302 Rest and Sleep

  1. When the body is in a decreased state of activity and you feel refreshed:
  2. Factors that influence rest:
    —Juggling demands---find little time to rest and relaxation

    —Children involved in extracurricular  activities

    —Trying to excel academically

    —Environment not conducive  to physical and mental relaxation
  3. —A state of rest accompanied by altered consciousness and relative inactivity.

    —Complex rhythmic state involving a progression of repeated cycles
    • SLEEP
    • ***—Sleep loss that results in fatigue and decreased competence increases the risk of a sleep related MVA
  4. Physiology of Sleep:
    —Reticular activating system (RAS) and Bulbar synchronizing region----work together to control the cyclic nature of sleep.

    —During sleep, the RAS experiences few stimuli from the cerebral cortex and the periphery of the body

    —Wakefulness occurs when this system is activated with stimuli from the cerebral cortex (alarm clock) and from periphery sensory organs and cells (pain)
  5. What are some of the neurotransmitters involved in the sleep process?
    • —Excitation
    •    —Norepinephrine
    •    —Acetylcholine
    •    —Dopamine
    •    —Serotonin
    •    —Histamine

    • —Inhibition
    •    —Gamma-aminobutyric acid (GABA)
  6. Circadian Rhythms
    Regulate certain biologic and behavioral functions in humans
  7. How often do circadian rhythms complete a full cycle?
  8. What all does circadian rhythms create a fluctuation in?
    • —Heart rate
    • —Blood pressure
    • —Body temperature
    • —Hormone secretion
    • —Metabolism
    • —Performance and mood
  9. —When physiologic and psychological rhythms are _________ the person is awake:
    High or Most Active
  10. —When physiologic and psychological rhythms are ________, the person is asleep:
  11. What regulates the circadian rhythms?
    • internal/biological "clock"
    • (influenced by social pressures & occupational demands)
  12. What are the 2 major stages of sleep:
    1. Non-rapid eye movement (NREM)

    2. Rapid eye movement (REM)
  13. What do we study/analyze stages of sleep with?
    Electroencephalograph (EEG)- receives and records electrical currents from the brain.

    Electrooculogram (EOG)- records eye movements

    Electromyograph (EMG)- records muscle tone 
  14. Facts about NREM:
    —75% total sleep

    —4 stages:

    • —Stages I and II
    •    —about 5% and 50% sleep time

    —   light sleep

    —   Aroused with ease

    • —Stages III and IV
    •    —10% of total sleep time

       —Deep sleep state- termed delta sleep or slow wave sleep

    —   Arousal threshold  usually greater in stage IV
  15. In which stage of NREM sleep does the person fall into a
    stage of sleep but can be aroused with relative ease?
    Stage 2

    • In Stage 2 of NREM sleep, the person falls into a stage
    • of sleep but can be aroused with ease. In Stage 1, the person is in a transitional stage between wakefulness and sleep. In Stages 3 and 4, the depth of sleep increases, and arousal becomes increasing difficult.

  16. Which nervous system dominates during NREM?
    —Parasympathetic nervous system:

    —Decrease pulse

    —Decrease respiratory rate

    —Decrease blood pressure

    —Decreased metabolic rate

    —Decreased body temperatures
  17. Facts about REM:
    —More difficult to arouse

    —20-25% of person’s nightly sleep time

    —Increase pulse

    —Increase respiratory rate

    —Increased blood pressure

    —Increased metabolic rate

    —Increase body temperature

    —Decreased general skeletal muscle tone

    —Decreased deep tendon reflexes
  18. REM is believed to play an important role in:
    learning, memory, adaptation
  19. When a person who is deprived on sleep for several nights spends more time in REM sleep the next several nights:
    REM rebound
  20. Single Normal Sleep Cycle:
    Image Upload 1
  21. How many cycles of sleep occur each night?
    • 4-5 per night
    • *each cycle lasts 90-100 minutes & cycles become longer as morning approaches
    • *more deep sleep occurs in the delta stage in 1st half of night
  22. Sleep Requirements and Patterns:
    —8 hours standard for adults

