1. Basic Human Needs Sleep

2. Sleep
Proper rest & sleep are as important to good health as good nutrition and adequate exercise
Amount of sleep required varies among individuals
Physical & emotional health on the ability to fulfill these basic human needs

3. Sleep
Without proper amounts of rest & sleep, the ability to concentrate, make judgments, & participate in daily activities decreases & irritability increases

4. Functions of Sleep Theories
Associated with healing & restoration
Quality of sleep important to health promotion

5. Physiology of Sleep
Sleep-cyclical physiological process that alternates with longer periods of wakefulness
Sleep-wake cycle influences & regulates physiological function & behavioral responses

6. Circadian Rhythms Cyclical rhythms are part of everyday life
Most familiar rhythms is the 24 hr day-night cycle known as diurnal or circadian rhythm
Menstrual cycle-infradian rhythm

7. Circadian Rhythm
Influence the pattern of major biological and behavioral functions
Body temperature, heart rate, blood pressure, hormone secretion, sensory acuity & mood depend on the maintenance of the 24 hr cycle

8. Circadian Rhythms
Affected by: light, temperature, external factors (work schedules, social activities)
Biological clock- synchronize sleep cycle, individualized to person, different people function best at different times of the day

9. Sleep Regulation
Sleep involves a sequence of physiological states (stages of sleep) maintained by highly integrated central nervous system activity that is associated with all body systems
(C-V, endocrine, nervous, respiratory)

10. Sleep Regulation
Each sequence can be identified by specific physiological responses and brain activity patterns
Current theory indicates sleep is thought to be an active mutliphase process
Major sleep center-hypothalamus
Control & regulation of sleep may depend on the interrelationship between 2 cerebral mechanisms that intermittently activate & suppress the brain’s higher centers to control sleep & wakefulness

11. Reticular Activating System
Located in upper brain stem
Believed to contain special cells that maintain alertness & wakefulness
RAS receives visual, auditory, pain, and tactile sensory stimuli
Activity from the cerebral cortex(thoughts, emotions) also stimulate RAS

12. Reticular Activating System
Wakefulness results from neurons in the RAS that release catecholamines such as norepinephrine

14. Bulbar Synchroninizing Region (BSR)
Sleep may be produced by the release of seretonin from specialized cells in the Raphe sleep system of the pons & medulla also known as the BSR
Whether a person remains awake or falls asleep depends on a balance of impulses received from higher centers (thoughts), peripheral sensory receptors (sound, light) and the Limbic system (emotions)

15. Falling Asleep
As people try and fall asleep, they close their eyes and assume a relaxed position, stimuli to RAS decline. If the room is quiet & dark, activation to RAS declines further
At some point BSR takes over, causing sleep

16. Stages of Sleep Measured by EMG, EEG, EOG
Normal sleep involves 2 phases: NREM (Nonrapid eye movement) REM (Rapid eye movement)

18. NREM Sleep
NREM-sleeper progresses through 4 stages during a typical 90 min sleep cycle
Progresses from stage 1-4
Sleep becomes increasingly deep
Lighter sleep- stages 1-2
Deeper sleep- stages 3-4
REM sleep is the phase at the end of each 90 minute cycle

20. REM Sleep Vivid, full color dreaming
Typified by autonomic response by rapidly, moving eyes, fluctuating heart & respiratory rates and increased or fluctuating BP
Very difficult to arouse sleeper
Duration of REM sleep increases with each cycle, averages about 20 min

22. Sleep
Once person falls asleep, person usually passes through 4-6 complete sleep cycles per night
Each cycle consisting of 4 stages of NREM sleep and a period of REM sleep
Pattern- NREM stages 1-4 followed by a reversal of stages, 4,3,2, ending with a period of REM sleep
Reach REM sleep 90 minutes into sleep cycle

23. Functions of Sleep
Allows body to rest, slows vitals, preserves cardiac function, decrease in muscle tone
Sleep restores biological processes
Body conserves energy during sleep (Lowers metabolic rate)
REM sleep important for cognitive restoration, memory storage, & learning, during sleep brain filters information about the day’s activities

25. Functions of Sleep
Loss of REM sleep can lead to feelings of confusion & suspicion
Prolonged sleep loss affects mood, motor performance, memory & equilibrium
Sleep deprivation-results in traffic accidents, home, work related accidents

