Provide Support for Sleep

1.1 How does sleep contributes to an individual’s wellbeing?

Sleep is important for our health and well-being. Extensive research has been done on the effects of sleep. These studies consistently show that sleep plays a vital role in promoting physical health, longevity, and emotional well-being. This explains why, after a good night’s sleep, we feel better, our thoughts are clearer, and our emotions are less fragile. Without adequate sleep our judgment, mood, and ability to learn and retain information are weakened.

Sleep contributes to an individual’s well being by our body producing extra protein molecules while we’re sleeping that helps strengthen our ability to fight infection and stay healthy. It helps to reduce the levels of stress and inflammation in your body. Sleep can help lower blood pressure and elevated levels of stress hormones, which are a natural result of today’s fast paced lifestyle. It allows the brain to better process new experiences and knowledge. Sleep helps regulate the hormones that affect and control appetite so it can help us to loose weight and reduces the occurrence of mood disorders. It makes us more alert and may prevent cancer as people who work late shifts have a higher risk of breast cancer and colon cancer.

Sleep can be divided into two types: rapid eye movement (REM) sleep and non-REM (NREM) sleep. NREM sleep has four stages of increasingly deep sleep. Stage 1 sleep is the lightest, while stage 4 is the deepest. During normal sleep, we move cyclically through these types and stages of sleep. But if our sleep is repeatedly interrupted and we are unable to progress normally through REM and NREM sleep, we may feel tired, fatigued, and have trouble concentrating and paying attention while awake.

1.2 Can you identify reasons why an individual may find it hard to sleep?

Sleep problems are very common and can affect people in different ways. It can occur for a number of reasons for example medical reasons – such as heart dissease or bladder infection , mental illness – such as dementia, emotional reasons, as a result of old age, depression, stress, noisy or hot sleep environment as well, or also eating or drinking late – too much alcohol or caffeine before going to bed. It is also possible to think you have a sleep problem when in fact you are still getting enough sleep but it is different from what you expect. Disturbing dreams or not enough exercise so we are not tired can makes us not be able to sleep as well.

1.3 Can you describe the possible short-term and long-term effects on an individual who is unable to sleep?

Adult needs between 7 to 9 hours sleep a night. Irritability, moodiness, disinhibition, apathy, slowed speech and flattened emotional responses, impaired memory, impaired immune system and an inability to multitask are some of the first signs a person experiences from lack of sleep. These will ussually go away if we are able to sleep and become well rested. There are also long term effects of not getting enough sleep. Not sleeping can reduce glucose metabolism by as much as 40 percent, which can lead to diabetes and obesity (lack of sleep can cause weight gain by increasing hunger and affecting metabolism, and extra weight can cause sleep disorders such as apnea which cause sleep deprivation.)

People who don’t get enough sleep tend to be more susceptible to infections and have slower healing times. High blood pressure, depression, mental impairment are other diseases that can result from long-term sleep deprivation. Extreme long-term effects of a lack of rest can include cardio vascular disease – heart failure , stroke and chronic fatigue,cancer, mortality. Sleep disorders such as sleep apnoea, insomnia, sleep deprivation and restless legs syndrome can affect your career and quality of life as well as putting us and our family at risk if we are unable to perform such tasks as driving without being drowsy.

2. BE ABLE TO ESTABLISH CONDITIONS SUITABLE FOR SLEEP

2.1 Can you describe conditions likely to be suitable for sleep?

The room we sleep in is vital to getting rest. It should be dark, clean and have good ventilation so its slightly cool. It is unhealthy to inhale dust. Extreme temperatures should be avoided as it disturbs the sleep. Its better to have a window open to get fresh air and have the right amount of blankets and soft pillows than breathing stale air. The sheets and nightwear should be nice and clean.

