Chapter 43 Sleep

Drugs & Their effects on Sleep: Beta-Adrenergic Blockers

-Cause nightmares -Cause insomnia -Cause awakening from sleep

Sleep-wake cycles across the life span

-Children and infants have up to 14 hours of sleep a day, 6 hours of REM, 8 hours of NON-REM sleep -Adults sleep around 8 hours, 1-2 hours REM, 6-7 hours NON-REM -Older adults require even less sleep about 6 hours, 1 hours of REM and 5 hours of NON-REM sleep

Sleep Diary

-Client may be asked to keep track of: -Time factors associated with sleep -Activities performed 2-3 hours prior to sleep -Consumption of caffeine, alcohol -Medications -Bedtime rituals -Difficulty remaining awake during day -Any worries or fears that may be contributing

Drugs & Their effects on Sleep: Anticonvulsants

-Decrease REM sleep time -Cause daytime drowsiness

Drugs & Their effects on Sleep: Nicotine

-Decreases total sleep time -Decreases REM sleep time -Causes awakening from sleep -Causes difficulty staying asleep

Stage 4: NREM

-Deepest stage of sleep -Very difficult to arouse sleeper -If sleep loss has occurred, sleeper will spend considerable portion of night in this stage -VS are significantly lower than during waking hours -Stage lasts approx. 15-30 minutes -Sleepwalking and enuresis sometimes occur

Insomnia

-Difficulty falling asleep -Waking up frequently -Difficulty staying asleep -Daytime sleepiness -Difficulty concentrating -Irritability -Risk factors: older age & females

Sleep Apnea

-Frequent short breathing pauses during night -More than 5 apneic episodes >10 sec/hr considered abnormal -Symptoms include snoring, frequent awakenings, difficulty falling asleep, morning headaches, memory and cognitive problems, irritability -Types: obstructive (obese patients, swollen tonsils), central (CNS disturbance; basically forget to breath), or mixed -Wear a CPAP at night

Sleep Deprivation: Physiologic Signs & Symptoms

-Hand tremors -Decreased reflexes -Slowed response time -Reduction in word memory -Decrease in reasoning and judgment -Cardiac dysrhythmias

Client Education

-Importance of sleep -Conditions that interfere with sleep -Safe use of sleep medications -Effects of prescribed medications on sleep -Effects of disease states on sleep

Stage 3: NREM Sleep

-Important for children and adolescents -Initial stages of deep sleep -Sleeper difficult to arouse and rarely moves -Muscles completely relaxed -Vital signs decline but remain regular -Lasts 15 to 30 minutes -Hormonal response includes secretion of growth hormone (stages 3 & 4)

Enuresis

Bed wetting

Which statement made by the patient indicates a need for further teaching on sleep hygiene? a. I'm going to do my exercises before I eat dinner b. I'm going to go to bed every night at about the same time c. I set my alarm to get up at the same time every morning d. I moved my computer to the bedroom so I could work before I go to sleep

d. I moved my computer to the bedroom so I could work before I go to sleep This statement requires further teaching. Good sleep hygiene practices state that the bedroom should only be used for sleeping. Work and study should not be done in the bedroom

Drugs & Their effects on Sleep: Benzodiazepines

-Alter REM sleep -Increase sleep time -Increase daytime sleepiness

Stage 1: NREM

-Lightest level of sleep -Lasts a few minutes -Decreased physiological activity beginning with a gradual fall in vital signs and metabolism -Person easily aroused by sensory stimuli such as noise -If person awakes, feels as though daydreaming has occurred -Reduction in autonomic activities

Outcomes for Clients with Sleep disturbances

-Maintain (or develop) a sleeping pattern than provides sufficient energy for daily activities -Enhance feeling of well being -Improve the quality and quantity of the client's sleep

Sleep Deprivation: Psychological signs and symptoms

-Mood swings -Disorientation -Irritability -Decreased motivation -Fatigue -Sleepiness -Hyperexcitability

Drugs & Their effects on Sleep: Diuretics

-Nighttime awakenings caused by nocturia

Stage 2: NREM Sleep

-Period of sound sleep -Relaxation progresses -Arousal still easy -Lasts 10 to 20 minutes -Body functions still slowing