26. Dreams Dreams occur in NREM & REM More vivid & elaborate in REM
Important to the consolidation of long-term memory

27. Physical Illness Affect on Sleep
Any illness resulting in pain, physical discomfort(SOB) or mood problems (anxiety, depression) can result in sleep problems
Respiratory disease often interferes with sleep (COPD & orthopnea)
Nocturia disrupts sleep cycle
Restless leg syndrome

28. Sleep Disorders Insomnia Parasomnias
Sleep Disorders Associated with Medical or Psychiatric Disorder
Hypersomnias
Circadian Rhythm Sleep Disorders
Sleep-Related Movement Disorders
Refer to P &P pg Box 42-3

29. Parasomnias
Undesirable behaviors that occur predominately during sleep
More common in children
Arousal disorders
Sleep-wake transition disorder
Parasomnia associated with REM sleep
Other Parasomnias

30. Insomnia
Symptom experienced by clients who have a chronic difficulty falling asleep, frequent awakenings from sleep and/or a short sleep or non-restorative sleep
C/O excessive daytime sleepiness

31. Insomnia
May be transient due to emotional stress, family, work, or school problem, or loss of a loved one
May be associated with poor sleep hygiene, habits and practices associated with sleep

32. Sleep Apnea
Lack of airflow through nose & mouth for periods of 10 seconds or longer during sleep
3 Types- Central, Obstructive, Mixed
Most common type-Obstructive Sleep Apnea (OSA)

33. Obstructive Sleep Apnea
Relaxation of muscles & structures of oral cavity during sleep
Upper airway becomes obstructed
Person still attempts to breathe resulting in loud snorting & snoring sounds
Deviated septum, nasal polyps, enlarged tonsils can predispose you to OSA
Results in severe interference with deep sleep and EDS

36. Obstructive Sleep Apnea
18 million in U.S.
Causes a serious decline in oxygen level
Risk for cardiac dysrythmias, heart failure, pulmonary hypertension, stroke, HTN
Most common im men, the obese, and postmenopausal women

37. Sleep Apnea Treatment
Weight loss
Sleeping on side
CPAP
Bi-PAP

40. Central Sleep Apnea
Involves dysfunction in the brains respiratory control center
Impulse to breathe temporarily fails
Nasal airflow & chest wall movement cease, O2 sat falls
Seen in brain stem injury, muscular dystrophy, encephalitis
Bipap mask

41. Narcolepsy
Dysfunction of the mechanisms that regulate sleep & wake states
Excessive daytime sleepiness
Fall asleep uncontrollably during day at inappropriate times
REM sleep within 15 minutes
May be genetic

42. Sleep Deprivation Occurs as a result of dyssomnias
Causes include: illness, emotional stress, medications, environmental disturbances, shift work
Nurses at risk, patients at risk

43. Symptoms of Sleep Deprivation
Blurred vision
Clumsiness
Slow response
Decreased reasoning
Decreased visual alertness
Arrhythmias
Confusion
Disorientation
Irritability
Sleepiness
Agitation
Decreased motivation

44. Normal Sleep Requirements
Neonates
Infants
Toddlers
Preschool
School age
Teens
Young adults
Middle Adults
Older Adults

45. Factors Affecting Sleep
Drugs & Substances
Lifestyle
Usual sleep patterns & excessive daytime sleepiness
Emotional stress
Environment
Exercise & fatigue
Diet

46. Nursing Process Assessment
Sleep assessment
Description of sleep problems
Usual sleep pattern
Current life events
Emotional & mental status
Bedtime routines & environment
Behaviors of sleep deprivation: “ICU Syndrome”

47. Nursing Diagnosis Anxiety Ineffective Breathing Pattern
Sleep Pattern Disturbance
Alteration in Sensory Perception
Ineffective Coping
Acute Confusion
Fatigue

48. Implementation Environmental controls Promoting bedtime routines
Promoting Comfort
Establishing periods of rest & sleep
Stress Reduction
Bedtime snacks
Pharmacological agents

49. Pharmacological Agents
Hypnotics-induce sleep
Sedatives- produce a calming effect
Long term use can disrupt sleep
Benzodiazepines- Xanax, Valium, Ativan, Dalmane, Restoril, Halcion, Versed, Librium, Serax
Non-Benzo Hypnotics: Ambien, Lunesta, Rozerem
Barbiturates: Seconal, Nembutal
OTC Sleep aids