COMFORT, REST &

SLEEP, PAIN
NURSING FOUNDATION
UNIT 9

Rani.G.S ., MSc (N)

SYLLABUS:UNIT 9 9.3 Pain (Discomfort)
 Physiology
9.1 Comfort  Common cause of pain
 Factors Influencing Comfort  Types

 Types of beds including latest  Assessment - pain scales and narcotic

scales
beds, purposes & bed making
 Pharmacological and Non-
 Therapeutic positions
pharmacological pain relieving
 Comfort devices measures-Use of narcotics, TENS

9.2 Sleep and Rest devices, PCA

 Invasive techniques of pain
 Physiology of sleep
management
 Factors affecting sleep
 Any other newer measures
 Promoting Rest and sleep  CAM (Complementary & Alternative
 Sleep Disorders healing Modalities)
 9.1: COMFORT

Definition
 A sense of physical or psychological ease,
often characterized by a lack of hardship.
 Comfort is a sense of mental and physical
well being.
 FACTORS INFLUENCING COMFORT

Physical Psychological Environmental

•Clothing •Fear & anxiety in •Temperature
•Sleep regard to illness •Humidity
•Pain •Concern for the •Light
•Restricted family •Ventilation
movement •Interruption in •Noise
daily routine
•Lack of privacy
 COMFORT DEVICES
 Hospitals use many mechanical devices for
ensuring safety and comfort of the patients.
1. BED BARS/ SIDE RAILS
• Used to prevent patients from falling out of bed.

• Patients who require this safety measure are

1. post operative patients,

2. unconscious,

3. semi-conscious,

4. mentally disturbed,

5. sedated,

6. blind,

7. children

8. very old patients.

2. BACK REST
 Back rest is a mechanical device used to support the patient's back at

an angle so that back, head and the arms of the patient are well

supported.

 Back rest is used for patients, who suffer from cardiac and pulmonary

distress since it permits maximum chest expansion.

Purpose

 To support the back.

 To relieve dyspnoea.

 To promote drainage from abdominal cavity.

 To facilitate easy breathing, it is especially used for heart patients and

asthma patients.
3. CARDIAC TABLE
 It is usually used for patients who are propped up in a sitting position for

change of position.

 The cardiac table is placed with a pillow on it, on which the patient can

lean forward and can take rest;

 The same table is used without pillow for writing or for meals.

 This position is used for patients with cardiac conditions or asthma as they

cannot breathe easily in lying down position.

Purposes

1. Helps to use the accessory muscles for respiration.

2. The position should be changed to relieve fatigue and prevent embolism.

4.FOOT-BOARDS (FOOT-RESTS)

 These are made of wood and are L shaped, so that one

end can be slipped under the mattress to hold the other
end in a firm upright position.
 Used to prevent foot drop by maintaining good alignment.

Purposes
 To maintain the normal position of feet
 To provide comfort
 To prevent foot drop.
5. SAND BAG
 These are canvas, rubber or plastic bags filled with
sand.
 In 1,5 and 10 lbs in weight.

Purposes
 To relieve discomfort
 To support the body parts.
 To support fracture bones
 To prevent foot drop or wrist drop.
6. BED BLOCKS
 These are made of wood, may be high or
low.
 These are placed under the foot of the bed
for various reasons like Shock, traction and
postural drainage.

Purpose
 To promote drainage
 To improve cerebral circulation.
7.PILLOWS
 Comforting device that are provided to the
patients, to provide necessary support for the
neck, spine, to alleviate or preventing many
common forms of back pain and neck pain.

Purposes
 To provide comfort
 To prop up the head, neck, and shoulders.
 Helps in relieving pressure.
8. HAND ROLLS

 Cloths rolled into a cylinder about 4-5 inches

long and 2-3 inches in diameter and stuffed
firmly.
 Used to keep the fingers firm being held in a
tight fist .
 Used in patients who are unable to move the
hands due to paralysis, injury or disease.
9. THIGH ROLLS
 Made by folding a sheet to a desired length
of 2-3 feet and then rolled into a tight
cylinder.
 Used to support the hips and thighs .
 To keep feet in good alignment
 10. AIR AND WATER
MATTRESSES
 Used for very thin and obese patients.
 Used for those who are prone to get pressure sores.
 Principle is that pressure exerted by the body will
be distributed equally in all directions.