Drugs & Their effects on Sleep: Caffeine

-Prevents person from falling asleep -Causes person to awaken during night -Interferes with REM sleep

Functions of Sleep

-Purpose of sleep is physiological and psychological restoration and maintenance of biological functions -Restores normal levels of activity -Restores normal balance among parts of the nervous system -Necessary for protein synthesis -Psychological well-being -Dreams: occur in NREM & REM sleep; important for learning, memory and adaptation to stress

NANDA; Sleep pattern disturbances as etiology of other diagnoses

-Risk for injury -Ineffective coping -Fatigue -Risk for impaired gas exchange -Deficient knowledge -Anxiety -Activity intolerance

General Nursing Interventions for Sleep Disturbances

-Scheduling nursing care to promote uninterrupted sleep -Teaching stress reduction, relaxation techniques or good sleep hygiene -Limited interruptions during the night, provide a quiet environment with a comfortable room temperature, limit the number of visitors and duration of visits, carry out all the procedures within a given time frame

Sleep Pattern Assessment

-Sleep history -Health history -Physical exam -If warranted, a sleep diary and diagnostic studies

Drugs & Their effects on Sleep: Alcohol

-Speeds onset of sleep -Reduces REM sleep -Awakens person during night and causes difficulty returning to sleep

Drugs & Their effects on Sleep: Opiates

-Suppress REM sleep -Cause increased daytime drowsiness

Drugs & Their effects on Sleep: Antidepressants & Stimulants

-Suppress REM sleep -Decrease total sleep time

NANDA: Disturbed Sleep Pattern

-with specific descriptions such as difficulty falling asleep or difficulty staying asleep -Various etiologies may be involved and specified

Sleep Cycle

Once asleep a person passes through 4 to 5 sleep cycles

Sleep Regulation

Regulated by a sequence of physiological states integrated by CNS activity

Physiology of Sleep

Sleep is an altered state of consciousness where perception of and reaction to environment is decreased

Nocturia

Urination during the night

Which statement made by the parent of a school aged child requires follow up by the nurse? a. I encourage evening exercise about an hour before bedtime b. I make sure that the room is dark and quiet at bedtime c. We use quiet activities such as reading a book before bedtime

a. I encourage evening exercise about an hour before bedtime Best evidence related to sleep hygiene recommends avoiding exercise within 2 hours of bedtime. Exercise should be in the morning or afternoon. Encourage the parent to use quiet activities before bedtime to promote sleep

Which sleep hygiene actions at bedtime can the nurse delegate to the nursing assistant? (select all that apply) a. giving the patient a backrub b. turning on quiet music c. dimming the lights in the patient's room d. giving a patient a cup of coffee e. monitoring for the effect of sleeping medication that was given

a. giving the patient a backrub b. turning on quiet music c. dimming the lights in the patient's room

The school nurse is teaching health promoting behaviors that improve sleep to a group of high school students. Which points should be included in the education a. go to bed at the same time each night b. study in your bedroom to have quiet space c. turn on the television to help you fall asleep d. avoid drinking coffee or soda before bedtime e. turn off your cell phone at bedtime

a. go to bed at the same time each night d. avoid drinking coffee or soda before bedtime e. turn off your cell phone at bedtime

A 72 year old patient asks the nurse about using an over the counter antihistamine as a sleeping pill to help her get to sleep. What is the nurse's best response? a. Antihistamines are better than prescription medications because these can cause a lot of problems b. Antihistamines should not be used because they can cause confusion and increase your risk of falls c. Antihistamines are effect sleep aids because they do not have many side effects d. Over the counter medications when combined with sleep-hygiene measures are a good plan for sleep

b. Antihistamines should not be used because they can cause confusion and increase your risk of falls. Older adults should avoid the use of over the counter antihistamines. These medications have a long duration of action in older adults and can cause confusion, constipation, urinary retention, and increased risk of falls.

