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Sleep Basics for Health Promotion


Title: Sleep Basics for Health Promotion Author: Barbara B. Richardson Last modified by: Eugene Created Date: 7/13/2010 4:26:24 PM Document presentation format – PowerPoint PPT presentation

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Title: Sleep Basics for Health Promotion

  • Sleep Basics for Health Promotion
  • Barbara B. Richardson, PhD

Learning Objectives
  1. Describe normal developmental sleep changes
    across the lifespan
  2. Identify normal sleep patterns and common sleep
  3. Describe potentially adverse health outcomes
    associated with inadequate sleep

Learning Objectives
  1. Integrate knowledge of sleep when completing a
    health assessment, nursing care plan, and patient
  2. Evaluate environmental factors and describe
    nursing interventions to promote sufficient sleep

What is sleep?
  • 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?
  • Sufficient sleep is essential for maintaining
    optimal physical health, mental and emotional
    functioning, and cognitive performance.
  • Inadequate sleep time and poor quality sleep
    interfere with quality of life and can be
    hazardous to health

Current Theory Suggests a 2-Process Model of
Sleep/Wake Regulation
  • 1 Sleep homeostasis or internal drive, exact
    mechanism unknown
  • Pressure to sleep increases throughout the day
    until an internal threshold is crossed causing
    sleep to occur
  • Waking occurs when homeostatic drive decreases
    sufficiently to cross opposite threshold
  • 2 Circadian rhythms
  • Refers to cyclical changes that occur over a 24
    hour period driven by an internal biological
    clock located in the brain in the
    suprachiasmatic nucleus (SCN)
  • Synchronized to external physical environment

Sleep Across the Life Span
Developmental Patterns of Sleep
  • All aspects of sleep behavior across the lifespan
    demonstrate a large degree of variability among
    individuals and across cultures
  • 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
  • Newborn sleep has 2 stages 50 quiet or
    non-rapid eye movement (NREM) sleep and 50
    active or rapid eye movement (REM) sleep
  • Total sleep time 16 to 17 hours / 24 hour
    period with frequent awakenings for feeding and

Children Ages 1-5 Years
  • Amount of total sleep time decreases to 11 to 13
    hours / 24 hour period
  • Generally sleep through the night
  • Nap during the day as needed

Sleep in Middle Childhood (5-12 years)
  • Total sleep time 10-12 hours
  • May experience parasomnias (sleep problems) such
    as enuresis (bedwetting), nightmares, and
    sleep walking

Sleep in Adolescents (12-18 years)
  • Need 9 hours of nightly sleep for optimal
    health, emotional well being, and cognitive
  • Often experience delayed sleep phase syndrome .
    cant go to sleep until late at night and prefer
    to sleep later in the morning
  • Frequently do not get sufficient sleep

Sleep in Adulthood
  • Generally need 7.5 to 8 hours of nightly sleep
  • Increasing frequency of problems sleeping
    including common sleep disorders such as
    obstructive apnea, insomnia, and restless leg

Sleep in Aging Adults (65 years)
  • 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
  • Increased number of nighttime awakenings
  • Frequently awaken very early in the morning
  • Sleep may be impacted by illness and medications

Assessing Sleep
  • Always include questions about sleep when
    assessing health status (except in emergency
  • Inquire about number of hours client generally
    sleeps (quantity) and how well he/she usually
    sleeps (quality).
  • Whenever possible, observe (in a hospital or care
    facility) and record clients sleep patterns

Use standardized sleep assessment tool if possible
  • Using a survey to inquire about a clients normal
    sleep patterns encourages a thorough assessment
  • 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
  • B - bedtime problems?
  • E - excessive sleepiness during the day?
  • A - awakenings at night?
  • R - regularity of sleep (number of hours)?
  • S - sleep disordersincluding sleep apnea and
  • 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
  • Stress and environmental factors
  • Pregnancy
  • Menopause
  • Chronic pain
  • Major depression
  • Chronic illnesses such as cancer,
    cardio-pulmonary disease, and Alzheimers

Impaired Sleep and Adverse Health Outcomes
  • Adverse health outcomes resulting from
    insufficient sleep include physiological,
    behavioral / cognitive, emotional, and/or social
  • Physiological outcomes include increased risk for
    obesity, hypertension, and impaired immune system

Impaired Sleep and Adverse Health Outcomes
  • 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.
  • Insufficient sleep may be a factor in sports
    related and automobile accidents.
  • Not enough sleep may lead to use of caffeine and
    other stimulants to maintain wakefulness

