Frequently Asked Questions
Chapter 40: Sleep and Rest

How is sleep affected by age?

The amount of sleep a person needs gradually declines over a lifetime. Neonates sleep very soundly from 16 to 20 hours per day. Infants require 12 to 18 hours per day. Toddlers need 12 to 14 hours per day, including one or two naps during the day. Nighttime rituals, such as bathing, brushing teeth, and reading books, begin at this age. Preschool children need 10 to 12 hours per day. They awaken frequently due to dreams and nightmares. School-age children need 10 to 12 hours per day but often resist bedtime and develop a fear of the dark. Adolescents sleep 8 to 10 hours per day and handle bedtime on their own. Young adults need about 8 hours per day, gradually declining to 6 to 8 hours for middle-aged adults, and 5 to 7 hours per day for older adults.

What is the relationship between the five stages of sleep and the sleeping cycle?

An individual has four to six sleep cycles per 7- to 9-hour sleep period. Each sleep cycle lasts 70 to 100 minutes and includes the five stages of sleep: Stage 1 NREM, stage 2 NREM, stage 3 NREM, stage 4 NREM, and REM.

What are some suggestions the nurse can give to clients who are experiencing psychophysiological insomnia?

When a client is experiencing psychophysiological insomnia, the nurse can suggest that the client (1) use the bed for sleep and sex only; (2) go to bed only when sleepy; (3) get out of bed within 20 minutes if not asleep; (3) do something until sleepy, then return to bed; (4) establish a routine time for sleep and awakening; (5) get up promptly when the alarm goes off; (6) avoid taking naps in the daytime; (7) abstain from caffeine, alcohol, and tobacco use and avoid spicy foods; (8) exercise 3 times a week for 20 minutes; (9) eat a nutritionally-balanced diet supplemented with B-complex vitamins; (10) avoid eating less than 3 hours before bedtime; (11) use stress-management activities, such as progressive muscle relaxation, breathing exercising, and warm baths, each day; (12) keep a sleep diary to get a clue about factors promoting and impeding sleep; and (13) use a mattress that promotes good back support.

What questions should the nurse ask during assessment regarding altered sleep patterns?

The nurse can question the client about the following when doing a sleep assessment:
(1) the nature of the problem (inability to fall asleep, difficulty remaining asleep, inability to get back to sleep after wakening, restless sleep, or daytime sleepiness), (2) the quality of the problem (number of hours of sleep related to sleep goal, number hours of sleep, duration and frequencies of naps, and number of wakings per sleep period), (3) environmental factors (lighting, bed, noise level, stimulating factors, sleep partner), (4) associated factors (meals eaten, activity before retiring, life stressors, anxiety level, pain, recent illness or surgery), (5) alleviating factors (diet, warm drink before retiring, reading, listening to quiet music, taking a bath), and (6) effect of problem (fatigue, irritability, confusion).

Which nutrients tend to promote sleep?

Nutritional substances that promote sleep are B-complex vitamins, niacin, pantothenic acid, vitamin B6, vitamin B12, and magnesium promote sleep.

What nursing interventions can a nurse use to help the hospitalized client sleep?

The nurse should help the client to engage in his or her usual bedtime routine, keep the hospital room neat and clean, provide a private room, avoid interrupting sleep from 2400 to 0600, keep noise levels down on the nursing unit, and avoid turning on bright lights in client rooms except for important procedures.