1. Sleep, Rest & Comfort Trisha Economidis, MS, ARNP Lake-Sumter Community College Fall, 2012

2. Sleep Quiz • How many Americans suffer from sleep disorders? • A. 100,000 • B. 1 million • C. 50-70 million

3. How many sleep disorders have been identified? • A. 10 • B. 50 • C. 90

4. Who has a greater incidence of insomnia? • A. Men • B. Women

5. For women, sleep disturbances are often related to hormonal hallmarks (menstruation, pregnancy, menopause). • A. True • B. False

6. Sleep patterns of the older adult include which of the following: (Select all that apply) • A. Need more sleep than younger adults • B. Take longer to fall asleep than younger adults • C. Awake more frequently and stay awake longer than younger adults • D. Frequent awakening is often due to physical discomfort and nocturia

7. Physiology of sleep • Biorhythms – Biological • Controlled within the body • Environmental • Circadian rhythm- Biorhythm • Day-night 24 hour clock

8. Types of sleep • Non-Rem • REM (Rapid Eye Movement) • Occurs in 90-100 minute cycles

9. Sleep Cycle

10. Factors Affecting Rest & Sleep • Comfort • Anxiety • Environment

11. Factors Affecting Rest and Sleep • Lifestyle • Work • Exercise • Travel • Diet • Drugs • Medications

12. Average Sleep Requirements • Table 33-1 Page 814

13. Alterations in Sleep patterns Dyssomnias • Dyssomnias • Insomnia • Sleep-wake Schedule • Restless Leg Syndrome • Sleep Deprivation • Hypersomnia • Narcolepsy

14. Dyssomnias • Sleep Apnea- airway occlusion • Hypercapniaand hypoxemia • May have increased heart rate, increased bp • S/S: excessive sleepiness, fatigue, snoring, nocturia • Diagnosis: Made by sleep study • Untreated can lead to : • Hypertension • Dysrhythmias • Angina • MI • Stroke • Mood swings • Impotence • Personality changes

15. Sleep Apnea • Obstructive Sleep Apnea – caused by occlusion of the airway during sleep. • TX: CPAP – Continuous Positive Air Pressure • Central Sleep Apnea – Dysfunction in central respiratory control • Mixed Apnea – combination of Obstructive and Central Sleep Apneas

16. CPAP

17. Altered Sleep Patterns Parasomnias • Sleepwalking (Somnambulism) • Occurs during Stage 3-4 of sleep • Sleep talking • Bruxism-teeth grinding or clenching • Night Terrors • Nocturnal Enuresis

18. What is the Risk?

19. Sleep Hygiene Practices • Assessment of Sleep Patterns and rituals • Relaxation • Eliminate stressful situations before bed • Muscle relaxation • Activities that relax rather than stimulate • Warm bath

20. Sleep Hygiene • Environment • Adjust light, noise, temp to promote sleep • Use bedroom for sleep & sex only • Go to bed at same time each night • Help client to understand what things can affect sleep patterns

21. Pharmacologic Interventions for Sleep • Be aware of potential side effects and possible dependency issues • Shouldn’t mix with alcohol and most are not recommended for long-term use

22. Pharmacologic Interventions • Non-benzodiazepines: Ambien, Sonata, Lunesta • Benzodiazepines: Valium, Ativan, Klonopin, Xanax • Caution: Hazardous in elderly; must use cautiously in children; can cause ADDICTION

23. Pharmacologic Interventions, cont. • Barbiturates: sedative/hypnotic/anticonvulsants; Seconal, Luminal, Nembutal • Tricyclic Antidepressants: major side effect is drowsiness. Elavil, Tofranil • OTC Sleep aids • Antihistamines • Herbal remedies • Melatonin

24. Nutrition Impact on Sleep • No large fatty meals before sleep • L-tryptophan increases sleep (milk & cheese) • Protein – increases alertness (not a good before bed snack) • Carbohydrates promote sleep • crackers, bread, cereal

