<p> Rest and Sleep Study Guide</p><p> Sleep  Physical and emotional health depends on adequate sleep and rest.  To help a patient gain needed sleep and rest, you need to understand the nature of sleep, the factors influencing it and interventions you can provide to promote sleep and rest.  You also need to understand how to promote optimal sleep and rest for you!</p><p> Physiology of Sleep  ______Rhythms . 24 hour day/night cycle affected by light and temperature . External factors like stress, activities affect it . Melatonin supports it . Everyone has a biological clock that is synchronized by light and activity . Different people function best at different times of the day (ex: early bird vs night owl)</p><p> Sleep Wake Regulation  Depends on interrelationship between 2 parts of brain that either activate or suppress the brain’s higher centers to control sleep or wakefulness  When you try to fall asleep, the stimuli to the RAS (Reticular Activating System) decline; Gradually the BSR (Bulbar Synchronizing Region) takes over, causing sleep. You will not reawaken until you finish your normal sleep cycle or are awakened by stimuli in the environment</p><p> Stages of Sleep  2 phases: . NREM: 4 stages through a 90 minute sleep cycle . ______is the phase at the end of the sleep cycle with increased brain activity and rapid eye movements; this is when vivid dreaming occurs  Understand Figure 29-2 and Box 29-1  People who have difficulty falling asleep remain in NREM Stage 1 for an hour or more (instead of normal 10-30 mins)  NREM Stage 4 is deepest level of sleep; person is very difficult to arouse; VS are lower; sleepwalking and ______sometimes occur</p><p> Sleep Cycle Graph </p><p> Functions of sleep  Sleep is a time of restoration and preparation  Sleep is a part of maintaining normal biological processes and optimal immune performance (repair and renewal of cells)  REM sleep is important for cognitive restoration and assists with memory storage and learning; loss of REM sleep leads to feelings of confusion</p><p> Dreams  Researchers believe dreams are important for the consolidation of long-term memory and emotional healing . This is why it is important to:  Review coursework right before bedtime  Get a good night’s sleep before an exam  Sleep Patterns across the Lifespan  Newborns/Infants: sleep 16 hrs/day  By age 2 sleep through night and take daily naps; often unwilling to go to bed. (Bedtime routines are helpful)  School age does not nap; needs quiet activities before bedtime  Teens often experience excessive daytime sleepiness due to lifestyle demands  By middle adulthood total time sleeping begins to decline and Stage 4 decreases. This continues with advancing age  Sleeping difficulties increase with age (50%). They awaken more often then have difficulties getting back to sleep. Sleep efficiency is decreased.</p><p> Factors Affecting Sleep  Illness: pain, difficulty breathing, nausea or mood problems cause sleep problems  Medications affect sleep. Tryptophan may help sleep  Lifestyle: shift changes, unaccustomed heavy work, late night activities  Usual sleep patterns and EDS  Emotional Stress  Environment is important: ventilation, light, temp, bed  Noise decreases REM  Fatigue: moderate=more restful  Food: lg meal within 3-4 hrs interferes; ______and caffeine interfere; weight loss and gain can interfere</p><p> Sleep Disorders  Insomnia  Sleep Apnea  Narcolepsy  Sleep Deprivation  Parasomnias</p><p> Routine Sleep Assessment  From patient, bed partner, or parent of child  Sleep history: usual bedtime, normal bedtime rituals, preferred environment, what time arises. </p><p> Sleep Problem Assessment  If there is a problem, assess in greater depth . Usual Sleep pattern . Description of Sleeping Problems . Sleep Log . Physical Illness and Meds . Current Life Events . Emotional and Mental Status . Bedtime Routines . Bedtime Environment . Behaviors of Sleep Deprivation . Patient Expectations</p><p> Plan of Care  See Care Plan: Disturbed Sleep Pattern . Review Assessment, Nursing Diagnosis, Goals, Interventions and Evaluation  Natural Interventions for Sleep  Environmental Controls  Promoting Bedtime Routines . research shows listening to relaxing music is helpful  Promote comfort  Promote activity during the day  ______ Beneficial bedtime snacks  Pharmacologic approaches . Review meds with HCP re: insomnia . Use sleeping meds as last resort and for limited time</p><p> Managing Sleep Disturbances  In acute care: . Manage noise; Plan to avoid awakening patients . Safety precautions if up at night or excessive daytime sleepiness . Bring ______- if use at home . Comfort measures: personal hygiene before bed; removal of irritating stimuli  In Continuing Care: . Previous interventions plus: . Increase daily activities . Limit time spent in bed . Reduce sleep disruptions . Patients with dementia: shortened activities and use soothing techniques at night</p><p> Evaluation  Individualized goals and interventions: check shortly after trying and ask after awakening.</p>