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SLEEP
Learning Objectives
1. Describe normal developmental sleep
changes across the lifespan
2. Identify normal sleep patterns and
common sleep disorders
3. Describe potentially adverse health
outcomes associated with inadequate
sleep
4. Integrate knowledge of sleep when
completing a health assessment,
nursing care plan, and patient
education.
5. Evaluate environmental factors and
describe nursing interventions to
promote sufficient sleep
Learning Objectives
What is sleep?
o Sleep is a dynamic and regulated set of
behavioral and physiological states during
which many processes vital to health and
well-being take place.
Why is sleep important?
o Sufficient sleep is essential for maintaining
optimal physical health, mental and
emotional functioning, and cognitive
performance.
o Inadequate sleep time and poor quality
sleep interfere with quality of life and
can be hazardous to health
Sleep Across the Life Span
Developmental Patterns of Sleep
o All aspects of sleep behavior across the
lifespan demonstrate a large degree of
variability among individuals and across
cultures
o Sleep patterns are shaped by intrinsic biological
processes and psycho-social factors such as
cultural norms, family values, school, and work.
Newborn and Infant Sleep
o Newborn sleep has 2 stages;
50% “quiet or non-rapid eye movement
(NREM) sleep” and
50% “active or rapid eye movement
(REM) sleep”
o Total sleep time = 16 to 17 hours / 24 hour
period with frequent awakenings for feeding
and nurturing
Children Ages 1-5 Years
o Amount of total sleep time decreases
to ~11 to 13 hours / 24 hour period
o Generally sleep through the night
o Nap during the day as needed
Sleep in Middle Childhood
(5-12 years)
o Total sleep time 10-12 hours
o May experience parasomnias
(sleep problems) such as
enuresis (bedwetting),
nightmares,
and sleep walking
Sleep in Adolescents
(12-18 years)
o Need ~9 hours of nightly sleep for optimal
health, emotional well being, and cognitive
functioning
o Often experience delayed sleep phase
syndrome …. can’t go to sleep until late at
night and prefer to sleep later in the morning
o Frequently do not get sufficient sleep
Sleep in Adulthood
o Generally need 7.5 to 8 hours
of nightly sleep
o Increasing frequency of problems sleeping
including common sleep disorders such as
obstructive apnea, insomnia, and restless
leg syndrome
Sleep in Aging Adults
(65+ years)
o Still need ~7 to 8 hours of total sleep time…
may decrease to as little as 6 hours a night
with naps common during the day
o Increased number of nighttime awakenings
o Frequently awaken very early in the morning
o Sleep may be impacted by illness and
medications
Assessing Sleep
o Always include questions about sleep
when assessing health status (except in
emergency situations)
o Inquire about number of hours client
generally sleeps (quantity) and how well
he/she usually sleeps (quality).
o Whenever possible, observe (in a hospital
or care facility) and record client’s sleep
patterns
Use standardized sleep assessment
tool if possible
o Using a survey to inquire about a
client’s normal sleep patterns
encourages a thorough assessment
including:
– Sleep environment
– Quality of sleep
– Amount of sleep
– Problems associated with sleep
If Standardized Assessment is Not
available, use BEARS* Sleep Assessment
as a guide
o B - bedtime problems?
o E - excessive sleepiness during the day?
o A - awakenings at night?
o R - regularity of sleep (number of hours)?
o S - sleep disorders…including sleep apnea
and snoring
o Also, may inquire about lifestyle factors
impacting sleep such as work schedule,
alcohol use, illness, medications, bed sharing
arrangements, etc….
Sleep problems can be associated
with many conditions including:
o Stress and environmental
factors
o Pregnancy
o Menopause
o Chronic pain
o Major depression
o Chronic illnesses such as
cancer, cardio-pulmonary
disease, and Alzheimer’s
Impaired Sleep and Adverse Health
Outcomes
o Adverse health outcomes resulting from
insufficient sleep include physiological,
behavioral / cognitive, emotional, and/or social
responses.
o Physiological outcomes include increased risk
for obesity, hypertension, and impaired immune
system functioning
o Inadequate sleep impacts behavior in children
and adults and may result in impaired daytime
functioning, including decreased school or
work place performance due to decreased
alertness, poor memory, and impaired problem
solving.
o Insufficient sleep may be a factor in sports
related and automobile accidents.