25. Nursing Diagnoses for Sleep • Sleep Deprivation: Occurs over long periods of time and symptoms more severe (confusion, even psychosis) • Disturbed Sleep Pattern: time limited sleep pattern. Ex.: related to hospitalization – can be treated by nursing therapy

26. A patient is diagnosed with narcolepsy. The nurse’s primary intervention should address the patient’s: • A. Inability to provide self-care • B. Impaired thought processes • C. Potential for injury • D. Excessive fatigue

27. Correct Answer: C • Narcolepsy is excessive sleepiness in the daytime that can cause a person to fall asleep uncontrollably at inappropriate times (sleep attach) and result in physical harm to self or others

28. The nurse is planning a teaching program for a patient with a diagnosis of obstructive sleep apnea. Which is the most common intervention that the nurse should plan to discuss with this patient? • A. Encouraging sleeping in the supine position • B. Using devices that support airway patency • C. Positioning two pillows under the head • D. Administering sedatives

29. Answer: B. • A continuous positive airway pressure (CPAP) mask worn over the nose when sleeping keeps the upper airway patent through continuous positive airway pressure.

30. Which is the most important nursing intervention that supports a patient’s ability to sleep in the hospital setting? • A. Providing an extra blanket • B. Limiting unnecessary noise on the unit • C. Shutting off lights in the patient’s room • D. Pulling curtains around the bed at night.

31. Answer: B • Noise is a serious deterrent to sleep in a hospital. The nurse should limit environmental noise (distributing fluids, providing treatments, rolling drug and linen carts) and staff communication noise. • (Turning off the lights is unsafe. You may dim the lights or put a night light on to provide enough illumination for safe ambulation to the bathroom)

32. What concept associated with sleep should the nurse consider to best plan nursing care for a hospitalized patient? • A. People require eight hours of uninterrupted sleep to meet energy needs • B. Frequency of nighttime awakenings decreases with age • C. Fear can contribute to the need to stay awake. • D. Bed rest decreases the need for sleep.

33. Answer: C • Fear of loss of control, the unknown, and potential death results in the struggle to stay awake, which interferes with the ability to relax sufficiently to fall asleep.

34. Comfort Chapter 30

35. Comfort/Pain • True or False? • The nurse is the best judge of a patient’s pain

36. Answer: False • Pain is SUBJECTIVE – only the client can judge the level and severity of pain

37. TRUE OR FALSE? • You should wait until pain has reached the maximum amount bearable before medicating.

38. Answer: False • Pain control/relief is much more effective when given when pain begins

39. True or False? • True pain always produces observable signs/symptoms such as grimacing or moaning

40. Answer: False • Many people are stoic when it comes to expressing pain. One’s culture may also have an impact on the expression of pain.

41. True or False? • If the patient doesn’t look like he’s in pain, it’s ok to withhold medications or decrease the dose.

42. Answer: False • Pain is a subjective experience. Only the patient knows how much pain he/she is experiencing.

43. True or False? • Clients taking pain medications will become addicted.

44. Answer: False • While it does happen, it is unlikely when analgesics are administered and monitored carefully

45. So….What IS Pain? • A sensation that HURTS • A SUBJECTIVE experience • An interference : a multi-dimensional experience and impact • Protective

46. Types or Origins of Pain • Cutaneous - superficial • Somatic - ligaments, joints, muscles • Visceral – internal organs/body cavities • Neuropathic – nerve pain • Radiating – Starts at origin, but extends to other locations • Referred – Pain felt distant to origin • Phantom

47. Phantom

48. Duration of Pain • Acute Pain - Sudden onset/short duration (up to 6 months) • Chronic Pain –Has lasted 6 months or longer • Intractable Pain – Chronic and very resistant to relief • http://www.youtube.com/watch?v=HskbfhiVJro

49. Quality of Pain • What does it feel like? • Sharp? • Dull? • Aching? • Stabbing? • Burning? • Crushing? • Tingling?

50. Intensity or Severity of Pain • How much does it hurt????? • Pain Rating Scales imperative – Allows assessment of level of pain and effectiveness of interventions • 0-10 scale • Faces Pain Rating Scale • Poker Chips - “pieces” of pain