Nursing Care and Sleep Issues in Patient

Afza.Malik GDA

Sleep Issues in Patient and Nursing Care

Whats is Sleeping and Biological Circadian,Physiological Changes During Sleep on Sonography,Sleep Patterns,Sleep ans Nursing Scientists,Sleep Problems,Illness and Sleep Issues,Nursing Research on Sleep During Illness or Disease.

Whats is Sleeping and Biological Circadian

    Sleep is a behavior represented by a series of distinguishing brain and somatic state changes oscillating with waking on a regular basis in synchrony with the environmental light/dark cycle (circadian = every 24 hours)

    Poor sleep has numerous health related consequences, including impaired attention, memory, and problem solving as well as physical performance, altered immune system function, and tissue healing; in some cases, it may herald early onset of psychiatric impairment, particularly major depression. 

    It has been associated with more injury accidents, absences from work, medical problems, provider visits, and hospitalizations.

Physiological Changes During Sleep on Sonography

    In research, sleep can be measured physiologically by using sonography (electroencephalogram (EEG), electromyogram, and electrooculogram) to reveal a series of stages, or by activity monitors that distinguish sleep from waking. Sleep also can be assessed behaviorally (by direct observation) or by self-reported perceptions (retrospective recall or global impressions as histories or concurrent reporting in diaries or logs). 

    Using sonography, sleep begins with transitional signs, progresses into a light stage, and then into deep (slow wave) sleep, followed by a period. of rapid-eye-movement (REM) sleep to complete one sleep cycle, taking about 60-90 minutes. Consequently, a full night of sleep consists of 3-6 cycles, depending on total sleep duration. 

    Limitations of sleep measures include that physiological measures are time-consuming, require expensive technology, and can interfere with natural sleep. Behavioral observations are tedious, time consuming, and potentially inaccurate. 

    Self-report methods are subject to preferred answers and the propensity to report negative impressions indiscriminately. Peoples' impressions of their sleep do not always match physiological documentation.

Sleep Patterns 

    Biological scientists seek to understand the regulation of sleep/wake states. Behavioral scientists seek to understand the function of sleep, normative patterns across age groups or species, the need for sleep, and insight into predictive features of poor sleep. 

    Abnormal behaviors during sleep (eg, apneas or large muscle movements) and abnormal bouts or timing of sleep (eg, narcolepsy) claim the interests of clinical scientists. 

    Nursing scientists most often seek to understand how sleep, or more precisely sleeplessness, is related to health and illness, what can be done to promote sleep, and how sleep is affected by environments and life contexts, which often include care environments, eg, critical or long-term care, or contexts, eg, enduring pain, injury, diseases, or major transitions.

Sleep ans Nursing Scientists

    Sleep science generated to date by nursing scientists is built on the premise that personal stress impacts sleep/wake quality. The notions that illness/disease and hospitalization are sources of stress that interfere with usual sleep/wake behavior are prominent. The vast majority of work is descriptive and only a few interventions, either individual or environmental, have been tested. 

    KC Richards (1998) tested massage and found it tended to improve the sleep of critically ill older men. Other studies done several years ago use ocean sounds with evidence of better perceived sleep-in post-coronary artery bypass graft surgery, and progressive muscle relaxation in seniors with evidence of better perceived and sonographic sleep variables. 

    In one review, it has been noted that sleeplessness is very common in infants and children, and clinicians frequently are asked for treatment advice in a review of cognitive behavioral treatments (Owens, France, & Wiggs, 1999). Studies were reviewed that used behavior extinction and modification of parental behavior believed to reinforce waking behaviors as a theoretical basis, including the use of minimal checks, parental presence, stimulus control, and scheduled awakenings. 

    While these interventions are relevant to nursing practice, only one study appeared to involve nursing scientists: a parent sleep education program showing that a significantly smaller percentage of babies in the intervention groups had settling and night waking difficulties than in the control group (Kerr, Jowett , & Smith, 1996). 

    Earlier, the use of recorded bedtime stories for effect on the time to fall asleep in hospitalized children was tested with implications that the use of parental voice might prolong time needed to fall asleep. Redeker (2000) in an integrative review of sleep-in acute care settings revealed that sleep disturbances are common but highly variable, due to multiple personal, health status, and environmental factors. 

    She advocated systematic research to determine correlates of sleep disturbance to identify those most at risk and to derive theoretical and conceptual bases for sleep promoting interventions.

    KA Lee (2001) and colleagues have looked at sleep and fatigue in times of transition in women during the menstrual cycle, in pregnancy and postpartum, and in nurses working shifts. 

    In the menstrual cycle luteal phase, time to REM sleep was shorter when compared to follicular phase, and women. with premenstrual negative affect symptoms had less deep sleep during both menstrual cycle phases, Women transitioning through pregnancy report sleep problems, both prenatal and postpartum and primigravidae more than multigravida. 

    In a descriptive study of registered nurses working and not working outside of day shifts, shiftwork was associated with more sleep disturbances and sleepiness, but age and family factors, more than alcohol and caffeine intake, contributed to the differences in types of sleep disturbances. This group has also looked at fatigue issues in women with HIV/AIDS.

Sleep Problems 

    Two groups of investigators have developed research programs focused on individuals with sleep problems. Roger's group has a program of research investigating subjects with narcolepsy. They have found that those with narcolepsy have disturbed sleep and nap more, that memory is not measurably affected although concentration is, and that timed naps can improve time to fall asleep for certain patients (Rogers & Dreher, 2002). 

    Shaver (2002) and her colleagues have ongoing work describing sleep in midlife (perimenopausal) women and particularly those with insomnia. They have found that menopausal status is not deeply linked to sonographic sleep except if hot flashes are manifested. 

    One group of midlife women reporting insomnia had high life strain, expressed high psychological distress, but exhibited little abnormality in sonographic sleep patterns and few classical symptoms of menopause such as hot flashes. Another group with insomnia reported hot flash activity but had less overall distress and life strain than the other group. 

    Implications are that intervention to manage hot flash and menopausal symptoms are more warranted in the latter, and that life and stress management skills might be more effective in the former group.

Illness and Sleep Issues

    Research programs are developing related to sleep and major illness. This includes, for example, in renal dialysis groups (Parker, KA, 2003); in women with chronic fatigue and fibromyalgia (Landis et al., 2003); related to sleep apnea ( Chasens &Umlauf , 2003) and Parkinson's disease; but also with post abdominal surgery, after CABG; with cancer, and in hospitalized adults and children.

Nursing Research on Sleep During Illness or Disease

    In synchrony with a central focus for nursing practice, studies by nursing scientists mainly represent understanding sleep related to illness/disease. The majority of studies incorporate descriptive methodology limited to self-reports of sleep. 

    It is imperative for the development of nursing sleep science that more sustained study is done to predict those at high risk for negative consequences with vulnerable populations, particularly older adults and the chronically ill, those suffering from sleep disorders for which behavioral treatments are prominent ( eg , insomnia, narcolepsy), and those in high-risk environments (eg, hospitals, high-stress factors). 

    Since sleep is a behavior responsive to behavioral interventions, behavioral intervention tests, including dose response, titration, timing, individualized response types, and the factors affecting behavioral choice and adherence are especially needed. 

    Furthermore, the application of biobehavioral methods that combine physiological and perceptual measures will do much to develop our future knowledge, which is important to symptom management, illness/disease prevention, and health promotion.


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