    —14-20 hours for infants

    —10-14 hours for growing children

    —Fatigue –warns body that sleep is needed

    —Chronic fatigue is abnormal

    • —Older adults:
    •    —More time to fall asleep
    •    —Wake earlier
    •    —Naps may result in sleeping fewer hours at night
  23. Factors affecting Sleep:
    —Developmental consideration

    —Page 1085 for variations and nursing implications

    • —Motivation
    • --—Desire to be awake may help overcome sleepiness
    • --—Minimal motivation to be awake, sleep occurs
    • —
    • Culture:
    • *—Bedtime rituals

    —*Sleep position and place

    —*Pattern of sleep

    • —Lifestyle and Habits:
    • *—Circadian Cycles-body prepares for sleep by decreasing body temp and releases melatonin

    • —*Melatonin (produced at night)-decreases wakefulness  and
    • promotes sleep

    —*Shift work---disrupts natural process

    —*Television shows

    • —*In ability to relax-----stress
    • —Physical activity and exercise:
    • *Increase fatigue and promote relaxation
    • *—Increase REM and NREM

    • —Dietary Habits:
    • —*L-tryptophan—promotes sleep

    —*Protein---recommended for insomnia----however, may actually increase alertness and concentration

    • *Carbohydrates– promote calmness and relaxation
    • —Alcohol Intake:
    • *—Small amounts –induce sleep
    • *—Large amounts– limit
    • *REM and delta sleep

    • —Caffeine- containing Beverages:
    • *—Central nervous system stimulant
    • —*Chocolate
    • —*Tea
    • —*Coffee
    • —*Colas

    • —Smoking:
    • *—Nicotine is a stimulant

    • —Environmental Factors:
    • *—New /strange
    • *—Noise---too much---not enough

    —Psychological Stress

    • —Illness:
    • *—Gastric secretions increase during REM
    • (—people with peptic ulcer  awaken at night with pain)
    • ...—Eating a snack or antacids neutralize acidity

    Pain associated with CAD and MI is more likely with REM sleep

    —*Epilepsy seizures are most likely to occur during NREM and appear depressed with REM sleep

    —Liver failure and encephalitis tend to cause a reversal in day –night sleeping habits

    —Hypothyroidism tends to decrease the amount of NREM sleep, esp stage II and IV

    —End Stage Renal Disease (ESRD) disrupts nocturnal sleep and leads to excessive daytime sleepiness
  24. Medications that affect Sleep:
    • —Drugs decrease REM:
    • sleep
    • —Barbiturates
    • —Amphetamines
    • —Antidepressants

    • —Additional causes of sleep problems:
    • —Diuretics
    • —Antiparkinsonian drugs
    • —Some antidepressants
    • —Antihypertensives
    • —Steriods
    • —Decongestants
    • —Caffeine
    • —Asthma medications
  25. Sleep Aids:
    • —Short term sleep aids—with less residual sleepiness
    • —*Sonata
    • *Ambien

    • —Long term (chronic insomnia)
    • *—lunesta
  26. Dyssomnias:
    —sleep disorder characterized by insomnia or excessive sleepiness




    —Sleep apnea

    —Restless leg syndrome

    —Sleep deprivation
  27. Insomnia:
    —Difficulty falling asleep, intermittent sleep, or early awakening from sleep can occur

    • Caused by:
    • Periods of stress
    • —Change in environment


    —Jet lag

    • —Person reports feeling tired, lethargic, irritable, and difficulty concentrating
    • —Treatment usually unnecessary

    • —Chronic insomnia lasts longer than 3-4 weeks
    • —Depression common cause of chronic insomnia

    —Misuse of Alcohol or caffeine

    —Pharmacologic therapy may include sedatives or hypnotics short-term (low dose)
  28. Non-pharmocalogic therapy for Insomnia:
    —Stimulus control


    —If unable to fall asleep in 15-20 mins should try again later

    —Sleep restrictions

    —Limit time in bed to actual sleep time

    —Sleep hygiene

    —Avoid factors that affect sleep----alcohol, caffeine, activity

    —Cognitive therapy

    —Multi-component therapy

    Relaxation therapy
  29. Hypersomnia:
    —Excessive sleep particular during day

    —Nap do not relieve symptoms

    • —When awake usually:
    • —Disoriented
    • —Irritated
    • —Restless
    • —Slower speech and thinking processes
  30. Causes of Hypersomnia:
    —Another sleep disorder—sleep apnea

