Chapter 34: Sleep & Rest
What Are the Main Points in This Chapter?
-Sleep is a basic physiological need. -Sleep and rest promote physical, mental, and spiritual well-being by restoring energy and reducing body demands while the body repairs itself. -Illness can interfere with the ability to sleep and rest; conversely, people who suffer from sleep disorders have an increased susceptibility to illnesses. -The hypothalamus and various neurotransmitters are involved in the physiology of sleep. -Circadian rhythm is a biorhythm that is influenced by both internal and external stimuli, especially the light-dark patterns of day and night. -The brain waves produced during REM sleep are similar to those of alert wakefulness. REM is characterized by rapid eye movements and dreaming. -Duration of sleep varies according to age. -Factors affecting sleep include developmental needs and stressors, work, exercise, foods, other lifestyle factors, use of medications, illness, pain, and the environment. -Common sleep disorders include insomnia, sleep apnea, and narcolepsy. -It is important to obtain information about the patient's usual sleep patterns and rituals; this may require use of a sleep diary. -Nursing interventions to promote sleep include scheduling nursing care, creating a restful environment, promote comfort, and supporting bedtime rituals and routines. -Pain is one of the main deterrents to sleep. Hormonal fluctuations and stress also contribute to sleep difficulties. -Sleep medications, as a rule, should be used only as a temporary measure. -Teaching patients and their families about the importance of rest and sleep is an important health promotion intervention.
The nurse works rotating 12-hour day and night shifts. She wakes up after about 3 or 4 hours and has trouble going back to sleep. Feeling unrefreshed, nauseated, irritable, and headachy, she consults another nurse for advice on sleep hygiene. What is the best advice for avoiding sleep deprivation? 1) Follow a regular routine h.s. and after awakening. 2) Eat a small, carbohydrate snack shortly before bed. 3) Take melatonin consistently before going to sleep. 4) Take a 30- to 60-minute nap during the afternoon.
Answer: 1) Follow a regular routine h.s. and after awakening. Rationale: Follow a regular routine for bedtime and morning awakenings. This helps the body to regulate a natural circadian cycle. This means you should go to bed each night at the same time, even on days you are off work. Avoid eating carbohydrates (e.g., crackers, cereal, or bread) before bed; they boost blood glucose levels, so a few hours later, the rapid drop in sugar will wake you. The effectiveness of melatonin as a sleep aid remains controversial. It is not shown to be effective for shift-related sleep deprivation or jet lag. Although approved by the Food and Drug Administration (FDA), melatonin is unregulated and may vary in strength and purity across manufacturers. Avoid naps during the day, unless you are an older adult who takes short "power naps." Daytime napping can lead to nighttime insomnia.
What are prevailing characteristics of narcolepsy? Select all that apply. 1) Involuntary 2) Cataplexy 3) Hallucinations 4) Temporary paralysis
Answer: 1) Involuntary 3) Hallucinations Rationale: The person with narcolepsy experiences a sudden, uncontrollable urge to sleep lasting from seconds to minutes, even though the person sleeps well at night. The person cannot avoid the "sleep attacks" but awakens easily. Narcolepsy is characterized by involuntary episodes of sleepiness, slurred speech, slackening of the facial muscles, a feeling of impending weakness of the knees, paralysis, and hallucinations. Some have other symptoms, such as cataplexy, a sudden loss of muscle tone usually triggered by an emotional event (e.g., laughter, surprise, or anger), but most only have hypersomnia.
What is the hormone that promotes sleep? 1) Melatonin 2) L-tryptophan 3) Progesterone 4) Oxytocin
Answer: 1) Melatonin Rationale: The levels of melatonin, which is the natural hormone that promotes sleep, decline in the latter decades of life. It is produced at night by the pineal gland in the brain.
The nurse is caring for a woman who complains of an unpleasant, crawling and tingling sensation in her legs. She tells the nurse that she has an irresistible urge to move around that prevents her from falling asleep What does the nurse suggest that she try before resorting to medication for relief. Check all that apply. 1) Drink a caffeinated beverage. 2) Apply vibration to legs. 3) Massage the lower legs. 4) Try active release therapy. 5) Walk around and stretch legs. 6) Apply night splints to both legs.
