Phosphene-Induced Sleep

[Davey Do]

An interesting Event occurred with a Patient that I'd like to share with you.

This Geriatric Patient was on a 1:1 Status as a result of being a High Fall Risk with Combative Behaviors. The Patient is Oriented to Self only and overtly manifests Symptoms of Psychosis, such as being Delusional.

The Staff assigned to this Patient is a very good LPN. This LPN Monitors the Patient well, speaks Soothingly, and provides for Basic Needs. Despite this LPN's Soft Presence, the Patient became Irritable and attempted to Ambulate without the Walker or Direct Assistance and would only Sporadically Redirect.

During an Short Interval of Diversional Activity when the Patient eating some Comfort Food, I administered some PO PRN Medications of Vistaril and Zyprexa.

Some time later, the Patient continued to be Restless and again attempted to Ambulate without Assistance. The LPN and I sat at the Patient's bedside and responded to Verbalizations stemming from a Delusional State. For example, when the Patient said something like, "I've got to get up and Tow that Line" we'd respond with something like, "You sure are Hard Worker! Do you think it'd be a Good Idea to get Some Rest now so you can be ready for Tomorrow's Hard Work?"

Although the Patient was obviously getting Drowsy and Fighting Sleep, the Restless Behavior continued. I asked, "Hey- would you help me out here?" Patients usually want to help, as this one did. I asked the Patient to put their Legs up on the Bed and Lay back. Then I asked the Patient to close their Eyes. The Patient did as I Requested, yet continued to talk. I asked the Patient what they saw behind their Closed Eyes. "My Mother" was the Response. When I asked for More Information, the Patient said, "She's in bed and I make sure she has her Medications Three Times a Day". I Reinforced the Patient's Care for their Mother and then requested that the Patient "just look at your Mother and don't say anything". I soon heard slow, regular Respirations, indicating the Patient had fallen asleep.

In a Thread on the Breakroom side of AN.com, I wrote about a Technique used to fall Asleep. That Portion of the Post is Replicated here:

"The Other night, a Pt c/o insomnia, even though all Appropriate PRNs had been administered. I shared a Self-Taught Method I use to fall asleep with this Pt:

First, I use a method of Breathing, which is a Sanskrit Word, called "Pranayama"- relatively deep Inhalations and Exhalations.

Once My Breathing is Regular without Conscious Thought, I "examine" the Flashes of Light I see with my eyes closed. I make pictures out of these Flashes of Light, and typically, I'm asleep within a Short Amount of Time.

After discussing This Technique with the Pt, I looked up some Information on Wikipedia. To My Delight, I found that these Flashes of Light are termed to be "Phosphene" which "is a phenomena characterized by the experience of seeing light without light actually entering the eye... phosphenes can be directly induced by mechanical, eletrical, or magnetic stimulation of the retina or visual cortex as well as by random firing of cells in the visual system."

I won't bore you with my Subsequent Study of Alpha Waves, the Cerebral Cortex or the Occipital Lobe of the Brain, but My Technique was reinforced by this Information."

The Patient in the Original Scenerio may have Interpretted the Phosephene as an Image of their Mother. When the Patient stopped Talking and focused on the Image, a type of Meditation was experienced and sleep followed.

[TerpGal02, ASN]

That is really interesting. Might be trying that one out. With a lot of Tue dementia pts we get, esp the ladies, I'll unfold a bog stack of clean linens and ask if they would mind helping me fold the wash. That usually calms them right down. Those repetative tasks, y'know. My fave relaxation techniques are progressive muscle relaxation and guided imagery. The latter often works quite well with the kids who get homesick at night.

[aTOMicTom]

You sure sound calm and thoughtful, Davey Do. Your pts are lucky to have you.

I'll file this away under "wisdom, geriatric sleep inducing".

Tom

[Davey Do]

Thank you both for the Repiles.

TerpGal: Yeah- It seems that People who were Busy in their Previous Life find a Sort of Relaxation in Performing a Known Task Repatedly. And Guided Imagery is Great Stuff. I was introduced to that Relaxation Technique back in the 80's when Chemical Dependency was a Good-Sized Inpatient Process.

I hadn't thought about the Homesick Kid Thing. You've given me an Idea, TerpGal, that I just might Put into Practise when I work on the Child or Adolescent Psych Unit.

Tom: Thanks for the Kind Words. Outwardly, the Majority of Those I come in Fleeting Contact With believe I am as you say: Calm and Thoughtful. However, My Outward Demeanor is a Learned Image Taught to me by Those Who Have Gone Before. It's like a Past Supervisor, for Whom I had Great Respect, once told me, "When you walk through That Door you're 'On' and There for the Patient".

Thanks again.