Purposes
 To improve circulation
 To provide comfort
 To prevent pressure sores.
11. BED CRADLE
 Frame used to hold the top linen from
coming into contact with the patient.
 Varies widely in size and in material.
 Are of wooden, metal, electronic .
 Used to allow air to circulate
12.AIR CUSHION
 Round in shape and made of rubber.
 can be inflated with air.
 Should be used with cover to avoid direct contact of
rubber with the skin.

Purposes
 Used to take off the weight of the body.
 It provides relaxation as it yields to shift off body
weight
 It relieves pressure on certain parts of the body.
13. RINGS
 Air rings are made up of rubber.
 The air rings are inflated about half full treated for leakage, covered
and place under the patients hip.
 Cotton rings are made wrapped with bandage.
 Made up of cotton and gauze.
 Placed under bony prominences such as heels, elbows, and knees to
relieve pressure.

Purpose
 To lift hip from bed to prevent bed sores
 To prevent direct pressure on bony prominences
 To improve the circulation.
ROLE OF NURSE
 Identify the comfort needs of patients.
 Design interventions to meet identified
needs
 Deliver interventions in a caring manner.
 Ensure enhanced comfort measures.
 Always ensure patient and family
satisfaction.
 THERAPEUTIC POSITIONS
 Patients are put in special positions for
 examination,
 Treatment,
 to obtain specimens etc.
 1.HORIZONTAL RECUMBENT / SUPINE
POSITION
 Used for most physical examinations.
 Patient is on his back with legs extended.
 Arms may be above the head, alongside the
body or folded on the chest.

Purposes
 To provide comfort to the patient.
 To perform physical examination.
 To check vital signs.
2. DORSAL RECUMBENT
POSITION
 Patient on his back with knees flexed and soles of feet
flat on the bed.

Purposes
 To provide comfort to the patient
 To perform physical examination
 To check vital signs
 To provide perineal care.
 To perform genital examination.
 To perform urinary catheterization.
3. FOWLER’S POSITION

 A standard patient position in which the patient is

seated in a semi-sitting position (45-60 degrees)
and may have knees either bent or straight.
Purposes
 To provide comfort to the patient
 To relieve dyspnea
 To relieve abdominal distension
 To relieve pressure on back
 To aid in postural drainage
 4. DORSAL LITHOTOMY POSITION

 Used for examination of pelvic organs.

 Feet are usually placed in stirrups.

Purposes
 to perform examination of pelvic organs
 to perform vaginal examinations
 to perform genitourinary operations
 to perform vaginal delivery
5. PRONE POSITION
 Used to examine spine and back

 Patients lie on abdomen with head turned to one side .

 Arms may be alongside body or above head.

Purposes

 to provide comfort to the patient

 to examine the spine and back

 to relieve pressure on the back

 to position the patient with injury, burns of the back.

 to assess posterior thorax.

 6. SIM’S POSITION
 Used for rectal examination
 Patient is on left side with right knee flexed against
abdomen and left knee slightly flexed.
 Left arm is behind the body
 Right arm placed comfortably

Purposes
 to provide comfort to the patients
 to perform vaginal examinations
 to perform rectal examination
7. LATERAL POSITION
 Patient lies with head, neck and back in straight line.

 legs parallel with knees slightly flexed

 pillows placed under head and neck to maintain alignment.

Purposes

1. To provide comfort to the patient.

2. To relieve pressure on back.

3. To administer enema.

4. To administer rectal suppository.

5. To administer flatus tube.

6. To check rectal temperature.

7. To perform rectal examination.

8. To give back care.

8. KNEE CHEST POSITION
 Patient is on knees with chest resting on bed and elbows
resting on bed or arms above head
 Head is turned to one side.
 Thighs are straight and lower legs are flat on bed.

purposes
 to perform vaginal examination
 to perform rectal examination
 to perform sigmoidoscopy
 to correct position of displaced uterus and other pelvic organs.
9.TRENDELENBURG POSITION

 Patient lies on his back with the foot of bed elevated on

wooden blocks.
 Patient’s head and trunk are lower than the legs.