Answer: 2) Apply vibration to legs. 3) Massage the lower legs. 5) Walk around and stretch legs. Rationale: People with restless legs syndrome (RLS) should avoid stimulants (e.g., caffeine). Other self-care measures include walking, massaging, stretching, heat or cold compresses, medication, vibration, and acupressure. Active release therapy targets soft tissue to break up scar tissue and adhesions that are caused by overuse, or repetitive or pressure injuries. A night splint holds the foot with the toes pointed up and with the foot and ankle at a 90-degree angle. This position applies a constant, gentle stretch to the plantar fascia when it is inflamed (i.e., plantar fasciitis).
What are the physical effects shown in the research that can result from chronic and long-standing sleep deprivation? Select all that apply. 1) Nicotine dependence 2) Insulin resistance 3) Stroke 4) Headache 5) Pain sensitivity 6) Infection
Answer: 2) Insulin resistance 3) Stroke 4) Headache 5) Pain sensitivity 6) Infection Rationale: Lack of sleep increases the risk heart disease and stroke. Sleep restriction is also linked to increased appetite through changes in the appetite control hormones. In addition, not enough sleep leads to reduced energy expenditure, all of which can lead to obesity and type 2 diabetes. Headaches are common with sleep deprivation. Poor sleep intensifies the body's sensitivity to pain. Sleep is a time for rest and restoration. It strengthens the immune system and helps the body to fight infection. Nicotine can lead to poor sleep quality. Nicotine dependence generally is not the result of not getting enough sleep.
The nurse in the hospital has a prescription to administer medication at 0400 to Mrs. Giovanni. Mrs. Giovanni is asleep when the nurse enters the room. She is difficult to arouse and confused. Identify the stage of sleep Mrs. Giovanni was likely in when the nurse awakened her. 1) Stage I 2) Stage II 3) Stage III 4) REM
Answer: 3) Stage III Rationale: Stage III is the deepest sleep and the most restorative. In this stage, the delta waves are highest in amplitude, slowest in frequency, and highly synchronized. The body, mind, and muscles are very relaxed. It is difficult to awaken someone in stage III sleep, and if awakened, the person may appear confused and react slowly.
How would the nurse be able to identify the person with narcolepsy from one with seizures? 1) Episodes are short in duration. 2) Episodes come on suddenly. 3) The patient can be aroused from the episode. 4) The patient loses voluntary control of his muscles.
Answer: 3) The patient can be aroused from the episode. Rationale: The patient with narcolepsy can be aroused from the sleep episode. A person with seizure activity is unresponsive to stimulus and does not resolve in relationship to arousing. Narcolepsy and seizures are triggered suddenly. Both involve involuntary control of motor function with paralysis and cataplexy. Typical seizures last less than 8 minutes. Most narcoleptic episodes are also brief, with microactivity lasting only a few minutes. Infrequently, the uncontrollable urge to sleep goes on for up to an hour.
Depression, hyperthyroidism, hypothyroidism, pain, and sleep apnea are examples of: 1) disorders that are provoked by sleep. 2) conditions known as parasomnias. 3) conditions that cause secondary sleep disorders. 4) disorders associated with narcolepsy.
Answer: 3) conditions that cause secondary sleep disorders. Rationale: Secondary sleep disorders occur when a disease causes alterations in sleep stages or in quantity of sleep. Depressed people may spend more time in bed; however, in general, they have difficulty falling asleep, experience less slow-wave (deep) sleep, spend less time in REM sleep, awaken early, and have less total sleep time. An increase in thyroid secretion causes an increase in stage III and IV sleep. Hypothyroidism causes a decrease in those stages. Hyperthyroidism creates increased metabolic rate, making it difficult to fall asleep. Acute pain and chronic pain interfere with sleep. They inhibit sleep, increase arousals during sleep, and cause longer awake intervals during the night. During periods of sleep apnea, O2 level in the blood drops, and the CO2 level rises, causing the person to wake up frequently.
The duration of sleep is regulated by the: 1) electrical impulses transmitted to the cerebellum. 2) person's innate biorhythms. 3) amount of sleep a person usually requires. 4) reticular activating system.