Common Sleep Problems
  • Parasomnias include sleepwalking, bed wetting,
    nightmares and night terrors (all common in
    children), nocturnal sleep related eating
    disorders, and bruxism (teeth grinding)
  • Sleep disorders include insomnia, obstructive
    sleep apnea, restless leg syndrome, and narcolepsy

  • Defined as trouble falling asleep or staying
  • May be due to stress, anxiety, hormonal changes,
    lifestyle, environmental factors, physical
    ailments, or psychiatric illness
  • May be transient (lasting less than 4 weeks),
    short term (1-6 months) or chronic (gt 6 months)

Obstructive Sleep Apnea (OSA)
  • During sleep, breathing pauses or stops for 10-20
    seconds or more, 20-30 times an hour. Oxygen
    levels in blood drop, normal breathing starts
    again with a loud snort.
  • Results in excessive daytime sleepiness
  • Often associated with overweight / obesity
  • Can be treated with continuous positive airway
    pressure (CPAP)

Restless Leg Syndrome
  • Neurological disorder characterized by unpleasant
    sensations in the legs and an uncontrollable urge
    to move when resting as an attempt to relieve
    these feelings.
  • Causes difficulty falling asleep
  • Cause unknown, difficult to treat

  • Chronic neurological disorder caused by the
    brains inability to regulate sleep-wake cycles
    normally. Cause unknown.
  • Characterized by frequent urges to sleep
    occurring anytime.
  • Can be disabling due to involuntarily falling
    asleep at school, work, or anywhere.
  • Cannot be cured, may be treated with various

Treatment of Sleep Problems
  • Behavior modification programs, hypnosis, or
    meditation may be effective
  • Self-prescribed over-the-counter sleep aids
  • Prescription medications

Sleep Medications
  • Over the counter medications include
  • antihistamines or drugs containing
    diphenhydramamine hydrochloride
  • diphenhydramine citrate
  • doxylamine succinate

OTC Sleeping Aids
  • Not intended for long term use
  • May interfere with alertness during the day so
    should avoid driving or other potentially
    dangerous activities
  • Reduce the quality of sleep by decreasing the
    amount of time spent in deep sleep

Prescription Medications
  • Must be used at the direction of a physician
  • Often do not cure the cause of sleeping problems,
    just help alleviate the symptoms
  • Can be addictive / become drug dependent
  • May cause physical side effects
  • May interact with other medications or alcohol

Prescription Medications
  • Primary classes include
  • Short acting sedatives hypnotics (Ambien,
    Sonata, Lunesta)
  • Melatonin receptor agonists (Rozerem)
  • Benzodiazepines tranquilizers (Dalmane,
    Restoril, ProSom)
  • Sedating anti-depressants (Desyrel)

To Get a Good Nights Sleep Practice Good Sleep
  • Maintain a regular sleep / wake schedule whenever
    possible even on weekends and vacations
  • Avoid napping during the day, especially after
    3pm. Limit naps to lt 1 hour.
  • Establish a regular, relaxing bed time routine

Guidelines For Better Sleep
  • Exercise regularly but not within 2 hours of
  • Avoid eating large meals just before going to
  • Avoid caffeinated beverages, particularly after
  • Avoid the use of alcohol and nicotine as these
    substances can disrupt sleep

Environmental Factors Impacting Sleep
  • Light exposure to light inhibits ability to
    fall asleep and bright light in the morning can
    shorten sleep
  • Noise traffic, TV, music, phones, and computers
    can disturb sleep
  • Bed sharing
  • Room temperature (too hot or too cold can inhibit

Good sleep promotes good health
  • Assess sleep patterns and sleeping environment
  • Implement nursing interventions to promote
    adequate sleep


  • Bellenir, K. (Ed.).(2008). Sleep information for
    teens. Detroit, MI Omnigraphics.
  • Mindell JA, Owens JA. (2003). A clinical guide to
    pediatric sleep diagnosis and management of
    sleep problems. Philadelphia, PA Lippincott
    Williams Wilkins.

  • Sleep Research Society Basics of Sleep Guide.
    2005. Sleep Research Society, Westchester, IL.
  • Yager, J. Thorpy, M. (2001). Sleeping well The
    sourcebook for sleep and sleep sisorders.
    Publisher Facts on File. ISBN 9780816040902

Contact Information
  • Barbara B. Richardson, PhD