Chapter 42 - Sleep

Developmental Stage: Toddlers Sleep Patterns: ?

By the age of 2 years, children usually sleep through the night and take daily naps. Total sleep averages 12 hours a day. After 3 years of age, children often give up daytime naps. It is common for toddlers to awaken during the night. The percentage of REM sleep continues to fall. During this period, toddlers may be unwilling to go to bed at night because of a need for autonomy or a fear of separation from their parents.

For each of the following situations, give two examples of nursing measures that will promote sleep. Environmental controls (2)

Reduce light, reduce noise; also refer to Box 42-11 on p. 956 for other examples

For each of the following situations, give two examples of nursing measures that will promote sleep. Promoting safety (2)

Reduce the risk of postoperative complication for patients with sleep apnea (airway); use of CPAP

For each of the following situations, give two examples of nursing measures that will promote sleep. Stress reduction (2)

Giving patient control over their health care minimizes uncertainty and anxiety; back rubs ;cautious use of sedatives

Describe how each of the following affects sleep and give an example of each. Environment

Good ventilation is essential for a restful sIeep, as are the size and firmness of the bed; light levels affect the ability to fall asleep.

Many factors affect the ability to gain adequate rest and sleep. Briefly give examples of each of the following in relation to health promotion. Stress reduction

Pursue a relaxing activity for adults; children need comforting and night lights.

Parasomnias

e. More common in children, an example is sudden infant death syndrome (SIDS)

Narcolepsy

q. Dysfunction of mechanisms that regulate the sleep and wake states (excessive daytime sleepiness)

Identify sources for sleep assessment

Patients, bed partner, and parent of children

All of the following are symptoms of sleep deprivation except: 1. Irritability 2. Hyperactivity 3. Decreased motivation 4. Rise in temperature

4. See Box 42-3 on p. 944 for other symptoms of sleep deprivation; most physiological symptoms are decreased, not increased.

A nursing care plan for a patient with sleep problems has been implemented. All of the following would be expected outcomes except: 1. Patient reports satisfaction with amount of sleep. 2. Patient falls asleep within 1 hour of going to bed 3. Patient reports no episodes of awakening during the night 4. Patient rates sleep as an 8 or above on the visual analog scale

2. A sleep-promotion plan frequently requires many weeks to accomplish.

The 24-hour day-night cycle is known as: 1. Ultradian rhythm 2. Circadian rhythm 3. Infradium rhythm 4. Non-REM rhythm

2. Definition of, influences the pattern of major biological and behavioral functions

Which of the following substances will promote normal sleep patterns? 1. Alcohol 2. Narcotics 3. L-tryptophan 4. Beta-blockers

3. A natural protein found in milk, cheeses, and meats

Mrs. Peterson complains of difficulty falling asleep, awakening earlier than desired, and not feeling rested. She attributes these problems to leg pain that is secondary to her arthritis. What would be the appropriate nursing diagnosis for her? 1. Fatigue related to leg pain 2. Insomnia related to arthritis 3. Deficient Knowledge related to sleep hygiene measures 4. Insomnia related to chronic leg pain

4. The related factor of the sleep disturbance is physiological for this patient (leg pain).

Many factors affect the ability to gain adequate rest and sleep. Briefly give examples of each of the following in relation to health promotion. Bedtime snacks

A dairy product that contains L-tryptophan is often helpful to promote sleep; do not drink caffeine, tea, colas, and alcohol before bedtime

Developmental Stage: Neonates Sleep Patterns: ?

A neonate up to the age of 3 months averages about 16 hours of sleep a day, sleeping almost constantly during the first week. The sleep cycle is generally 40 to 50 minutes with wakening occurring after one to two sleep cycles. Approximately 50% of this sleep is REM sleep, which stimulates the higher brain centers. This is essential for development because neonates are not awake long enough for significant external stimulation.

Many factors affect the ability to gain adequate rest and sleep. Briefly give examples of each of the following in relation to health promotion. Promoting comfort

Clothing, extra blankets, void before retiring

Developmental Stage: Older adults Sleep Patterns: ?