Answer: 4) reticular activating system. Rationale: In the morning, with an increase in environmental light, the hypothalamus is signaled to induce gradual arousal from sleep. The reticular formation is then activated by the stimuli from the cerebral cortex. The reticular formation is responsible for maintaining wakefulness. Together, the reticular formation and cortical neurons are called the reticular activating system (RAS). The RAS regulates the duration of sleep.
A breastfeeding mother of a newborn
Answer: A breastfeeding mother typically suffers some degree of sleep deprivation because of nighttime feedings. Breastfed infants usually will feed every 2 to 4 hours in the first months of life before taking solid foods.
Describe the progression of a typical sleep cycle for a young adult.
Answer: A sleeping young adult progresses back and forth through lighter and deeper stages of sleep, about six times during an 8-hour sleep period. After falling asleep in stage I, a person progresses through successively deeper stages of NREM sleep from stage I to stage III. Then the sequence reverses, and the person progresses through successively lighter stages to stage II, but instead of proceeding to stage I, the person enters the REM stage. After REM sleep, the person cycles back through NREM stages II and III, and back again from III to II to REM. If awakened at any time, however, the sleeper starts the cycle again at stage I.
For which of the following sleep disorders would the nurse most likely need to include safety measures in the plan of care? A. Narcolepsy B. Restless legs syndrome C. Sleep deprivation D. Bruxism
Answer: A. Narcolepsy Rationale: Persons with narcolepsy experience sudden, uncontrollable episodes of sleep that may lead to various forms of injury even in the hospital environment.
___________ is a substance that disrupts REM sleep, causes spontaneous awakenings, and can induce nocturia.
Answer: Alcohol
Identify at least three types of environmental stimuli that can disturb sleep.
Answer: Answers may include any three of the following environmental stimuli that can disturb sleep: -Room temperature (too cool, too warm) -Bedclothes (too heavy, too light) -Noise -Not having one's usual environment (e.g., no music) -Amount of light -Sleeping alone (or with someone)
Describe three independent nursing interventions to promote sleep.
Answer: Answers may include any three of the following nursing interventions: -Encourage use of relaxation exercise. -Allow visitors when needed for emotional security and relaxation, but limit visitors if the patient requires rest/sleep. -Explain procedures to decrease anxiety and promote healthy coping. -Listen attentively to decrease anxiety and convey compassion and caring. -Schedule nursing care to avoid interruption of sleep (e.g., don't awaken a patient to administer a sleeping pill, provide for rest periods). -Use nursing judgment to decide when a procedure must be done and when it is more important for your patient to sleep. -Alter routines; for example, allow the patient to sleep as long as he can in the morning and bring his breakfast later. -Unless the patient is critically ill, do not awaken him for morning vital signs when he is sleeping. -Create a restful environment; for example, be sure the bed linens are tight on the bottom and loose on top to allow movement; keep linens clean and free of irritants; use extra pillows, a blanket from home, or any other item that may help the patient rest; keep the patient in good body alignment; keep the room dark and quiet, unless the patient prefers a light; as much as possible, control the temperature of the room and provide good ventilation. -Promote comfort (e.g., be sure to offer pain medications at their scheduled times and before time to sleep; offer fluids, cool cloths, massage, or backrub). -Support bedtime rituals and routines (e.g., reading, watching TV, or praying; having warm milk, a favorite doll, blanket, or bedtime story; brushing teeth or hair). -Offer appropriate bedtime snacks/beverages (e.g., juice, crackers). -Teach the client to avoid alcohol and caffeine (e.g., tea, coffee, chocolate, colas). -Encourage the client to drink plenty of fluids during the day, but restrict large amounts of fluid close to bedtime. -Advise the person to not smoke after the evening meal. -Promote relaxation (e.g., guided imagery, progressive muscle relaxation, music therapy).
List and define at least three parasomnias.
