, o Involves initial stages of deep sleep
o Muscles are completely relaxed
o Vital signs decline but remain regular
o Sleeper is difficult to arouse and rarely moves
Stage 4 NREM
o Stage lasts approximately 15-30 minutes
o Deepest stage of sleep
o If sleep loss has occurred, sleeper spends a majority of the night in this stage
o Vital signs are significantly lower than during waking hours
o Sleep walking and enuresis (bed-wetting) sometimes occur
o It is very difficult to arouse sleeper
REM Sleep:
o Begins about 90 minutes after sleep has begun; *Very difficult to arouse the sleeper
o Duration increases with each sleep cycle and averages 20 min.
o Vivid, full-color dreaming occurs; less-vivid dreaming occurs in other stages
o Characterized by: rapidly moving eyes, fluctuating heart & respiration rates, Increased or
fluctuating BP, Decreased skeletal muscle tone, and increase of gastric secretions.
*REM sleep necessary for brain tissue restoration & important for cognitive restoration
➢ What bedtime rituals would prevent a person from falling asleep?
o Going to bed fully awake & thinking about other things causes insomnia
o Trying to finish work or resolve family problems before bedtime
o If pt. doesn’t fall asleep within 30 min. Advise pt. to get out of bed and do a quiet activity until
sleepy enough for bed
o Limit caffeine to morning coffee and limit alcohol intake
o Avoid heavy meals for 3 hours before bedtime
➢ What are healthy bedtime rituals?
o Comfortable room temp., proper ventilation, minimal sources of noise, comfortable bed,
proper lighting, sometimes extra pillows are important; Important for person to go to sleep
when they feel fatigued or sleepy; Avoid excessive mental stimulation before bedtime.
, Relaxation (deep breathing, guided imagery, reading, soft music); Wear loose-fitting nightwear;
Void before bed
➢ When performing a sleep assessment, what are some questions you might want to ask?
o What time do you usually get in bed each night?
o How much time does it usually take to fall asleep? Do you do anything special to help you fall
asleep?
o How many times do you awaken during the night? Why?
o What time do you typically wake up in the morning?
o How many hours do you sleep each night?
➢ What are sleep assessments?
o Description of sleep problems; Usual sleep patterns; Physical and psychological illness; Current
lifestyle events; Emotional and mental status; bedtime routines; bedtime environment;
behaviors of sleep deprivation; Meds, medical history, observation
➢ Tools for sleep assessment:
o Epworth sleepiness scale (evaluates severity)
o Pittsburgh sleep quality index (assesses quality and sleep patterns)
o Visual analogue scale (best night/worst night sleep)
o Numeric scale (0-10 sleep rating)
➢ Looking at the following sleep diagnosis, what nursing diagnosis would you choose for each patient?
**(Be able to define each disorder, along with appropriate outcomes for each as well!!)
o Insomnia: Chronic difficulty falling asleep, frequent awakenings from sleep, and/or a short
sleep/nonrestorative sleep, associated with poor sleep hygiene- the most common sleep-
related complaint.
o Narcolepsy: Dysfunction of mechanisms that regulate sleep and wake states
▪ Excessive daytime sleepiness is most common complaint associated with this disorder
▪ During day, patient suddenly feels overwhelming sleepiness and falls asleep; REM occurs
within 15 min.
**Nursing Diagnoses for Insomnia and narcolepsy:
1. Disturbed sleep pattern R/T excessive daytime sleeping AEB difficulty falling or remaining
asleep.
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