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EARNING
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1
Explain the physiology and the functions of sleep.
Concepts for Lecture
1. Sleep is an altered state of consciousness in which the individual’s
perception of and reaction to the environment are decreased.
The cyclic nature of sleep is thought to be controlled by centers
located in the lower part of the brain. Neurons within the reticular
2. Neurotransmitters affect the sleep–wake cycle. Serotonin is thought
to lessen the response to sensory stimulation and gamma–
3. Another key factor to sleep is exposure to darkness. Darkness and
preparing for sleep cause a decrease in the stimulation of the RAS.
4. Sleep is a complex biological rhythm. When an individual’s biologi-
cal clock coincides with the sleep–wake cycle, the individual is said
5.
The effects of sleep are not completely known. Sleep exerts physiologi-
cal effects on both the nervous system and other body structures. Sleep
in some way restores normal levels of activity and normal balance
C
HAPTER
45
SLEEP
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UGGESTIONS FOR
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LASSROOM
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CTIVITIES
•
Review the anatomical structures and neuro-
transmitters involved in the physiology of
sleep.
328 CHAPTER 45 / Sleep
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2
Identify the characteristics of the sleep states: NREM and REM sleep.
Concepts for Lecture
1. Sleep architecture refers to the basic organization of normal sleep.
3. Stage I is the stage of very light sleep and lasts only a few minutes.
The individual feels drowsy and relaxed, the eyes roll from side to
4. Stage II is the stage of light sleep during which the body processes
continue to slow down. The eyes are generally still, the heart and
5. Stages III and IV are the deepest stages of sleep, differing only in the
percentage of delta waves recorded during a 30–second period. Dur-
ing delta sleep or deep sleep, the individual’s heart and respiratory
6. Physiological changes that occur in NREM sleep include: arterial
blood pressure falls; pulse rate decreases; peripheral blood vessels
7.
REM sleep usually occurs every 90 minutes and lasts 5 to 10 minutes.
Most dreams take place during REM sleep. The brain is highly active,
L
EARNING
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UTCOME
3
Describe variations in sleep patterns throughout the life span.
Concepts for Lecture
1. Newborns sleep 16 to 18 hours a day, on an irregular schedule, with
periods of 1 to 3 hours spent awake. They enter REM sleep immedi-
S
UGGESTIONS FOR
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LASSROOM
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CTIVITIES
•
Invite practitioners from a sleep clinic to dis-
cuss the stages and functions of sleep.
S
UGGESTIONS FOR
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LASSROOM
A
CTIVITIES
•
Have the students interview parents of young
children to determine the sleep patterns of
their children. Compare findings in class.
S
UGGESTIONS FOR
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LINICAL
A
CTIVITIES
• Have the students interview assigned clients
to determine their usual sleep patterns and
2. At first, infants awaken every 3 to 4 hours, eat, and then go back to
sleep. Periods of wakefulness gradually increase during the first
3. Toddlers (1 to 3 years of age) require 12 to 14 hours of sleep. Most
4. The preschool child (3 to 5 years of age) requires 11 to 13 hours of
sleep per night, particularly if the child is in preschool. Sleep needs
5.
Adolescents (12 to 18 years of age) require 9 to 10 hours of sleep each
6. Most healthy adults need 7 to 9 hours of sleep; however, there is
7.
A hallmark change with age is a tendency toward earlier bedtime and
wake times. Older adults (65 to 75 years) usually awaken 1.3 hours
L
EARNING
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4
Identify factors that affect sleep.
Concepts for Lecture
1. Factors that affect normal sleep include illness, environment, life-
style, emotional stress, stimulants and alcohol, diet, smoking, moti-
vation, and medications.
Lifestyle factors such as irregular schedules, time of day when a
person exercises, and stress may alter sleep.
Emotional stress is the number one cause of short-term sleeping
difficulty due to inability to relax sufficiently. The amount of nore-
S
UGGESTIONS FOR
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LASSROOM
A
CTIVITIES
•
Invite several nurses who work the night shift
to discuss how they have adapted their sleep–
wake patterns. Also have the nurses discuss
the sleep patterns of hospitalized clients.
•
Divide the students into groups. Assign each
group a factor that influences sleep. Have each
group investigate research on this factor and
present findings to the class.
findings.
Nicotine is a stimulant, and smokers have more difficulty falling
asleep and are easily aroused.
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5
Describe common sleep disorders.
Concepts for Lecture
1. Common sleep disorders include insomnia, excessive daytime sleep-
2. Insomnia is described as difficulty falling asleep or remaining
asleep. Manifestations include difficulty falling asleep, waking up
3. Excessive daytime sleepiness is a result of hypersomnia, narcolepsy,
sleep apnea, and insufficient sleep.
