20. CCA Study Notes: Rest, Sleep, Sleep Disorders, and Promoting Sleep

The Big Picture

Rest gives the body and mind time to relax. Sleep is also a basic physical need. Both are affected by comfort, surroundings, health, emotions, routines, and personal preferences.

People do not all rest or sleep in the same way. Some need more sleep than others. Some prefer different positions, bedtime routines, room conditions, or rest times.

A CCA helps by respecting the client’s wishes, following the care plan, reducing unnecessary interruptions, and watching for problems with sleep.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Understanding Rest

Rest means being calm, relaxed, at ease, and free from anxiety and stress.

Rest often involves little physical activity. A person may also rest while doing a calming activity, such as reading, listening to music, or watching television.

Several things help promote rest:

• a comfortable position
• good body alignment
• a quiet setting
• clean, dry, wrinkle-free bedding
• a clean and uncluttered room, when the client prefers it

Personal preference matters. Clients may sleep in different ways. Some may not have slept in a bed for much of their lives, including for cultural reasons.

Some clients prefer to sleep sitting in a chair. A client with chronic obstructive pulmonary disease may find breathing easier while sitting.

Clients should also choose personal comfort measures, such as the number of blankets they want.

Basic Needs Can Affect Rest

A client may have trouble resting when basic needs remain unmet.

Rest may be affected by:

• thirst
• hunger
• elimination needs
• pain
• discomfort
• anxiety
• fear
• unmet needs for love and belonging

A support worker helps promote rest by helping meet the client’s needs.

For clients who live alone or in a facility, visits or telephone calls from family and friends may also help them relax.

Give Clients Time to Rest

Care should be planned and organized so clients have time to rest without unnecessary interruptions.

Some people feel refreshed after resting for 15 or 20 minutes. Others need longer.

Clients who are ill or injured often need more frequent rest. A client may need rest during care, after care, or after meals.

Some clients need several hours to finish activities such as:

• oral hygiene
• bathing
• grooming
• dressing

Do not rush the client. Allow rest periods as needed.

A physician may also order bed rest for a client.

What Sleep Does

Sleep is a basic physical need.

During sleep:

• the body saves energy
• the mind and body rest
• body functions slow down
• vital-sign levels fall
• tissues heal and repair
• stress, tension, and anxiety decrease

After sleep, a person usually feels more refreshed, energetic, and mentally alert.

NREM and REM Sleep

A normal adult moves through four to six cycles of sleep.

These cycles include:

• nonrapid eye movement (NREM) sleep
• rapid eye movement (REM) sleep

Each cycle contains four levels of NREM sleep and one level of REM sleep.

Children and infants sleep more deeply than older people. Older people tend to sleep more lightly.

Average Sleep Needs by Age

The amount of sleep people need generally decreases with age.

Age Group	Average Hours Per Day
Newborns, birth to 4 weeks	14–18 hours
Infants, 4 weeks to 1 year	12–14 hours
Toddlers and preschoolers, 1 to 6 years	11–12 hours
Middle and late childhood, 6 to 12 years	10–11 hours
Adolescents, 12 to 18 years	8–9 hours
Young adults, 18 to 40 years	7–8 hours
Middle-aged adults, 40 to 65 years	7 hours
Late adulthood, 65 years and older	5–7 hours

People who are sick or recovering from illness or injury may need more sleep.

Sleep Quantity and Sleep Quality

The amount of sleep a person gets is only one part of healthy sleep.

Sleep quality refers to how well the person sleeps.

A person with good-quality sleep sleeps soundly and feels refreshed afterward. Poor-quality sleep may involve restlessness or frequent waking.

Factors That Affect Sleep

Illness

Pain, discomfort, nausea, and coughing can disturb sleep.

Treatment or medication schedules may also wake clients during the night.

Nutrition

Some foods and drinks affect sleep.

Caffeine may interfere with sleep. Sources include:

• coffee
• chocolate
• tea
• colas

A protein found in milk, cheese, and beef can promote sleep.

Exercise

Exercise makes people tired and helps them sleep.

Exercise is also a stimulant. Physical activity too close to bedtime may interfere with sleep.

Number to remember: Allow at least 2 hours between exercise and bedtime.

Environment

Many people sleep better in their own beds and familiar surroundings.

Sleep may be affected by:

• unfamiliar surroundings
• noise
• light
• other environmental changes

Promote a quiet setting and provide the amount of light the client prefers.

Medications

Sleeping pills promote sleep.

Medications used for anxiety, depression, and pain may cause drowsiness. They may also interfere with sleep.

The person may not feel mentally alert or refreshed the next day.

Alcohol

Alcohol disrupts normal sleep patterns.

A person may wake during the night and have trouble falling asleep again.

Change and Stress

Changes in routine can interfere with sleep.

A change may be small, such as staying awake later than usual to watch television. Major stressful events, such as starting a new job or going through a divorce, can also disturb sleep.

Emotional Problems

Fear, worry, anxiety, and depression affect sleep.

A person experiencing emotional distress may:

• have trouble falling asleep
• wake frequently
• have trouble returning to sleep

Nocturia

Nocturia means needing to urinate during the night.

Nocturia disrupts sleep.

With advancing age, bladder tone decreases. This increases the need to urinate frequently.

Sleep Disorders

Sleep disorders are persistent problems that affect the amount and quality of sleep.

They can cause fatigue, irritability, poor judgement, and other problems.

Signs and symptoms include:

• hand tremors
• slowed responses to questions, conversations, or situations
• difficulty finding the right word
• decreased attention
• decreased reasoning and judgement
• irregular pulse
• red, puffy eyes with dark circles
• moodiness or mood swings
• disorientation
• fatigue or sleepiness
• restlessness or agitation
• irritability
• hallucinations
• coordination problems
• slurred speech

Facility Routines and Sleep

Facility routines do not always match each resident’s normal sleep-and-wake cycle.