Complaints of sleeping difficulties increase with age. More than 50% of adults 65 years or older report problem with sleep. Episodes of REM sleep tend to shorten. There is a progressive decrease in stage 3 and 4 NREM sleep; some older adults have almost no stage 4 sleep, or deep sleep. Older adults awaken more often during the night, and it takes more time for them to fall asleep. The tendency to nap seems to increase progressively with age because of the frequent awakenings experienced at night. The presence of chronic illness often results in sleep disturbance for older adults. For example, an older adult with arthritis frequently has difficulty sleeping because of painful joints. Changes in sleep pattern are often attributable to change in the CNS that affect the regulation of sleep. Sensory impairment reduces an older person's sensitivity to time cues that maintain circadian rhythms.

Developmental Stage: Middle adults Sleep Patterns: ?

During middle adulthood, the total time spent sleeping at night begins to decline. The amount of stage 4 sleep begins to fall, a decline that continues with advancing age. Insomnia is particularly common, probably because of the change and stresses of middle age. Anxiety, depression, and certain physical illnesses cause sleep disturbances. Women experiencing menopausal symptoms often experience insomnia.

Describe how each of the following affects sleep and give an example of each. Food and caloric intake

Eating a large, heavy, or spicy meal at night often result in indigestion that interferes with sleep; caffeine, alcohol, and nicotine produce insomnia.

Many factors affect the ability to gain adequate rest and sleep. Briefly give examples of each of the following in relation to health promotion. Environmental controls

Eliminate distracting noises; promote comfortable room temperature, ventilation, bed, and mattress to provide support and firmness.

Describe how each of the following affects sleep and give an example of each. Exercise and fatigue

Exercise 2 hours or more before bedtime allows the body to cool down and maintain a state of fatigue that promotes relaxation.

Many factors affect the ability to gain adequate rest and sleep. Briefly give examples of each of the following in relation to health promotion. Establishing periods of rest and sleep

Increasing daytime activity lessens problems with falling asleep

Developmental Stage: Infants Sleep Patterns: ?

Infants usually develop a nighttime pattern of sleep by 3 months of age. Infants normally take several naps during the day but usually sleep an average of 8 to 10 hours during the night for a total daily sleep time of 15 hours. About 30% of sleep time is in the REM cycle. Awakening commonly occurs early in the morning, although it is not unusual for infants to awaken during the night.

For each of the following situations, give two examples of nursing measures that will promote sleep. Promoting comfort (2)

Keep beds clean and dry and in a comfortable position; application of dry or moist heat; splints; and proper positioning

Many factors affect the ability to gain adequate rest and sleep. Briefly give examples of each of the following in relation to health promotion. Pharmacologic approaches

Melatonin (nutritional supplement to aid in sleep), valerian, kava

Describe how each of the following affects sleep and give an example of each. Usual sleep patterns

Most persons are sleep deprived and experience excessive sleepiness during the day, which can become pathological when it occurs at time when individuals need or want to be awake.

Developmental Stage: Young adults Sleep Patterns: ?

Most young adults average 6 to 8 1/2 hours of sleep a night. Approximately 20% of sleep time is REM sleep, which remains consistent throughout life. It is common for the stresses of jobs, family relationships, and social activities frequently to lead to insomnia and the use of medication for sleep. Daytime sleepiness contributes to an increased number of accidents, decreased productivity, and interpersonal problems in thi age group. Pregnancy increases the need for sleep and rest. Insomnia, periodic limb movement, restless leg syndrome, and sleep-disordered breathing are common problems during the third trimester of pregnancy.

Developmental Stage: Preschoolers Sleep Patterns: ?

On average, preschoolers sleep about 12 hour a night (about 20% is REM). By the age of 5 years, preschoolers rarely take daytime naps except in cultures where siesta is the custom. Preschoolers usually have difficulty relaxing or quieting down after long, active days and have problems with bedtime fears, waking during the night, or nightmares. Partial wakening followed by normal return to sleep is frequent. In the waking period, children exhibit brief crying, walking around, unintelligible speech, sleepwalking, or bedwetting.

Developmental Stage: Adolescents Sleep Patterns: ?

On average, teenagers get about 7 1/2 hours of sleep per night. The typical adolescent is subject to a number of changes such as school demands, after- school social activities, and part-time jobs that reduce the time spent sleeping.