Answer: Answers may include any three of the following parasomnias: -Sleepwalking (somnambulism) occurs during stage III of NREM sleep, usually 1 to 2 hours after falling asleep. The person who is sleeping leaves the bed and walks about with little awareness of surroundings. He may perform what appear to be conscious motor activities (e.g., opening doors, walking) but does not wake up. The person is not aware of sleepwalking and has no memory of the event on awakening. The event may last 3 to 4 minutes or longer. Children sleepwalk more often than adults. If the child does not outgrow the condition or serious safety risks exist, medications may be given to suppress stage III sleep. Stress, fatigue, and some medications can cause sleepwalking. -Sleeptalking occurs during NREM sleep, just before the REM stage. It does not usually interfere with the person's rest. Speech is often nonsensical and garbled. -Bruxism, grinding and clenching of the teeth, usually occurs during stage II NREM sleep. It can eventually erode tooth enamel, loosen the teeth, and lead to misalignment. -Night terrors are sudden arousals in which the person (usually a child) is physically active and expresses fear or strong emotion. The child is not awake, though, and is difficult to awaken. Once awakened, the child has no memory of the event. Unlike nightmares or highly disturbing state of confusion, which occur during REM, night terrors occur during stage III (deep NREM) sleep. -REM sleep behavior disorders are associated with REM (or dreaming period) sleep, in which the sleeper violently acts out the dream. People have actually injured themselves or others without waking. -Enuresis (bedwetting) is nighttime incontinence. It has incorrectly been associated with dreaming; however, most incidents occur during NREM sleep, during the first third of the night when the child is difficult to arouse. It is distressing because of the stress society places on continence, the inconvenience of keeping bed linens clean, and the misconception that the child is bedwetting to act out against parents.
Name at least two nursing diagnoses that might have a sleep problem as the etiology.
Answer: Answers may include any two of the following nursing diagnoses for a sleep problem: -Risk for Injury or Falls related to sleepwalking (or REM sleep behavior disorder or narcolepsy) -Fatigue (or Activity Intolerance) related to chronic insufficient quality or quantity of sleep (e.g., secondary to insomnia) -Ineffective Coping related to decreased cognitive functioning and awareness, secondary to lack of sleep -Disturbed Thought Processes related to decreased cognitive functioning, secondary to lack of sleep Anxiety (or Fear) related to fear of death from sleep apnea
List two sleep-provoked disorders, and explain how the sleep stage affects the disease.
Answer: Answers may include any two of the following sleep-provoked disorders: -Coronary artery disease. During REM sleep, dreams may increase heart rate and provoke angina and ECG changes. -Bronchial asthma. People with asthma may experience bronchospasm during REM sleep. In adults, asthma attacks may occur at any time during the night. In children, they occur mostly during the final two-thirds of the night, when there is less stage III sleep. -Chronic obstructive pulmonary disease (COPD). Persons with COPD experience lowered oxygen tension and increased carbon dioxide retention during sleep, especially during REM sleep when neuromuscular control is normally depressed. This can result in pulmonary spasm and transient pulmonary hypertension. -Diabetes. Blood glucose levels vary during sleep. When diabetes is uncontrolled, it may profoundly affect the blood sugar during sleep when the person is not alert enough to deal with it. Therefore, a person with uncontrolled diabetes may need to have blood glucose levels monitored during sleep. -Duodenal ulcers. During REM sleep, people with duodenal ulcers secrete up to 20 times more gastric acid than do people who do not have duodenal ulcers. This increased acid often produces nocturnal epigastric pain and sleep loss.
What are two other classes of medications that are sometimes prescribed for sleep?
Answer: Answers may include the following classes of medications (other than sedative/hypnotic nonbarbiturates) prescribed for sleep: -Benzodiazepines -Tricyclic antidepressants -Barbiturates
Katie is a new graduate nurse who has just begun working the night shift. She complains that she feels very irritable and is experiencing general malaise. An experienced coworker explains that A. this problem is a result of hypersomnia. B. this problem will resolve as Katie's body adjusts to the new day/night schedule. C. Katie should try medication to help alleviate her symptoms. D. Katie should try cutting down the number of hours she is sleeping during the day.
Answer: B. this problem will resolve as Katie's body adjusts to the new day/night schedule. Rationale: Katie is experiencing some mild symptoms of sleep deprivation, which are affecting her circadian rhythm. Hypersomnia may result from sleep deprivation. Medication will not adjust circadian rhythms; cutting down on sleep will exacerbate the problem.
Mr. Martinez has had extensive abdominal surgery. In terms of promoting wound healing and tissue growth, which stage of sleep is most important for him? A. NREM I B. NREM II C. NREM III D. REM
Answer: C. NREM III
Why are sleeping pills not recommended for chronic insomnia?
