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Sleep
By Richard Araneta
Promotion of Comfort, Rest,
and Sleep
• Rest – a state of calmness, relaxation without
  emotional stress or freedom from anxiety
• Sleep – a state of consciousness in which the
  individual’s perception and reaction to the
  environment are decreased
Sleep Regulation
• Hypothalamus – major sleep center in the body
• Reticular Activating System (RAS)
  • Maintains alertness and wakefulness which results
    from neurons on the RAS that relate catecholamine
    such as norepinephrine
• Bulbar Synchronizing Region (BSR)
  • Specialized cells in the raphe nuclei sleep system of
    the pons and medulla relate serotonin producing
    sleep works with RHS to control cyclic nature of
    sleep
Sleep Regulation
• Serotonin is the major transmitter associated with
  sleep
Theories of Sleep
• Passive
  • The ascending reticular activity system (RAS) in the
    upper brain stem sympathy fatigues and therefore
    belongs inactive thus, sleep occurs
• Active
  • Proposes that there are centers that cause sleep by
    inhibiting other brain centers
Biorhythms – “biological
clock”
• Circadian rhythms
  • 24 hour, day-night cycle
• Infradian rhythm
  • Occurs longer than 24 hours
  • Ex: monthly cycle
• Ultradian rhythm
  • Cycles lasting less than 24 hours
  • Completed in minutes or hours
  • Ex: REM in sleep
Physiologic Changes During
Sleep
•   Arterial blood pressure falls
•   Pulse rate decreases
•   Peripherical blood vessels dilate
•   Activity of the GI tract occasionally increases
•   Skeletal muscles relax
•   Basal metabolic rate decreases (10-30%)
Effects of Disturbance in
Sleep-Wake Cycle
•   1.   Poor sleep
•   2.   Anxiety
•   3.   Restlessness
•   4.   Irritability
•   5.   Impaired Judgment
Stages of Sleep
• Non-rapid eye movement
 • Stage one
    •   Lightest level of sleep, eyes roll from side to side
    •   Lasts a few minutes
    •   Gradual fall in VS and metabolism
    •   Easily aroused by sensory stimuli
    •   Person feel as if daydreams has occurred
Stages of Sleep
 • Stage two
   •   Sound sleep
   •   Relaxation progresses
   •   Arousal relatively easy
   •   Lasts 10-20 min
   •   Body functions continue to slow
Stages of Sleep
 • Stage three
   •   Domination of the parasympathetic nervous system
   •   Initial stages of deep sleep
   •   Difficult to arouse and rarely moves
   •   Muscles completely relaxed
   •   VS decline but remain regular
       • Lasts 15-30 min
Stages of Sleep
 • Stage four
   •   Delta sleep-deepest stage of sleep
   •   Very difficult to arouse
   •   Lasts 15-30 min
   •   Sleep walking and exoresis (bedwetting)
   •   Restore the body’s biological processes
       • Ex: protein synthesis and cell division for renewal of tissues
Stages of Sleep
• Rapid eye movement
 •   Vivid full color dreaming
 •   Occurs 90 min after sleep begins
 •   Rapidly moving eyes
 •   VS irregular; SNS dominates
 •   Gastric secretions increase
 •   Very difficult to arouse
 •   Brain is highly active, hence paradoxical sleep
Sleep Cycle
• The person passes consecutively through four
  stages of NREM sleep
• The pattern is then reversed
  • Return from stage IV down to REM then goes up to
    stage IV but never to stage I
Classifications of Sleep
Disorders
• Dyssomnias – characterized by insomnia or
  excessive sleepiness
• Parasomnias – pattern of waking behavior that
  appear during sleep
Dyssomnias
• 1. Insomnia
  • Initial insomnia
  • Intermittent or maintenance insomnia
  • Terminal insomnia
• 2. Hypersomnia
  • Characterized by
    • Excessive sleep
    • Related to physiological problems, CNS damage
      metabolic disorders
Dyssomnias
• 3. Narcolepsy
  • “sleep attack”
  • Excessive daytime sleepiness
  • REM sleep within 15 min of falling asleep
  • Cataplexy – sudden muscle weakness during intense
    emotions
  • Hypnagogic hallucinations – dreams difficult to
    distinguish from reality
  • Sleep paralysis also occurs
Dyssomnias
• 4. Sleep apnea
  • Characterized by the lack of airflow through the nose
    and mouth for periods of 10 seconds or longer
    during sleep; snoring is common
    • Types
       • Obstructive
       • Central
       • Mixed
• 5. Restless leg syndrome
Dyssomnias
• 6. Sleep deprivation – a syndrome brought about
  by prolonged disturbance in sleep
Parasomnias
•   1.   Somnambulism/ sleep walking
•   2.   Sleep talking/ soliloquy
•   3.   Nocturnal erections
•   4.   Bruxism – teeth grinding
•   5.   Enuresis – bed wetting
•   6.   Night terrors
•   7.   Sleep – related eating disorders
Nursing Interventions to
Promote Sleep
• Prepare a restful environment
• Promote bedtime rituals
• Offer appropriate bedtime snacks and beverages
• Promote relaxation and comfort
• Respect normal sleep-wake patterns
