Stanford Sleepiness Scale 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 #2 “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Sleep Characteristics to Assess “oRestlessness “Sleep postures “© Sleep activities “Snoring “Leg jerking Key Findings of Physical Assessment “Energy level ‘Facial characteristics “Behavioral characteristics “Physical data suggestive of sleep problems 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Treatment for Dyssomnias “Pharmacologic therapy © Sedatives © Hypnotics “Nonpharmacologie therapy © Cognitive behavioral therapy (CBT) «= Progressive muscle relaxation measures © Stimulus control «= Sleep restriction; sleep hygiene measures = Biofeedback and relaxation therapy