-
Lack of Sleep
- •Problem in US is lack of sleep:
- –Causes decreased concentration, sleepiness, fatigue,
- distractibility
- •Chronic lack of sleep puts person at risk:
- –Hypertension
- –Diabetes
- –Heart attack
- –Stroke
- –Accidents, especially car
-
Physiologly of Sleep
•Sleep is altered state of consciousness where perception of and reaction to environment decreased
- •Person is unaware of the environment & will respond
- selectively to external stimuli
- –Meaningful stimuli: Alarm clock, smoke alarm
- –Non-meaningful stimuli: Everyday noises, soft light
-
Sleep & Wake Cycle - Wake
- •Melatonin- decreased
- •Cortisol- the “stimulating hormone” is increased
- •Neurotransmitters associated with wakefulness are high:
- –Acetylcholine
- –Dopamine - helps connections of brain for parkinsons
- –Noradrenaline
-
Sleep & Wake Cycle - Sleep
- •Neurotransmitters
- –Serotonin- lessens response to sensory stimuli
- –GABA- shuts off RAS
- •Darkness & preparing for sleep
- –decreases stimulation of RAS
- •Hormones
- –Melatonin- secreted, person feels less alert
- –Growth hormone (GH)- secreted
- –Cortisol- the “stimulating hormone” is inhibited
- - - higer risk for diabeties
-
Circadian Rhythm
- •Humans have many biological rhythms
- •Circadian rhythm is one type
- •Circadian-means “about day” & involves the sleep-wake cycle
- •Circadian synchronization
- –Person awake when body temp highest and asleep when body temp lowest
- *why hospital feels colder at night
-
Sleep Cycles
- •Refers to basic organization of sleep
- •Two types that alternate in cycles during sleep
- –NREM: non-rapid-eye movement
- –REM: rapid eye movement
-
NREM Sleep
- •Occurs when activity in RAS inhibited
- •Constitutes 75% - 80% of sleep
- •Consists of 4 stages
- –As progress through the stages:
- •body systems slow down (BP, P, HR, CO, RR, metabolic rate, temp)
- •Harder to awaken
- •Skeletal muscles relax
- •Intracranial pressure decreases
- •Stage 1: lasts few minutes, light sleep, easily awakened
- •Stage 2: lasts only 10-15 minutes, more difficult to
- awaken
- •Stage 3 & 4: deeper sleep, involves delta waves,
- very difficult to awaken, snoring. Essential for restoring energy and releasing important growth hormones
-
REM Sleep
- •Occurs every 90 minute
- •Lasts 5 to 30 minutes
- •Acetylcholine and dopamine increase
- •Most dreams take place
- •Brain is highly active
- •Brain metabolism increases as much as 20%
- •Distinctive eye movements occur
- •Voluntary muscle tone decreased
- •Deep tendon reflexes absent
- •Gastric secretions increase
- •HR and RR often are irregular
- •Regions of brain associated with learning, thinking, organizing information stimulated
- –Lack of REM: apathy, depression, irritability, confusion, impaired memory
-
Sleep Cycles
- •Cycle through NREM and REM
- •Complete cycle lasting 90-110 minutes
- •Length of time for each stages varies with each cycle
- •Adult sleeper has 4-6 cycles per 7-8 hours
- •If awakened during a stage- must start at stage 1 NREM
-
Sleep Patterns: Infants & Toddlers
- •Infant:
- –Awaken every 3 to 4 hours
- –Periods of wakefulness gradually increase
- –By 6 months, most infants sleep through the night
- and establish a pattern
- –Establish a pattern of daytime naps
- •Toddler (1-3 years):
- –Require 12 to 14 hours
- –Most still need an afternoon nap
- –Nighttime fears and nightmares are also common
-
Sleep Patterns: Pre-school & school age children
- •Preschool child (3-5 years)
- –Require 11 to 13 hours of sleep
- –Sleep needs fluctuate in relation to activity and
- growth spurts
- •School-age child (aged 5 to 12)
- –Require 10-11 hours of sleep
- –Most receive less
-
Sleep Patterns: Adolescents
- •Require 9-10 hours of sleep each night
- •Few actually get that much sleep
- •Circadian rhythms tend to shift
- –Tendency to stay up later and wake later
-
Sleep Patterns: Adults & Elders
- •Adults
- –Most healthy adults need 7-9 hours of sleep
- –Individual variations
- •Elders
- –Tendency toward earlier bedtime and wake times
- –May show an increase in disturbed sleep
- –Need to sleep does not decrease with age
-
Factors that Effect Sleep
- •Illness
- –Pain
- –Endocrine disorders- thyroid, low estrogen, increased body temp, frequent urination
- •Environment- hospital
- •Lifestyle
- –Jobs
- –kids
- •Emotional stress-
- –anxiety stimulates sympathetic NS
- •Stimulants
- –Caffeine
- –Alcohol (disturbs REM)
- –Smoking
- •Diet
- –Some food promote sleep
- –Weight gain & loss
- •Motivation- forcing self to stay awake or interest in activity
- •Medications- page 1172, Box 45-2
-
Drugs that Disrupt Sleep