4. Hypersomnia refers to conditions where the affected individual
5. Narcolepsy is a disorder of excessive daytime sleepiness caused by
the lack of the chemical hypocretin in the area of the central nervous
6. Sleep apnea is characterized by frequent short breathing pauses dur-
ing the night. More than five apneic episodes or five breathing paus-
es longer than 10 seconds per hour is considered abnormal.
7.
A parasomnia is behavior that may interfere with sleep or occur during
sleep. The International Classification of Sleep Disorders (Judd &
8.
Healthy individuals who obtain less sleep than they need will experience
sleepiness and fatigue during the day. They may develop attention and
concentration deficits, reduced vigilance, distractibility, reduced motiva-
S
UGGESTIONS FOR
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LASSROOM
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CTIVITIES
•
Have each student select and write a short
paper on a sleep disorder and present it to the
class.
•
Invite a staff member from a sleep clinic to
discuss diagnostic testing of sleep disorders.
• If possible, arrange for several students to
visit a sleep clinic. Ask the students to observe
assigned clients.
CHAPTER 45 / Sleep 331
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6
Identify the components of a sleep pattern assessment.
Concepts for Lecture
1. A complete assessment of a client’s sleep difficulty includes a sleep
2. A sleep history includes the following questions: When does the
client usually go to sleep, awake, nap, and, if a child, any bedtime
rituals; does the client have any problems with sleep; has anyone ev-
er told the client that he or she snores loudly or thrashes around dur-
3. During the health history, the nurse obtains information about any
4. The physical examination rarely yields information related to sleep
disorders unless the client has obstructive sleep apnea. Signs of this
5. A sleep specialist may ask the client to keep a sleep diary including
all or some of the following: time factors associated with sleep;
6.
Diagnostic studies performed by sleep disorder laboratories include pol-
ysomnography, including electroencephalography (EEG), electromyo-
gram (EMG), and electro-oculogram (EOG).
L
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7
Develop nursing diagnoses, outcomes, and nursing interventions related to
sleep problems.
Concepts for Lecture
1. Disturbed Sleep Pattern is the NANDA diagnosis given to clients
with sleep problems. It is usually made more specific with descrip–
2. Sleep pattern disturbances may also be stated as the etiology of
S
UGGESTIONS FOR
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LASSROOM
A
CTIVITIES
•
Have the students practice performing a sleep
history on each other.
•
Have the students keep a sleep diary and share
findings with the class.
• Have the students perform a sleep assessment
on their assigned clients. Discuss findings in
postconference.
S
UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
• Have the students review the defining character-
istics of the Disturbed Sleep Pattern diagnosis.
•
Provide the students with a case study in
which disturbed sleep is the etiology of anoth-
er nursing diagnosis. Ask the students to iden-
tify the appropriate nursing diagnosis, develop
goals and desired outcomes, and select appro-
priate nursing interventions.
care plan related to sleep patterns for their
3. The major goal for clients with sleep disturbances is to maintain (or
develop) a sleeping pattern that provides sufficient energy for daily
4.
The nurse plans specific nursing interventions to reach the goal based on
the etiology of each nursing diagnosis. These interventions may include
L
EARNING
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8
Describe interventions that promote normal sleep.
Concepts for Lecture
1.
Sleep hygiene refers to interventions used to promote sleep. These in-
2. Clients need to learn the importance of sleep in maintaining active
and productive lifestyles, the conditions that promote sleep and those
3. Bedtime rituals are routines that are conducive to comfort and relax-
4. Creating a restful environment is important. All individuals require a
sleeping environment with minimal noise, a comfortable room tem-
5.
The environment must also be safe. Clients may feel more secure with
side rails. Beds should be placed in low positions, night-lights should be
turned on, and call bells should be placed within reach of the client.
A concerned, caring attitude, along with the following interven-
tions, can significantly promote client comfort and sleep:
• Provide loose-fitting nightwear.
• Assist clients with hygienic routines.
S
UGGESTIONS FOR
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LASSROOM
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CTIVITIES
• Invite a certified massage therapist to assist
students to practice effleurage on each other.
•
Have the students select a relaxation technique
to investigate and present to the class.
•
Have the students interview people of various
ages to discover bedtime rituals. Discuss
S
UGGESTIONS FOR
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LINICAL
A
CTIVITIES
•
Have the students review charts to determine
sleep, half-life, any adverse reactions, and any
contraindications for use.
CHAPTER 45 / Sleep 333
Individuals of any age, but especially older adults, are unable to
6.
Medications that enhance sleep are often prescribed on an as-needed
(prn) basis. They include sedative-hypnotics (which induce sleep) and