Sleep is regulated by a sequence of physiological states integrated by central nervous system activity
What are the steps of the sleep cycle?
Presleep period+ 4 to 5 complete sleep cycles (NREM+one REM) per night
What is REM sleep?
Rapid eye movement sleep
What are the stages of sleep?
Stages 1, 2, 3, 4, and rapid eye movement (REM)
What are circadian rhythms?
Often referred to as the "body clock", circadian rhythm is a 24-hour cycle that rules us all. This internal body clock is affected by external forces, such as sun rise and time zones.
What are the 2 main purposes of sleep?
-Physiological and psychological restoration
-Maintenance of biological functions
When do dreams occur?
-Dreams occur in both Non-REM and REM sleep but the ones we will remember because they're more vivid are the ones we have during REM sleep
Which types of diseases and/or illnesses are more susceptible to affect our quality/amount of sleep?
-Respiratory (Sleep apnea or cold)
-Cardiovascular (Chest pain or poor blood circulation)
-Musculoskeletal (could be a sprained ankle=pain)
-Nocturia (needing to urinate during sleep time)
What are some symptoms of sleep apnea?
-Stop breathing during sleep for at least 10 seconds
-You never feel rested
-Often wake up with headaches
What is the best way to diagnose sleep apnea in a person?
-When the person is married, the spouse is the best witness because they see it happen and they hear them snore loud
What is hypersomnolence?
-Excessive sleeping
Insomnia is often related to...
-Stress
What is narcolepsy?
Chronic neurological disorder caused by the brain's inability to regulate sleep-wake cycles normally. People with narcolepsy often experience disturbed nocturnal sleep and an abnormal daytime sleep pattern.
Which 3 nocturnal habits are considered parasomnias (undesirable motor and verbal responses)?
-Talking and walking in your sleep
-Braxism (gritting your teeth)
-Enuresis (bed wetting)
True or False? Shift work will not affect the amount of sleep you usually get nor will it disrupt your sleeping patterns.
False
True or False? Sleep deprivation is considered a sleep disorder.
True
Quick Quiz! During rounds on the night shift, the nurse notes that a patient stops breathing for 1 to 2 minutes several times during the shift. What is this condition called?
D. Sleep apnea
Rest is crucial and everyone benefits from it. What are these benefits? (3)
-Mental relaxation
-Freedom from anxiety
-State of mental, physical, and spiritual activity
Quick Quiz! A 4 year old pediatric patient resists going to sleep. What action should the nurse take in order to assist this patient?
C. Maintain the patient's home sleep routine
The younger a person is, the (more, less) she sleeps and as the person gets older the (more, less) she needs sleep.
Younger=more sleep
As the person is getting older =less sleep
We don't need to know how long each categories of people sleep but it's a good way to see that as people are getting older, the less they get or need sleep each night.
-Neonate=16h
-Infant=10-12h+naps=14h+
-Toddlers=12-14h with naps
-Preschoolers=13h
-School aged children=9 to 10h
-Adolescents=Varies
-Young adults=6 to 8.5h
-Middle and older adults=Decline in total number of hours
What are the 7 factors affecting sleep?
-Drugs and substances
-Lifestyle
-Usual sleep pattern
-Emotional stress
-Environment
-Exercise and fatigue
-Food, drinks and caloric intake
What are the most susceptible drugs and substances that may affect a person's sleep?
-Hypnotics
-Diuretics
-Antidepressants
-Alchohol
-Caffeine
-Narcotics
-Beta-blockers
-Anticonvulsants
-Anti-parkinsonians
And from a personal point of view and I swear to god or whatever I can swear on, that my ADHD meds (which are in the class of central nervous system stimulants), if not taken at a certain time, its possible that I may not fall asleep at all or that I fall asleep very late at night.
What are the most susceptible lifestyle patterns that may affect a person's sleep?
-Work schedule
-Social activities
-Routines
What are the most susceptible emotional stresses that may affect a person's sleep?
-Worries (could be related to any kind of worries but most people worry about work and money)
-Physical health
-Death
-Losses
In order to have a high quality night of sleep, which factors eliminated from the room's environment?
-Noises should be reduced to a minimum
-Darkness should be promoted (it has been proven that lighting affects your sleep quality and that it has become worse with cell phones charging, laptops charging and emitting light or any kind of electronics near your body when you sleep)
-A routine should be installed (going to bed around the same time every night and getting up around the same time every morning)
True or False? It's good for your sleep if you go for a run (or workout) right before going to bed.
False
In order to be able of going to bed at a reasonable time at night, any caffeinated beverages should be avoided after what time of the day?
