Chapter 8: Sleep & Sleep Disorders Nursing Care

Sleep is presented as a reversible state of reduced consciousness that is essential for survival, directly impacting mood regulation, cognitive performance, memory consolidation, immune function, metabolic processes, and overall physical health. The sleep-wake cycle is governed by the ascending reticular activating system and regulated through complex interactions of neurotransmitters including acetylcholine, norepinephrine, dopamine, and orexin for wakefulness, balanced by inhibitory signals from GABA and melatonin. The circadian rhythm, controlled by the suprachiasmatic nucleus, synchronizes with environmental light cues to maintain proper sleep timing. Sleep architecture consists of cyclical alternations between non-rapid eye movement sleep stages and rapid eye movement sleep, with NREM progressing through stages N1, N2, and N3 slow-wave sleep, followed by REM sleep characterized by vivid dreaming. The chapter emphasizes how sleep insufficiency and fragmentation lead to serious health consequences including cognitive impairment, metabolic dysfunction, cardiovascular disease, immune suppression, and increased accident risk, particularly affecting hospitalized patients who face environmental disruptions, frequent medical procedures, and medication effects. Major sleep disorders covered include insomnia managed through cognitive-behavioral therapy and targeted medications, obstructive sleep apnea treated with continuous positive airway pressure therapy and lifestyle modifications, periodic limb movement disorder addressed with dopaminergic agents, circadian rhythm disorders managed through light therapy and melatonin supplementation, narcolepsy controlled with wake-promoting medications and safety measures, and parasomnias requiring environmental modifications and behavioral interventions. Special attention is given to older adult considerations and the nursing role in sleep assessment, patient education regarding sleep hygiene practices, and advocacy for evidence-based sleep interventions to prevent long-term health complications.