Describe how each of the following affects sleep and give an example of each. Emotional stress

Personal problems or certain situations (retirement, physical impairment, or the death of a loved one) frequently disrupt sleep.

For each of the following situations, give two examples of nursing measures that will promote sleep. Establishing periods of rest and sleep (2)

Plan care to avoid awakening patient for nonessential tasks; allow patients to determine the timing and method of delivery of basic care

Describe how each of the following affects sleep and give an example of each. Lifestyle

Rotating shifts cause difficulty adjusting to the altered sleep schedule, performing unaccustomed heavy work, engaging in late-night social activities, and changing evening mealtimes.

Many factors affect the ability to gain adequate rest and sleep. Briefly give examples of each of the following in relation to health promotion. Promoting bedtime routines

Sleep when fatigued or sleepy, bedtime routines for children and adults need to avoid excessive mental stimulation before bedtime.

Describe how each of the following affects sleep and give an example of each. Drugs and illicit substances

Sleepiness, insomnia, and fatigue often result as a direct effect of commonly prescribed medications, including hypnotic, diuretic, alcohol, caffeine, beta-adrenergic blockers, benzodiazepines, narcotics, anticonvulsants, antidepressants, and stimulants

Developmental Stage: School-age children Sleep Patterns: ?

The amount of sleep needed varies during the school years. Six-year-old children average 11 to 12 hours of sleep nightly, and 11-year-old children sleep about 9 to 10 hours. Children who are 6 or 7 year old usually go to bed with some encouragement or by doing quiet activities. Older children often resist sleeping because of an unawareness of fatigue or a need to be independent.

Many factors affect the ability to gain adequate rest and sleep. Briefly give examples of each of the following in relation to health promotion. Promoting safety

Use a small night light and a bell at the bedside to alert family members.

List the common nursing diagnoses related to sleep problems (10)

a. Anxiety b. Ineffective Breathing Pattern c. Acute Confusion d. Compromised Family Coping e. Ineffective Coping f. Fatigue g. Insomnia h. Readiness for Enhanced Sleep i. Sleep Deprivation j. Disturbed Sleep Pattern

List the components of a sleep history (8)

a. Description of sleeping problems b. Usual sleep pattern c. Physical and psychological illness d. Current life events e. Emotional and mental status f. Bedtime routines g. Bedtime environment h. Behaviors of sleep deprivation

With regard to sleep disturbances, the patient is the source for outcomes evaluation. List three outcomes for a patient with a sleep disturbance. (3)

a. Patient fall asleep after reducing noise and darkening a room. b. Patient describes the number of awakenings during the previous night. c. Patient and family demonstrate understanding after receiving instructions on sleep habits.

List four goals appropriate for a patient needing rest or sleep. (4)

a. Patient will identify factors in the immediate home environment that disrupt sleep in 2 weeks. b. Patient will report having a discussion with family members about environmental barrier to sleep in 2 week . c. Patient will report changes made in the bedroom to promote sleep within 4 weeks. d. Patient will report having fewer than two awakenings per night within 4 weeks.

Nocturia

a. Urination during the night, which disrupts the sleep cycle

Polysomnogram

b. Involves the use of electroencephalogram (EEG), electromyogram (EMG), and electrooculogram (EOG) to monitor stages of sleep

Excessive daytime sleepiness (EDS)

c. Results in impaired walking function, poor work performance, accidents, and emotional problems

Insomnia

d. Most common sleep complaint, signaling an underlying physical or psychological disorder

Sleep

f. Cyclical process that alternates with longer periods of wakefulness

REM

g. Rapid eye movement (REM) phase at the end of each sleep cycle

Biological clock

h. Synchronizes sleep cycles

Circadian rhythm

i. Influences the pattern of major biological and behavioral functions

Sleep hygiene

m. Practices that the patient associates with sleep

NREM

j. Sleep that progresses through four stages (light to deep)

Dreams

k. More vivid and elaborate during REM sleep and are functionally important to learning

Sleep apnea

l. Characterized by the lack of airflow through the nose and mouth for 10 seconds or longer during sleep

Hypersomnolence

n. Inadequacies in wither the quantity or quality of nighttime sleep

Sleep deprivation

o. Problem patients experience as a result of dyssomnia

Cataplexy

p. Sudden muscle weakness during intense emotions at any time during the day