WKU Nursing_ Sleep.txt
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- And newborn sleeps an average of how many hours at a time? How many hours daily?
- They sleep a average of 16 to 24 hours a day, averaging about 4 hours at a time.
An infant's sleep pattern is unique. On average an infant sleeps how many hours a night?
Sleep 10 to 12 hours at night. Sleep in an average of 10 to 12 hours at night with possibly several naps during the day
What type of sleep constitutes much of the sleep cycle of a young infant?
Younger school aged children require how many of sleep hours nightly?
12 to 12 hours
Order: school aged children require how many hours of sleep?
8 to 10 hours. ( sleep needs usually increase whe physical growth peaks
4 nursing implications dealing with infants sleep patterns
Teach parents to position infant on the back.
Advise parents that eye movements, groaning, grimacing, and moving are normal activities at this age
Encourage parents to have infant sleep in separate area rather on bed
Caution against placing pillows, crib bumpers, quilts, stuffed animals in crib because pose a suffocation risk
Toddler sleep average of how many hours a night
Initially sleep 4 12 hours at night with two naps during the day. Then sleep 8 to 10 hours a night and nap once during the day.
At what age do children a crib to a youth bed?
The sleep pattern of teenagers varies widely. The gross for that normally occurs may necessitate the need for more sleep however stress part time employment may cause adolescents to have a restless sleep. What are some nursing implications for this age group?
Advise parents that complaints of fatigue or inability to do well in school maybe related to not enough sleep.
(EDS) excessive daytime sleepiness may also make the teenager to accidents and behavioral problems.
Average amount of sleep required by young adults is?
8 hours but many young adults require less.
Are young adult sleep pattern is affected by:
Physical health, occupation, and exercise. Lifestyle demands may interfere as well
An infant sleeping in what position increases the risk for sudden infant death syndrome (SIDS)
A preschooler generally sleep how many hours at night? what is the average?
Generally sleep 9 to 16 hours. 12 hours being average.
At what age do children no longer nap?
Nursing implications for preschoolers sleep patterns?
Encourage parents to continue bedtime routines.
Advise parents that waking from nightmares or night terrors are common during the stage. ( waking the child and comforting him/her or use of a night light helps)
For a young adult REM constitutes what percentage of sleep?
Nursing implications for young adults include:
Reinforce that developing good sleep habits has a positive effect on health
If lost sleep is a problem explore lifestyle demands and stress as possible causes
Suggest use of relaxation techniques and stress reduction exercises rather than resorting to medication. (medications decrease REM sleep and lose their effectiveness over time)
Sleep patterns of middle aged adults:
Total sleep time decreases during these years with a decrease in stage 4 sleep. Percentage of time spent awake in bed begins to increase. Become more aware of sleep disturbances during this period.
Older adults sleeping how many hours a night?
- Average of 5 to 7 hours is adequate.
- (Sleep is less sound and stage 4 sleep is absent or considerably decreased. REM sleep shortens. Difficulty falling asleep/problems when sleeping.)
Factors in older adults that are factors in causes of inability to sleep:
- Psychological factors
- Decline in physical health
- Drug therapy (nocturia)
- Environmental factors
Nursing implications for older adults sleeping patterns:
- Comprehensive nursing assessment/individualized interventions in long term care
- Emphasize concern for safe environment because confusion may be present when first waking up
- Use sedatives with caution because of declining physiologic function and concern with polypharmcy
- Encourage to discuss sleep concerns with physicians
Condition where the body is relaxed, free from anxiety, and physically calm
Purposes of Rest (3)
- Conserves and restore energy
- Does not imply inactivity
- Relieves stress
- (Holistic approach to nursing)
Define: Sleep (more than one definition)
Recurrent, altered state of consciousness that occurs for sustained period
ACTIVE state essential for physical and mental restoration. It is complex rhythmic state involving progression of repeated cycles each representing different phases of body and brain ativity. Considered to be a state of conciousness with perception to environment decreased with response to meaningful stimuli.
