Sleep and Rest

George Ann Daniels, MS, RN

Sleep Stages

Stage 1 Transition Stage 2 Light Sleep Stage 3 & 4 Slow wave Stage R!M sleep

R!M Sleep

R!M"Rapid e#e $ove$ent %ital signs &l'(t'ate )2 (ons'$ption in(reases Ther$oreg'lations lost %aginal se(retion in(rease !re(tions Drea$s"vivid

Sleep Rh#th$
*) $in'te (#(les d'ring whi(h people pass
thro'gh the sleep stages

+hara(teristi(s o& nor$al sleep and rest

Awareness o& the need &or sleep
Sleepiness
,rge to go to sleep

-atig'e
State o& weariness

Restoration and .rote(tion

+onserves energ# S#nthesis o& (ells /ana0olis$1

Nor$al sleep and rest patterns

Short sleepers
2 ho'rs or less
!&&i(ient, hardwor3ing

One to two
awakenings per noc normal for young adults Should awake well rested, refreshed, and energized Cultural habits Circadian Rhythms

Long sleepers
* ho'rs or $ore +reative

Sleep laten(# period +hange o& position

2)"4) ti$e4 night

Li&espan
New0orns4in&ants
5'iet sleep and a(tive sleep 3 wa3ing states
5'iet awa3e, a(tive awa3e, and (r#ing

New0orns sleep 12"16 ho'rs per da#

Divided into seven sleep periods 0etween the da# and
night

7n&ants have a shorter sleep (#(le / )"2)

$in'tes1

 Adaptive tas3 &or the in&ant

!sta0lish sleep"wa3e patterns (o$pati0le with the
environ$ent

Most in&ants sleep thro'gh the night 0e 3 $onths Total sleep ti$es (ontin'e to drop as the in&ant
gets older

Toddler4.res(hooler 1 #ear naps on(e or twi(e per da# Total sleep ti$e drops to 13"14 ho'rs at age
2 12 ho'rs 0# age

 +hild
Sleep needs are in relationship to growth sp'rts
and a(tivit# patterns

Adoles(ents
Re8'ire $ore sleep than 0e&ore p'0ert# Growth and hor$one Ad'lts %ar# Middle ad'lts
7n(rease in no(t'rnal awa3enings Sleep satis&a(tion de(reases

 9lder ad'lts
Stage 4 sleep de(reases Di&&i('lt# re$aining asleep Shorter no(t'rnal period with in(rease in
da#ti$e naps Total ti$e in 0ed in(reases
Napping, longer sleep laten(#, in(reased n'$0er and
length o& awa3enings, and general &atig'e

!d'(ate elderl# a0o't nor$al sleep pattern

(hanges

-a(tors A&&e(ting Sleep and Rest

Need
Morning people4evening people !nviron$ent New environ$ent Sleep roo$ do'0les with wor3 area 90:e(ts o& pla# $a# interr'pt a (hild sleep Red'(tion o& environ$ental sti$'li
Light , noise, and te$perat're

 Relationships
.arenting, 0ereaved,ho$esi(3, (riti(al (are 'nits;

Shi&t <or3 N'trition and Meta0olis$

='nger or di&&i('lt# sleeping a&ter a large $eal, ingestion
o& (ertain &oods de(rease sleep laten(# and in(rease stage 4 sleep;

!li$ination .atterns
Need to void Li$it &l'ids>de(rease no(t'rnal sti$'lation

!?er(ise and Ther$oreg'lation

.h#si(all# &it people have de(reased sleep laten(# <ar$th in(reases slow"wave sleep

 Li&est#le and ha0its

@edti$e rit'als Li&est#le patterns
,p at and asleep 0# A

7llness
A('te or (hroni(
Loss o& stage 3 sleep

.ain, d#spnea, hor$one (hanges /h#perth#roidis$1,

s3in (onditions, an?iet# &ro$ illness

Medi(ations and +he$i(als

=#pnoti(s, al(ohol, (a&&eine Mood states

Alterations in sleep
7nso$nia
.er(eived di&&i('lt# in sleeping Months to #ears 3 t#pes
9nset inso$nia Maintenan(e inso$nia !arl#"awa3ening inso$nia

 Nar(oleps#
Disorder o& e?(essive da#ti$e sleepiness
(hara(teriBed 0# short, sleep atta(3s Last 1) C1 $in'tes 9nset 's'all# in adoles(ents

Sleep apnea
Re('rrent periods o& a0sen(e o& 0reathing &or 1)
se(onds or longer, o(('rring at least ho'r
90str'(tive sleep apnea +entral apnea Mi?ed apnea

ti$es per

 .eriodi( li$0 $ove$ent

Repetitive dorsi&le?ion o& the &oot and &le?ion o&
the 3nee 9n(e ever# 1 "2) se(onds Restless legs s#ndro$e
+rawling, it(hing sensations in the legs at rest

+ir(adian rh#th$ disr'ptions

Det lag

.araso$nias
Nor$al a(tivities in the da# that is a0nor$al
d'ring sleep
Sleepwal3ing, tal3ing, 0ed wetting

7$pa(t on ADLEs

De(reased energ# 7$paired (oping and (ognitive responses Role per&or$an(e So(ial intera(tions 7rrita0ilit# 7$paired (on(entration

 S'0:e(tive

Assess$ent

=ow $an# ho'rs o& sleep do #o' 's'all# getF <hat ti$e do #o' 's'all# go to 0edF <hat ti$e do #o' 's'all# get 'pF <hat helps #o' sleepF =ow do &eel when #o' wa3e 'pF =ow $'(h sleep do #o' 0elieve #o' needF <hat helps #o' rela?F <hat are #o'r sleep rit'alsF

=ow o&ten do #o' ta3e naps or rest periodsF Do #o' ta3e an#thing to help #o' sleepF Assess (a&&eine, ni(otine, and al(ohol inta3e; Assess wor3 ho'rs 7denti&# d#s&'n(tions

Sleep apnea, snoring, stress

90:e(tive Data
+ir(les 'nder e#es, #awning, nodding, slow responses, irrita0ilit#,
i$paired (on(entration, word"&inding di&&i('lties, %S

Diagnosti( test
Sleep st'dies, )2 levels

NDG
Sleep pattern Dist'r0an(e R4T
7nternal sensor# alterations
7llness, stress

!?ternal sensor# alterations

Light, noise, so(ial sti$'lation, strange environ$ent

!9
+lient will report &ewer pro0le$s &alling
asleep; +lient will have an in(rease sleep ti$e to 2 ho'rs per night; +lient will report &eeling $ore rested;

7nterventions

!nviron$ent $odi&i(ations .riva(# and se('rit# Sleep rit'als Managing individ'al sleep needs Medi(ation