Sleep & Rest PDF

REST, COMFORT, SLEEP  REST Rest is a condition in which the body is in a decreased state of activity without physical emotional stress and freedom from anxiety When people are at rest, they usually feel mentally relaxed, free from anxiety, and physically calm Rest do...

REST, COMFORT, SLEEP  REST Rest is a condition in which the body is in a decreased state of activity without physical emotional stress and freedom from anxiety When people are at rest, they usually feel mentally relaxed, free from anxiety, and physically calm Rest does not imply inactivity  SLEEP Sleep is a condition in which the body is in a decreased state of activity without physical emotional stress and freedom from anxiety Sleep is a recurrent, altered state of consciousness that occurs for sustained periods Sleep is a cyclical physiological process that alternates with longer periods of wakefulness. – Circadian rhythm – Biological clocks  Sleep Regulation Sleep involves a sequence of physiological states maintained by the CNS RAS ( reticular activating system) = wakefulness & BSR (bulbar synchronizing region) = sleep  Physiology of sleep The cyclic nature of sleep is thought to be controlled by centers located in the brain and by Circadian Rhythms Reticular activating system (RAS) located at the brain stem and cerebral cortex plays an important role in sleep wake cycle Sleep begins with the activation of the pre optic area of the anterior hypothalamus  Physiology of sleep Sleep promoting neurons act over wake promoting neuorons by releasing Gamma Amino Butyric Acid (GABA) The inhibition of wake promoting neurons results in intensifying sleep process Another key factor to sleep is exposure to darkness Darkness and preparing for sleep cause a decrease in stimulation of the RAAS  Physiology of sleep During this time, the pineal gland in the brain begins to actively secrete the natural hormone Melatonin, and the person feels less alert With the beginning of daylight, Melatonin is at its lowest level in the body and the stimulating hormone, cortisol is at its highest causing wakefulness  STAGES OF SLEEP NREM sleep = nonrapid eye movement - involves 4 stages. About 75-80% of sleep during a night is NREM sleep REM sleep = rapid eye movement  Stage 1: NREM Lightest level of sleep Lasts a few minutes Gradual fall in vital signs and metabolism Easily aroused by sensory stimuli Waken, person feels as though daydreaming has occurred  Stage 2: NREM Period of sound sleep Relaxation progresses Arousal is still relatively easy Stage lasts 10-20 minutes Body functions, vital signs & metabolism, slow  Stage 3: NREM Involves initial stages of deep sleep Sleeper is difficult to arouse and rarely moves Muscles are completely relaxed Lasts 15-30 minutes  Stage 4: NREM Very difficult to arouse sleeper Deepest stage of sleep If sleep loss has occurred, sleeper will spend considerable portion of night in this stage Vital signs are significantly lower than during waking hours Lasts approximately 15-30 minutes Sleepwalking and enuresis may occur  REM SLEEP Vivid, full-color dreaming Loss of skeletal muscle may occur in REM. tone occurs Usually begins about 90 Gastric secretions minutes after sleep has increase begun Typified by autonomic Very difficult to arouse response of rapidly Duration of REM sleep moving eyes, fluctuating increased with each heart and resp rates, cycle and averages 20 increased BP minutes  Functions/Purpose of Sleep Restoration of tissues and growth Thermoregulation Conservation of energy Regulation of emotions. Sleep deprivation causes irritability, anxiety etc Neural maturation Memory and learning. There will be information transfer between cerebral cortex and hippocampus during sleep  Normal sleep requirements Newborn: 16 -18 hours/day Infants: 12 -14 hours Toddlers: 10 -12 hours Preschool: 11 -12 hours School age: 8 -12 hours Adolescence: 8 -10 hours Adults: 6 -8hours Elders: 6 hours  FACTORS THAT AFFECT SLEEP Age Physical illness Drugs and substances Lifestyle Emotional stress Environment Exercise and fatigue Food and caloric intake  SLEEP DISORDERS INSOMNIA SLEEP APNEA NARCOLEPSY SLEEP DEPRIVATION PARASOMNIAS  SLEEP DISORDERS Sleep disorders are mainly classified into 3 categories Dysominias Parasomnias Disorders due to other medical conditions  Sleep disorders Dysomnias – sleep is normal. Client sleeps too little, too much or at the wrong time Common problems include:- Insomnia Hypersomnia Narcolepsy Sleep apnea Sleep deprivation  INSOMNIA Inability to fall asleep or remain asleep Frequent awakenings from sleep Short sleep or nonrestorative sleep Insomnia can result from physical