COMFORT, REST, ACTIVITY, AND MOBILITY FUNCTIONS

Sleep Disturbance

  1. Types of sleep:
    1. Rapid eye movement (REM) sleep: colorful, dramatic, emotional, implausible dreams.
    2. Non - REM sleep-stages:
      1. Stage 1: lasts 30 sec - 7 minfalls asleep, drowsy; easily awakened; fleeting thoughts.
      2. Stage 2: more relaxed; no eye movements, clearly asleep but readily awakens; 45% of total sleep time spent in this stage.
      3. Stage 3 (delta sleep): deep muscle relaxation; decreased temperature, pulse, respiration (TPR).
      4. Stage 4 (delta sleep): very relaxed; rarely moves.
    3. Sleep cycle - common progression of sleep stages:
      1. Stages 1,2, 3,4,3, 2, REM, 2, 3,4, etc.
      2. Delta sleep most common during first third of night, with REM sleep periods increasing in duration during night from 1 - 2 min at start to 20 - 30 min by early morning.
      3. REM sleep varies.
        1. Adolescents spend 30% of total sleep time in REM sleep.
        2. Adults spend 15% of total sleep time in REM sleep.

  2. Sleep deprivation (dyssomnias):
    1. Assessment:
      1. Non - REM sleep loss: physical fatigue due to less time spent in normal deep sleep.
      2. REM sleep loss: psychological effects - irritability, confusion, anxiety, short - term memory loss, paranoia, hallucinations.
      3. Desynchronized sleep: occurs when sleep shifts more than 2 hr from normal sleep period. Irritability, anoxia, decreased stress tolerance.
    2. Analysis/nursing diagnosis:sleep pattern disturbance may be related to:
      1. Interrupted sleep cycles before 90 min sleep cycle is completed.
      2. Unfamiliar sleeping environment.
      3. Alterations in normal sleep/activity cycles (e.g., jet lag).
      4. Preexisting sleep deficits before hospital admission.
      5. Medications, e.g., alcohol withdrawal or abruptly discontinuing the use of hypnotic or antidepressant medications.
      6. Pain.
    3. Nursing care plan/implementation:
      1. Obtain sleep history as part of nursing assessment. Determine normal sleep hours, bedtime rituals, factors that promote or interrupt sleep.
      2. Duplicate normal bedtime rituals when possible.
      3. Make environment conducive to sleep: lighting, noise, temperature.
        1. Close door, dim lights, turn off unneeded machinery.
        2. Encourage staff to muffle conversation at night.
      4. Encourage daytime exercise periods.
      5. Allow uninterrupted periods of 90 min of sleep. Group nighttime treatments and observations that require touching the client.
      6. Minimize use of hypnotic medications.
        1. Substitute back rubs, warm milk, relaxation exercises.
        2. Encourage physician to consider prescribing hypnotics that minimize sleep disruption (e.g., chloral hydrate and flurazepam HC1 [Dalmane]).
        3. Taper off hypnotics rather than abruptly discontinuing.
      7. Observe client while asleep.
        1. Evaluate quality of sleep.
        2. It may be sleep apnea if client is extremely restless and snoring heavily.
      8. Health teaching: avoid caffeine and hyperstimulation at bedtime; teach how to promote sleep - inducing environment, relaxation techniques.
    4. Evaluation/outcome criteria: verbalizes satisfaction with amount, quality of sleep.