Answer: Chronic use of sleeping medications is not recommended for the following reasons: -They are habit forming. -They become less effective with long-term use. -They can have serious side effects. However, sedative/hypnotic treatment is justified in short-term insomnia to avoid the known consequences of insomnia on mood and performance. Short-term, aggressive treatment may prevent the development of chronic insomnia.
Mrs. Sebink has been in the acute care facility for 4 days. It is 0100 and she tells the nurse that this is the third night that she has not been able to get to sleep. The nurse's most appropriate action is to do which of the following? A. Have the patient begin a sleep diary. B. Provide the patient with a warm cup of tea. C. Obtain the patient's sleep history. D. Obtain a prescription from the physician for a sleeping pill.
Answer: D. Obtain a prescription from the physician for sleep-enhancing medication. Rationale: Other responses are incorrect. Although the information gathered from a sleep diary and/or sleep history would be helpful, the patient's problem is most likely a temporary problem related to the strange hospital environment. A brief sleep history should be available on Mrs. Sebink's admission assessment. Most teas contain caffeine, which might exacerbate the problem of difficulty falling asleep.
Describe ways in which depression can affect sleep.
Answer: Depression can affect sleep in the following ways: Difficulty falling asleep Less slow-wave (deep) sleep Less time in REM sleep Awaken early Less total sleep time Hypersomnia (excessive sleeping)
The instrument that records the electrical activity in the brain is a/an __________.
Answer: Electroencephalograph (EEG)
Persons who are depressed have a heightened ability to fall asleep rapidly.
Answer: False
All medications that produce sleep are habit forming and therefore should be avoided as long as possible.
Answer: False Rationale: Although they have not undergone extensive testing, there are several herbal products available that may be used as sleep aids.
What factors in the hospital may contribute to sleep deprivation in patients?
Answer: Illness and hospital care are common causes of sleep deprivation, especially for patients in critical care units (CCUs). In the CCU, lights, equipment noise, and frequent interruptions for treatments and assessments, in addition to the client's fragile physical condition, combine to create sleep deprivation.
________ is the most common sleep disorder.
Answer: Insomnia
What is the most common dyssomnia?
Answer: Insomnia is the most common dyssomnia.
Why should people contact their prescriber before taking nonprescription sleep aids?
Answer: People should contact their healthcare provider before taking nonprescription (over the counter) sleep medications because they can interact with other medicines they may be taking. Also, they do have side effects, which may be dangerous for people with certain health conditions.
What is the stage that must be "made up" if not enough time is spent in it?
Answer: REM sleep must be made up.
For a chronic, long-term sleep problem, would you use a diagnosis of Sleep Pattern Disturbance, Sleep Deprivation, or Readiness for Enhanced Sleep?
Answer: Sleep Pattern Disturbance is the NANDA-I nursing diagnosis defining a time-limited interruption in sleep resulting from external factors, such as room temperature and humidity, noise, lighting, noxious odors, sleep partner, unfamiliar sleep surroundings or bed, interruptions, lack of privacy, and physical restraints. A Sleep Pattern Disturbance can be reported as difficulty falling asleep, awakening with trouble getting back asleep, verbal complaint of not feeling rested after awakening, or dissatisfaction with sleep in general. Sleep Deprivation is the NANDA-I nursing diagnosis to use when the patient has a decreased amount, consistency, or quality of sleep over prolonged periods of time. Defining characteristics of Sleep Deprivation are more severe than those for Sleep Pattern Disturbance, so nursing activities may focus as much on relieving symptoms (e.g., confusion, paranoia) as on sleep promotion. Readiness for Enhanced Sleep is the NANDA-I diagnosis when a client has no particular sleep problem but desires improved quality of sleep.
List the stages of sleep.
Answer: Sleep includes the following stages of NREM and REM sleep: -NREM (non-rapid eye movement, also called slow-wave sleep) - stages I, II, and III. -REM (rapid eye movement).
Compare and contrast sleep and rest. How are they different? Alike?
