Sleep f22 Student PDF

# Chapter 43 Sleep ## NURS 300 ## Objectives * Explain the effects of the 24-hour sleep-wake cycle has on biological function. * Outline the stages that regulate sleep. * Explain the functions of sleep. * Compare and contrast the sleep requirements of different age groups. * Identify factors that...

# Chapter 43 Sleep ## NURS 300 ## Objectives * Explain the effects of the 24-hour sleep-wake cycle has on biological function. * Outline the stages that regulate sleep. * Explain the functions of sleep. * Compare and contrast the sleep requirements of different age groups. * Identify factors that normally promote and disrupt sleep. * Compare and contrast characteristics of common sleep disorders. * Select interventions to promote normal sleep for patients. ## Circadian Rhythms * **Circadian rhythms** - everyone's day-night, 24-hour clock, the rhythmic biological clock. * Influence pattern of biological and behavioral functions. * Predictable changing of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood. * Affected by light, temperature, social activities, and work routines. * Biological rhythm of sleep frequently becomes synchronized with other body functions. * Different people function best at different times of day. * Poor quality of sleep results when a person's sleep-wake cycle changes. * Anxiety, restlessness, irritability, and impaired judgment are symptoms of sleep cycle disturbances. * Failure to maintain an individual's usual sleep-wake cycle negatively influences overall health. ## Sleep Regulation * Regulated by sequence of physiological states integrated by central nervous system (CNS) activity. * **Hypothalamus** - Location of major sleep center. * Two processes regulate sleep/wake cycles. * **Homeostatic process:** regulates length and depth of sleep * **Circadian rhythm:** influences time and duration of sleep/wake cycles ## Sleep Cycle * Normal sleep pattern for adult begins with a presleep period during which the person is aware only of a gradually developing sleepiness. * Lasts 10 to 30 minutes; however, if the person has difficulty falling asleep, it lasts an hour or more. * Once asleep, the person usually passes through 4 to 6 complete sleep cycles per night, each cycle consisting of three stages of nonrapid eye movement (NREM) sleep and a period of rapid eye movement (REM) sleep for a total of 90-110 minutes. * Quality of sleep from stage 1 through stage 3 becomes increasingly deep. * Lighter sleep characteristic of stages 1 & 2, during which a person is more easily arousable. Stage 3 involves a deeper sleep, from which a person is more difficult to arouse. * With each successive cycle, stage 3 NREM sleep shortens and REM sleep lengthens. * Sleep becomes more fragmented with aging, and an older person spends more time in lighter stages (less REM time). ## Functions of Sleep * Sleep functions as a time of restoration, memory consolidation, and preparation for the next period of wakefulness. * Restores biological functions. * Decreased heart rate, respirations, temperature, blood pressure, muscle tone. * Release of human growth hormone for repair and renewal of cells. * Protein synthesis and cell division for tissue renewal. * Basal metabolic rate lowers to conserve energy supply. * Memory storage and learning. * REM sleep important for early brain development, cognition, and memory. * Changes in brain associated with memory storage and learning. * Sleep deprivation and sleep disorders affect immune function and metabolism, can cause confusion and suspicion, lead to altered bodily functions (mood, motor performance, memory, equilibrium) and chronic diseases (hypertension, diabetes, obesity, depression). ## Dreams * Dreams occur during both NREM and REM, but dreams during REM stage are more vivid and elaborate. * Dreams are functionally important to learning, memory processing, and adaptation to stress. * Dream content often includes current events, childhood events or things from the past, and immediate concerns such as arguments or fears. * Personality influences quality of dreams (creative person has elaborate and complex dreams, depressed person dreams of helplessness). * Most people forget their dreams - people who recall dreams vividly usually awaken just