Sleep and Rest
Select the correct characteristics associated with a normal sleep pattern. Each night of sleep consists of ___________________ cycles of sleep. Each sleep cycle is __________ long. Each cycle has ______________ non-rapid eye movement (NREM) cycle(s) and _________________ rapid eye movement (REM) cycle(s). REM lasts up to _________ minutes during the ____________ cycle of sleep.
4-6 90-110 3 1 60 last
Sleep Characteristics of Adolescents The sleep characteristics of adolescents include which of the following? Adolescents require less sleep than adults. Adolescents normally sleep less than 7 hours a night. Adolescents experience more REM sleep than school-age children. Adolescents normally sleep 8-10 hours a night.
Adolescents normally sleep less than 7 hours a night, but it is recommended that this age group sleeps 8-10 hours. This is attributed to increasing school demands and activities as well as part-time jobs for this age group. In addition, adolescents often have electronic devices in their rooms which can lead to poor sleep hygiene and quality, resulting in excessive daytime sleepiness (EDS) and subsequently an increase in behavioral and mood issues. REM sleep and sleep requirements typically decrease as people age.
Neonates and infants (up to age 2) normally sleep 15-16 hours per day. Approximately 50% is REM sleep and this stimulates the higher brain centers essential for development so that there is enough wake time to allow for significant external stimulation. Toddlers (up to age 5) normally sleep 12 hours per day with nighttime waking and decreasing REM sleep is common. Toddlers typically fight going to bed at night due to their need for autonomy and the separation anxiety often seen in this age group. Preschoolers and school-age children (age 5-11) normally sleep 9-12 hours a day with the amount of sleep decreasing as the child ages. After a long day of activity, the preschooler typically has difficulty relaxing or quieting down for bedtime. With this age group, bedtime fears, nightmares, brief crying, walking around, unintelligible speech, sleepwalking, or bed-wetting are not uncommon. For school-age children, sleep requirements vary and decrease with age. Adolescents (beginning with age 12) normally sleep less than 7 hours a night, but it is recommended that this age group sleep 8-10 hours. This is attributed to increasing school demands and activities as well as part-time jobs for this age group. In addition, adolescents also have electronic devices in their rooms and they lead to poor sleep hygiene and quality, resulting in excessive daytime sleepiness (EDS) and subsequently an increase in behavioral and mood issues and alcohol use. Young and Middle Adults normally sleep 6-9 hours a night. Stage N3 sleep declines with advancing age, with insomnia becoming common as the stresses of adulthood set in. Anxiety, depression or physical illnesses also contribute to poor sleep quality. Older adults experience an increase in sleep difficulties with age and less time spent in deep, REM sleep. More frequent periods of NREM sleep occur and it takes longer for the older adult to fall asleep.
Lack of proper sleep can cause: Decreased immunity Decreased mood and mental relaxation Decreased motor performance Decreased tissue renewal Decreased ability to recover from illness Decreased memory consolidation Decreased ability to concentrate Client admitted with an infection - Decreased immunity, Decreased tissue renewal, Decreased ability to recover from illness Client recovering from surgery - Decreased immunity, Decreased tissue renewal, Decreased ability to recover Client with an increased fall risk - Decreased motor performance, Decreased memory consolidation and ability to concentrate Client admitted for a suicide attempt - Decreased mood and mental relaxation, Decreased memory consolidation and ability to concentrate Client with dementia - Decreased mood and mental relaxation, Decreased memory consolidation and ability to concentrate
Normal Sleep Patterns Based on the knowledge of normal sleep patterns, the nurse caring for a client who is in the deepest stage of sleep would expect to observe which of the following clinical signs during hourly rounds? Select all that apply. The client is difficult to arouse and rarely moves. The client's respiratory rate is higher than her previously observed baseline. The client's telemetry monitor shows a pulse rate that is fluctuating from her previously observed baseline. The client's respiratory rate is lower than the previously observed baseline. The client's eyes are moving around under her eyelids.
N3 is the deepest stage of sleep characterized by a significant decrease in brain and muscle activity. Vital signs are significantly lower than during waking hours. The client is difficult to arouse and rarely moves. REM occurs about 90 minutes after sleep has begun. The duration of REM increases with each sleep cycle and averages 20 minutes. This is the stage in which dreaming and rapid eye movement occur, as well as a fluctuation in heart, respiratory, and blood pressure rates. Also, the client loses skeletal muscle tone, gastric secretion increases, and the client is very difficult to arouse.