Answer: Sleep is a state of rest accompanied by altered consciousness and relative inactivity. Sleep is characterized by reduced skeletal muscle activity. Blood pressure and pulse rate decrease, and skin vessels dilate. The metabolism falls by 20% to 30%, so energy is conserved. At rest, the body is disturbed by all exterior noises, whereas in sleep, it is screened from them by altered consciousness. Rest is a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed. Although necessary and beneficial, rest without sleep is inadequate. Sleep restores the normal levels of normal brain activity and "balance" in the central nervous system; rest alone cannot do this. Many organs that function during rest suspend their activities in sleep.
Why is promoting sleep an important nursing intervention?
Answer: Sleep is an important nursing intervention because it enhances wellness and speeds recovery from illness. Sleep and illness are interrelated. Prolonged lack of sleep can result in illness, and illness interferes with sleep. Sleep and rest are both essential to life and for keeping the body, mind, and spirit in excellent physiological shape. Rest and sleep restore energy, improve learning, and strengthen the immune system. Without the proper amount of sleep, the body ceases to function efficiently.
Why is snoring significant?
Answer: Snoring is a physical sign of obstructive sleep apnea. Also, snoring can significantly reduce the quality of sleep.
What are the clinical signs of sleep deprivation?
Answer: The following are clinical signs of sleep deprivation: -Daytime drowsiness -Restlessness -Perceptual disorders -Impaired cognitive functioning -Irritability -Slowed reaction time -Somatic (body) complaints -General feeling of malaise -Changes in IgG, IgM, IgA If sleep deprivation is severe and prolonged, delusions, paranoia, and other psychotic behaviors may occur.
A preschooler being treated for pneumonia
Answer: The following factors may affect the sleep of a preschooler being treated for pneumonia: -Difficulty breathing, need to be awakened for treatments, experiencing new environmental stimuli, and so on -Usual factors associated with toddlers and preschoolers (e.g., frightened to go to bed because of imagined monsters or intruders or may waken frequently at night because of bad dreams, the need to use the bathroom, illness, heavy snoring, tossing off the bedclothes, or falling out of bed)
An adolescent with cancer
Answer: The following factors may affect the sleep of an adolescent with cancer: -Anxiety -Various medications that might interfere with sleep (e.g., opioids for pain) -Lifestyle factors commonly associated with adolescence (e.g., keeping up with the academic demands and other pressures at school; staying up late to watch television, text friends, surf the Internet, or study; dating; using alcohol or drugs; consuming large amounts of caffeinated colas and other beverages) can interfere with the quality or amount of sleep.
An older man who has fractured his hip
Answer: The following factors may affect the sleep of an older man who has a fractured hip: -Nocturia and discomfort or pain -Medications, such as opioids for pain -Unfamiliar environment
For each of the following patients, propose at least two factors that might affect sleep: A newborn in the neonatal intensive care unit
Answer: The following factors may affect the sleep of newborns in the NICU: -Lights and noise and other unfamiliar stimuli -Pain and other noxious stimuli, such as needlestick and suctioning -Physical illness symptoms (e.g., dyspnea, fever) -Handling by caregiver or parent
Name at least one nursing diagnosis that might have a sleep problem as the defining characteristic.
Answer: The following nursing diagnoses might have a sleep problem as the defining characteristic: -Spiritual Distress related to challenges to belief system as manifested by nightmares, sleep disturbances, and verbalization of inner conflict about beliefs Other diagnoses that might cause symptoms of sleep difficulties include the following: -Anxiety -Chronic Sorrow -Death Anxiety -Decisional Conflict -Diarrhea -Dysfunctional Grieving -Impaired Gas Exchange -Nausea -Pain -Relocation Stress Syndrome
Describe the physiological activity characteristic of each stage of sleep.