after a period of REM sleep. ## Physical Illness * Any illness that causes pain, physical discomfort, anxiety, or depression often results in sleep problems. * Trouble falling or staying asleep. * Examples: thyroid disease, restless leg syndrome. * Early morning awakening. * Example: hypertension. * Frequent arousals. * Examples: heart failure, peptic ulcer disease. * Force patients to sleep in unfamiliar positions. * Examples: post-surgery, respiratory disease. * Nocturia (urination during night). * Example: older adults with reduced bladder tone. ## Sleep Disorders * Sleep disorders cause disturbed nighttime sleep that can result in insomnia, abnormal movements or sensation during sleep, or excessive daytime sleepiness. * Many people have significant sleep problems from inadequate quantity or quality of sleep and experience hypersomnolence (excessive sleepiness). * Sleep laboratory studies such as a polysomnogram (monitors EEG, ECG, and EOG) are used to diagnose sleep disorders. ### Sleep Disorders * **Insomnia:** Difficulty falling asleep, frequent awakenings, or short sleep. * Can be transient, recurrent, or chronic. * Often signals an underlying physical or psychological disorder (possible medical). * **Sleep Apnea:** Lack of airflow through nose/mouth for 10 seconds up to 1-2 minutes. * **Obstructive (OSA):** airway blocked when muscles relax during sleep. * **Central (CS):** dysfunction of respiratory center in the brain. * **Narcolepsy:** Dysfunction of processes that regulate sleep and wake states. * Fall asleep uncontrollably at inappropriate times. * Symptoms can include cataplexy (sudden muscle weakness during intense emotions) and sleep paralysis (unable to move or talk just before waking or falling asleep). * **Sleep Deprivation:** Insufficient or disrupted sleep - acute or chronic. * Emotional stress, Medications, Environmental disturbances, hospitals. * **Parasomnias:** Sleep problems more common in children. * Sudden infant death syndrome (SIDS), Somnambulism (sleepwalking), Night terrors, Nightmares, Nocturnal enuresis (bed-wetting), Body rocking, Bruxism (Teeth Grinding). ## Sleep and Rest * At rest, people feel mentally relaxed, free from anxiety, and physically calm. * Rested people experience feelings of rejuvenation, feeling refreshed & able to carry out activities of daily living. * People have their own habits for obtaining rest. * Illness and unfamiliar healthcare routines easily affect rest and sleep patterns. * Rest does not imply inactivity. * Bed rest does not guarantee that a patient will feel rested. * Always be aware of a patient's need for rest. Lack of rest for long periods causes illness or worsening of existing illness. ## Normal Sleep Requirements & Patterns | Age Group | Sleep Requirements | |---|---| | Neonates | 16 hours a day | | Infants | 8 to 10 hours at night plus naps for a total of 15 hours per day | | Toddlers | Total 12 hours a day | | Preschoolers | 12 hours a night | | School Age | 9 to 12 hours | | Adolescents | Recommended 8-10 hours but often get less than 7 hours | | Young Adults | Get 6 to 8 1/2 hours | | Middle and Older Adults | Total time spent sleeping at night declines, with lighter sleep and often sleep disturbances (less REM sleep) | ## Factors Affecting Sleep | Category | Factors | |---|---| | **Physical Illness** | Hypertension, respiratory, musculoskeletal, chronic illness, GI, nausea | | **Lifestyle** | Work schedule, social activities, routines | | **Emotional Stress** | Worries, physical health, death, losses | | **Exercise & Fatigue** | Moderate exercise & fatigue cause a restful sleep | | **Drugs and Substances** | Medications can alter sleep and weaken daytime alertness to cause sleepiness, insomnia, or fatigue | | **Sleep Hygiene** | Practices that a person associates with sleep | | **Environment** | Noise, lights, room temperature | | **Food & Calorie Intake** | Time of day, caffeine, nicotine, alcohol | ## Nurse's Role * Ask about usual sleep patterns, sleep disturbances, bedtime routines and preferences. * **Sleep Promotion** * Environmental controls. * Promoting bedtime routines. * Promoting safety. * Promoting comfort. * Establishing periods of rest and sleep. * Stress reduction. * Bedtime snacks. * Pharmacological approaches.