- Alcohol
- Amphetamines
- Antidepressants
- Beta-Blockers
- Broncodialators
- Caffeine
- Decongestants
- Narcotics
- Steroids
-
Sleep Disorder: Insomnia
- •Difficulty falling asleep or remaining asleep
- •Waking up frequently
- •Daytime sleepiness
- •Difficulty concentrating
- •Irritability
- •Risk factors
- –Older age due to medical conditions
- –Female- hormone fluctuations
-
Sleep Disorders: Excessive Daytime Sleepiness
- •Insufficient sleep
- •Hypersomnia
- –Has sufficient sleep at night but cannot stay awake
- during day
- –Medical cause (hypothyroidism)
- •Narcolepsy
- –Cause: lack of hypocretin in CNS that regulates sleep
- –Have excessive daytime sleepiness & have sleep
- attacks
- –Sleep at night usually begins with sleep-onset REM
-
Sleep Apnea
- •Frequent short breathing pauses during night
- •More than 5 apneic episodes > 10 sec/hr considered abnormal
- •Symptoms include snoring, frequent awakenings, difficulty falling asleep, morning headaches, memory and cognitive problems, irritability
- •Types include obstructive (mouth), central (resp center of brain), mixed
-
Parasomnia
- •Behavior that may interfere with or occur during sleep
- •Arousal disorders
- –Sleepwalking, sleep terrors
- •Sleep-wake transition disorders
- –Sleep talking
- •Associated with REM sleep
- –Nightmares
- •Others
- –Bruxism- teeth grinding, jaw clenching
-
Sleep Pattern Assessment
- •Sleep history
- •When does client usually go to sleep?•Bedtime rituals?•Does client snore?•Can client stay awake during day?•Taking any prescribed or OTC medications?
- •Health history
- •Obtain information about medical or psychiatric problems that may influence sleep
- •Medication history
- •Physical exam
- •Rarely yields information unless client has obstructive sleep apnea
- –Enlarged and reddened uvula and soft palate
- –Enlarged adenoids and tonsils (children)
- –Obesity (adults)
- –Neck circumference > 17.5 inches (men)
- –Deviated septum (occasionally)
- •Sleep diary
- •Client may be asked to keep track of
- –Time factors associated with sleep
- –Activities performed 2-3 hours prior to sleep
- –Consumption of caffeine, alcohol
- –Medications
- –Bedtime rituals
- –Difficulty remaining awake during day
- –Any worries or fears that may be contributing
- •Diagnostic studies•Polysomnography done in lab. These done together with electrodes to measure muscle movement and
- brain waves:
- –EEG (electroencephalogram)
- –EMG (electromyogram)
- –EOG (electro-oculogram)
- •Other
- –Measure ECG, resp, O2, leg movement
-
NANDA Nursing Diagnosis
- •Sleep deprivation
- •Insomnia
- •Other ND from sleep pattern disturbances:
- –Risk for injury
- –Ineffective coping
- –Fatigue
- –Risk for impaired gas exchange
- –Anxiety
- –Activity intolerance
-
Nursing Interventions for Sleep Disturbances
- •Reducing environmental distractions
- •Promoting bedtime rituals
- •Providing comfort measures
- •Scheduling nursing care to promote uninterrupted sleep
- •Teaching stress reduction, relaxation techniques or good sleep hygiene
-
Sleep Hygiene
- •Reducing environmental distractions
- •Promoting bedtime rituals
- •Providing comfort measures
- •Scheduling nursing care to promote uninterrupted sleep
- •Teaching stress reduction, relaxation techniques or good sleep hygiene
-
Client Education
- •The importance of sleep
- •Conditions that promote or interfer with sleep
- •Safe use of sleep medications
- •Effects of prescribed medications on sleep
- •Effects of disease states on sleep
-
Bedtime Rituals
- •Routines promote sleep. Usually first nursing intervention to try. If interfered with, can affect one’s sleep
- •Adults
- –Listening to music
- –Reading
- –Soothing bath
- –Praying
- •Children- need to be socialized into rituals
- –Bedtime stories, holding favorite toy
-
Medications
- •Prescribed as PRN
- •Sedative-hypnotics (induce sleep)-
- –General CNS depression
- –Unnatural sleep- NREM & REM is altered
- –May cause daytime sleepiness & hangover
- –Rebound insomnia
- –Table 45-1 (Ambien- not alter REM)
- –Barbituates (alter REM) cannot be stopped abruptly
- •Anti-anxiety or tranquilizers-
- –Suppress CNS response to stimuli
- •Using medications:
- –Be aware of actions, effects, risks of specific medications
- –Use smallest does possible
- –Regular use can cause tolerance & rebound insomnia
-
Medications for Insomnia
- Chloral hydrate (Noctec) - Half-life 7-10 hours
- Eszopilone (Lunesta) - 6 hours
- Ethchlorvynol (Placidyl) - 10-20 hours
- Flurazepam (Dalmane) 47-100 hours
- Glutethimide (Doriden) 1-12 hours
- Lorazepam (Ativan) 10-20 hours
- Melatonin - 1 hour
- Temazepan (
|
|