5 pm
When a nurse questions a patient about his sleep history, what are the 7 questions she might be likely to ask him? These questions will help the nurse to get the bigger picture concerning the factors that may influence her patient's sleep.
-Description of sleeping problems
-Usual sleep pattern
-Physical/psychological illness
-Current life events
-Bedtime routines
-Bedtime environment
-Behaviors of sleep deprivation
When the nurse has questioned her patient's sleeping history, what is she able to do with all this information that she has gathered?
-She is able to write a diagnosis in the patient's chart in order to inform the physician about the patient's situation. She's also able to make a care plan in order to help the patient to get better sleep, setting priorities and collaborate with him.
Examples of diagnosis:
-Anxiety
-Ineffective breathing patterns
-Compromised family coping
-Disturbed sensory perception
-Sleep deprivation
A patient with sleeping issues is being discharged today and going back home. Which home health promotion elements may the nurse implement to this leaving patient? (8)
-Avoid bedtime snacks that are high in calories (or sugar)
-Pharmacological approaches
-Promoting sleep in older adults
-Sleep hygiene
What is the name of the device that could be suggested by a physician for a patient with sleep apnea issues?
-CPAP (continuous positive airway pressure)
A patient with sleeping issues is hospitalized. Which acute care elements may the nurse implement in order for her patient to get a better sleeping pattern? (5)
Quick Quiz! A patient suffers from a sleep pattern disturbance. What is the most important nursing intervention to promote adequate sleep?
A. Reorganize the treatment and vital signs schedule at night
Which 2 classes of medications are the most common in order to treat sleeping disorders?
-Hypnotics (Temazepam trade name is Restoril or Melatonin)
-Sedatives (Lorazepam trade name is Ativan or Oxazepam trade name is Serax)
The nurse is gathering a sleep history from a client who is being evaluated for obstructive sleep apnea. What common symptom will the client most likely report?
A. Headache
The nurse incorporates what priority nursing intervention into a plan of care to promote sleep for a hospitalized client?
A. Avoid awakening the client for nonessential tasks
Older adults are cautioned about the use of nonprescription sleeping medications because these medications can:
C. Lead to further sleep disruption even when they initially seemed to be effective.
The client reports vivid dreaming to the nurse. Through understanding of the sleep cycle, the nurse recognizes that vivid dreaming occurs in which sleep phase?
C. REM sleep
The nurse teaches a client taking phenytoin (Dilantin), an anticonvulsant, that this group of medications causes which symptom of a sleep problem?
C. Increased daytime sleepiness
Which intervention is appropriate to include on a care plan for improving sleep in the older adult?
C. Decrease fluids 2 to 4 hours before sleep
Which statement made by a mother being discharged to home with her newborn infant indicates a need for further teaching?
C. My grandmother told me that babies sleep better on their stomachs."
The nurse is developing a plan of care for a client experiencing narcolepsy. Which intervention is appropriate to include on the plan?
C. Encourage client to take one or two 20-minute naps during the day
What nursing measure promotes sleep in school-aged children?
C. Encourage quiet activities prior to bedtime
To validate the suspicion that a married male client has sleep apnea, the nurse first:
C. Question the spouse if she is awakened by her husband's snoring
When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about:
A. Opioids
The nurse finds a client sleepwalking down the unit hallway. An appropriate intervention the nurse implements is:
B. Lightly tapping the client on the shoulder and leading him or her back to bed.
The nurse is sure to implement strategies to reduce noise on the unit particularly on the ______ night of admission, when the client is especially sensitive to hospital noises.
D. First
Which of the following medications are the safest to administer to adults needing assistance in falling asleep?
B. Triazolam (Benzodiazepines class)
The nurse is providing health teaching for a client using herbal compounds such as valerian for sleep. What points need to be included?
F. Should not be used indefinitely
D. May interfere with prescribed medications
E. Over time they can lead to further sleep problems
F. Are not regulated by Health Canada
The nurse recognizes that a client is experiencing insomnia when the client reports...
A. Difficulty staying asleep
B. Extended time to fall asleep
C. Feeling tired after a night's sleep
D. Falling asleep at inappropriate times
A. Difficulty staying asleep
B. Extended time to fall asleep
C. Feeling tired after a night's sleep
The nurse teaches the mother of a newborn that in order to prevent sudden infant death syndrome (SIDS), the best position in which to place the baby after nursing is...
D. Supine
D. Side lying
To assist an adult client to sleep better, the nurse recommends which of the following?
A. Consuming a small glass of warm milk at bedtime