Assessment in Sleep and Rest Needs

The nurse should inquire if the client feels he is getting enough sleep and rest.
Questions should focus on specific sleep patterns, such as how many hours a night the
person sleeps, interruptions, whether the client feels rested, any problems sleeping
(e.g., insomnia), what ritual the client uses to promote sleep, and any concerns the
client may have regarding sleep habits. Some of this information may have already
been presented by the client, but it is useful to gather data in a more systematic and
thorough manner at this time. Inquiries about sleep can bring out problems, such as
anxiety, which manifests as sleeplessness, or inadequate sleep time, which can
predispose the client to accidents. Compare the client’s answers with the normal sleep
requirement for adults, which is usually between 5 and 8 hours a night. However,
sleep requirements vary depending on age, health, and stress levels.

Focus Assessment Criteria on Sleep Disturbance

Subjective Data
A. Assess Characteristic Limitation
1. Sleep pattern (now, past)
 Mention sleep on 1-10 scale (10=can take a rest, be fresh)
 Usual sleep time and wake up time
 Difficulty to sleep and wake up
2. Sleep need
To decide total sleep that is needed, let him sleep until wake up in the morning
(without alarm). This must be done for few days. After that, calculate total sleep
time (minus 20-30 minutes). The result is the time that he needs to sleep for usual.
3. Existence of symptoms history
 Complains: lack of sleeping, anxiety, sensitivity, depression, scare (bad
dream, dark, maturational situation)
 Onset and duration
 Location
 Description (dicetuskan oleh? Diperberat oleh? Decreased by?)
B. Assess Related Factors
1. Interruption
 Noise
  Journey schedule
 Elimination need
2. Usage of sleeping aid or sleep ritual
 Taking a bath with warm water
 Pillow
 Toys, books
 Eat, drink
 Positions
 Medicines
3. Take a nap (frequency, duration)

Objective Data
A. Assess Characteristic Limitation
1. Physical characteristic
 Appearance (pale, dark around eyes circle, concave eyes)
 Menguap
 Feels sleepy all day long
 Decrease of vision range
 Sensitivity

Assessment Questions about Sleep Disturbances

• How would you describe your sleeping problem? What changes have occurred
in your sleeping pattern? How often does this happen?
• Do you have difficulty falling asleep?
• Do you wake up often during the night? If so, how often?
• Do you wake up earlier in the morning than you would like and have difficulty
falling back to sleep?
• How do you feel when you wake up in the morning?
• Do you sleep more than usual? If so, how often do you sleep?
• Do you have periods of overwhelming tiredness? If so, when does this
happen?
 • Have you ever suddenly fallen asleep in the middle of a daytime activity? If
so, has any muscle weakness or paralysis occurred?
• Has anyone ever told you that you snore, walk in your sleep, talk in your
sleep, or stop breathing for a while when sleeping?
• What have you been doing to deal with this sleeping problem? Does it help?
• What do you think might be causing this problem? Do you have any medical
condition that might be causing you to sleep more (or less)? Are you receiving
medications for an illness that might alter your sleeping pattern? Are you
experiencing any stressful or upsetting events or conflicts that may be
affecting your sleep?
• How is your sleeping problem affecting you?

Assessing
Assessment relative to a client’s sleep includes a sleep history, a sleep diary, a
physical examination, and a review of diagnostic studies.
Sleep history
 Usual sleeping pattern, specifically sleeping and waking times; hours or
undisturbed sleep; quality of or satisfaction with sleep (e.g., effect on energy
level for daily functioning); and time and duration of naps.
 Bedtime rituals performed to help the person fall asleep (e.g., a glass of hot
fluid, reading or other method of relaxing, and special equipment or
positioning aids).
 Use of sleep medication and other drugs. Sleep can be disturbed by a variety
of drugs, such as stimulants or steroids, if they are taken close to bedtime.
Hypnotics and sedating antidepressants may cause excessive daytime
sleepiness.
 Sleep environment (e.g., dark room, cool or warm temperature, noise level,
night-light).
 Recent changes in sleep patterns or difficulties in sleeping.
If the client indicates a recent pattern change or difficulties in sleeping, a more
detailed history is required. This detailed history should explore the exact nature of
the problem and its cause, when it first began and its frequency, how it affects daily
living, what the client is doing to cope with the problem, and whether these methods
have been effective.
Sleep Diary
Sometimes clients with a sleeping problem can provide more precise
information if they keep a written record of their sleep pattern and the habits
associated with it. Such a sleep diary or log can be kept by clients who are sleeping at
home and should b maintained for at least 1 week. A sleep diary may include all or
selected aspects of the following information that pertain to the client’s specific
problem:
 Total number of sleep hours per day
 Activities performed 2 to 3 hours before bedtime (type, duration, and time)
 Bedtime rituals (e.g., ingestion of food, fluid, or medication) before going to
bed
 Time of (a) going to bed, (b) trying to fall asleep, (c) falling asleep
(approximate), (d) any instances of waking up and duration of these periods,
and (e) waking up in the morning
 Any worries that the client believes have a positive or negative effect on sleep
Keeping such a diary may become stressful for some clients and further affect
their sleep. The nurse needs to advise the client to obtain the assistance of a bed
partner in keeping the diary or to discontinue the diary if it presents a problem. When
a diary is completed, the nurse and client can develop flowcharts or graphs that will
assist in organizing the data and identifying the specific problem.
Physical Examination
Examination of the client includes observation of the client’s facial
appearance, behavior, and energy level. Darkened areas around the eyes, puffy
eyelids, reddened conjunctiva, glazed or dull-appearing eyes, and limited facial
expression are indicative of sleep insufficiency. Behaviors such as irritability,
restlessness, inattentiveness, slowed speech, slumped posture, hand tremor, yawning,
rubbing the eyes, withdrawal, confusion, and incoordination are also suggestive of
sleep problems. Lack of energy may be noted by observing whether the client appears
physically weak, lethargic, or fatigued.
 In addition, the nurse assesses whether the client has a deviated nasal septum,
enlarged neck, or is obese. These findings may be associated with obstructive sleep
apnea or snoring.

Diagnostic Studies
Sleep is measured objectively in a sleep disorder laboratory by
polysomnography: an electroencephalogram (EEG), electromyogram (EMG), and
electro-oculogram (EOG) are recorded simultaneously. Electrodes are placed on the
center of the scalp to record brain waves (EEG), on the outer canthus of each eye to
record eye movement (EOG), and on the chin muscles to record the structural
electromyogram (EMG). The following may also be monitored, depending on
findings of the initial interview; respiratory effect and airflow, ECG, leg movements,
and oxygen saturarin. Oxygen saturation is determined by monitoring with a pulse
oximeter, a light-sensitive electric cell that attaches to the ear or a finger. Oxygen
saturation and ECG assessments are of particular importance if sleep apnea is
suspected. Through polysomnography, the client’s activity (movements, struggling,
noisy respirations) during sleep can be assessed. Such activity of which the client is
unaware may be the cause of arousal during sleep.