o Not enough sleep may lead to use of caffeine
and other stimulants to maintain wakefulness
Impaired Sleep and Adverse Health
Outcomes
Common Sleep Problems
o Parasomnias – include sleepwalking, bed
wetting, nightmares and night terrors (all
common in children), nocturnal sleep related
eating disorders, and bruxism (teeth grinding)
o Sleep disorders – include insomnia, obstructive
sleep apnea, restless leg syndrome, and
narcolepsy
Insomnia
o Defined as trouble falling asleep or staying
asleep
o May be due to stress, anxiety, hormonal
changes, lifestyle, environmental factors,
physical ailments, or psychiatric illness
o May be transient (lasting less than 4 weeks),
short term (1-6 months) or chronic (> 6 months)
To Get a Good Night’s Sleep –
Practice Good Sleep Hygiene!
o Maintain a regular sleep / wake schedule
whenever possible … even on weekends and
vacations
o Avoid napping during the day, especially after
3pm. Limit naps to < 1 hour.
o Establish a regular, relaxing bed time routine
Guidelines For Better Sleep
o Exercise regularly – but not within 2 hours
of sleep
o Avoid eating large meals just before going
to sleep
o Avoid caffeinated beverages, particularly
after lunch
o Avoid the use of alcohol and nicotine as
these substances can disrupt sleep
Environmental Factors Impacting
Sleep
o Light – exposure to light inhibits ability to fall
asleep and bright light in the morning can
shorten sleep
o Noise – traffic, TV, music, phones, and
computers can disturb sleep
o Bed sharing
o Room temperature (too hot or too cold can
inhibit sleep)
Good sleep promotes good health
o Assess sleep patterns and
sleeping environment
o Implement nursing interventions
to promote adequate sleep

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Sleep

  • 2. Learning Objectives 1. Describe normal developmental sleep changes across the lifespan 2. Identify normal sleep patterns and common sleep disorders 3. Describe potentially adverse health outcomes associated with inadequate sleep
  • 3. 4. Integrate knowledge of sleep when completing a health assessment, nursing care plan, and patient education. 5. Evaluate environmental factors and describe nursing interventions to promote sufficient sleep Learning Objectives
  • 4. What is sleep? o Sleep is a dynamic and regulated set of behavioral and physiological states during which many processes vital to health and well-being take place.
  • 5. Why is sleep important? o Sufficient sleep is essential for maintaining optimal physical health, mental and emotional functioning, and cognitive performance. o Inadequate sleep time and poor quality sleep interfere with quality of life and can be hazardous to health
  • 6. Sleep Across the Life Span
  • 7. Developmental Patterns of Sleep o All aspects of sleep behavior across the lifespan demonstrate a large degree of variability among individuals and across cultures o Sleep patterns are shaped by intrinsic biological processes and psycho-social factors such as cultural norms, family values, school, and work.
  • 8. Newborn and Infant Sleep o Newborn sleep has 2 stages; 50% “quiet or non-rapid eye movement (NREM) sleep” and 50% “active or rapid eye movement (REM) sleep” o Total sleep time = 16 to 17 hours / 24 hour period with frequent awakenings for feeding and nurturing
  • 9. Children Ages 1-5 Years o Amount of total sleep time decreases to ~11 to 13 hours / 24 hour period o Generally sleep through the night o Nap during the day as needed
  • 10. Sleep in Middle Childhood (5-12 years) o Total sleep time 10-12 hours o May experience parasomnias (sleep problems) such as enuresis (bedwetting), nightmares, and sleep walking
  • 11. Sleep in Adolescents (12-18 years) o Need ~9 hours of nightly sleep for optimal health, emotional well being, and cognitive functioning o Often experience delayed sleep phase syndrome …. can’t go to sleep until late at night and prefer to sleep later in the morning o Frequently do not get sufficient sleep
  • 12. Sleep in Adulthood o Generally need 7.5 to 8 hours of nightly sleep o Increasing frequency of problems sleeping including common sleep disorders such as obstructive apnea, insomnia, and restless leg syndrome
  • 13. Sleep in Aging Adults (65+ years) o Still need ~7 to 8 hours of total sleep time… may decrease to as little as 6 hours a night with naps common during the day o Increased number of nighttime awakenings o Frequently awaken very early in the morning o Sleep may be impacted by illness and medications
  • 14. Assessing Sleep o Always include questions about sleep when assessing health status (except in emergency situations) o Inquire about number of hours client generally sleeps (quantity) and how well he/she usually sleeps (quality). o Whenever possible, observe (in a hospital or care facility) and record client’s sleep patterns
  • 15. Use standardized sleep assessment tool if possible o Using a survey to inquire about a client’s normal sleep patterns encourages a thorough assessment including: – Sleep environment – Quality of sleep – Amount of sleep – Problems associated with sleep
  • 16. If Standardized Assessment is Not available, use BEARS* Sleep Assessment as a guide o B - bedtime problems? o E - excessive sleepiness during the day? o A - awakenings at night? o R - regularity of sleep (number of hours)? o S - sleep disorders…including sleep apnea and snoring o Also, may inquire about lifestyle factors impacting sleep such as work schedule, alcohol use, illness, medications, bed sharing arrangements, etc….
