Engage Fundamentals Comfort, Rest, & Sleep PDF

Comfort, Rest, and Sleep Dr. Paola Reyes, DNP, MSN-Ed., CHEP, CMSRN Engage Fundamentals 1 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. ...

Comfort, Rest, and Sleep Dr. Paola Reyes, DNP, MSN-Ed., CHEP, CMSRN Engage Fundamentals 1 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  Sleep Sleep is essential for health and healing. Without quality sleep, the body is not adequately able to rejuvenate. Inadequate sleep will affect almost every system in the body, potentially leading to chronic health problems such as depression, heart disease, hypertension, and diabetes. 2 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. Circadian Rhythm Internal process that controls the sleep-wake cycle. Occurs approx. every 24 hours. Regulates a client's biological clock and causes them to be sleepy at night and wake on their own in the morning. Synchronizes with environmental cues such as light and temperature; however, the body will maintain circadian rhythms without prompts. 3 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. Sleep-Wake Homeostasis Assists the body to remember to sleep after a given time. Regulates the level of sleep according to the amount of sleep deprivation a client is experiencing. Affected by factors such as the lighting in a room, medications, caffeine, foods, sleep environment, and stress. 4 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. Brain Structures Essential to Sleep Hypothalamus: commands nerve cells, affecting sleep and arousal Suprachiasmatic Nucleus: controls behavioral rhythm directly from the eyes through light exposure Brain Stem: controls shift between wake and sleep; pons and medulla oblongata influence rapid eye movement (REM) Thalamus: blocks out external distractions during sleep; transmits images, sounds, and sensations during REM sleep Pineal Gland: manufactures melatonin (a natural substance that helps the body prepare for sleep) 5 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. Stages of Sleep: Stage 1 The wake stage/lightest stage of sleep. Consists predominantly of alpha and beta electrical brain waves. Alpha waves are electrical brain waves in the frequency range of 8 to 12 hertz. Beta waves are electrical brain waves in the frequency range of 12 to 30 hertz. When a person becomes drowsy and closes their eyes, the alpha waves dominate over the beta waves. Breathing is normal, and skeletal muscle tone is present. Can last from 1-5 minutes and is approx. 5% of total sleep cycle. 6 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. Stages of Sleep: Stage 2 Deeper sleep. Consists of sleep spindles or K- complex electrical waveforms that trigger the superior temporal gyri, anterior cingulate, insular cortices, and the thalamus. Client becomes challenging to awaken. Heart rate and body temperature decrease. First sleep cycle lasts approx. 25 minutes; however, it becomes progressively longer with each successive sleep cycle. Consumes approx. 50% of a total sleep cycle. Number of cycles increase with aging. 7 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  Stages of Sleep: Stage 3 Deepest sleep. Consists of delta electrical brain waves, which are slower frequency, higher-amplitude signals. If awoken in stage three, clients may have mental cloudiness for 30 to 60 minutes. During this stage, immune system strengthens, and the muscles, tissues, and bones repair and regenerate. Number of cycles decline with aging. Can last up to 40 minutes. 8 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. Stages of Sleep: Stage 4 Includes REM, the dreaming stage. Looks like an awake cycle on an EEG; however, the skeletal muscles remain atonic (loss of muscle tone). Client's breathing is irregular and erratic, and their heart rate may be elevated. Typically begins 90 minutes after falling asleep. Initial cycle lasts 10 minutes and will become longer as the night progresses. Can last up to 1 hour. 9 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. Sleep Patterns: Adults Adults (20-35) spend 2-5% of their sleep time in stage one, 45-55% in stage two, 10-20% in stage three, and 20-25% in REM. These sleep cycles occur approximately 4-5 times, while the client is sleeping. 10 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. Sleep Patterns: Older Adults Older adults (65+) have a decrease in stage three sleep cycles and an increase in stage two. They wake up more frequently and take longer to fall asleep. This pattern may cause older adults to stay in bed longer, leading to other health issues such as a worsening of musculoskeletal weakness, arthritis, and pulmonary disorders. 11 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  Recommended Hours of Sleep Newborns (birth to 28 days): 14 -17 hours Infants (1 month to 1 year): 12-15 hours Toddlers (1-3 years): 11-14 hours Preschool (3-6 years): 10-13 hours School-age children (6-12 years): 9-11 hours Adolescents (12-20 years): 8-10 hours Young adults (20-35 years): 7-9 hours Middle adults (35-65 years): 7-9 hours Older adults (65+): 7-8 hours 12 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  Sleep Deprivation Sleep deprivation occurs when a client does not meet the body's biological sleep requirements. Sleep deprivation can affect higher-order cognitive projects, impair judgment, decrease response time, and trigger seizure disorders, migraines, and tension headaches. 13 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  Promoting Sleep Avoid stimulants, such as caffeine, alcohol, and nicotine at least four to six hours before bedtime. Remove unnecessary light and noise. Establish a bedtime routine, such as taking a warm shower or bath. Keep room dark, quiet, and at a comfortable, cold temperature. Go to bed only when tired. 14 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. Promoting Sleep (cont.) If no sleep in 20 minutes, go to another room and read or listen to music. Turn the clock away from view. Go to bed and wake up at same time each day. Keep naps short and before 3 p.m. Complete exercise at least three hours before going to bed. Remove work items and televisions from bedroom when possible. The bedroom should be for sleep and sexual activity only. 15 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. Sleep Disorders Insomnia is an ongoing inability to sleep despite having the opportunity to do so. Apnea is a condition in which there is an absence of inspiratory airflow for a minimum of 10 seconds. Hypopnea is associated with a decrease in oxygen saturation and lasts 10 seconds or longer. Obstructive sleep apnea (OSA) is related to the recurrent episodes of upper airway collapse and obstruction while sleeping combined with waking from sleep. 16 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  Sleep Disorders Cont. OSA sleep disorder in which the throat muscles intermittently relax and block the airway during sleep, causing breathing to repeatedly stop and start Diagnosed with nocturnal polysomnography 17 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. OSA Risk Factors 18 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved. Sleep Disorders (cont.) Narcolepsy is a chronic sleep condition characterized by sudden sleepiness and sudden periods of sleep. Hypersomnia is a disorder of excessive daytime fatigue without improvement after more sleep. Restless leg syndrome (RLS), also called Willis-Ekbom disease, is an uncontrollable urge to move the legs during sleep. 19 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  References Holman, H. C., Williams, D., Johnson, J., Sommer, S., Ball, B. S., Morris, C., Leehy, P., Hertel, R., & Assessment Technologies Institute (Contributors). (2019). Fundamentals for nursing: Review module (10th ed.). Assessment Technologies Institute. Taylor, C., Lynn, P. 1., & Bartlett, J. L. (2023). Fundamentals of nursing: the art and science of person-centered nursing care. 10th edition. Philadelphia, Wolters Kluwer. 20 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.