Purposes
 to perform pelvic examinations
 to perform operations on pelvic organs
 to treat shock
 to aid in postural drainage
 to promote venous return.
10. REVERSE TRENDELENBURG POSITION

 Head and shoulders are at a higher level than

the hips, legs and feet

Purpose
 To reduce intracranial pressure
 BED MAKING
Definition:
 It is the process of making ideal bed for
patient according to their situations and
procedures.
 PURPOSES
 To give neat and tidy appearance to the unit.
 To provide a safe, comfortable place for the
patient.
 To achieve repositioning more easily.
 To prevent pressure ulcers.
 To promote rest and sleep.
 Purposes contd..

 To promote cleanliness.
 To economize time, material and energy.
 To keep it ready for emergency.
 To provide active and passive exercises to the
patient.
 To establish rapport with the patient.
 To observe the patient.
 To relieve fatigue.
 PRINCIPLES OF BED MAKING

 Barrier nursing to prevent cross infection.

 Clean and comfortable bed to ensure rest and sleep and to

prevent complications.

 Appropriate body mechanics to maintain body alignment and

prevent fatigue.

 Organized functioning to save time, effort and material.

 Make all beds in a nursing unit alike for uniformity of appearance.

 Handle all linen in order to reduce dust and spread of

microorganisms
 GUIDELINES FOR BED MAKING

1. Gather all the required linen and accessories

before making the bed.

2. Avoid shaking the linen to prevent the spread

of microorganisms and dust particles.

3. Avoid placing linens, clean or dirty, on another

patient's bed.

4. Do not place dirty linen on the floor.

 Guidelines contd...

5. Do not hold dirty linen against your uniform.

6. Always use good body mechanics; raise the bed

to its highest position to make bed making

easier.

7. Stay on one side of the bed until it is

completely made; then move to the other side

and finish the bed. This saves time and steps.

 Guidelines contd...

8. Observe the patient and document any nursing

observations.

a. Check for areas of redness that may lead to decubitus

formation.

b. Note tolerance of activity level while out of bed.

c. Note observations about the physical and emotional

status of the patient.

d. Note any patient teaching or reinforced teaching given

and the patient's response.

e. Check for drainage, wetness or other body fluids and

record.
 TYPES OF BED
1. Unoccupied bed: Open bed & Closed bed
2. Occupied
3. Admission bed
4. Cardiac bed
5. Amputation bed/divided bed
6. Fracture bed
7. Postoperative bed
8. Therapeutic bed (eg, renal bed, blanket
bed)
1. UNOCCUPIED BED :CLOSED BED

 Bed that is made when not occupied by a patient.

 An empty bed in which the top covers are
arranged in such a way that all linen beneath the
bedspread is fully protected from dust and dirt
until the admission of new patient.

INDICATION:
 Keep the bed ready for receiving the new patient.
2. UNOCCUPIED BED: OPEN BED
 The term open bed is used to describe the
hospital bed when it is about to be occupied by
a client.
 This is prepared for an ambulatory patient or
an new client.

INDICATION:
 To provide a clean, smooth, and comfortable
bed to the patient.
 PREPARATION OF PATIENT & UNIT
 Move furniture away from the bed
 Arrange the linens in the reverse order
 Place the linen basket at bed side
 Lower the head end of the bed, keep the
bed in flat position & lower side rails
 ARTICLES

1. A clean tray containing

 2 bowls with 2 clean mitten ( one for dry dusting & one for damp dusting )

 A basin with disinfectant solution (Savlon 1:20)

 Kidney tray

2. A chair or stool to arrange the linen

3. Clean linens arranged in the reverse order

 Bottom sheet

 Mackintosh

 Draw sheet

 Top linen

 Blanket

4. A hamper or dirty linen basket

 PROCEDURE

SLNO
STEPS
Remove wrist watch & Wash hands.
1
Remove pillow & place it over the seat of the chair or stool with
2
open end away from the entrance of the room.
Remove any personal items on the bed, inside pillow cover, under
3
pillow under mattress.
Stand at the right side of the bed & strip linen from all sides starting
4
from head end to foot end. Moving around the bed systematically.