• Schedule nursing care to avoid disturbances
• Adequate exercise but avoid stimulating activity
  before bedtime
• Use medication to produce sleep

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Sleep

  • 2. Promotion of Comfort, Rest, and Sleep • Rest – a state of calmness, relaxation without emotional stress or freedom from anxiety • Sleep – a state of consciousness in which the individual’s perception and reaction to the environment are decreased
  • 3. Sleep Regulation • Hypothalamus – major sleep center in the body • Reticular Activating System (RAS) • Maintains alertness and wakefulness which results from neurons on the RAS that relate catecholamine such as norepinephrine • Bulbar Synchronizing Region (BSR) • Specialized cells in the raphe nuclei sleep system of the pons and medulla relate serotonin producing sleep works with RHS to control cyclic nature of sleep
  • 4. Sleep Regulation • Serotonin is the major transmitter associated with sleep
  • 5. Theories of Sleep • Passive • The ascending reticular activity system (RAS) in the upper brain stem sympathy fatigues and therefore belongs inactive thus, sleep occurs • Active • Proposes that there are centers that cause sleep by inhibiting other brain centers
  • 6. Biorhythms – “biological clock” • Circadian rhythms • 24 hour, day-night cycle • Infradian rhythm • Occurs longer than 24 hours • Ex: monthly cycle • Ultradian rhythm • Cycles lasting less than 24 hours • Completed in minutes or hours • Ex: REM in sleep
  • 7. Physiologic Changes During Sleep • Arterial blood pressure falls • Pulse rate decreases • Peripherical blood vessels dilate • Activity of the GI tract occasionally increases • Skeletal muscles relax • Basal metabolic rate decreases (10-30%)
  • 8. Effects of Disturbance in Sleep-Wake Cycle • 1. Poor sleep • 2. Anxiety • 3. Restlessness • 4. Irritability • 5. Impaired Judgment
  • 9. Stages of Sleep • Non-rapid eye movement • Stage one • Lightest level of sleep, eyes roll from side to side • Lasts a few minutes • Gradual fall in VS and metabolism • Easily aroused by sensory stimuli • Person feel as if daydreams has occurred
  • 10. Stages of Sleep • Stage two • Sound sleep • Relaxation progresses • Arousal relatively easy • Lasts 10-20 min • Body functions continue to slow
  • 11. Stages of Sleep • Stage three • Domination of the parasympathetic nervous system • Initial stages of deep sleep • Difficult to arouse and rarely moves • Muscles completely relaxed • VS decline but remain regular • Lasts 15-30 min
  • 12. Stages of Sleep • Stage four • Delta sleep-deepest stage of sleep • Very difficult to arouse • Lasts 15-30 min • Sleep walking and exoresis (bedwetting) • Restore the body’s biological processes • Ex: protein synthesis and cell division for renewal of tissues
  • 13. Stages of Sleep • Rapid eye movement • Vivid full color dreaming • Occurs 90 min after sleep begins • Rapidly moving eyes • VS irregular; SNS dominates • Gastric secretions increase • Very difficult to arouse • Brain is highly active, hence paradoxical sleep
  • 14. Sleep Cycle • The person passes consecutively through four stages of NREM sleep • The pattern is then reversed • Return from stage IV down to REM then goes up to stage IV but never to stage I
  • 15. Classifications of Sleep Disorders • Dyssomnias – characterized by insomnia or excessive sleepiness • Parasomnias – pattern of waking behavior that appear during sleep
  • 16. Dyssomnias • 1. Insomnia • Initial insomnia • Intermittent or maintenance insomnia • Terminal insomnia • 2. Hypersomnia • Characterized by • Excessive sleep • Related to physiological problems, CNS damage metabolic disorders
  • 17. Dyssomnias • 3. Narcolepsy • “sleep attack” • Excessive daytime sleepiness • REM sleep within 15 min of falling asleep • Cataplexy – sudden muscle weakness during intense emotions • Hypnagogic hallucinations – dreams difficult to distinguish from reality • Sleep paralysis also occurs
  • 18. Dyssomnias • 4. Sleep apnea • Characterized by the lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep; snoring is common • Types • Obstructive • Central • Mixed • 5. Restless leg syndrome
  • 19. Dyssomnias • 6. Sleep deprivation – a syndrome brought about by prolonged disturbance in sleep
  • 20. Parasomnias • 1. Somnambulism/ sleep walking • 2. Sleep talking/ soliloquy • 3. Nocturnal erections • 4. Bruxism – teeth grinding • 5. Enuresis – bed wetting • 6. Night terrors • 7. Sleep – related eating disorders
  • 21. Nursing Interventions to Promote Sleep • Prepare a restful environment • Promote bedtime rituals • Offer appropriate bedtime snacks and beverages • Promote relaxation and comfort • Respect normal sleep-wake patterns • Schedule nursing care to avoid disturbances • Adequate exercise but avoid stimulating activity before bedtime • Use medication to produce sleep