    —Drug or alcohol abuse

    —Head trauma or other injury to CNS

    —Certain meds



    —Other medical conditions (Multiple sclerosis, epilepsy)
  31. Treatment for Hypersomnia:
    **—symptomatic in nature

    —Stimulant drugs


    —Attention to diet

    —Behavioral changes
  32. Narcolepsy
    —Uncontrollable desire to sleep

    —Individuals tend to fall asleep quickly and find it difficult to wake up

    —Sleep fewer hours than others and

    —Sleep restlessly

    —Neurological disorder

    —Sleepiness during day is often first symtom
  33. Common feautures of Narcolepsy:
    —Sleep attacks –irresistible urge to sleep

    —Cataplexy- sudden loss to muscle tone –usually experienced during a period of strong emotion

    —Hypnagogic hallucinations- nightmare or hallucinations

    —Sleep onset REM period- during sleep attack person moves directly to REM

    —Sleep paralysis- skeletal paralysis that occurs during transition from wakefulness to sleep
  34. Treatment for Narcolepsy:
    —CNS stimulant (ritalin) causes wakefulness

    —Provigil-wakefulness promoting compound

    —Gamma-hydroxybutyric acid(GHB)-sedative used for treating disturbed nocturnal sleep

    —Most used regularly---discontinuation causes sleep to return
  35. Sleep Apnea
    —Absence of breathing (apnea) or diminished breathing efforts(hypopnea) during sleep between snoring intervals

    —Breathing ceases 10-20 seconds—up to 2 mins

    —Seen most commonly in middle aged men who are obese and have thick necks

    —Obstructive sleep apnea (OSA)- results when airway is occluded because of the collapse of the hypopharynz

    —Sleep apnea may be caused by allergic rhinitis
  36. Restless Sleep Syndrome
    —Can not lie still

    —Report unpleasant creeping, crawling, or tingling sensations in the legs

    —Irresistible urge to move the legs

    —Massaging legs, walking, doing knee bends, and moving the legs sometimes helps
  37. Treatment for Restless Leg Syndrome
    —Eliminate caffeine, tobacco, and alcohol

    —Take mild analgesic at bedtime

    —Apply heat or cold

    —Use relaxation techniques

  38. Sleep Deprivation
    —Decrease in the amount, consistency, or quality of sleep

    —May result in decreased REM or NREM sleep

    —Partial sleep deprivation

    • —Loss of concentration, inattention, impaired information processing and poses safety
    • risk

  39. Parasomnias:
    —Patterns of waking behavior that appear during sleep

    —Somnambulism—Sleep walking

    —Sleep talking

    —Night terrors

    —Bruxism –grinding teeth

    —Enuresis- urinating in sleep

    —Sleep related eating disorders

    —Seen more in children

    —Prevent injury
  40. When assessing Sleep/Rest:
    —Sleep history 

    —Daily functioning

    —Use of sleep aids

    —Presence of sleep disturbances and contributing factors

    • —If admitted to hospital, —assess usual sleep wake patterns:
    • —Bedtime rituals

    —If problem identified perform system analysis

    • —EX: reports needs 8-9
    • hours of sleep to feel his best and usually gets this without problem.

    —Sleep diary

    —14 days

    —Sleep wake patterns

    —Physical assessment

    —Energy level

    —Facial characteristics- glazing eyes

    —Behavioral characteristics- yawning slow speech

    —Physical characteristics- obesity, enlarged neck


    —Nocturnal Myoclonus
  41. Marked muscle contractions that result in jerking of legs during sleep
    Nocturnal Myoclonus
  42. 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

    —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
  43. Implemation for Good Sleep/Rest patterns:
    • —Prepare restful environment
    • —Promote bedtime rituals
    • —Offering appropriate  bedtime snacks
    • —Promoting relaxation
    • —Promote comfort
    • —Respecting normal sleep wake patterns
    • —Scheduling nursing care to avoid unnecessary disturbances
    • —Using medications to produce sleep
    • —Teach rest and sleep

Card Set
302 Rest and Sleep
Exam 1