Purposes of sleep (3)
- Restoring physical health and mental well being
- Provides time for repair and recovery
- Sensory Experience
Adequate rest and sleep are important in: (5)
- Promoting general health
- Ensuring recovery from illness
- Aid healing process
- Increases ability to learn and concentration and recalling knowledge
- Help perso to be socially adaptable
Physiology function of sleep: (8)
- Heart rate, BP, and temp lowers
- Body repairs and renews tissue
- Energy conservation
- Hormones released
- Cells nourished
- Learning is stored
- Stress relief
- Muscles relax
Physiology of Sleep: RAS
Reticular activating system (located in brainstem)
- Relays stimuli from cortex and periphery senses related to state of alertness, facilitates wakefulness
- Activated by stimuli from cortex and peripheral organs and cells (ex. Noises, pain, movement-shaking)
Physiology of Sleep: BSR
Bulbar synchronizing region(in brainstem)
Releases serotonin (neurotransmitter associated with sleep) so it supports sleep
Physiology of Sleep: Hypothalamus
Control center for sleeping and waking (as well other involuntary actions in body)
Physiology of Sleep: Circadian rhythms and what affects them
- Influence pattern of major physiological and behavioral functions
- (Predictable changing of body temp, HR, BP, hormone secretion, sensory acuity, and mood)
- 24 hour day-night cycle
- (Light temperature social activites and work routines affect circadian rythym.)
Biological clock-synchronizes sleep cycles
Physiology of Sleep: Sleep-wake regulation and results of sleep cycle disturbances
- Influences and regulates body functions and behavioral functions.
- Controlled by BSR, RAS, and hypothalamus
Physiology of Sleep: Two main stages of sleep
- Non-rapid eye movement(NREM)
- Rapid eye movement
Physiology of Sleep: Sleep Cycle
Number of cycles depends on total amount of time slept
Stages of the sleep cycle: NREM Stage 1
Transitional stage between wakefulness and sleep. Relaxed but somewhat aware of surroundings.
Involuntary muscle jerking may occur and wake person. Can be aroused easily
Lasts a few minutes and constitues about 5% of total sleep
NREM stages that are considered light sleep?
Stage 1 and 2
NREM stages that are considered deeper sleep
Stage 3 and 4
Stages of the Sleep Cycle: NREM stage 2
- Can be aroused with relative ease from stage of sleep
- Stage constitutes 50 to 55% of sleep
Stage of sleep cycle: NREM stage 3
- Depth of sleep increases and arousal more difficult
- 10% of total sleep
Stages of the sleep cycle: NREM stage 4
- Greates depth of sleep (delta sleep)
- Arousal from sleep difficult
- Physiological changes
- Constitutes 10% of total sleep
Physiologic changes of NREM stage 4 sleep: (5)
- Slow brain waves reorded on EEG
- Pulse and respiratory rates decrease
- BP decreases
- Muscles relax
- Metabolism slows and temp lowers
NREM stage 3 and 4 are affected by age. What are those afffects?
- Stages 3 and 4 decrease with age.
- Stage 4 could be absent by 75.
Stages of the sleep cycle: REM physiological changes (7)
- Eyes dart back and forth quickly
- Small muscle twitiching. Large muscle immobility
- Respirations irregular, sometimes interspersed with apnea
- Rapid pulse
- BP increases or fluctuates
- Increase in gastric secretions
- Metabolism increases as well as temp
Rem sleep appears at what stage of NREM?
Starts and ends during the middle of NREM stage 2
REM constitutes what percentage of sleep?
Single Normal Sleep Cycle
Wakefulness-NREM 1-NREM 2-NREM 3-NREM4-NREM3-NREM2-REM-NREM2
Functions of sleep cognitively
- Dreams (creative person has more vivid dreams)
- REM important for brain tissue and cognitive restoration
- Helps sort out concerns
- Helps people erase fantasies or nonsensical memories
Ranges for newborn, infant, toddler, preschool, school age, adolescents, adults, and elders: time sleeping
- Newborn 16 to 18
- Infant 12 to 14. Up to 22
- Toddlers 10 to 12
- Preschool 11-12
- School age 8 to 12
- Adolescents 8-10
- Adult 6-8
- Elders 6
Factors affecting Sleep
- Physical illness
- Drugs and substances
- EDS/usual sleep patterns
- Emotional stress
- Environment and sound
- Exercise and fatigue
- Food and caloric intake
Sleep Disorders: Dyssomnias
Characterized by insomnia or excessive sleepiness
Sleep Disorders: Parasomnias
Patterns of waking behavior that appear during sleep
Types of Dyssomnias
- Sleep apnea
- Restless leg syndrome
- Sleep deprivation
Insomnia (most common)
Difficulty falling asleep or remaining asleep that lasts for at least one month. Can be caused by traumatic event related to sleep or bedtime, often associated with increased physical or psychological arousal at night.