We can minimize noise and light during sleep by using ear plugs and window blinds. Sleeping on comfortable, supportive mattresses helps enhance sleep quality and assure the well-being of our spine. Some people like sleeping without the pillow, big pillows hinder your breathing and tire out the neck. The bed should only be for sleeping, many people tend to read, work, watch television, some even eat in their beds, but the mind should never associate the bed with anything else. We need to make sure we have enough space in bed so we can move around.Sleeping in a curled up position should be avoided we need to stretch out to have a good night sleep.

2.2 What can you do to minimise aspects of the environment likely to make sleep difficult for an individual?

Sleeping problems may be caused by environmental causes including: The bedroom may be too hot or too cold.
Poor lighting may cause the person to become disoriented. The person may not be able to find the bathroom.
Changes in the environment, such as moving to a new home or having to be hospitalised, can cause disorientation and confusion.

Things we can try include:

Keep the environment as consistent as possible.

Check whether the person is too hot or cold on wakening. Dementia may affect their internal thermostat. Shadows, glare or poor lighting may contribute to agitation and hallucinations, so provide adequate lighting. Nightlights might help cut down on confusion at night and may assist the person to find the bathroom. If finding the bathroom is a problem, a commode next to the bed might help. Make sure the bed and bedroom are comfortable and familiar. Familiar objects may help to orient the person. Avoid having daytime clothing in view at night, as this may make the person think it is time to get up. Make sure that the person is getting adequate exercise. Try taking one or two walks each day.

2.3 How can you adjust own behaviour to contribute to a restful environment?

Achieving restful sleep begins with keeping a consistent sleep schedule and creating an environment that promotes relaxation. Eight hours of sleep should be sufficient. Some people only need five hours of sleep per night, while others need ten hours of sleep. Establishing a regular routine throughout the day and a fixed hour for going to bed contributes to a good night sleep. We should avoid napping during the day. Television or computer, visitors or exciting activities should be limited to earlier time of the day as these can excite a person for example dementia sufferers. To sleep well should try to avoid huge meals in the evening as well as stimulants like coffee, tea, cola, chocolate or alcohol. Most herbal teas contain no caffeine and some help us naturally sleep better.

Lots of food stores and grocery stores will stock big variety of herbal teas many blended specifically to help as sleep. Milk can also help you sleep. It contains an amino acid called tryptophane. Which produces the effect of a sedative. Also we should avoid drinking too much fluid in the evening to avoid visits to bathroom during the night. If we want to exercise its better to do it during the day as late evening exercise can stimulate body temperature and make falling asleep more difficult. Before going to bed we should engage in quiet activities, like reading book or listening to music to help body relax. Relaxation therapy, massage and acupressure can help to sleep better as well.

2.4 Can you describe actions to take if the behaviour or movement of others hinders an individual’s ability to sleep?

In many care and nursing homes there are shared rooms, where residents are disturbing each other at night by talking in sleep, or not being able to sleep and walk around and entering into other residents rooms. There are long halls with hard floor that transmits the noise very easily, very disturbing can be numerous call bells which other residents can hear when they want to have their bedroom doors opened. Also turned on television and radio loudly contributes to disturbed sleep often television not watched and radio not listened to.

Every individual has the right to undisturbed sleep but also others have the right to behave or move about if they want to. A solution that is fair for everyone should be found. So for example residents should be allocated separate rooms so they dont disturb each other, their doors should be closed if they wish to have their television or radio on and turned down if its too loud. Closing the bedroom doors also helps to minimise the noise from the numerous alarms.

The bed partner’s movements or snoring may also interfere with an individual’s sleep.

3. BE ABLE TO ASSIST AN INDIVIDUAL TO SLEEP

3.1 Can you explain the importance of a holistic approach to assisting sleep?

A holistic approach to improving sleep means more than taking care of the body and mind, it means making some positive changes to life. It means recognising and adjusting areas of life that cause stress and anxiety that may be affecting sleep. Although it is not possible to control what life has in store, acceptance is an important part of the philosophy of life that aims to create a balance between the individual and external influences. A holistic approach to sleep may include:

