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Stage I of NREM sleep
- The person is in a transitional stage between wakefulness and sleep.
- The person is in a relaxed state but still somewhat aware of the surroundings.
- Involuntary muscle jerking may occut and waken the person.
- The stage normally last only minutes.
- The person can be easily aroused.
- This stage continues only about 5% of total sleep
Stage II of NREM sleep
- The person falls into a stage of sleep.
- The person can be aroused with relative ease.
- This stage continues 50-55% of sleep.
Stage III NREM sleep
- - depth of sleep increases, and arousal becomes increasingly difficult.
- - this stage composes about 10% of sleep
Stage IV NREM sleep
- The person reaches the greatest depth of sleep, which is called delta sleep.Arousal from sleep is difficult.
- Physiologic changes in the body include the following:
- *slow brain waves are recorded on an EEG
- *pulse and respiratory rates decrease
- *blood pressure decreases
- *muscles are relaxed
- Metabolism slows and the body temperature is low.
- This consitutes about 10% of sleep
- Eyes dart back and forth quickly.
- Small muscle twitching, such as on the face.
- Large muscle immobility, resembling paralysis.
- Respirations irregular; sometimes intersparced with apnea.
- Rapid or irregular pulse.
- Blood pressure increases or fluctuates.
- Increase in gastric secretions.
- Metabolism increases; body temperature increases.
- Encephalogram tracings active.
- REM enters from stage II of NREM sleep and reenters sleep at stage II
- Arousal from sleep difficult.
- Constitutes about 20-25% of sleep.
Sleep pattern for Newborns and Infants
Sleep 16-18 hours per day
Sleep patterns for Preschoolers
Sleep 10-12 hours a day
Adult sleep patterns
Most adults need 7-8 hours of sleep a night
Sleep patterns for school aged children and teens
Need at least 9 hours of sleep per night
What should you do when you enter the room of a patient who expresses they are tired and they do not want you to perform a vital assessment?
Validate their concern and ackowldge you will come back: "I understand you didn't get a lot of sleep last night, I will let you rest and I will come back."
Factors effecting sleep
- Developmental Considerations: Variations in sleep patterns are related to age.
- Motivation: A desire to be wakeful and alert helps overcome sleepiness or sleep.
- Culture: An individuals cultural beliefs and practices can influence rest and sleep (ex. Asian pt may choose herbal tea rather than a sleeping medication).
- Lifestyle and Habits: Various lifestyle factors can affect a person's ability to sleep well (ex. a person who works the night shift might have trouble adjusting to the schedule of a hospital stay).
- Physical Activity & Exercise: Activity and exercise increase fatigue and, in many instances, promote relaxation that is followed by sleep. Some people are able to work-out before bed and some are not.
- Dietary Habits: Small protein-carbohydrate containing snack effectively promotes sleep. No caffiene within 4-5 hours before bed.
- Environmental Factors: Sleeping in strage or new environments influences both NREM and REM sleep. TV in bedroom, falling asleep with the TV on.
- Psychological Stress: Affects sleep in 2 ways - the person experiencing stress may find it difficult to obtain the amount of sleep her or she needs or REM sleep decreases in amount which tends to add to anxiety and stress.
- Illness: Certain ilnesses are more closely related to sleep disturbances than others (ex. b/c gastric secretions increase during REM sleep, people w/peptic ulcers awaken at night w/pain).
- Medications:Sleep quality is influenced by certain drugs (barbituates, amphetamines and antidepressants).
- Charaterized by difficulty falling asleep, intermittent sleep or early awakening from sleep.
- Most common of all sleep disorders.
- Characterized by an uncontrollable desire to sleep.
- Treated with Ritalin or Aderoll.
- Important to take as directed or until finished. If patient stops taking meds for symptoms the symptoms will come back.
- Condition in which a person experiences the absence of breathing or diminished breating efforts (hypopnea) during sleep between snoring intervals.
- Ceasation is usually from 10-20 seconds but can last as long as 2 minutes.
- Can sometimes mimic restlessness or no respirations. Make sure to ASSESS before calling code on a patient who has a hx of sleep apnea or is taking meds which could cause sleep apnea.
Restless Leg Syndrome
- People with RLS cannot lie still and report unpleasant creeping, crawlings or tingling sensations in the legs.
- Tx: elminating the use of caffeine, tobacco or alcohol, taking a mild analgesic at bedtime, applying hear or cold to the extermity, relaxation techniques (Biofeedback or TENS).
- Refers to a decrease in the amount, consistency or quality of sleep.
- Physiologically looks tired.
- Psychosocially is irritated.
- Somnambulism: Sleepwalking
- Enuresis: Urinating during sleep
- Bruxism: Teeth Grinding
- Nocturnal Erection
Assessing Rest and Sleep: Sleep History
- Interview questions help identify the patient's sleep-wakefulness patterns and the effect of these patterns on everyday functioning.
- Patient's use of sleep aids.
- Presence of sleep disturbances and contributing factors.
Assessing Rest and Sleep: Sleep Diary
Provides more specific data on the patient's sleep-wakefulness patterns over a long period of time (usually 14 days).
Assessing Rest and Sleep: Physical Assessment
- Decreased energy levels.
- Facial Signs.
- Behavioral characteristics.
- Physical data.
- Mental changes.
Sleep Pattern Disturbance Nursing Diagnosis
- Physical Discomfort
- Exercise just before sleep
- Physical Illness
- Changes in bedtime rituals
- Etiology:Altered sleep-wake patterns
- Anxiety related to inability to fall asleep
- Activity intolerance related to sleep deprivation
- Fatigue related to insomnia
Expected Outcomes for Sleeping Patterns
- Maintain a sleep-wake pattern that provides sufficient energy for the day.
- Demonstrate self care behaviors that provide balance between rest and activity.
- Identify stress-relieving rituals that enable falling asleep more easily (ex. ocean sounds).
- Deomonstrate decreased signs of sleep deprivation.
- Verbalize feeling less fatigued and more in control of life activities.
Implementing a Healthy Sleep Cycle (in the hospital)
- Prepare a restful environment: make sure overhead light is turned off, etc..
- Promote bedtime rituals: try to implement bedtime rituals used at home in the hospital setting.
- Offering appropriate bedtime snacks and beverages: Milk and/or protein-carbohydrate snack.
- Promote Relaxation: Back rub, night-time bath, etc...
- Promote Comfort: Make sure bed is properly made, etc...
- Respect normal sleep-wake patterns.
- Scheduling nursing care to avoid unnecessary disturbances: consolidation of care when appropriate.
- Use medicaion to promote sleep: can have opposite effect on the elderly.
- Teaching about rest and sleep: opprotunity for patient teaching.
- Relax the best they can if they still cannot sleep.
Temazepam or Restoril
- 7.5 - 30mg at hs (sleep)
- Used to increase total sleep time
- Needs to have at least 8 hours of sleep
- Side Effects - drowsiness, anorexia, diarrhea, palpitations
- Patient teachings: Do not take with alcohol. Take as directed. Make sure patient is aware of side effects and activites to avoid while taking medication.
- 5-10mg at hs (sleep)
- Short acting, quick onset
- Preserves deep sleep
- Side Effects: headache, drowsy. lethargy
Evaluation of Sleep
- We want the patient to:
- Verbalize feelings related to rest/sleep
- Indentify factors that influence rest/sleep
- Indentify factors that promote rest/sleep
- Fuctioning during waking hours
- Eliminate behaviors related to sleep deprivation