HLTEN504A - INCP Comfort Rest Sleep

What is sleep Sleep is a sensory experience. Perception of and reaction to the surrounding environment decrease during sleep. The sleeping person can be aroused by tactile, auditory and visual disturbances. Sleep is influenced by an individual biologic clock that regulates not only sleep but also levels of alertness throughout the day. Sleep is a cyclic phenomenon. Within a 24-hour period, individuals have one major sleep period and one major wake period

Circadian Rhythms Relates to the behavioral and biological activity in 24 hrs. Internal clock synchronized to light / dark cycles and other daily cues. Circadian clock synchronized to local time. The human clock is found in a distinct group of cells in the hypothalamus. These specialized cells have a connection with the pineal gland. This gland secretes melatonin. Night time causes melatonin secretion to be increased, day time causes secretion to be inhibited. Even when night time cues are absent Melatonin is still released in a cyclic manner The special cells are activated by light hitting the retina of the eyes.

Areas of the brain which influence sleep control: The reticular activating system (RAS) and the bulbar synchronising region (BSR) in Pons Varoli. Both work together, alternately activating and suppressing the brain’s higher centres to control sleep. Hinwood, 1987, p. 227

Reticular activating system – is localised in upper brain stem Contain specialised cells that maintain alertness and wakefulness Receives stimuli from – visual, auditory, pain, tactile, emotions Wakefulness results from neurons in RAS releasing neurotransmitters such as ~Nor adrenaline ~Dopamine ~Gamma-aminobutyric acid (GABA) ~As the person begins to fall asleep and relax, RAS stimuli declines. Further decrease of activation occurs in a quiet, dark room.BSR takes over and sleep occurs

Two states of sleep Sleep has two distinct states Non-rapid eye movement (NREM), which has four stages Rapid eye movement (REM) These two states occur in approximately 90-minute cycles throughout the sleeping time.

Sleep stages

Stages of sleep Stage 1  Is experienced as we fall asleep and is the transition between being awake and asleep – eye and body movements slow down  It lasts between 5 and 10 minutes.  Easily aroused from this state  This will be increased in those people suffering insomnia and disorders that produce frequent arousal patterns e.g. apnoea

Stages of sleep Stage 2 Is the baseline of sleep, last for around 20 mins Body temp and heart rate begins to slow Arousal still relatively easy It occupies approximately 45-60% of sleep

Stages of sleep Stage 3 – transitional stage to deep or delta wave sleep Muscles are completely relaxed, and may last minutes. Very difficult to wake from this stage Can feel groggy and disorientated for several minutes if woken In children delta sleep occupies up to 40% of all sleep time.

Stages of sleep Stage 4 – second stage of deep sleep May last up to mins Very difficult to wake Both 3 & 4 are important to feeling refreshed when waking Sleep walking and enuresis may occur

Stages of sleep REM sleep Lasts 5-30 mins, beginning about mins after commencement of sleep It composes 20-25% of a normal night’s sleep. Breathing, eye movement, heart rate and brain wave activity increase. Vivid dreams occur. There is also a loss of muscle tone (as if paralysed) in skeletal muscles

Sleep patterns of older adults It often takes longer to fall asleep Beginning in middle age, stages 3and 4 sleep become less prominent There is a moderate reduction in total REM sleep time The percentage of sleep time in stages 1 and 2 increases Nocturnal awakenings increase in frequency and duration. Because of frequent and longer night-time awakenings, total time spent asleep is shorter There is a tendency to nap during the day so that total time spent asleep is redistributed in a 24-hour cycle

Conditions to promote proper rest Physical comfort Elimination sources of physical irritation Controlling sources of pain Providing warmth Maintaining hygiene Maintaining proper anatomical alignment or positioning Removing environmental distractions Provide adequate ventilation

Conditions to promote proper rest Freedom from; W orry Making decisions Participating in personal health care Gaining an understanding of health problems and their implications Practicing restful activities regularly Knowing the environment is safe Sufficient sleep

Improving sleep hygiene Regular sleep and waking times go to bed when sleepy use relaxation techniques to promote sleep if unable to sleep within minutes get out of bed Avoiding daytime naps if naps are used, limit to 20 minutes or less twice a day Optimising sleep environments Use night light if required Keep path to bathroom free of obstacles Provide privacy Provide enough pillows for comfort

Improving sleep hygiene Regular sleep and waking times go to bed when sleepy use relaxation techniques to promote sleep if unable to sleep within minutes get out of bed Avoiding daytime naps if naps are used, limit to 20 minutes or less twice a day Optimising sleep environments Use night light if required Keep path to toilet free of obstacles Provide privacy Provide enough pillows for comfort

Improving sleep hygiene Minimise noise and moderate temperature Sometimes soft music can mask other noise Control noise in the hospital Make sure that the heater is on/off, fan on/off, windows open/closed; Provide enough blankets, socks to promote warmth Eliminate daytime sedation and night time stimulants Ensure that medications or their interactions are not cause of insomnia

Effects of Sleep deprivation Benefits of power naps Visitors and other clients Meditation and relaxation Pain management Medications