Doing sufficient exercise, maintaining a healthy diet and avoiding alcohol and caffeine Using techniques such as massage and natural products to enhance a night time pre-sleep ritual Making the bedroom harmonious and restful using feng shui and avoiding toxins, Adopting practices that are beneficial to health and relaxation such as yoga and meditation Adapting the home and environment to aid sleep by creating a peaceful and soothing environment in the bedroom and home Experimenting with music, sounds and readings that may encourage a restful feeling Finding herbal drinks that enhance sleep and avoiding stimulating foods before bedtime

3.2 How can you encourage the individual to communicate the support they need to sleep?

Communicating with older adult can create a barrier to effective communication especially when they have a hearing loss,speech problem, mental illness ( dementia etc.) or taking particular medication this can all complicate conversations and understanding. We need to direct the speech, question at individual’s face, make eye contact and speak clearly. We need to be patient, and smile. We also need to make sure there is no background noise – any music or other people talking. Turn off the radio and TV.

Ask other person or people to stop talking while you communicating to older adult or leave if possible. We repeat or rephrase the sentences and questions if needed. We use direct questions: ” Are you comfortable?” ”Would you like one more pillow under your head?” We can use visual aids to help us show the individual what we are talking about and help us communicate more effectively. For example ”Are you warm enough?Would you like a blanket?” (pointing to the blanket) or ”Would you like commode by your bed?” ( pointing to the commode). We can use pictures, write notes, use signs or symbols.

We pause between sentences and questions to give them time to think and understand and digest the informations and questions. When we pause we show respect and patience.

3.3 How can you assist the individual to find a position for sleep consistent with their plan of care?

Researchers suggest that the position people find themselves in when they wake up is a good position to get into when attempting to fall asleep. In assisting a resident with finding a position comfortable for a good night sleep we have to consider repositioning resident during the night to avoid pressure sores and pain from lying on one side all night if they are not able to move by themselves. To do this we have to follow their plan of care which suggest the best position for them to sleep by using extra pillows to support their head, side or legs or knees, heating pads or hot water bottles to comfort any pain, use of specialised mattresses and beds to be able to raise resident back or legs into required comfortable position. Also to make their sleep position comfortable we can use pressure reducing aids according to their plan of care.

Some examples of the sleeping positions:

Best Sleeping Positions for Scoliosis Patients

While sleeping positions are not causes of scoliosis, they can produce discomfort or pain. Adult patients should avoid sleeping on their stomachs, as this arches the back. Instead, they should try and lie on their back with a small pillow tucked under the knees. Alternatively, they can lie on their side with a pillow between their knees.

Sleeping positions for bad back:
Leg Pillow Position

Lie on the side and curl the legs up toward the chest. Tuck the pillow in between the legs. The position of the legs and the elevation of the top leg will help align the spine and give you a better chance of waking up without a sore back.

Knee Pillow Position

When sleeping on the back , put a pillow or a rolled-up towel and place it under the backs of the knees. This will reduce the amount of pressure on the sciatic nerve.

Stomach Sleeping Position

Lying on the stomach is bad enough.but if you cant sleep any other way then put a thick pillow under the lower stomach and pelvis and sleep without the head on a pillow. This position will properly align the spine and help the body to wake up in the morning with less pain.

Best Sleeping Posture for Better Digestion

Sleeping on the Left Side Helps in Better Digestion: The different studies have indicated that while sleeping on the left position, can help in adequate removal of the stomach acid whereas sleeping on the right side has been found to worsen the heart burn condition. Thus, sleeping on left side is actually very good for heart burn and even other digestive problems and is thus an important sleeping position for better digestion.

Adding a Pillow While Sleeping Aids in Better Digestion: Another appropriate sleeping position for better digestion is to add a pillow between the knees while sleeping. If you are habitual of sleeping on your back and have problem sleeping on the left hand side then one can opt for a body pillow. This not only adds comfort to the sleep but also promotes digestion

3.4 How do you suppport the individual to use aids for sleep in ways that reflect the plan of care and follow agreed ways of working?