The nurse is providing health teaching for a patient using herbal compounds such as kava for sleep. Which points need to be included? (Select all that apply) a. can cause urinary retention b. Should not be used indefinitely c. May have toxic effects on the liver d. May cause diarrhea and anxiety e. Are not regulated by the FDA

b. Should not be used indefinitely c. May have toxic effects on the liver e. Are not regulated by the FDA Herbal products help promote sleep. These products need to be used cautiously because they are not regulated by the FDA. They should not be used longer term and can interact with prescribed medications. Kava needs to be used cautiously because it can be toxic to the liver

Which statement made by a mother being discharged to home with her newborn infant indicates that she understands the discharge teaching related to best sleep practices? a. I'll give the baby a bottle to help her fall asleep b. We'll place the baby on her back to sleep c. We put the baby's stuffed animals in the crib to make her feel safe d. I know the baby will not need to be fed until morning

b. We'll place the baby on her back to sleep This is based on the current evidence that shows that parents need to place an infant on his or her back to prevent suffocation. Bottles, stuffed animals and pillows should not be placed in the bed with an infant.

The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient? a. have patient follow hospital routines b. avoid waking patient for nonessential tasks c. give prescribed sleeping medications at dinner d. turn tv on low to late-night programming

b. avoid waking patient for nonessential tasks avoiding awakening patient for nonessential tasks promotes sleep. Cluster activities and allow the patient time to sleep. Do not perform tasks such as lab draws and bathing during the night unless absolutely essential. Patients should try to follow home routines related to sleep habits.

The nurse is developing a plan of care for a patient experiencing obstructive sleep apnea (OSA). Which intervention is appropriate to include on the plan? a. Instruct the patient to sleep in a supine position b. Have patient limit fluid intake 2 hours before bedtime c. Elevate the head of the bed to sleep d. Encourage patient to take an over the counter sleep aid

c. Elevate the head of the bed to sleep Lifestyle changes and modifications of sleep habits should be included on a plan of care for a patient with OSA. Individuals should sleep with the head of the bed elevated and use a side or prone position. Other modifications include a good sleep-hygiene practices, alcohol modification, smoking cessation and weight reduction

Which statement made by an older adult best demonstrates understanding of taking sleep medication? a. I'' take the sleep medicine for 4 or 5 weeks until my sleep problems disappear b. Sleep medicines won't cause any sleep problems once I stop taking them c. I'll talk to my health care provider before I use an over the counter sleep medication d. I'll contact my health care provider if I feel extremely sleepy in the mornings

c. I'll talk to my health care provider before I use an over the counter sleep medication The use of non prescription sleep medications is not advisable. Over the long term these drugs lead to further sleep disruption even when they initially seemed effective.

The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow up? a. I feel refreshed when I wake up in the morning b. I use soft music at night to help me relax c. It takes me 45-60 minutes to fall asleep d. I take the pain medication for my leg pain about 30 minutes before I go to bed.

c. It takes me 45-60 minutes to fall asleep This indicates a potential sleep problem, individuals should fall asleep within 30 minutes of going to bed. Encourage him or her to get out of bed and do a quiet activity until he or she feels sleepy

The patient reports episodes of sleepwalking to the nurse. Through understanding of the sleep cycle, the nurse recognizes that sleepwalking occurs during which sleep phase? a. Rapid Eye Movement (REM) Sleep b. Stage 1 non-rapid eye movement (NREM) sleep c. Stage 4 NREM sleep d. Transition period from NREM to REM sleep

c. Stage 4 NREM Sleep Stage 4 NREM sleep is the deepest stage of sleep. It is difficult to rouse the sleeper in this stage. During this stage sleepwalking and enuresis (bed-wetting) sometimes occur

The nurse is administering a benzodiazepine sleep aid to an older adult. What should be the priority assessment for the patient? a. Incontinence b. Nausea and vomiting c. Bradycardia d. Respiratory Depression

d. Respiratory depression Benzodiazepines in older adults should be used on a short-term, limited basis. Respiratory depression is an adverse effect of benzodiazepines in older adults. Other adverse effects for which to assess include next-day sedation, amnesia, rebound insomnia, and impaired motor functioning and coordination