SLEEP , COMFORT

REST

• When people are at rest, they usually feel mentally relaxed, free from anxiety, and physically calm

• Rest does not imply inactivity

SLEEP• Sleep is a recurrent, altered state of

consciousness that occurs for sustained periods

• Sleep is a cyclical physiological process – Circadian rhythm– Biological clocks

Sleep Regulation• Sleep involves a sequence of physiological

states maintained by the CNS

• RAS ( reticular activating system) = wakefulness & BSR (bulbar synchronizing region) = sleep

STAGES OF SLEEP

• NREM sleep = nonrapid eye movement - involves 4 stages

• REM sleep = rapid eye movement

Stage 1: NREM

• Lightest level of sleep

• Lasts a few minutes

• Easily aroused by sensory stimuli

• Waken, person feels as though daydreaming has occurred

Stage 2: NREM

• Period of sound sleep

• Relaxation progresses

• Arousal is still relatively easy

• Stage lasts 10-20 minutes

• Body functions, vital signs & metabolism, slow

Stage 3: NREM

• Involves initial stages of deep sleep

• Sleeper is difficult to arouse and rarely moves

• Muscles are completely relaxed

• Lasts 15-30 minutes

Stage 4: NREM

• Very difficult to arouse sleeper

• Deepest stage of sleep

• If sleep loss has occurred, sleeper will spend considerable portion of night in this stage

• Vital signs are significantly lower than during waking hours

• Lasts approximately 15-30 minutes

• Sleepwalking and enuresis may occur

REM SLEEP• Vivid, full-color dreaming

may occur in REM.

• Usually begins about 90 minutes after sleep has begun

• Typified by autonomic response of rapidly moving eyes, fluctuating heart and resp rates, increased BP

• Loss of skeletal muscle tone occurs

• Gastric secretions increase

• Very difficult to arouse• Duration of REM sleep

increased with each cycle and averages 20 minutes

Functions/Purpose of Sleep

• Restoration– Psychological– Physiological

• Biological

• Cognitive

• Conservation of energy

FACTORS THAT AFFECT SLEEP

• Physical illness

• Drugs and substances

• Lifestyle

• Emotional stress

• Environment

• Exercise and fatigue

• Food and caloric intake

SLEEP DISORDERS• INSOMNIA

• SLEEP APNEA

• NARCOLEPSY

• SLEEP DEPRIVATION

• PARASOMNIAS

INSOMNIA

• Chronic difficulty falling asleep

• Frequent awakenings from sleep

• Short sleep or nonrestorative sleep

SLEEP APNEA

• Disorder in which the individual cannot breath and sleep at the same time

• Lack of airflow through the nose and mouth for periods from 10 seconds to 1-2 minutes, there can be 10 or 15 to more than 100 respiratory events per hour of sleep

• Three types: central, obstructive, and mixed

CENTRAL SLEEP APNEA• Caused by cessation of diaphragmatic and

intercostal respiratory effort as a result of dysfunction of the brain’s respiratory control center

• Impulse to breath fails, temporarily

• Least common form

OBSTRUCTIVE APNEA

• Most common form

• Characterized by cessation of airflow despite the effort to breath

• Occurs when muscles or structures of the oral cavity or throat relax during sleep

• Usually have loud snoring

NARCOLEPSY

• A CNS dysfunction of mechanisms that regulate the sleep and wake states

• Falls asleep uncontrollably at inappropriate times

• Treated with stimulants

SLEEP DEPRIVATION

• S/S: blurred vision, fine motor clumsiness, decreased reflexes, slowed response time, decreased reasoning and judgment, cardiac arrhythmias

• Psychological S/S: confusion, disorientation, increased sensitivity to pain, irritable, withdrawn, agitation, decreased motivation

PARASOMNIAS• Sleep problems that are more common in children, one

common exception is bruxism (tooth grinding)

• SIDS

• Somnambulism(sleepwalking)

• Nightmares

• Nocturnal enuresis (bedwetting)

ASSESSMENT

• Normal sleep pattern, restful? sufficient?

• Self- reported

• Sleep log

• Bedtime routines

• Bedtime environment

• Client expectations

Pain

• Physical sensation

• Involves physical, emotional and cognitive components

• Stimulus

Physiology of Pain

• Transduction

• Transmission

• Perception

• Modulation

Types of Pain

• Acute• Chronic• Idiopatic• Inferred

– nociceptive– neuropatic

Pain Assessment• Scales

• Nonverbal pain indicators

• Behavioral indicators

Pain Management

• Pharmacological interventions

• Non-pharmacological interventions

• Barriers

• Cultural considerations

• Reassessment

Environmental factors affecting common and sleep

• Comfortable room temperature

• Proper ventilation

• Minimal noise

• Comfortable bed

• Proper lighting

Promoting Bedtime Routines

• Help client to relax in preparation for sleep

• Avoid mental stimulation before bedtime

• Relaxation exercises

• Guided imagery

• Good sleep hygiene

Sleep Hygiene

• Avoid sleeping long hours during weekend or holiday

• Bedroom should not be used for intensive studying, snacking, TV watching, or other nonsleep activity

• Avoid worrisome thinking when going to bed

• Avoid heavy meals for 3 hours before bedtime

Promoting comfort

• Encourage client to wear loose-fitting nightwear

• Instruct family on ways to position client and support dependent body parts to aid in muscle relaxation

• Have client void before going to bed

• Back massage

• Keep bed linens dry

Activity

• If client is at home, encourage physical activity during daytime

• Avoid rigorous exercise at least several hours before bedtime

Control of noise in hospital

• Close doors to client’s room

• Keep doors to work areas closed

• Reduce volume of nearby telephones and paging equipment

• Avoid abrupt loud noises

• Keep necessary conversations at low levels