NSG 326 Adult Health ISleep & RestNaps!!!Factors Affecting SleepHow Sleep Apnea OccursCPAP With Nasal MaskSleep CycleSleep DisordersSlide 9Effects of Sleep Disorders on the BodyNursing InterventionsWhy Women Need Better Sleep by Alice Park TIME March 31, 2008 p. 64Gerontologic ConsiderationsSlide 14Slide 15Slide 16Sleep Deprivation EffectsSleep Needs of NursesSlide 19Slide 20Case StudySlide 22Discussion QuestionsSlide 24Slide 251NSG 326 Adult Health IWeek #2SLEEP2Sleep & RestRest – state of decreased physical & mental activity that leaves a person feeling refreshed.Sleep – sustained altered state of consciousness that involves a rhythmic pattern of repeated cycles.Energy & well-being are restoredDisturbed by illness, environmentNo specific # hours of sleep needed to assure adequate rest, varies with individualSleep disorders can cause daytime sleepiness, fatigue, depression, & anxiety3Naps!!!4Factors Affecting SleepDevelopmental considerations Emotional stress/anxiety – can cause loss of sleep or oversleep.Sleep patterns – changes in circadian rhythm; sleep deprivation Illness – nocturia, leg cramps, pain, anxiety, depression, thyroid disease, COPDEnvironmental factors – noise, light, ventilation, room temperature, uncomfortable bed, presence of bed partnerDrugs & other substances – L-tryptophan promotes sleep; hypnotics only temporary increase in sleep, hangover effect, may worsen sleep apnea; antidepressant & stimulants; alcohol; caffeine; digoxin causes nightmares;5How Sleep Apnea OccursFig. 9-4. How sleep apnea occurs. A, The patient predisposed to obstructive sleep apnea (OSA) has a small pharyngeal airway. B, During sleep, the pharyngeal muscles relax, allowing the airway to close. Lack of airflow results in repeated apneic episodes. C, With CPAP, continuous positive airway pressure splints the airway open, preventing airflow obstruction. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.6CPAP With Nasal MaskFig. 9-5. Management of sleep apnea often involves sleeping with a nasal mask in place. The pressure supplied by air coming from the compressor opens the oropharynx and nasopharynx. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.7Sleep Cycle8Sleep DisordersInsomniaSituational stressorsRestless Leg SyndromeSleep ApneaObstructive most commonNarcolepsyExcessive daytime sleepinessSleep Deprivation10Effects of Sleep Disorders on the BodyFig. 9-3. Effects of sleep deprivation and sleep disorders on the body. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.11Nursing InterventionsRestful environmentPromote bedtime routines/ritualsNon-caffeinated bedtime snacksPromote relaxation & comfortSchedule nursing care to avoid unnecessary disturbancesNo smoking, alcohol, exercise before bedtimeAvoid long naps during the dayGive sleep medications only as last resort12Why Women Need Better Sleepby Alice Park TIME March 31, 2008 p. 64Most Women know that nothing kills a good complexion like a bad night's slumber; there's a reason, after all, that it's called beauty sleep. If that's not motivation enough to keep up with your nightly shut-eye, here's another: doctors are learning that poor sleep habits may make women more vulnerable than men to heart disease and diabetes.13Gerontologic ConsiderationsOlder age is associated with •Overall shorter total sleep time•Decreased sleep efficiency•More awakenings•Insomnia symptoms that frequently occur with depression, heart disease, pain, and cognitive problemsCopyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.14Gerontologic ConsiderationsAwakening to use the bathroom during the night increases risk for falls.Medications used by older adults can contribute to sleep problems.Because older adults may not talk about sleep problems, a sleeping assessment should be performed.Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.15Gerontologic ConsiderationsDrug therapies are challenging with older adults:•Avoid long-acting benzodiazepines.•Hypnotics should be used briefly.•All drugs for sleep disturbances are started at a lower dose and are monitored carefully.Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.17Sleep Deprivation Effects100,000 motor vehicle accidents per year & 1500 deaths$18 billion in employer productivity lossesAwake for 24 hours = blood alcohol level of 0.10Think about effect on nurses caring for patients!Think about effect on a patient working to recover from an illness or surgery!18Sleep Needs of NursesNurses on permanent night or rapidly rotating shifts are at increased risk of experiencing circadian rhythm shift work disorder.Use strategies to help reduce distress associated with shift work.•e.g., on-site nappingCopyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.19A patient at the outpatient clinic is complaining of insomnia and anxiety. He tells you that he recently lost his job and is not able to pay the bills. Which of the following responses would be the most appropriate?1. “Can you tell me what is happening in your life?” 2. “You are healthy and will be able to find another job.”3. “If you stop focusing on your problems, you will sleep better.”4. “Did you receive a severance package from your employer?”Audience Response QuestionCopyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.20An elderly patient in the hospital complains of sleep deprivation. Which of the following interventions may improve sleep patterns for this patient? 1. Decrease noise and dim the lights at bedtime 2. Administer an opioid pain medication to induce sleep 3. Set the room temperature at 78o F to induce drowsiness 4. Offer to give the patient a back massage until he falls asleepAudience Response QuestionCopyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.21Case Study52-year-old man enters his physician’s office with his wife.She is concerned because he seems to stop breathing in his sleep.He weighs 280 lb and drinks alcohol regularly.Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.22Case StudyThe physician orders a sleep study.After the study, the patient is diagnosed with sleep apnea.He returns to the office to learn his results, where he is given a CPAP.Copyright © 2011, 2007 by