Rest and Sleep and Nursing Role

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

Dyssomnias

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

Parasomnias

• 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