Comfort Rest and Sleep
Comfort Rest and Sleep
Comfort Rest and Sleep
Kozier C 45
Objectives
Identify the characteristics of NREM
and REM sleep
Identify the four stages of NREM sleep
Describe variations in sleep patterns
throughout the life span
Identify factors that affect normal sleep
Describe common sleep disorders
Objectives
Identify the components of a sleep
pattern assessment
Develop nursing diagnosis, outcomes,
and nursing interventions related to
sleep problems
Describe interventions that promote
normal sleep
Question 1
A client has a history of sleep apnea. The nurse
should ask which of the following most
appropriate questions?
1. Do you have a history of cardiac irregularities?
2. Do you have a history of any kind of nasal
obstruction?
3. Have you had chest pain with or without
activity?
4. Do you have difficulty with daytime sleepiness?
Rationales 1
1. Although cardiac arrhythmias may occur, they are
usually only detectable during a sleep study, and thus the
client would not be aware of them.
2. Nasal obstruction is rarely the cause of sleep apnea or a
complaint of clients with sleep apnea.
3. There are many causes of chest pain, and this is unlikely
to be something reported by clients with sleep apnea
unless they have underlying cardiac disease.
4. Correct. Most clients with sleep apnea report excessive
daytime sleepiness. If they don’t volunteer this, clients
should be asked if they fall asleep or struggle to stay
awake at work.
Physiology of Sleep
Darkness & preparing for sleep cause
decrese in stimulation of the RAS
Pineal gland secretes melatonin
This results in person feeling sleepy
Growth hormone is secreted & cortisol
inhibited.
Biorhythms
Circadian Rhythms = “about a day”
Circadian Synchronization = awake when
physiologic and psychological rhythms
are most active and asleep when lest
active.
Cicadian regularity
Begins by 3rd week of
life
May be inherited
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Factors Affecting Sleep
Age- One of the most important factors
affecting persons sleep and rest periods.
Illness- causing pain or physical distress can
result in sleep problems.
Environment-Noise level
Fatigue- more tired the shorter the first (REM)
sleep
Lifestyle-Shift work
Factors Affecting Sleep
Emotional Stress
Alcohol and Stimulants
Diet
Smoking
Motivation
Medications
Drugs That Affect Sleep
Alcohol Antidepressants
Beta-blockers Caffeine
Bronchial dilators Steroids
Decongestants Narcotics
Amphetamines
Common Sleep Disorders
Insomnia- most common sleep disorder, inability to
obtain an adequate amount or quality of sleep.
Hypersomnia- Opposite of insomnia, excessive
sleep, especially daytime.
Narcolepsy- Sudden wave of overwhelming
sleepiness that occurs during the day. Referred to
as “sleep attack”.
Primary Sleep Disorders
Sleep Apnea- periodic cessation of breathing
during sleep.
Obstructive apnea
Central apnea
Mixed
Morning headaches
Memory/cognitive problems
Irritability.
Sleep Disorders
Parasomnias- Behavior that may interfere with
sleep. (somnambulism, sleep talking,
Nocturnal enuresis, nocturnal erections,
bruxism).
Insufficient Sleep - prolonged disturbance
resulting in decreases amount, quality,
consistency of sleep.
Box 43-3 Parasomnias
Assessment of Sleep
Assessment of a client’s sleep includes:
a sleep history,
sleep diary,
physical examination,
Bedtime rituals
Use of sleep medications
Sleep environment
Changes in sleep pattern
Sleep Diary
Written record to be much more precise
Total number of sleep hours a day
Activities performed 2-3 hours before sleep
Bedtime rituals
Obesity (adults)