There are different types of aids we can use for sleep ;

-pressure relieving devices , specialised mattresses, beds – Beds, mattresses and overlays differ considerably and can be classified in various ways .. Pressure-relieving devices vary in the materials they are made from and in their pressure-relieving mechanisms. For example ,constant low pressure (CLP) devices mould around the patient to distribute their weight over a larger area, while alternating pressure (AP) devices mechanically vary the pressure beneath patients so that the duration of pressure is reduced. With AP devices: the patient lies on air-filled sacs, which sequentially inflate and deflate and relieve pressure at different anatomical sites for short periods; these devices may incorporate a pressure sensor.

* commodes, urinary bottles, sleeping pills, incontinence products (kylies, incontinence pads, incontinence underwear, incontinence conveen sheath, urine nightbags, urine legbags, …) Decisions about which sleeping aids to use should be based on an overall assessment of the individual and comply with individuals plan of care. We can help an individual to choose an aid they need for example suggesting an extendedwear absorbent incontinence products to promote uninterrupted sleep or an alternative – a toileting schedule – commode by bed during the night.

4. BE ABLE TO MONITOR SLEEP

4.1 How can you establish with the individual and others how sleep will be monitored?

A ‘care plan’ is agreed by the team looking after an individuals and their illness. Sleep is important component of individuals care and therefore there is a requirement to give support to comply with the ‘care plan’. Every monitoring of individual’s sleep is recorded in the care plan. Sleep monitoring enables individuals to become aware of relevant unobservable behavior, provide sleep indicators to track sleep quality over time and feedback upon their sleep-hygienic behaviors, and may release the individual from a range of therapy related activities.

4.2 How do you record agreed observations relating to the individual’s sleep and the assistance given In home care setting we monitor individual’s sleep behaviour at their home and record the monitoring hourly. We record the date, time, hour, visits to toilet, breathing, if individual was choking during the sleep, coughing, if client was wondering during the night, how many times individual was awake, how many times individual was repositioned, any unussual behaviour etc. These records are kept to demonstrate compliance with the agreed ‘care plan’ and will be part of the individuals records.

5. KNOW HOW TO ACCESS INFORMATION AND ADVICE ABOUT DIFFICULTIES WITH SLEEP

5.1 Can you describe situations in which additional information or assistance about sleep would be needed?

Wondering during the night – for example could be caused also by restless leg syndrome – it is a disorder characterized by sensations in the legs that cause an individual discomfort unless the legs are moved. While these sensations can occur throughout the day, they are most likely to happen shortly after going to bed. Usually the individual with restless leg syndrome feels the urge to move the legs around in their sleep, but these sensations can also become so strong that the sufferer must get up and walk around.

Incontinence problem, if individual is on medication -for example diuretics make u go to toilet at night. Commode by the bed is good sleeping aid and helps to avoid falls when going to toilet.

Frequent choking or coughing during the night – maybe signs of sleep apnea. It is a disorder that can affect anyone at any age. A person experiences pauses in breathing when the airway becomes obstructed during sleep. The most common cause for blockage is enlarged tonsils or adenoids. Upper respiratory illnesses and/or allergies can also contribute to the development of sleep apnea. Beside pauses in breathing, symptoms of sleep apnea can include -snoring, mouth breathing, restless sleep, sweating, night wakings.

There are a number of factors to address when establishing a plan to reinforce a positive sleep pattern. First, any underlying medical problems that may be affecting sleep should be assessed. We need to consider also checking for food and/or environmental allergies or intolerances, gastrointestinal disturbances, and seizure. Also sleep disturbances can be a side effect of other medications an individual takes and so this should be considered, too.

5.2 How do you access additonal information and assistance?

Through training, supervisor or manager.
From :
The family, friends
The doctor
Local community health service
Local council
National Dementia Behaviour Management Advisory Service Tel. 1800 699 799 National Dementia Helpline Tel. 1800 100 500
Commonwealth Carer Respite Centre Tel. 1800 059 059
Carer Resource Centres Tel. 1800 242 636
Aged Care Information Line Tel. 1800 500 853 7.