Bundle the linen each at a time & discard it in to the linen hamper
5
if they are not to be reused ( if reusing fold the sheet neatly dust it
in laundry bag & keep along with sheets arranged for the procedure)
 Clean the mattress as two half, first with dry duster & then with
6 damp duster. ( Dry dusting collected in the kidney tray)

Fold the mattress from top to bottom & clean under surface of
7 mattress & cot with dry duster & then damp duster.

Replace the duster & keep the mattress flat.

8
Place the bottom sheet at the centre of the bed.
9
Open up the bottom sheet, make mitered corners, first at the head
10 end & then at the foot end & tuck on that side moving from head
to foot. NB: Maintain body mechanics when
tucking the linen
11 Spread the mackintosh & place draw sheet over it. Tuck them
together on the side you are standing. Tuck the middle portion
first, then head end followed by foot end.

12 Move to the other side of the bed, tighten bottom sheet & make
mitered corners at head end & foot end, while tucking pull the
sheets with both hands.

13 Tuck the bottom sheet mackintosh & draw sheet together on the
side.
14 Spread the top sheet with top end below the head end of the
mattress.
15 Place the blanket over the top sheet 15 to 20 cm below from the
top of mattress. Cuff the top sheet over the blanket.
AFTER CARE
 Help the client to get in to the bed . One corner of
the top linen is folded back to let the patient in.
Cover the client with top linen.
 Provide comfort devices if prescribed.
 See that the whole unit is clean & tidy before you
leave the unit.
 Bed in general ward should be arranged in straight
line.
 The bed pans, urinals, sputum cups kidney tray
etc.. lying in the client’s unit are to be taken
away emptied, cleaned & are put back in their
proper place.
 The windows & doors should be dusted to keep
them dust free.
 The cupboard are to be dusted & articles are to
be arranged in order & according to use.
 Sent the laundry bag with soiled linen to laundry. If
stains present on the sheet remove them with
appropriate method before it is sent to laundry
 If there are any blankets , put them in sun &
disinfect before they are stored in cupboard
 The duster should be soaked in anti septic lotion to
disinfect it , rinse it with clean water & put to dry
 Record the procedure in nurse’s record with
observations made on the client
3. OCCUPIED BED
 Bed that is made while occupied by a patient.
 Changing a bed line and making a comfortable
neat bed while it is occupied by a patient.

Indication:
 To provide a clean and comfortable bed with
the least disturbance to the patient in it.
 PREPARATION OF PATIENT & UNIT
 Assess patient’s general condition & check for
any limitation in physical activity.
 Explain the need of the procedure to the
patient.
 Adjust the height of the bed , lower the side
rails near to you , leaving the opposite side
rails up.
 ARTICLES

1. A clean tray containing

 1 bowl with 1 clean mitten ( for dry dusting)
 Kidney tray

2. A chair or stool to arrange the linen

3. A hamper or dirty linen basket

4. Clean linens arranged in the reverse order

 Bottom sheet
 Mackintosh
 Draw sheet
 Top linen
 Blanket
 PROCEDURE

Remove wrist watch & Wash hands.

1
Check the bed linen for patients personal items & remove extra
2 pillows.
Adjust the height of the bed .Low side rails near to you, leaving
3 opposite side rails up. Release any equipment attached to the
bed linen with clips like call light, IV tubing’s, Foley’s catheter
etc.

Remove the blankets leaving the top sheet over the patient &
4 cover the patient with top linen without covering the face.

Position of the patient on the far side of the bed facing away.
5 Adjust the pillow under head.
11 Spread the mackintosh & draw sheet & fan-fold it towards the
patient. Tuck mackintosh & draw sheet together on your side.

12 Raise the side rails on working side & go to other side.

13 Lower side rails & assist the patient to roll slowly to the other side of
the bed over the folded linen.

14 Loosen the edges of the soiled linen from underneath the mattress.

15 Remove the bottom sheet, mackintosh & draw sheet by folding it in

to a bundle & place in the linen bag.
16 Dust the mattress with dry duster & spread the fan-folded clean linen
smoothly over the edge of the mattress from head end to foot end.

