Sleep Pattern & Its Disturbances: Nursing Implications

Sleep is the state of natural rest observed throughout the animal kingdom, in all mammals and birds, and in many reptiles, amphibians, and fish. In humans, other mammals, and many other animals that have been studied - such as fish, birds, ants, and fruit-flies - regular sleep is necessary for survival. The capability for arousal from sleep is a protective mechanism and also necessary for health and survival.
Sleep can e defined as a normal state of altered consciousness during which the body rests; it is characterized by decreased responsiveness to the environment, and a person can be aroused from it by external stimuli.
Sleep is generally characterized by a reduction in voluntary body movement, temporary blindness, decreased reaction to external stimuli, loss of consciousness, a reduction in audio receptivity, an increased rate of anabolism (the synthesis of cell structures), and a decreased rate of catabolism (the breakdown of cell structures.
Almost a third of the general population has some problems with sleep during any given year. More than half of the 9000 participants in a study of sleep in elderly persons (65 years or older) reported the following as sleep pattern disturbance that they experience most of the time:
* Trouble falling asleep
* Frequent awakening
* Waking too early
* Needing to nap
* Not feeling rested
These disturbances may be secondary to situational, environmental or developmental stressors, or they may be associated with illness or with pre-existing disorders. The relationship is often reciprocal, in that the disorder decreases sleep & the decreased sleep affects the disorder.
The purpose of sleep is still unclear. Theories suggest that:
* It is a time of restoration and preparation for the next period of wakefulness
* During NREM stage 4 body releases human growth hormone for the repair and renewal of epithelial and specialized cells such as brain cells
* Protein synthesis and cell division for the renewal of tissues occur during rest and sleep
* REM sleep appears to be important for cognitive restoration
The benefits of sleep often go unnoticed until a person develops a problem resulting from sleep deprivation. A loss of REM sleep leads to feelings of confusion. Various body functions ( eg. Motor performance, memory and immune function) alter when prolonged sleep loss occurs
Sleep duration and quality vary among persons of all age groups
* Infants 16 Hours /Day
* Toddlers 12 Hours /Day
* Preschoolers 11 Hours /Day
* Schoolers 9 - 10 hours /day
* Adolescents 8 – 9 hours /day
* Adults 6 – 8 hours /day
As people age, their circadian clock advances, causing advanced sleep phase syndrome. The syndrome is common in older adults and often is the reason behind the complaint of waking early in the morning and unable to get back to sleep. They get sleepy early in the evening.
A number of factors affect the quality and quantity of of sleep. Often more than one factor combined to cause a sleep problem.
* Physical illness (eg. Nausea, mood disorders, breathing difficulty, pain)
* Drugs and substances (eg. Tryptophan)
* Lifestyle (eg. Daily routines, exercises)
* Usual sleep patterns and excessive daytime sleepiness
* Emotional stress
* Environment ( ventilation)
* Sound
* Exercise and fatigue
* Food and caloric intake