PROMOTING REST & SLEEP

KRISTINE JOY L. RICAFORT-ACERA

REST
 Diminished state of activity
 Calmness
 Relaxation without emotional stress
 Freedom from anxiety
SLEEP
 State of consciousness in which the individual’s
perception and reaction to the environment are
decreased
 Characterized:
 Minimal physical activity
 Variable level of consciousness

 Changes in body’s physiologic processes

 Decreased responsiveness to external EV

 PHYSIOLOGY OF SLEEP
 Biorhythms
 Circadian (Circa dies –about a day)
 Circadian synchronization
 Awake-physiological& psychological rhythms are active
 REGULARITY – 3rd week of life
STAGES OF SLEEP
 NREM
 Slow-wave sleep
 Deep, restful sleep
 ↓ some physiologic functions (↓ VS, metabolism,
U& muscle action)
 STAGE I –VERY LIGHT SLEEP
 Drowsy & relaxed, eyes roll from side to side, HR &
RR slightly drop, can be readily awakened
 STAGE II-LIGHT SLEEP
 Eyes are still, HR & RR slightly & body temperature
falls
 10-15 but constitute 40-45% of total of sleep
 STAGE III –
 HR & RR, body processes slows further
 More difficult to arouse
 Not disturbed by sensory stimuli
 Skeletal muscles are very relaxed
 Reflexes are diminished
 Snoring
 STAGE IV DEEP SLEEP
 Delta sleep
 HR & RR drops 20-30% (Waking hours)
 Very relaxed, rarely moves, difficult to arouse
 Restore the body physically
 Eyes roll * some dreams occur
 REM
 Occurs every 90 minutes & last 5-30 minutes
 Most dreams occur (remember)

 Brain- highly active & brain metabolism ↑ 20%

 Paradoxical sleep

 Difficult to arouse or may awake spontaneously,

muscle tone is depressed, gastric secretions ↑,
HR & RR irregular
SLEEP CYCLES
 NREM & REM – lasting 1.5 hours in adults
 STAGE I, STAGE II & STAGE III -20-30 minutes
 STAGE IV – 30 minutes
 Back to NREM STAGE III and II -20 minutes
 1st REM occur –10 minutes
 4-6 cycles in 7-8 H
Function
 To cope with daily stresses
 Prevent fatigue
 Conserve energy
 Restore mind and body (NREM)
 Enjoy life fully
 Increase in synthetic processes in the brain (REM)
PATTERNS OF SLEEP
 Newborn-16-18 H divided into 7 sleep periods
 INFANTS- 22H a day (12-14 H in other)
 TODDLERS -10-12 hours
 PRESCHOOL – 11-12 hours
 SCHOOL AGE-8-12 hours
 ADOLESCENTS- 8-10 hours
 YOUNG ADULTS- 7-8 hours
 MIDDLE ADULTS- 6-8 hours
 OLD ADULT- 6 hours
FACTORS AFFECTING SLEEP
 ILLNESS
 ENVIRONMENT
 FATIGUE
 LIFESTYLE
 EMOTIONAL STRESS
 STIMULANTS & ALCOHOL
 DIET –wt. loss ↓ sleep wt. gain ↑ sleep
 SMOKING
 MOTIVATION
 MEDICATIONS
SLEEP DISORDERS
 PARASOMIAS
 Behavior that may interfere with sleep and may even occur
during sleep
 SOMNAMBOLISM (Sleep walking)
 NIGHT TERRORS (after having slept for few hours, one bolts
upright in bed, shakes and screams, appears pale &
terrified)
 NOCTURNAL ENURESIS (bedwetting)
 SOLILOQUY (sleeptalking)
 NOCTURNAL ERECTIONS (wet dreams)
 BRUXISM (clenching & grinding of teeth during sleep)
PRIMARY SLEEP DISORDERS
 INSOMIA –inability to obtain an adequate amount
or quality of sleep
 TYPES:
 Difficulty in falling asleep (initial insomnia)
 Difficulty in staying asleep due to frequent/prolonged
waking (intermittent or maintenance insomnia)
 Early morning/ premature waking (terminal insomnia)

 Result of mental overstimulation due to anxiety

PRIMARY SLEEP DISORDERS
 HYPERSOMNIA- excessive sleeping (daytime)
 Medical condition (CNS damage0
 NARCOLEPSY – Greek NARCO (numbness) LEPSIS (seisuze)
“SLEEP ATTACK”
 Lack of hypocretin in CNS-regulate sleep
 SLEEP APNEA –cessation of breathing during sleep
 Obstructive-structures of the pharynx/ oral cavity block the
flow of air
 Central –defect in respiratory center of the brain
 Mixed – combination

 SLEEP DEPRIVATION – prolonged disturbance in

amount, quality, & consistency of sleep
NURSING MANAGEMENT
 ASSESSING
 Sleep history
 When do you usually sleep? Usually wake? Nape? For children, bedtime
rituals
 Do you have any problems with sleep? Has anyone told you that you
snore? Are you able to stay awake at work? Driving? Usual activities?
 Medications? OTC meds/herbal?
 Is there anything I need to know about your sleep?
 Health history
 Obtained to rule out medical/psychiatric causes of the client’s difficulty
sleeping
 P.E.
 Facial appearance, behaviors, & energy
 Obesity (adults)
 Sleep diary
 Time of going to bed?
 Instances of waking up and duration of periods?
 Waking up in the morning
 Naps & duration?
 Activities 2-3 hours before bedtime
 Caffeinated and alcoholic drinks?
 Factors that the client believes have a positive or negative effect on
sleep
 Diagnostic studies
 Polysomnography
 Electroencephalogram (EEG)
 Electromyogram (EMG)
NURSING DIAGNOSIS
 Fatigue related to insufficient sleep
 Anxiety related to sleep apnea and or the diagnosis of a
sleep disorder
 Activity intolerance related to sleep deprivation or excessive
daytime sleepiness
 Risk for injury related to somnambolism
 Ineffective coping related to insufficient quality and quantity
of sleep
 Risk for impared gas exchange related to sleep apnea
 Deficient knowledge (nonprescription remedies for sleep)
related to misinformation
PLANNING
 GOAL:
 Maintain a sleeping pattern that provides sufficient energy for daily
activities
 Enhancing the client’s feeling of well-being
 Improving quality and quantity of sleep
IMPLEMENTATION
 Adequate exercise -2 hours before bedtime
 High protein food (tryptophan)
 Observe habits of sleep periodocity and wake-up time
 Go to bed when sleepy
 Use bed for sleep
 SUPPORTIVE BEDTIME RITUALS
 Listening to music
 Readings soothing bath
 Praying
 CREATING RESTFUL ENVIRONMENT
 Minima; noise
 Comfortable room temperature
 Appropriate ventilation
 Appropriate lighting
 PROMOTING COMFORT & RELAXATION
 Provide loose-fitting nightwear
 Assist client with hygienic routine
 Bed linens are smooth & clean & dry
 Encourage client to void before bedtime
 Offer back massage
 Positioning