17 Pull, taut & secure the bottom sheet & Make mitered corners & Then tuck
the hanging sheet.

18 Straighten the mackintosh & draw sheet.

19 Assist the patient in rolling back to supine position & reposition the pillow.

20 Place the new top sheet over the patient open the sheet from head to foot
and unfold it over the patient , remove the used top sheet by pulling from
down and place it in the linen bag.
21 Place the blanket over the top sheet as in open bed .

22 Place the upper edge of the blanket 5-6 inches lower than the top
sheet as in open bed. Fold it over the blanket’s upper border to
form cuff

23 Make a horizontal toe pleat & modified mitered corner in the foot
end allowing the sides to hang free.

24 Change the pillow case & replace pillow with open end facing away
from door or entrance of room.

25 Replace the articles & wash hands.

AFTER CARE
 Make sure that the side rails are raised on both
sides
 Release the clips used for the positioning of the
equipment like iv tubing , catheter etc
 Position patient comfortably
 Provide or replace comfort devices used any
3. ADMISSION BED
 Bed prepared for the newly admitted patient.

 It is a specially made bed for patients who are admitted into the

ward.

 It is made in such a way that the patient is admitted without

delay.

Indications:

1. Provide minimum disturbance to the patient during admission

bath and physical examination.

2. Protect bed linen during admission bath and leave a fresh bed

immediately ready for use.

5. AMPUTATION BED/ DIVIDED BED
 Bed prepared for a patient having amputated limb.

Indications:
 Avoid disturbance to the patient when constant
observation or repeated applications or treatments
are necessary .
 Keep the stump in good position.
 Watch stump for hemorrhage constantly and apply
a tourniquet instantly if necessary.
6. FRACTURE BED
 It is one which is used for a patient with
fracture of leg or extremities to provide firm
support by the use of firm mattress.
Indications
 Aid in immobilizing the fracture.
 Prevent unnecessary pain
 Provide warmth and comfort to the patient.
 Prevent undue sagging of the mattress.
7. CARDIAC BED
 Bed prepared for a patient with heart
disease.

Indications:
 Relieve dyspnea
 Assist in recovery of the patient
 Provide comfort the patient
 Prevent complications
8. ANESTHETIC, SURGICAL OR POSTOPERATIVE BED

 Bed that is prepared to receive a patient

from the operating room.

Indications
 Protect bed linen from vomiting, bleeding,
drainage and discharges.
9. BLANKET BED
 Rheumatism or renal bed
 Provide extra warmth to the patient.

Indications
 Provide extra warmth the body in case of general
debility and shock
 Provide comfort to the aching joints in patients with
acute rheumatism.
 Improve perspiration for excretion of waste products
in case of nephritis.
10. BURN BED
 Bed prepared for patients with burn.

Indications:
 Prevent infection to the burn area.
 Help in healing of the burn area
 Provide comfort to the patient.
 Prevent the patient from sticking to the sheet
as a result of exudate's oozing the burn area .
LATEST BEDS
 9.2 SLEEP AND REST
Definition of sleep
 A circadian state characterized by partial or
total suspension of consciousness, voluntary
muscle inhibition and relative insensitivity to
stimulation.
Facts about sleep
 A relaxed state that is necessary to humans.
 It is universal and natural process.
 It is a state of composure that restores cerebral
function.
 Sleep is a sensory experience.
 The cyclic nature of sleep is thought to be controlled by
centres located in the brain - HYPOTHALAMUS.
 Sleep is a complex biologic rhythm.
 PHYSIOLOGY OF SLEEP
STAGES OF SLEEP
 Two stages

1. NREM Sleep/ S-sleep (synchronized

sleep)/quiet sleep/ orthodox sleep

2. REM (Rapid Eye Movement Sleep)/ D-sleep

(Dreaming sleep) / Active sleep/
paradoxical sleep.
 NREM (NON RAPID EYE
MOVEMENT) SLEEP
 Also referred as slow wave sleep because brain
waves of a sleeper are slower than a person who
is awake.
 Deep, restful sleep.
 Decrease in some physiologic functions.
 All metabolic processes including vital signs,
metabolism and muscle action slows.
 Swallowing and saliva production also reduced.
Include 4 stages