  • 17. Sleep problems can be associated with many conditions including: o Stress and environmental factors o Pregnancy o Menopause o Chronic pain o Major depression o Chronic illnesses such as cancer, cardio-pulmonary disease, and Alzheimer’s
  • 18. Impaired Sleep and Adverse Health Outcomes o Adverse health outcomes resulting from insufficient sleep include physiological, behavioral / cognitive, emotional, and/or social responses. o Physiological outcomes include increased risk for obesity, hypertension, and impaired immune system functioning
  • 19. o Inadequate sleep impacts behavior in children and adults and may result in impaired daytime functioning, including decreased school or work place performance due to decreased alertness, poor memory, and impaired problem solving. o Insufficient sleep may be a factor in sports related and automobile accidents. o Not enough sleep may lead to use of caffeine and other stimulants to maintain wakefulness Impaired Sleep and Adverse Health Outcomes
  • 20. Common Sleep Problems o Parasomnias – include sleepwalking, bed wetting, nightmares and night terrors (all common in children), nocturnal sleep related eating disorders, and bruxism (teeth grinding) o Sleep disorders – include insomnia, obstructive sleep apnea, restless leg syndrome, and narcolepsy
  • 21. Insomnia o Defined as trouble falling asleep or staying asleep o May be due to stress, anxiety, hormonal changes, lifestyle, environmental factors, physical ailments, or psychiatric illness o May be transient (lasting less than 4 weeks), short term (1-6 months) or chronic (> 6 months)
  • 22. To Get a Good Night’s Sleep – Practice Good Sleep Hygiene! o Maintain a regular sleep / wake schedule whenever possible … even on weekends and vacations o Avoid napping during the day, especially after 3pm. Limit naps to < 1 hour. o Establish a regular, relaxing bed time routine
  • 23. Guidelines For Better Sleep o Exercise regularly – but not within 2 hours of sleep o Avoid eating large meals just before going to sleep o Avoid caffeinated beverages, particularly after lunch o Avoid the use of alcohol and nicotine as these substances can disrupt sleep
  • 24. Environmental Factors Impacting Sleep o Light – exposure to light inhibits ability to fall asleep and bright light in the morning can shorten sleep o Noise – traffic, TV, music, phones, and computers can disturb sleep o Bed sharing o Room temperature (too hot or too cold can inhibit sleep)
  • 25. Good sleep promotes good health o Assess sleep patterns and sleeping environment o Implement nursing interventions to promote adequate sleep

Editor's Notes

  1. Adapted from Lee, K., Landis, C., Chasens, E., Dowling, G., Merritt, S., Parker.K., Redeker, N., Richards, K., Rogers, A., shaver, J., Umlauf, M., Weaver, T., 2004. Sleep and chronobiology: Recommendation for nursing education. Nursing Outlook, 52, 126-133.
  2. For excellent review of sleep patterns in childhood see http://www.sleepfoundation.org/article/sleep-topics/children-and-sleep
  3. http://www.sleepfoundation.org/article/hot-topics/five-clusters-sleep-patterns
  4. For examples of sleep assessments see Lee, K., and Ward, T. (2005). Critical components of a sleep assessment for clinical practice settings. Issues in Mental Health Nursing, 26:739-750.
  5. http://www.meritsleep.com/Web_Data/bears%20screen%20tool%20(peds)%2020090721.pdf Owens, J., and Dalzell, V. 2005. Use of “BEARS” sleep screening tool in a pediatric residents’ continuity clinic: A pilot study. Sleep Medicine, 6(1), 63-69.