People who experience primary insomnia are often anxious about not being able to sleep
Usually begins when person is at young adult or middle aged
Excessive sleepiness during normal waking hours. Has either lengthy episodes of daytime sleep or episodes of daytime sleep on a daily basis even though he or shes is sleeping normally at night. Some cases people have sleep drunkenness
Affects young adults between 15 and 30
Sudden and irrestistible onset of sleep during waking hours. Sleep attacks that patient can't fight. Usually 10-20 mins. Feels refreshed but sleepy again several hours later. 40% of narcoleptics have another mental disorder. Genders equally affected
Symptom of hypersomnia. Difficulty waking in morning and may appear confused or angry. More common in males
3 major symptoms of narcolepsy
- Cataplexy (sudden loss of muscle tone and stability-aka drop attacks)
- Hallucinations may occur just before falling asleep or right after waking up. Associated with episode of REM.
- Sleep paralysis occurs during transition from being aseep to waking up
Hallucinations occuring before falling asleep
Hallucinations occuring right after waking up
- Short naps during day
Most important issue for nurse to consider when caring for a patient with narcolepsy
Risk for injury
Sleep Apnea is characterized by:
Periodic interruption in breathing during sleep. Absence of air flow through nose or mouth during sleep. Person complains of fatigue and morning headache. Results in cardiac dysrhythmias and increased pulse and blood pressure. Potentially lethal.
Sleep apnea episodes:
- May occur several or a hundred times a night
- May last for as long as 1 minute or longer.
- During episodes oxygen levels in blood drop and carbon dioxide levels rising causing person to wake up.
3 types of sleep apnea
Obstructive (OSA)-stopping of air flow despite effor to breath. Soft tissues or muscles of ora pharynx relax and airway becomes partially or completely blocked.
Central-cessation of diaphragmatic and intercostal respiratory effort. Cessation a result of brain's respiratory control center. Impulse to breath temporarily fails.
Mixed-both obstructive and central
Treatment of sleep apnea includes:
- Therapy for underlying cardiac, respiratory, or emotional problems
- Use of continous positive ariway pressure(CPAP) at night
Most common symptoms reported by patients with sleep apnea is:
Most commom report by sleep partner:
Excessive daytime sleepiness.
Patient snores and gasps all night.
Restless Legs Syndrome (RLS)
- Complain of irresistable urge to move legs while at rest.
- Experience vague, uncomfortable feeling while at rest only relieved by moving legs
- Symptoms may be present all day long. Make it difficult to sit motionless.
- Symptoms may be present only in evening which can lead to sleep onset insomnia which tends to compound effects of RLS.
Conditions that have been known to increase incidence of RLS.
- Post-surgery condtion
- (Fever seems to decrease it)
RLS most common in?
Middle aged females. Incidences increase with age. Affecting 5% of population
- NANDA-I nursing diagnosis
- Result of prolonged sleep disturbances
Common causes of sleep deprivation
Illness and hospitalization
Signs and symptoms of sleep deprivation
- Daytime drowsiness, impaired cognitive function
- Restlessness, perceptual disorders, slowed reaction time
- Irritability, somatic complaints, malaise
- Possible delusions, paranoia
Types of Parasomnias
- Somnambulism: sleep walking
- Sleep talking
- Bruxism: grinding of teeth during sleep
- Night terrors
- Nocturnal enuresis: bedwetting
Somnambulism occurs during what stages of sleep?
Stages 3 and 4. Usually 1 to 2 hours after person falls asleep
An episode of somnambulism may include:
Walking about doing things like making coffee or brushing teeth. Episodes last 3-4 minutes or longer. Children sleepwalk more than adults. Not aware of actions and not acting out a dream. May be effected by stress but etiology not known.
Therapeutic intervention for somnambulism
Observe them every 2 hours and PRN when in your care because they are prone to accidents
Substance-Induced Sleep Disorders
- Alcohol abuse- associated with insomnia. May feel sleepy after drinking but wakes up or sleep fitfuly during second half of night. Increases severity of apnea.
