24 HOUR POSITIONING - THE MISSING LINK
Trudie Read OTR/L
“The American Dream.” Everyone is well aware of the importance of a good night’s sleep. However, this is a neglected concept for individuals with physical disabilities and for their caregivers. This paper covers the psychological and physiological benefits of sleep, with an emphasis on the needs of people with a physical disability and their caregivers. The necessity of maintaining a functional position through 24 hours is discussed, and the development of the DreamaÔ sleep/rest system is then reviewed with evaluation of its therapeutic features.
1. The participant will be able to summarize theories, physiological and psychological benefits of sleep.
2. The participant will be able to describe the need for 24 hour positioning.
3. Upon completion, the participant will have knowledge of the mechanics and benefits of the DreamaÔ sleep and rest system.
4. The participant will be able to identify suitable candidates who would benefit from 24 hour positioning support.
As far back as the ancient Greeks, sleep was considered a friend of mortals, a healer of body and mind, and governed by the minor god Hypnos. Later, Aristotle’s theory of sleep being the evil twin of wakefulness turned this thinking around (1). In the 18th century the feeling was that sleep was necessary but still valueless, to the extent that oversleeping or enjoying sleep demonstrated a character flaw, a symptom of sloth or low intelligence. Opinions in the 19th century were that sleep was caused by a build up of toxins in the body during the day, which were then released at night and resulted in sleep (2).
The
first clinical sleep laboratory was developed in 1920, by a Russian-American
doctor, Nathaniel Kleitman. During this period, concepts such as sleep cycles,
dreams, sleep deprivation and sleep disorders were discovered. This same team
discovered the REM sleep stage in 1953 (2).
Today,
sleep is considered to be the brains’ more active state. The National Sleep
Foundation (NSF), an independent nonprofit organization founded in 1990, state
that during our waking hours, the brain simply reacts to the environment, and
it is during sleep that these experiences are then replayed and processed (3).
Four stages of
sleep have been recorded, from starting to relax and decreasing heart rate
through to REM sleep. The average person goes through 5-6 sleep cycles a night,
with each subsequent REM stage becoming longer, taking 90 minutes to achieve
the REM stage. It is during this stage of deep sleep that the human growth
hormone is released and cells of the immune system are stimulated (4).
During
this restorative sleep, muscle and bone mass are developed, old cells are
replaced with new, and organs are re-energized. Without sufficient deep sleep
the individual may experience a decrease in reflexes, motivation and cognitive
skills, along with an increase in irritability and anxiety (2).
The
amount of sleep needed by an individual decreases from 16 hours/day as a newborn,
to 10-12 hours/day between ages 6-12 years, to 9-10 hours/day as a teenager and
finally 7-8 hours/day as an adult. It has been stated that people who have less
than 6 hours of sleep a night are at a higher risk for cancer, heart disease
and stroke (4).
The importance of REM sleep is
especially pertinent for people with physical disabilities, as they often
experience some degree of soft tissue trauma during the day. Usually related to
factors such as asymmetric posture, abnormal muscle tone, and inability to
shift position. Therefore, restorative sleep is essential for the replacement
of damaged cells. Also, any kind of disease process will place a demand on the
immune system, which is also stimulated in the deep sleep stage.
For
people who use an adaptive seating system during the day in order to maintain
joint range of motion, decrease contractures, prevent pressure areas and
promote optimum body system functioning, these same needs continue during the
night.
The
human body is a soft structure. During sleep an individual who is able to move
in a conventional, varied, and symmetrical manner, will tend to grow and remain
straight. However, when a person has severe difficulty in moving they are
unable to change the destructive asymmetric posture. Over time, the force of
gravity flattens the body and fixes into asymmetric shapes. If these asymmetric
positions are not corrected there is the risk of developing contractures,
pressure areas, stiffness and/or pain.
Conditions that create difficulty in moving can include, but are not limited to, neurological conditions involving abnormal muscle tone/weakness, post surgery/trauma situations and arthritic/rheumatoid illnesses. Individuals with these physical disabilities often spend more than 50% of their time in bed due to reliance on others, a need for intermittent resting during the day, the need for pressure relief and feeding needs.
Caregivers
of people with physical disabilities also have their sleep patterns disturbed
by having to attend to the individual throughout the night for repositioning,
feeding, cleaning, et cetera. Therefore, they are also prone to insufficient
sleep, which can decrease the immune system, reflexes, motivation and cognitive
skills, along with an increasing irritability and anxiety. These are often
areas that are already at a high level due to the demands of being a caregiver.
DEVELOPMENT
A sleep/rest system is needed for people with neurological conditions involving abnormal muscle tone/weakness, post surgery/trauma, arthritic or rheumatoid conditions and any condition requiring support of posture at rest, either temporary or permanent. The goals of such a system are to continue the good positioning achieved during the day, and to extend the sleep periods both for the individual and for the caregiver in order to address their physical, physiological and psychological needs.
The Better Sleep Council, a nonprofit organization founded in 1978, states that it is essential to create a restful sleeping environment, so that the sleep is restorative and uninterrupted. The council suggests that the sleep environment is comfortable, supportive, cool and quiet.
Market
research was conducted in the United Kingdom into sleeping systems for people
with a physical disability. It was found that 74% of caregivers said they
wanted some sort of nighttime positioning aid, preferably with a device that
was quiet, easy to use, fit on an ordinary bed and was easy to clean.
Jenx recognized this need for a
sleep/rest system that would provide postural support for both temporary and
permanent conditions, and designed The DreamaÔ.
Therapeutic Features:
· Optimal positioning maintained by Glide-lockÔ support pads, which prevent the development of contractures, stiffness and pain.
· Symmetrical position maintained in prone, supine or side lying for optimum body system functioning.
· Flexible aluminum base allows for easy management of aspiration, reflux, edema and fixed contractures.
· Supported rest position promotes extended deep sleep periods needed for body tissue repair and growth.
· Optimal body temperature maintained as individual cushions allow for air circulation.
· Good skin integrity promoted by pressure relieving foam, hypoallergenic cushion lining and soft cushion covers.
· Quiet repositioning of Glide-lockÔ supports allows for undisturbed sleep.
Standard Kit Includes:
· Base: Rust proof aluminum, easily cleanable with soapy water.
· Cushions: Full set of individual removable cushions which enables independent cleaning with a non-toxic solution.
· Cushion covers: Full set plus 4 extra for added convenience. Latex-free terrycloth covers are individually machine washable and tumble dry.
· 6 Glide-lock positioning pads with removable covers.
Areas of discussion may include:
· Suitable candidates for 24hr positioning.
· Need for research into benefits of sleep systems.
· Need for long-term studies into use of DreamaÔ: Ease of use, durability et cetera.
· Alternative sleep systems on the market.
· Effect of increased sleep periods to individual and caregiver.
· Effect of better positioning during sleep and rest.
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