Stage 1:
 Stage of very light sleep
 Person feels drowsy and relaxed
 Eyes roll from side to side
 Heart and respiratory rate drops slightly
 Sleeper can be readily awakened
 Lasts only a few minutes.
Stage 2:
 Stage of light sleep during which body processes
continue to slow down
 Eyes are generally still
 Heart and respiratory rate decreases slightly
 Body temperature falls
 Lasts for only 10-15minutes
 Constitutes 40-50% of total sleep
Stage 3:
 All body processes slow down further
 Very difficult to arouse
 The person is not disturbed by sensory
stimuli
 Skeletal muscles are very relaxed ,
reflexes are diminished .
 Snoring may occur
Stage 4:
 Deep sleep, called delta sleep
 Heart and respiratory rates drops 20-30% below
those exhibiting during waking hours.
 Sleeper is very relaxed.
 Difficult to arouse
 The eyes usually roll and some dreaming occurs.
 REM (RAPID EYE MOVEMENT)
SLEEP
 Not as restful as NREM sleep
 Most dreams takes place during REM
sleep
 Brain is highly active and brain
metabolism increase.
 Sleeper may be difficult to arouse or may
wake spontaneously.
 Muscle tone is depressed, heart and
respiratory rates are irregular.
 SLEEP CYCLE
 During a sleep cycle, people pass through NREM and

REM sleep

 The complete cycle usually lasting about 1.5 hours in

adults.

 In the first step of cycle, a sleeper passes through all

of the first 3 NREM stages in a total of about 20-30

minutes.

 Then stage 4 may last for about 30 minutes.

 After stage 4 NREM, the sleeper passes back

through stages 3 and 2 over about 20 minutes

thereafter, the first REM stage occurs, lasting

about 10 minutes, completing the first cycle.

 The usual sleeper experiences 4 to 6 cycles of

sleep during 7-8 hours of sleep.

STAGES OF ADULT SLEEP CYCLE
FACTORS INFLUENCING SLEEP
1. Motivation

2. Culture

3. Lifestyle and habits

4. Physical activity and exercises

5. Dietary habits :
o Tryptophan stimulate sleep
o Protein increases alerts and concentration.
o Carbohydrates appear to effect brain serotonin levels
and promotes calmness and relaxation.
6. Alcohol intake

7. Caffeine containing beverages

8. Smoking

9. Environmental factors

10. Psychological stress

11. Illness

12. Medications
 PROMOTING REST AND SLEEP
SLEEP PATTERN

 Establish a regular bedtime and wake up time for all days

to prevent disruptions in the biologic rhythm.

 Prevent lengthy day time rest periods. It should be for 30

minutes preferably once a day.

 Perform adequate exercise during the day to reduce

stress but avoid physical exercise 2 hours before bed

time.
 Avoid stressful activities and emotions before bed

times

 Establish a regular routine before sleep such as

reading, listening to soft music, warm bath or doing

bed time rituals like prayers and elimination, etc.

 Use good foam mattress for sleep if patient has

problem with sleep.

Environment
 Ensure appropriate lighting, temperature and
ventilation.
 Avoid excessive stimuli from the environment.
Diet

 Avoid heavy meals and hours before bed time.

 Avoid foods like alcohol, caffeine and beverages or

chocolates atleast 4 hours before bed time as those foods

can cause diuresis and interrupt sleep patterns.

 Decrease fluid intake 2-4 hours before sleep.

 If bed time snack is necessary give light carbohydrates foods

or warm drink like milk which help to induce sleep. Heavy

fatty foods can cause gastrointestinal upset that disturb

sleep.
Medications
 Avoid drugs like diuretics 6-8 hours prior to sleep
 Use sleeping medication as a last option if needed
like alprazolam and diazepam.
 Take analgesics 30 minutes before bed time to
relieve pain that may disturb sleep.
 Consult with health care provider about adjusting
with other medication that may cause Insomnia.
 SLEEP DISORDERS
Definition
 “A sleep disorder (somnipathy) is a medical
disorder of the sleep pattern of a person”.
 Some sleep disorders are serious enough to
interfere with normal physical, mental and
emotional functioning of the body.
 CLASSIFICATION OF SLEEP DISORDERS

1.INSOMNIA
 Insomnia is characterized by difficulty falling asleep,
intermittent sleep or early awakening from sleep.
 It is the most common of all disorders.
 Two types : primary insomnia & transient
situational insomnia.
1. Primary insomnia (Insomnia without identifiable cause):

 Many patients with insomnia have no clear, single

identifiable underlying cause for their difficulties with sleep.