Answer: The following physiological activity is characteristic of each stage of sleep: -Stage I is a light sleep in which the sleeper can easily be awakened. The person is relaxed; breathing is regular and deep; the eyelids slowly open and close, and the eyes roll from side to side. The person feels groggy, the eyelids feel heavy, and suddenly without notice the person falls asleep. Within 5 to 10 minutes, sleep progresses to stage II. Stage I accounts for about 5% of our total sleep during the night. Brain activity consists of alpha waves with occasional low-frequency theta waves. -Stage II is also light sleep. Brain activity slows. The eyes are still, and body processes begin to slow down (e.g., temperature, pulse, and blood pressure decrease). The sleeper is easily aroused. Stage II, which usually lasts for 10 to 15 minutes, helps us disconnect from the outside world. -Stage III is a deeper sleep. Slow-wave activity begins to occur in this stage. The person is difficult to arouse, slow eye movement stops, skeletal muscles are very relaxed, and snoring may occur. This stage may last 5 to 15 minutes. A young adult spends about 8% of sleep time in stage III. In this stage, the delta waves are highest in amplitude, slowest in frequency, and highly synchronized. The body, mind, and muscles are very relaxed. The heart rate is about 25% lower than when awake. It is difficult to awaken someone in stage III slow-wave sleep, and if awakened, the person may appear confused and react slowly. Some dreaming may occur in stage III, but dreams are less vivid than those that occur in REM sleep. Stage III sleep appears to be especially important for restorative processes such as protein synthesis, cell division, and tissue renewal. During this stage, the body releases human growth hormone, which is essential for repair and renewal of brain and other cells. -REM sleep is named because of its characteristic rapid eye movements, which can often be detected even though the sleeper's eyelids are closed. Metabolism, temperature, pulse, heart rate, and blood pressure increase, but muscle activity and deep tendon reflexes are depressed. Because most people who are awakened during REM sleep report that they have been dreaming, this loss of muscle tone is thought to be a protective response, to prevent the person from acting out the dreams. People are more difficult to arouse during REM sleep than during any other stage of sleep; however, more spontaneous awakenings occur during this stage than any other. When sleepers are successfully awakened during this stage, they are usually alert and can react normally, whereas those awakened during stages III of slow-wave (NREM) sleep take a few moments to wake up and react.
The nursing diagnosis Disturbed Sleep Pattern would be appropriate in the case of a patient who must be awakened every 2 hours for blood glucose monitoring.
Answer: True
What is the classification of zolpidem (Ambien)? Why is it an especially desirable medication for sleep?
Answer: Zolpidem (Ambien) is classified as a sedative/hypnotic nonbarbiturate. It is an especially desirable medication for sleep because it is short acting and does not produce a hangover effect.
Learning Theories
During sleep, a person reorganizes and stores information. Neurons that are involved in memory and attentive learning rest during sleep, especially during the stage of rapid-eye-movement (REM) sleep. This may be why you feel mentally sharper after you have had a good night's sleep. REM sleep also plays a role in memory retention and consolidation. A person deprived of REM sleep has great difficulty retaining complex material. Some theorists believe that sleep, particularly REM sleep, is designed to remove useless information from memory. Memory works in two ways: to store important information and to remove trivial information. This theory suggests that it is of equal importance to (a) remove unwanted information and to (b) store important data.
Restorative Theories
Restorative theories propose that sleep helps our body save and restore energy by slowing the body's metabolism. Without rest, the brain cannot function properly. Slow-wave sleep provides a restorative period of rest for the brain. Sleep helps replenish neurotransmitter stores because most neurons decrease their activity during sleep. The slow delta waves, which make it appear that the brain is resting, occur only during sleep.
Developmental Theories
Some theories indicate that sleep plays a role in the development of the brain. REM sleep is a major component of sleep for infants in utero and for newborns. REM sleep is thought to activate visual, motor, and sensory areas in the brain. In the infant's brain, this increases the ability of neurons to make the correct connections and to function properly. One developmental theorist proposes that sleep is an adaptive behavior to keep us away from trouble at night. In a natural environment, we are daytime beings; in the darkness of night, we cannot perform the same activities we engage in during the day. So by sleeping, we simply refrain from being active at night when our vision is less acute, and this, in turn, keeps us from harm.
dyssomnia
[dis-som´ne-ah] any of a group of primary sleep disorders characterized by disturbances in the quality, amount, or timing of sleep, including primary insomnia, primary hypersomnia, breathing-related sleep disorder, circadian rhythm sleep disorder, and narcolepsy. See also parasomnia.
parasomnia
a category of primary sleep disorders in which abnormal events occur during sleep, due to inappropriately timed activation of physiological systems. Included are nightmare disorder, sleep terror disorder, and sleepwalking disorder. See also dyssomnia.