discomfort, mental tension or anxiety  INSOMNIA Clinical manifestations include: Difficulty falling asleep Waking up frequently during the night Difficulty returning to sleep Waking up too early in the morning Daytime sleepiness Difficulty concentrating Irritability  HYPERSOMNIA Refers to conditions where the affected individual obtains sufficient sleep a night but still cannot stay awake during the day It can be caused by CNS damage, kidney, liver or metabolic disorders such as diabetes acidosis and hypothyroidism  SLEEP APNEA Disorder in which the individual cannot breath and sleep at the same time Lack of airflow through the nose and mouth for periods from 10 seconds to 1-2 minutes, there can be 10 or 15 to more than 100 respiratory events per hour of sleep Three types: central, obstructive, and mixed  CENTRAL SLEEP APNEA Caused by cessation of diaphragmatic and intercostal respiratory effort as a result of dysfunction of the brain’s respiratory control center Impulse to breath fails, temporarily Least common form  OBSTRUCTIVE APNEA Most common form Characterized by cessation of airflow despite the effort to breath Occurs when muscles or structures of the oral cavity or throat relax during sleep Usually have loud snoring  NARCOLEPSY A CNS dysfunction of mechanisms that regulate the sleep and wake states Disorder of excessive daytime sleepiness Falls asleep uncontrollably at inappropriate times Treated with stimulants  SLEEP DEPRIVATION A prolonged disturbance in quality and quantity of sleep can lead to sleep deprivation It produces various physiological and behavioural symptoms based on severity  SLEEP DEPRIVATION S/S: blurred vision, fine motor clumsiness, decreased reflexes, slowed response time, decreased reasoning and judgment, cardiac arrhythmias Psychological S/S: confusion, disorientation, increased sensitivity to pain, irritable, withdrawn, agitation, decreased motivation  PARASOMNIAS Something abnormal occurs during sleep itself, or during the times when the client is falling asleep or waking up Most common disorders are Bruxism Enuresis Periodic limb movement disorder Sleep talking Sleep walking  PARASOMNIAS Bruxism characterized by clenching and grinding of the teeth Periodic limb movement disorder (PLMD)- legs jerk twice or three times per minute during sleep. Common in older adults Nocturnal enuresis –bedwetting during sleep occurring in children over 3 years. Occurs 1 -2 hours after falling asleep  PARASOMNIAS Sleep talking – talking during sleep occurs during NREM sleep before REM sleep in older adults Somnambulism(sleepwalking) – occurs during stage III and IV of NREM sleep. Ocurs 1-2 hours after falling asleep Sleep walkers tend not to notice dangers e.g stairs  Disorders due to other medical conditions These disorders are associated with medical or psychiatric or other illness Causes include Depression Alcoholism Thyroid dysfunction Peptic ulcer COPD  ASSESSMENT Normal sleep pattern, restful? sufficient? Self- reported Sleep log Bedtime routines Bedtime environment Client expectations  Pain Physical sensation Involves physical, emotional and cognitive components Stimulus  Physiology of Pain Transduction Transmission Perception Modulation  Types of Pain Acute Chronic Idiopatic Inferred – nociceptive – neuropatic  Pain Assessment Scales Nonverbal pain indicators Behavioral indicators  Pain Management Pharmacological interventions Non-pharmacological interventions Barriers Cultural considerations Reassessment  Environmental factors affecting common and sleep Comfortable room temperature Proper ventilation Minimal noise Comfortable bed Proper lighting  Promoting Bedtime Routines Help client to relax in preparation for sleep Avoid mental stimulation before bedtime Relaxation exercises Guided imagery Good sleep hygiene  Sleep Hygiene Avoid sleeping long hours during weekend or holiday Bedroom should not be used for intensive studying, snacking, TV watching, or other nonsleep activity Avoid worrisome thinking when going to bed Avoid heavy meals for 3 hours before bedtime  Promoting comfort Encourage client to wear loose-fitting nightwear Instruct family on ways to position client and support dependent body parts to aid in muscle relaxation Have client void before going to bed Back massage Keep bed linens dry  Activity If client is at home, encourage physical activity during daytime Avoid rigorous exercise at least several hours before bedtime  Control of noise in hospital Close doors to client’s room Keep doors to work areas closed Reduce volume of nearby telephones and paging equipment Avoid abrupt loud noises Keep necessary conversations at low levels