2. Transient situational insomnia:

 This typically develops after change in the sleeping

environment (e.g. in an hospital) or before or after a

significant life event, such as a change of occupation, loss of

a loved one, illness or anxiety over a deadline or

examination.
2. HYPERSOMNIA
 It is a condition characterized by excessive sleep, particularly during the

day.

 A person may fall asleep for intervals during work, while eating or even

during conversations.

Causes of Hypersomnia

 Drug or alcohol abuse.

 Head trauma or other injury to the central nervous system.

 Effect of certain medications

 Depression

 Obesity

 Other medical conditions .

3. NARCOLEPSY
 Condition characterized by an uncontrollable desire to
sleep.
 A person with narcolepsy can literally fall asleep standing
up or while driving a car, in the middle of conversation or
while swimming.
 Individuals with narcolepsy tend to fall asleep quickly, find
it difficult to wake up, sleep fewer hours than others and
sleep restlessly.
4. SLEEP APNEA

 Periodic cessation of breathing during sleep.

 The person has

• loud snoring,

• frequent nocturnal awakenings,

• excessive daytime sleepiness,

• insomnia,

• morning headaches,

• deterioration,

• irritability

• hypertension, cardiac arrhythmias.

Types of Sleep Apnea

1. Obstructive apnea:
 A sleep disorder that involves cessation or
significant decrease in airflow in the presence
of breathing effort.
 It is the most common type of sleep-disordered
breathing and is characterized by recurrent
episodes of upper airway collapse during sleep.
2. Central apnea:
 It is thought to involve a defect in the respiratory
center of the brain.
 All the actions involved in breathing, such as chest
movement and air flow cease.

3. Mixed:
 It is a combination of central and obstructive apnea.
5. PARASOMNIA
 Parasomnia refers to abnormal behavior that
arises from or occurs during sleep.
 They usually do not produce insomnia or
excessive sleepiness.
a) Sleep walking (somnambulism):
 It may include semi-purposeful behavior,
such as dressing, but may be lacking in
coordination and appropriateness such as
voiding in the closet.
b) Sleep terrors:
 This disorder also called pavor nocturnus,
occurs primarily in young children.
 Sleep terrors are sudden arousals
accompanied by screaming tachycardia,
tachypnea, diaphoresis and other
manifestation of intense fear.
c) Sleep talking:
 Talking during sleep occurs during NREM
sleep before REM sleep.
 It rarely presents a problem to the person
unless it becomes troublesome to others.
d) Sleep bruxism:
 Bruxism is an involuntary, forceful grinding
of teeth during sleep.
 Bruxism is a manifestation of psychological
stress.
 Stress management usually resolve this
problem.
e) Nocturnal myoclonus (restless leg syndrome):
 A condition in which a person feels an urge to
walk in an attempt to relieve an irritating ache
or creepy feeling in the calves and thighs.
 Nocturnal myoclonus is common in the elderly
and can occur every 15 to 40 secs in a sleeping
state.
f) Sleep enuresis (bed wetting):
 Bed wetting during sleep can occur in
children over 3 years old.
 ASSESSMENT OF SLEEP DISORDERS

 Sleep history
 Physical examination
 Diagnostic studies
• Electroencephalography
• Wrist actigraphy
• Nocturnal polysomnography
 MANAGEMENT OF SLEEP DISORDERS
Medical management:
 Treat baseline problem if any
 Pharmacologic measures
• Hypnotics and sedatives
 Non pharmacologic measures
• Restful environment
• Promoting relaxation
• Bedtime rituals
• Normal sleep wake patterns
Nursing management