Rest and Sleep

Teresa V. Hurley, MSN, RN

Sleep Physiology

• Circadian Rhythm– Sleep-wake cycle or biological clocks– Early birds and night owls– Interruption of cycle

• Anxiety• Restlessness• Irritability• Impaired judgment

Sleep Physiology• Sleep Regulation by CNS, peripheral nervous, endocrine,

respiratory, muscular and cardiovascular systems• Stages of Sleep

– Non-rapid eye movement (NREM)• 4 stages during a 90 minute cycle from light to deep sleep (harder to arouse)• Body tissue restoration• HR decreases to 60/min or less• Interruption (confusion, suspicion, mood changes, immune suppression,

accidents)

– Rapid eye movement (REM)• End of each sleep cycle• Dreams more vivid and elaborate• Learning, memory processing, stress adaptation

Factors Affecting Sleep

Examples– Pain– Physical Discomfort– Difficulty Breathing (COPD, Asthma, Colds etc.)– Mood (anxiety or depression)– Nocturia– Restless legs syndrome prior to sleep (rhythmic

movements and itching)– GERDS

Sleep Disorders• Dyssomnias

– Intrinsic (initiate and maintain sleep due to psychophysiological)• Narcolepsy• Obstructive sleep apnea

– Extrinsic (external factors)– Circadian (sleep time/preference)

• Time zone change• Shift work

• Parasomnias– Sleepwalking– Sleep terrors– Sleep talking– Noctural leg cramps– Nightmares– Sleep paralysis– Teethgrinding– Bedwetting– SIDS

Factors Affecting Sleep

• Age: less time as age

• Drugs (L-trytophan in cheese, milk and meats promote sleep)

• Lifestyle (shift work, changing meal time)

• Emotional Stress

• Environment (temperature, sound, lighting)

• Exercise (less than 2 hours before bedtime)

Factors Affecting Sleep

• Food and Caloric Intake (caffeine, alcohol, spicy, large meal, milk allergies in infants and food allergies as corn, chocolate, yeast, food dyes, wheat, eggs; wtg loss and gain

Nursing Interventions

• Promote bed time rituals and routines

• Adjust environment

• Back rub if not contra-indicated

Provide Pain relief measures

Do not interrupt sleep unless absolutely necessary

Establish periods of rest and sleep

Pharmocolgic

• Hypnotics produce sleep

• Sedatives produce calming effect