- a.Physical activity: Activity increases fatigue and
promotes relaxation that is followed by sleep. It
also increases both REM and NREM sleep.
b.Psychological stress: The person experiencing
stress tends to find it difficult to obtain the
amount of sleep he/she needs, and REM sleep
decreases.
c. Motivation: A desire to be wakeful and alert
helps overcome sleepiness and sleep; when
there is minimal motivation to be awake, sleep
generally follows.
d.Culture: Bedtime rituals, sleeping place, and
pattern of sleep may vary according to culture.
e.Diet: Carbohydrates appear to have an effect on
brain serotonin levels and promote feelings of
calmness and relaxation; protein may actually
increase brain energy alertness and concentra-
tion.
f. Alcohol and caffeine: Alcohol in moderation
seems to help induce sleep in some people, but
large quantities limit REM and delta sleep. Caf-
feine is a CNS stimulant and may interfere with
the ability to fall asleep.
g.Smoking: Nicotine has a stimulating effect, and
smokers usually have a more difficult time
falling asleep.
h.Environmental factors: Most people sleep best
in their usual home environments.
i. Lifestyle: Sleep disorders are the major problem
associated with shift work, and developing a
sleep pattern is especially difficult if the shift
changes periodically. Sleep can be affected by
watching some types of television shows,
participating in stimulating activity, and level
of activity or exercise.
j. Exercise: Moderate exercise is a healthy way to
promote sleep, but exercise that occurs within 2
hours before normal bedtime can hinder sleep.
k.Illness: Illness is a physiologic and psychologi-
cal stressor and, therefore, influences sleep.
l. Medications: Sleep quality is influenced by cer-
tain drugs that may decrease REM sleep.
4.The cause of the sleep disturbance, the related
signs and symptoms, when it first began and how
often it occurs, how it affects everyday living, the
severity of the problem and whether it can be
treated independently by nursing, how the patient
is coping with the problem, and the success of any
treatments attempted - a.Energy level
b.Facial characteristics
c. Behavioral characteristics
d.Data suggestive of potential sleep problems
6.Make sure the patient has a comfortable bed, with
bottom linens tight and clean. The upper linens
should allow freedom of movement and not exert
pressure. A quiet, darkened room with privacy,
with proper ventilation and a comfortable temper-
ature, should be provided.
7.Sample answers:
a.Sleep Pattern Disturbance: Difficulty remaining
asleep related to noise of hospital environment
and need for periodic treatments
b.Sleep Pattern Disturbance: Excessive daytime
sleeping related to effects of biologic aging
c. Sleep Pattern Disturbance: Altered sleep–wake
patterns related to frequent rotations of shift
d.Sleep Pattern Disturbance: Premature wakening
related to alcohol dependency
e.Sleep Pattern Disturbance: Difficulty falling
asleep related to worries about family- a.Eyes: Dart back and forth quickly
b.Muscles: Small muscle twitching, large muscle
immobility
c. Respirations: Irregular; sometimes interspersed
with apnea
d.Pulse: Rapid or irregular
e.Blood pressure: Increases or fluctuates
f. Gastric secretions: Increase
g.Metabolism: Increases; body temperature
increases
h.Sleep cycle: REM sleep enters from stage II of
NREM sleep and reenters NREM sleep at stage
II; arousal from sleep difficult
9.Sample answers:
a.Prepare a restful environment.
b.Offer appropriate bedtime snacks and
beverages.
c. Promote comfort and relaxation.
10.Sample answers:
a.Usual sleeping and waking times: Do you usu-
ally go to bed and wake up around the same
time?
b.Number of hours of undisturbed sleep: Do you
have any difficulty falling asleep? Do you wake
up during the night?
c. Quality of sleep: Do you feel rested after the
amount of sleep you get?
d.Number and duration of naps: Do you find
yourself falling asleep during the day?
e.Energy level: Do you feel refreshed after a
night’s sleep?
f. Means of relaxing before bedtime: Do you
watch television or read before bedtime?
g.Bedtime rituals: What do you do before going
to bed?
h.Sleep environment: What is your bedroom
environment like?
i. Pharmacologic aids: Do you ever take
medications to help you fall asleep?
j. Nature of sleep disturbance: What do you think
is causing your sleep problem?
k.Onset of a disturbance: When did you first
notice that you had trouble falling asleep?
l. Causes of a disturbance: Are you doing
anything different before bedtime?
m.Severity of a disturbance: Do you have breath-
ing problems during the night?
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