Having trouble falling asleep or staying asleep is common among adults in the United States. The CDC reports that over 14% of adults report having sleep problems. Women seem to have more trouble falling asleep than men, and people between the ages of 45 and 65 struggle more than teenagers and younger adults. Sleeping difficulties can be caused by physical, psychological, or even social challenges. Nurses and other healthcare providers play an important role in managing patient sleep disorders, from identifying root causes to finding solutions.
Related: Nursing Management of Sleep Disorders, 2nd Edition
Patient sleep: Why does it matter?
If you have ever experienced sleep deprivation, you know how much it can impact your mood and cognitive functioning. Being tired makes it harder to perform at work, take care of loved ones, focus on learning, and make healthy choices throughout the day.
Besides the immediate effects of poor sleep, people who struggle with sleep disorders are more likely to suffer long-term consequences These may include hypertension, obesity and type-2 diabetes, impaired immune functioning, cardiovascular disease and arrhythmias, mood disorders, neurodegeneration and dementia, and even loneliness.
Patients who do not get enough sleep in a hospital can even experience delayed healing, increased anxiety, and in severe cases, delirium.
Stages of the sleep process
To better understand how sleep can affect health, providers must understand each stage in the sleep process. The Sleep Foundation explains that there are four basic stages of sleep, and each is important.
- N1 Sleep: This stage of sleep is the lightest stage. During N1 sleep, a person starts to relax and fall asleep. This stage usually lasts less than 7 minutes, and people are easily awakened during this stage of sleep.
- N2 Sleep: During this stage, the body temperature drops, breathing and heart rate slow, and brain activity decreases. Each cycle through N2 lasts about 20 minutes. Most people spend about 50% of their sleep time in this stage.
- N3 Sleep: Also referred to as “deep sleep,” these stages generally start out lasting 40 minutes, and get shorter with each sleep cycle. It is more difficult to wake someone up from this stage, and this deep sleep is thought to improve creativity and memory.
- REM Sleep: During REM sleep, brain activity picks back up, and people are more likely to experience vivid dreams. REM sleep does not usually occur unless a person has been asleep for at least 90 minutes, and REM sleep segments typically get longer as the night progresses.
People who wake frequently due to problems like anxiety and sleep apnea may not fall fully asleep for long enough to get into N3 or REM sleep. These patients often feel tired during the day, even after sleeping for 9-10 hours at night.
Physiological issues associated with inadequate sleep
Because sleep problems can cause so many other health problems, take a thorough medical history of any patient reporting excessive sleepiness, trouble falling or staying asleep, or trouble concentrating.
Some of the most common causes of poor sleep include:
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea happens when a person does not maintain adequate respiration at night. Typically, their tongue falls to the back of the throat, blocking the airway. The patient then wakes up to breathe normally and falls back asleep.
The moment of wakefulness is so short that patients do not even notice it happening. However, waking up so frequently during the night means that the body is unable to move into deeper stages of sleep.
To confirm a diagnosis of sleep apnea, a patient will have to spend a night in a sleep center, attached to monitors where their sleep and breathing patterns can be monitored. A diagnosis of sleep apnea is made if a patient has more than 5 interrupted breathing events during every hour of sleep.
Some patients struggling with sleep apnea require a CPAP mask to ensure adequate breathing throughout the night. Patients may be able to manage or eliminate their sleep problems by losing weight or using oral airway support devices.
Chronic pain
Patients suffering from chronic pain may also have poor sleep. Unfortunately, this is a positive feedback loop. Poor sleep usually leads to lower pain tolerance, which makes it even more challenging to get a good night’s sleep.
Patients suffering from chronic pain often use medications to manage their symptoms. Other options include ice or heat packs, mild to moderate exercise, weight loss, massage, and physical therapy.
PMS or menopause
Hormonal changes associated with premenstrual syndrome and menopause can cause changes in sleeping habits and cause trouble falling asleep or staying asleep. Heat flashes, nausea, stomach cramps, and heavy bleeding often interfere with sleep.
Caregivers may be able to offer hormonal medications, pain medication, and homeopathic treatment options to decrease symptoms and improve sleep quality.
Dementia and Parkinson’s Disease
Patients suffering from dementia often have sleep problems. Most commonly, these patients experience wakefulness during the night and excessive sleepiness during the day. Changes in the brain associated with dementia can also disrupt normal sleep cycles.
In addition, many sleeping medications interact with medications used to manage dementia and Parkinson’s, eliminating the option of using medication to help with sleep.
Managing patient sleep disorders: Solutions
There are many treatment options for patients struggling to get a good night’s sleep. These include:
- Good sleep hygiene
- Consistent sleep scheduling
- Maintaining a healthy weight
- Medication
- Managing underlying disease
Healthcare providers can work with patients to manage sleep disorders. This way they can help improve both quantity and quality of sleep. A patient who is getting adequate rest and experiences healthy sleep cycles is more likely to maintain their health in other areas.