- Amphetamines or cocaine- suffers from insomnia during drug use and hypersomnia during withdrawal
- Opiods-short term users sleepy. Long term may suffer from insomnia
Prescription medications-antihistamines, corticosteroids, asthma meds, drugs affecting CNS
Assessment of sleep is subjective. Methods to use:
- Sleep Hx
- Sleep pattern and description
- Sleep log
- Physical illness
- Live events-stress
- Bedtime routines
- Best questions "How would you describe your sleep? "What activities that helped you sleep in past?"
- Sleep deprivation-amount, consistency, or quality ofsleep is decreased over prolonged period
- Disturbed sleep pattern-difficult falling aleep or remaining asleep
- Readines for enhanced sleep
Major goal for clients with sleep disturbances is
To maintain (or develop) a sleeping pattern taht provides sufficient energy for daily activities.
Nursing interventions to promote sleep
- Prepare restful environment
- Promote bedtime rituals
- Offer appropriate bedtime snacks and beverages
- Promote relaxation and comfort
- Use night light
- Provide privacy
- Schedule nursingcare to avoid distrubances
- Void before sleep
- Remove any irritants against patients skin
Two systems believed to work together to control cyclic nature of sleep
Injury to the hypothalamus may cause a person to?
Sleep for abnormally long periods of time
A typical sleep cycle lasts how long?
90 to 100 minutes
Average person has how many sleep cycles a night?
Four to six cycles
A sleep cycle consist of:
Four stages of NREM and one stage of REM
Gradually developing sleepiness lasting 10 to 30 minutes. But to be up to one hour
How many minutes into the sleep cycle does REM occur normally?
90 minutes into cycle
What percentage of sleep is NREM?
75 to 85%
with each successful cycle which stages shorten and what stage lengthens?
Stage 3 and 4 shortens. REM lengthens (by last cycle REM can last 60 mins)
Newborns spend more time in deep sleep. True or False
Aging causes a person to spend more time in lighter stages of sleep. Also thier sleep becomes more?
Deep sleep can also be referred to as?
Slow wave sleep
Shifts to light sleep or wakefulness occurs:
Shifts to deep sleep tend to be:
Dreams while in REM sleep are:
More vivid and elaborate
During NREM stage 4 human growth hormone is released to do what?
Repair and renewal of epithelial and specialized cells such as brain cells
During NREM Stage 4 protein synthesis and cell division occurs to do what?
For cell renewal such as skin, bone marrow, gastric mucosa, and brain cells.
Dreams are functionally important because:
The filter information from the day, they are learning, processing, and an adaptation to stress
Most people dream about?
Why illness can affect sleep?
Causes pain, discomfort, mood problems such as anxiety and depression. May make it difficult to fall asleep or stay asleep. forces patients to sleep in unfamiliar positions. Respiratory Diseases may cause noctural angina, increased heart rate, and pressure.
Hypertension can cause?
early morning hypertensional fatigue
Medicines that can affect sleep. Anti depressants, diuretics, narcotics, and heart medications
- Anti depressants_ suppress REM
- Diuretics- nocturia
- Narcotics- suppress REM
- Heart medication- nightmares and insomnia
Sleep disorders are considered pathological when?
They occur one person needs to or wants to be wakeful
Excessive daytime sleepiness can cause:
Accidents, behavioral problems, emotional problems, impaired waking functions, poor performance
Emotional stress on sleeping?
Emotional stress can cause tension leaving to frustration when trying to go to sleep and it does not come. it causes a person to harder to fall asleep, oversleep, and to frequently wake during sleep cycles
Common stimulants that cause sleeplessness?
Coffee, Cola, Tea
Interventions for insomnia patients
It is more psychological biological. Encourage no daytime napping, try to wake at the same time each day, only attempt to sleep when sleepy so that you associate the bed with sleep
Hypersomnia can be a symptoms of :
Restless leg syndrome, sleep apnea, narcolepsy
Taking psychotropics, anxiety, depression meds. Withdrawl from meds. Alcohol or drug use.
Sleep talking occurs:
During NREM right before REM.
Most seen years 3 to 8. Abrupt awakening from NREM. Physically active often hallucinating lasting 10 to 15 minutes. Expresses strong emotions. Does not mean child will have emotional disorders.
Past age of toliet training been established. Most often in NREM, not associated with dreaming. Patient is best way to cope with it.
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