A nurse is caring for a client who has a history of migraines. The client tells the nurse, "I have not been sleeping well. My migraine headaches have returned after not having one for over a year." The nurse should identify which of the following are potential contributing factors to the client’s migraines? (Select all that apply.)

A. Nonpharmacological interventions for sleep promotion, such as relaxation techniques, massage, music therapy, and thermotherapy, can be safely implemented in both home and clinical settings. Limiting them to the home is unnecessary.

B. Clients on anticoagulants are at increased risk for bruising or bleeding. Massage could be harmful in these clients and should generally be avoided or performed with extreme caution.

C. Acupuncture, thermotherapy (such as warm baths or heat application), relaxation techniques, music therapy, and guided imagery are effective nonpharmacological interventions that help promote sleep by reducing stress, muscle tension, and anxiety.

D. This is not required for general sleep-promoting interventions. While clients with severe or chronic sleep disorders may benefit from specialist evaluation, routine nonpharmacological interventions can safely be initiated by nursing staff without a specialist referral.

A. Older adults experience a decrease in stage 4 sleep, which is the deepest, slow-wave sleep responsible for physical restoration, tissue repair, and immune system support. The reduction in stage 4 contributes to lighter sleep, less restorative rest, and increased susceptibility to awakenings during the night.

B. Stage 3 sleep, another component of deep, slow-wave non-REM sleep, also decreases with age. This decline reduces the total amount of restorative sleep, which can lead to daytime fatigue, difficulty concentrating, and increased nighttime awakenings.

C. Stage 1 sleep, the lightest stage of non-REM sleep, does not significantly decrease with age. Older adults continue to enter stage 1 sleep as a normal part of the sleep cycle. However, the proportion of light sleep relative to deep sleep increases, making the overall sleep more fragmented and easier to disrupt.

D. Older adults spend more time in stage 2 sleep, which is a lighter stage of non-REM sleep characterized by sleep spindles and slower brain activity. While stage 2 is important for memory consolidation and some restorative processes, it is easier to awaken from than stages 3 and 4. The increased proportion of stage 2 sleep contributes to frequent nighttime awakenings, lighter sleep, and shorter total sleep time, which are common complaints among older adults.