Basic Human Needs Sleep Sleep Proper rest sleep
Basic Human Needs Sleep
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
Sleep § Without proper amounts of rest & sleep, the ability to concentrate, make judgments, & participate in daily activities decreases & irritability increases
Functions of Sleep Theories § Associated with healing & restoration § Quality of sleep important to health promotion
Physiology of Sleep § Sleep-cyclical physiological process that alternates with longer periods of wakefulness § Sleep-wake cycle influences & regulates physiological function & behavioral responses
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
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
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
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)
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 inhibitory process § 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
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
Reticular Activating System § Wakefulness results from neurons in the RAS that release catecholamines such as norepinephrine
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)
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
Stages of Sleep § Measured by EMG, EEG, EOG § Normal sleep involves 2 phases: NREM (Nonrapid eye movement) REM (Rapid eye movement)
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
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
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
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
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
Dreams § § § Dreams occur in NREM & REM More vivid & elaborate in REM Important to the consolidation of long-term memory
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
Sleep Disorders § § § Dyssomnias Parasomnias Sleep Disorders Associated with Medical or Psychiatric Disorder § Proposed Sleep Disorder
Dyssomnias § Primary disorders that have their origin in different body systems § 3 major groups § Intrinsic sleep disorder § Extrinsic sleep disorder § Circadian rhythm sleep disorder
Intrinsic Sleep Disorders § § Psychophysiological insomnia Narcolepsy Periodic limb movement disorder Sleep apnea
Extrinsic Sleep Disorders § § Inadequate sleep hygiene Insufficient sleep syndrome Hypnotic-dependent sleep disorders Alcohol-dependent sleep dosorder
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
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
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
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)
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 § www. sleepeducation. com/Disorder. aspx? id=7
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
Sleep Apnea Treatment § Weight loss § Sleeping on side § CPAP § Bi-PAP
Central Sleep Apnea § Involves dysfunction in the brains respiratory control center § Impulse to breathe temporarily fails § Nasal airflow & chest wall movement cease, O 2 sat falls § Seen in brain stem injury, muscular dystrophy, encephalitis § Bipap mask
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
Sleep Deprivation § Occurs as a result of dyssomnias § Causes include: illness, emotional stress, medications, environmental disturbances, shift work § Nurses at risk, patients at risk
Symptoms of Sleep Deprivation § § § Blurred vision Clumsiness Slow response Decreased reasoning Decreased visual alertness § Arrhythmias § § § Confusion Disorientation Irritability Sleepiness Agitation Decreased motivation
Normal Sleep Requirements § § § § § Neonates Infants Toddlers Preschool School age Teens Young adults Middle Adults Older Adults
Factors Affecting Sleep § § § § Drugs & Substances Lifestyle Usual sleep patterns & excessive daytime sleepiness Emotional stress Environment Exercise & fatigue Diet
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”
Nursing Diagnosis § § § § Anxiety Ineffective Breathing Pattern Sleep Pattern Disturbance Alteration in Sensory Perception Ineffective Coping Acute Confusion Fatigue
Implementation § § § § Environmental controls Promoting bedtime routines Promoting Comfort Establishing periods of rest & sleep Stress Reduction Bedtime snacks Pharmacological agents
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
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