Page 207 - Cardiac Nursing

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C HAPTER 8 / Sleep 183
DISPLAY 8-1 Epworth Sleepiness Scale
Name:
Today’s date: Your age:
Your sex (male M; female F):
How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired?
This refers to your usual way of life in recent times. Even if you have not done some of these things
recently, try to work out how they would have affected you. Use the following scale to choose
the most appropriate number for each situation:
0 would never doze
1 slight chance of dozing
2 moderate chance of dozing
3 high chance of dozing
Situation Chance of Dozing
Sitting and reading
Watching TV
Sitting, inactive in a public place (theater or meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when
circumstances permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a care, while stopped for a few minutes in traffic
From Johns, M. W. (1991). A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep, 14(6), 540–545.
opportunity is defined as the time from lights out to the first 30- too hot nor too cold) is essential for normal thermoregulatory
second epoch scored as sleep. The average sleep latency across all changes needed to optimize sleep. 41 Excessive noise has also been
naps is calculated and expressed as the mean sleep latency. Possible shown to cause poor subjective and objective sleep meas-
mean sleep latency scores on the MSLT range from 0 to 20 min- ures. 118–121 Too much light exposure alters melatonin produc-
utes, with a low score indicating greater sleepiness. An MSLT score tion. 86 Nursing interventions themselves can significantly disturb
less than 5 minutes indicates pathological sleepiness and is a level at sleep. Comfortable beds/mattresses, pillows, and nightwear facili-
which patients often experience marked impairment of social tate sleep. 122
and/or occupational functioning and at which they are generally ad-
vised against driving or operating heavy equipment. 15,111 Scores be-
tween 5 and 10 minutes are considered to be in the “diagnostic gray IMPAIRED SLEEP, SLEEP
zone,” whereas scores greater than 10 are considered normal.
Actigraphy is an alternative method sometimes used to objec- DISORDERS, AND EXCESSIVE
tively measure sleep/wake patterns by monitoring periods of ac- DAYTIME SLEEPINESS
tivity and rest. 112,113 Using a battery-operated wristwatch-size mi-
croprocessor that senses movement with a piezoelectric beam, Impaired sleep can be generally categorized as either sleep depri-
continuous motion data can be obtained for long periods. Com- vation (resulting from inadequate sleep) or sleep disruption (re-
puter algorithms allow for analysis of activity and non-activity, as sulting from fragmented sleep during the night) 123 (Fig. 8-6).
well as scoring of sleep and wakefulness. 114 While actigraphy can- Sleep deprivation frequently occurs in association with particular
not determine sleep stages, information on total sleep time, per- lifestyles or stages of development. Sleep disruption is often seen
cent of time spent awake, number of awakenings, time between in health-related conditions. Both sleep deprivation and sleep dis-
awakenings, and sleep onset latency can be obtained. Actigraphy ruption result in sleep loss. 123 Important information has been
data correlate well with PSG data, particularly when sleep is nor- obtained through sleep deprivation studies that have shown that
mal. 112,115 Correlations decrease when sleep is disturbed or activ- sleep loss has numerous adverse effects including fatigue, anxiety,
ity is limited. 114,116,117 increase illness, increased sensitivity to pain, decreased immune
response, restlessness, disorientation, decreased alertness/attention
Environmental Assessment during the day, and decreased sense of well being. 124–130 The re-
sults of several studies suggest that the duration of self-reported
The environment can play an important role in the quantity and sleep time increases mortality, with those sleeping longer than
quality of sleep obtained. A thermoneutral environment (neither 9 hours and less than 5 hours per night, had an increased risk of