Frequent interruptions during the night or waking residents ⓘ too early can cause sleep deprivation.

Some facilities use approaches that allow clients to wake naturally in the morning when appropriate.

Better incontinence products and mattresses in some facilities help clients sleep better. Some facilities also change nighttime routines to reduce interruptions to sleep.

Insomnia

Insomnia is a persistent condition in which a person cannot fall asleep or remain asleep throughout the night.

A person with insomnia may also wake early and be unable to fall asleep again.

Clients who are ill or injured may experience insomnia because of:

• depression
• anxiety
• pain
• discomfort
• fear of dying during sleep

Sleep Deprivation

With sleep deprivation, both the amount and quality of sleep decrease.

Illness and hospital care are common causes of sleep deprivation in clients.

Light and sound during nighttime care can interfere with sleep.

Health care providers who work rotating shifts also often experience sleep deprivation.

Physiological Symptoms of Sleep Deprivation

Physical symptoms include:

• drooping eyelids
• blurred vision
• fine motor clumsiness
• slowed reflexes
• slowed response time
• decreased reasoning and judgement
• decreased auditory and visual alertness
• cardiac arrhythmias

Psychological Symptoms of Sleep Deprivation

Psychological symptoms include:

• confusion and disorientation
• increased sensitivity to pain
• irritability
• withdrawal
• apathy ⓘ
• excessive sleepiness
• agitation
• hyperactivity
• decreased motivation

Sleepwalking

A person who is sleepwalking walks around while asleep, often for several minutes.

Sleepwalkers are unaware of what they are doing. They do not remember the sleepwalking episode after waking.

Children sleepwalk more often than adults.

Sleepwalking may be caused by:

• stress
• fatigue
• some medications

Safety: The risk of falling during sleepwalking is high. Clients who are ill may also trip or pull out tubes and catheters.

Guide a sleepwalking client back to bed. Awaken the client gently because the person can startle easily.

Follow the Care Plan

When sleep-promoting measures are required, they are included in the client’s care plan.

CCA action: Check the care plan so you provide the correct care.

Observe the client closely. Report signs and symptoms of sleep deprivation.

Respect Bedtime Rituals and Routines

Many clients have personal routines before going to bed.

These may include:

• having a bedtime snack
• watching television
• reading
• checking on friends or loved ones

These routines matter to the client, and you must help the client follow them as much as possible.

Rest and Sleep With Dementia

Some types of dementia involve sleep disturbances.

Confusion and restlessness often increase at night. Night wandering is also common.

For some clients, night wandering in a safe and supervised setting can be helpful.

Protect Dignity

Protecting dignity can help a client rest.

Some clients may feel embarrassed wearing a hospital gown and prefer their own gown or pyjamas.

Clients may also feel better when they are clean and well groomed. Help with personal hygiene and grooming before rest.

Support Independence

Clients often have routines before resting.

These may include:

• using the bathroom
• brushing their teeth
• having a snack or beverage
• praying
• locking doors
• checking that loved ones are safe
• using a favourite blanket

Ask about the client’s preferences. Help the client follow these routines when possible.

Provide Individualized Care

Client-centred care must be planned or adapted to fit the client’s:

• choices
• physical strengths and limitations
• cognitive ⓘ strengths and limitations
• personality
• care plan

People react differently to pain and comfort.

A client who says they have pain should always be believed.

Respect Client Preferences

Allow clients to do as much as possible without assistance.

Clients choose when and where they want to rest.

Provide a restful environment based on their wishes.

Protect Privacy

Lack of privacy can prevent a client from resting.

Close the door and privacy curtains when the client wants privacy.

Support Safety

Clients need to feel safe from falls and other injuries before they can rest well.

In a facility, the call bell must be within the client’s reach.

Explain procedures before they are performed. Understanding why treatment is needed and what will happen can help the client feel safe.

Rest and Sleep in Older Adults

Older people have less energy than younger people and may nap during the day.

Organize care so naps are not disturbed.

Avoid: Do not wake an older client from a nap.

Long-term care clients are allowed to choose when they nap and sleep. They also have the right to choose measures that help promote comfort, rest, and sleep.

Follow both the care plan and the client’s wishes.

A client may be prepared for bed as early as 6:00 p.m. This does not mean the client is ready to sleep. The client may prefer to read, listen to the radio, or watch television.

Measures That Promote Sleep

When required, use the measures included in the client’s care plan.

Helpful measures include:

• organize care so the client gets uninterrupted rest
• encourage the client to avoid physical activity before bedtime
• discourage business or family matters before bedtime
• allow a flexible bedtime based on when the client feels ready to sleep
• provide a comfortable room temperature
• help the client take a warm bath or shower
• provide a bedtime snack when needed

Other measures include:

• have the client avoid caffeine and alcohol
• have the client urinate before going to bed
• make sure an incontinent client is clean and dry
• follow the client’s bedtime rituals
• make sure the client wears loose-fitting nightwear
• provide warmth with items such as blankets or socks
• make sure bedding is clean, dry, and wrinkle-free

Respect the client’s preferred relaxing activities:

• reading
• listening to music
• watching television

Stay and talk with the client.

Reduce things that disturb sleep:

• reduce noise
• close shades, blinds, or curtains to darken the room
• turn off or dim room and hallway lights

Support comfort as directed:

• position the client in good body alignment
• support body parts as ordered
• use measures to relieve pain
• give a back massage if ordered
• assist with relaxation exercises as ordered