Rest and Sleep and Nursing Role

rest, sleep, sleep lab

Physiology of Sleep

• Reticular activating system (RAS)
– Facilitates reflex and voluntary movements
– Controls cortical activities related to state of alertness
• Bulbar synchronizing region
• Hypothalamus — control center for sleeping and waking

Stages of Sleep

• Non-rapid eye movement (NREM)
– Consists of four stages
• Stage I and II — 5% to 50 % of sleep, light sleep
• Stage III and IV — 10% of sleep, deep-sleep states (delta sleep)
• Rapid eye movement (REM)


Sleep Cycle

• The person passes consecutively through four stages of NREM sleep.
• The pattern is then reversed.
– Return from stage IV to III to II
– Enter REM sleep instead of reentering stage I
• The person reenters NREM sleep at stage II and moves on to III and IV.


Factors Affecting Sleep

• Developmental considerations
• Psychological stress
• Motivation
• Culture
• Lifestyle and habits
• Physical activity and exercise


Factors Affecting Sleep (continued)

• Dietary habits
• Environmental factors
• Illness
• Medications


Illnesses Associated With Sleep Disturbances

• Peptic ulcers
• Coronary artery diseases
• Epilepsy
• Liver failure and encephalitis
• Hypothyroidism


Classification of Sleep Disorders

• Dyssomnias
• Parasomnias
• Sleep disorders associated with medical or psychiatric disorders
• Other proposed disorders


Sleep Disorders

• Dyssomnias— characterized by insomnia or excessive sleepiness
• Parasomnias — patterns of waking behavior that appear during sleep



• Insomnia
• Hypersomnia
• Narcolepsy
• Sleep apnea
• Restless leg syndrome
• Sleep deprivation



• Somnambulism

• Sleep talking
• Nocturnal erections
• Bruxism
• Enuresis
• Sleep-related eating disorder


Treatment for dyssomnias

• Pharmologic therapy
– Sedatives and hypnotics
• Nonpharmacologic therapy
– Stimulus control
– Sleep restriction
– Sleep hygiene
– Cognitive therapy
– Multicomponent therapy
– Relaxation therapy


Nursing Interview

• Identify patient’s sleep-wakefulness patterns
• Identify effect of these patterns on everyday functioning
• Assess patient’s use of sleep aids
• Assess the presence of sleep disturbances and contributing factors


Sleep Disturbance Assessment Parameters

• Nature and cause of problem
• Accompanying signs and symptoms
• Date of occurrence and effect of everyday living
• Severity of the problem
• Treatment of problem
• How the patient is coping with the problem


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


Key Findings of Physical Assessment

• Energy level
• Facial characteristics
• Behavioral characteristics
• Physical data suggestive of sleep problems


Sleep Characteristics to Assess

• Restlessness
• Sleep postures
• Sleep activities
• Snoring
• Leg jerking


Common Etiologies for Nursing Diagnoses

• Physical or emotion discomfort or pain
• Changes in bedtime rituals or sleep environment
• Disruption of circadian rhythm
• Exercise and diet before sleep
• Drug dependency and withdrawal
• Symptoms of physical illness


Nursing Interventions to Promote Sleep

• Prepare a restful environment
• Promote bedtime rituals
• Offer appropriate bedtime snacks and beverages
• Promote relaxation and comfort
• Respect normal sleep-wake patterns
• Schedule nursing care to avoid disturbances
• Use medications to produce sleep
• Teach about rest and sleep

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