Pendekatan Non-farmakologi untuk mengatasi masalah istirahat dan tidur

Wenny Artanty N, S.Kep.Ns.M.Kes

Common sleep disorder

Primary sleep disorder Parasomnias Sleep deprivation

Primary sleep disorder

Insomnia :
Hipersomnia
difficulty in falling asleep, intermittent sleep or early awakening from sleep Excessive sleep An uncontrollable desire to sleep (neurologic disorder) Refers to periods of no breathing between snoring interval, the person may not breathe for periods of 1020 second to a long as 2 minutes

Narcolepsy

Sleep apnea

Parasomnias
Parasomnias are patterns of walking behavior that appear during sleep examples :
Somnambulism : Sleepwalking Sleep taking Nocturnal erection Bruxism (grinding of teeth during sleep) Enuresis (bedwetting during sleep)

Sleep Deprivation
Sleep deprivation refers to a decreased amount, consistency, and quality of sleep. It may result from decreased REM sleep and NREM sleep

FOCUSED ASSESMENT GUIDE

Usual sleeping and waking time:

How many hours Wake up earlier in the morning, difficult to fall back a sleep Recent changes in your usual sleep-wake pattern Go to bed and wake up in the same time everyday

FOCUSED ASSESMENT GUIDE

Number of hours of undisturbed sleep
How have you been sleeping? Do you have and difficultly falling a sleep? Wake up frequently during at night Dream at night Dream frightening

FOCUSED ASSESMENT GUIDE

Quality of sleep Number and duration of naps Effect of sleep pattern on everyday function Energy level (ability to perform activities of daily living)

FOCUSED ASSESMENT GUIDE

Sleep aids
Relaxation before bedtime Bedtime ritual Sleep environment Pharmacologic aids

FOCUSED ASSESMENT GUIDE

Sleep disturbance and contributing factor:
Nature of the sleep disturbance Onset of disturbance Causes (physical, psychosocial, medicine related) Severity Symptoms Intervention attempts and result

NONFARMAKOLOGIC INTERVENTION

Preparing restful environment

Comfortable bed Linen should be tight and clean Quite and darkened room Privacy Temperature of the room (ventilation, quality bed covering )

Promoting bed time ritual

Variation for everyone Listening the radio Watching the television Talking to family member Prayer Children have favorite doll, stuffed toy, blanked, bedtime story, kiss everyone goodnight. Personal hygiene routine Snack

Offering appropriate bedtimes snacks and beverages

Because carbohydrates seem to help promotes sleep, high carbohydrates :
Roti Crackers Jus buah segar

Beverages containing caffeine should be avoided at least 4 to 5 hours before bedtime Avoid excessive fluid intake before bedtime

Promoting relaxation
Relaxation
Relaxation promotes the body reaction to decreasing respiratory, pulse, metabolic rate, blood pressure and energy use. Various techniques are used but each involves rhythmic breathing, reduces muscles tension and an altered states of consciousness

Promoting relaxation
Meditation

Meditation have four components :

The exercise should be performed for 20-30 minutes twice a day

Quite surroundings Passive attitude Comfortable position Word and mental image on which to focus

Promoting relaxation
Guided imagery :
person creates a mental images, concentrates on the image an become less responsive to stimuli (including pain)

Promoting relaxation
Biofeedback
Method of gaining mental control of the autonomic nervous system and thus regulating body responses such as blood pressure, heart rate and headache Technique that uses a teaching machine with feedback signal to help a client learn by trial and error to control involuntary body mechanisms (eg, poor circulation, muscle spasms)

Promoting relaxation
Hypnosis
A technique that produces a subconscious condition accomplished by suggestions made by hypnotherapies or self-hypnosis

Promoting relaxation
Back rub Warm bath

Promoting comfort
Depending on the cause and severity of the discomfort or pain :

Remaining whit a lonely frightened child or adult Using simple strategy of caring presence and touch Offering back massage Obtaining an extra blanket

Respecting Normal Sleep-wake pattern

Every effort should be made to observe the clients normal period of sleep

Scheduling Nursing Care to avoid unnecessary disturbance

Every effort should be made a time care during periods when the client is normally awake

Teaching about rest and sleep

A well-informed person is better able to cope with distressing situation Teaching should include aspects or normal variation in sleep pattern and common measures to promote relaxation and sleep Discussion about planning and acceptability Recommendation to specially practitioner

Evaluation
Verbalize feeling rested or having had restful nights sleep Identify factor that interfere with or disrupt the normal sleep pattern Use technique that effective promote sleep and provide a restful environment Concentrate and function effectively during walking hours Eliminate behavior related to sleep deprivation

Selesai
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