Sleep Disorders Which of the following sleep disorders often requires a machine providing positive pressure at night? Obstructive sleep apnea Narcolepsy Nocturia Chronic sleep deprivation
Obstructive sleep apnea (OSA) and central sleep apnea (CSA) are sleep disorders characterized by difficulty or inability to breathe and sleep simultaneously caused by a lack of airflow through the nose and mouth lasting seconds up 2 minutes. These periods of hypoxia and lack of deep sleep lead to insomnia and excessive daytime sleepiness (EDS), along with headaches, irritability, and depression. In addition, untreated sleep apnea causes an increased risk for hypertension, diabetes, heart disease and hear failure. Management includes treatment of the underlying cause of the sleep apnea and devises which change airway pressure during sleep.
Parasomnias Which of the following is true of the group of sleep disorders known as parasomnias? Select all that apply. Caused by brain injury or trauma More common in children More common in older adults Abnormal actions while asleep Occurs when falling asleep, sleeping, or waking up
Parasomnias are sleep issues typically seen more often in children and may be caused by autonomic nervous system abnormalities. Parasomnias include somnambulism (sleepwalking), night terrors, sleep paralysis, and nocturnal enuresis (bed-wetting). These may occur while falling asleep, during sleep, or when waking up. Treatment varies based on the particular issue. However, safety is a priority.
Sleep Deprivation Which of the following is true about sleep deprivation? Can be acute or chronic Is typically short in duration rather than chronic Is most commonly experienced by hospitalized patients Typically only results psychological symptoms
Sleep deprivation can be acute or chronic and typically occurs as a result of a sleep disorder, illness, emotional stress, certain medications, and/or environmental disturbances. When sleep is interrupted and fragmented, normal sleep cycles are impacted and over time, lead to the accumulation of sleep deprivation. It is manifested by a variety of physiological (such as decreased reflexes, blurred vision, cardiac arrhythmias) and psychological (such as confusion, agitation, apathy) symptoms.
Parasomnias Based on the nurse's knowledge about sleep disorders, which of the following situations presents a client safety concern for the nurse? Select all that apply. Newborn positioned in prone position to sleep A pediatric client with a history of somnambulism A pediatric client has had an episode of enuresis An elderly comatose client
Sudden infant death syndrome (SIDS) is believed to be related to the infant's sleep position and a prone position presents a safety concern. Somnambulism or sleepwalking can also present a safety concern in the pediatric population.
Narcolepsy Based on the nurse's knowledge of narcolepsy, which of the following is the priority concern for the nurse caring for a client diagnosed with narcolepsy? Headache caused by dysfunctional sleep Sleep deprivation due to hospitalization Depression and anxiety due to dysfunctional sleep Client safety due to an increased fall risk
The priority and most acute need is safety and the client's risk of falls. The other possible concerns can and should be addressed but only once the client's immediate safety is established. Narcolepsy causes EDS due to dysfunctional sleep and wake cycles. This disorder is characterized by sudden and overwhelming waves of sleepiness that causes the client to uncontrollably and suddenly fall asleep at any point during the day. The client reaches REM sleep quickly and may experience sudden but typically brief periods of muscle weakness with intense anger, sadness or laughter (cataplexy). If cataplexy is more severe, the client may actually fall down after losing control of voluntary muscles. Treatment includes various medications and improvement of sleep hygiene.
Factors Affecting Sleep There are many factors that affect sleep. Which of these factors can the nurse impact to decrease the likelihood of sleep disturbances for the hospitalized client? Select all that apply. Silence noises inside and outside the client's room Encourage the client to practice sleep hygiene Cluster treatments and assessments at night Keep light in the hospital room minimal at night Ensure bed linens are smooth, clean, and dry
There are factors affecting sleep that the nurse cannot directly impact in terms of sleep, such as the patient's age, development cycle, and illnesses. However, there are many things nurses can do to decrease the likelihood of sleep disturbances in the hospital and/or long-term care facility. These include encouraging good sleep hygiene, keeping linens clean, reducing noise and lighting, and clustering treatments and assessments, as much as possible, at night.
Sleep Characteristics of Adults The sleep characteristics of adults include which of the following? Select all that apply. The older adult spends more time in REM sleep Adults sleep more as age increases Adults sleep less as age increases The older adult spends less time in REM sleep
older adults experience an increase in sleep difficulties with age and less time in spent in the deep, REM sleep. More frequent periods of NREM sleep occur and it takes longer for the older adult to fall asleep.
Sleep is important for the _________________ of biological processes including tissue renewal.
restoration Sleep is important for the restoration of biological processes including tissue renewal. Proper rest and sleep are as important to health as good nutrition and adequate exercise. Sleep is a physiological process that is cyclical and alternates between periods of wakefulness that vary in length and depth, with the purpose of regulating physiological function and behavior responses.
