SLEEP AND REST

BY: LAMI G (BSC,MSC IN MRHN)

03/02/2025 BY LAMI G 1
 OBJECTIVES
At the end of this unit, the learners will be able to:
Define rest and sleep pattern
Define terms related to rest and sleep
Compare the characteristics of sleep and rest
Discuss characteristics of two kinds of sleep
Enumerate the function of sleep
Discuss factors effecting sleep
 Identify common sleep disorders
 Identify conditions necessary to promote sleep
 Discuss nursing process for a patient to promote sleep
03/02/2025 BY LAMI G 2
 REST AND SLEEP
Rest
 is a condition in which the body is in a decreased state of activity
without physical emotional stress and freedom from anxiety.

 Sleep
 is a state of rest accompanied by altered level of consciousness and
relative inactivity, and perception to environment are decreased

03/02/2025 BY LAMI G 3
 COMPARISON OF REST AND
SLEEP
The difference between rest and sleep is that

rest is considered a period of bodily inactivity such as relaxing at home

or on vacation and not doing much in terms of psychical activity.

Sleep is characterized by variable level of consciousness , changes in

physiological process, and decrease responsiveness to external stimuli.

Rest is what we do to let stress subside.

03/02/2025 BY LAMI G 4
 PHYSIOLOGY OF SLEEP
The cyclic nature of sleep is thought to be controlled by Centers located in the brain
and by Circadian Rhythms.
Reticular activating system (RAS) located at the brain stem and Cerebral Cortex plays
an important role in sleep wake cycle.
Neurotransmitters, located within the neurons in the brain effect the sleep wake cycle
For example
 serotonin is thought to lessen the response to sensory stimulation and GABA gamma
aminobutyric acid to shut off the activity of neurons in RAS. •
 Another key factor to sleep is exposure to darkness.
 Pineal gland in brain secrete melatonin , and the person feel less alert
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CONT....

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 CIRCADIAN RHYTHMS
It is a sort of 24-hour internal biological clock.

The term circadian is from the Latin “circa dies”, meaning “about a day.”

Biological rhythms exist in plants, animals, and humans.

In humans, these are controlled from within the body and synchronized with
environmental factors, such as light and darkness.

03/02/2025 BY LAMI G 7
 STAGES OF SLEEP
Stages Of Sleep identified by using
 Electroencephalogram (EEG) patterns,
 eye movements and
 muscle activity
Classified into two stages:
1. Non Rapid Eye Movement (NREM)
 Sleep o Stage 1, Stage 2, Stage 3, Stage
2. Rapid Eye Movement Stage(REM) Sleep.
 During sleep, NREM and REM sleep alternate in cycles

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NON RAPID EYE MOVEMENT
(NREM) SLEEP
First stage of sleep is known as NREM sleep.

About 75% to 80% of sleep during a night is NREM sleep.

 It consists of four stages:

Stage 1

Stage 2

Stage 3

Stage 4
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 NREM SLEEP
Stage 1: NREM

 Stage lasts a few minutes.

 It includes lightest level of sleep.

 Gradual fall in vital signs and metabolism.

 Eyes tend to roll slowly from side to side

Sensory stimuli such as noise easily arouses person.

 Sleeper may deny he is sleeping.

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 NREM SLEEP
Stage 2: NREM
 Stage lasts 10 to 15 minutes.
 44% to 55 %of total sleep
 It is a period of sound sleep.
 Relaxation progresses.
 Absent eye ball movements
 Body functions continue to slow.
 Arousal remains relative easy

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 NREM SLEEP
Stage 3: NREM

Stage lasts 15 to 30 minutes.

It involves initial stages of deep sleep.

Muscles are completely relaxed.

Vital signs decline but remain regular.

Sleeper is difficult to arouse and rarely moves

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NREM SLEEP
Stage 4: NREM

Stage lasts approximately 15 to 30 minutes.

It is the deepest stage of sleep.

Vital signs are significantly lower than during waking hours.

Sleepwalking and enuresis (bed-wetting) sometimes occur.

It is very difficult to arouse sleeper

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PHYSIOLOGICAL CHANGES
DURING NREM SLEEP
Arterial blood pressure falls
 Pulse rate decreases
 Peripheral blood vessels dilate
 Cardiac output decreases
 Skeletal muscles relax
 Basal metabolic rate decreases 10 % to 30%.
 Growth hormone level peak
Intracranial pressure decreases.

03/02/2025 BY LAMI G 14
LOSS OF NREM SLEEP
 In a sleep deprived client, the loss of NREM sleep causes

 Immunosuppressant

 Slows tissue repair

 Lowers pain tolerance

 Triggers profound fatigue

 And increase susceptibility to infection

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 REM SLEEP / PARADOXICAL
SLEEP
Stage usually begins about 90 minutes after sleep has begun.

Dreaming occurs in this stage

During REM the brain is highly active and the brain metabolism as much as increase
20%

 Stage is typified by rapidly moving eyes, fluctuating heart and respiratory rates,
increased or fluctuating blood pressure, loss of skeletal muscle tone, and increase of
gastric secretions..

 It is very difficult to arouse sleeper.

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CONT..

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 FUNCTIONS OF SLEEP
Conservation of energy

Restoration of tissues and growth

Thermoregulation

Regulation of emotions- sleep deprivation causes emotional disorders like

irritability, anxiety, depression etc.

Sleep is also necessary for protein synthesis

Memory and learning- there will be information transfer between cerebral

cortex and hippocampus during sleep
03/02/2025 BY LAMI G 18
 NORMAL SLEEP
REQUIREMENTS
Newborn: 16-18 hours /day
Infants: 12-14 hours
Toddlers(1-3years): 10-12 hours
 Preschool(3-5years): 11-12 hours
 School-Age(5-12years): 8- 12 hours
Adolescents(12-18years): 8-10 hours
Adult: 6-8 hours
 Elders (65-75years): 6 hours

03/02/2025 BY LAMI G 19
 FACTORS AFFECTING SLEEP
Both the quality & the quantity of sleep are affected by a
number of factors.

Sleep quality is a subjective characteristic

Quantity of sleep is the total time the individual sleeps.

1. AGE: New jobs, pregnancy and babies are common examples

that often disrupt the sleep of a young adult. Physiological
changes in the brain due to senility
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 CONT..
2. Illness

Illness that causes pain or physical distress (e.g., arthritis, back ache) can result in

sleep problems
Elevated body temperatures can cause some reduction in delta sleep and REM sleep

Side effects of medications

 Gastric reflux disease

 Respiratory and circulatory disorders, which may cause breathing problems or

discomfort
 Pain from arthritis, increased stiffness, or impaired immobility

 Nocturia (urge to urinate at night)

 Depression

Confusion related to delirium dementia

03/02/2025 BY LAMI G 21
 CONT..
3. Environment

 Environment can promote or hinder sleep

Any change—for example, noise in the environment—can inhibit sleep.

The absence of usual stimuli or the presence of unfamiliar stimuli can prevent people from

sleeping

Discomfort from environmental temperature (e.g., too hot or cold) and lack of ventilation

can affect sleep

Light levels can be another factor

 Another influence includes the comfort and size of the bed.

 A person’s partner who has different sleep habits, snores, or has other sleep difficulties
03/02/2025 BY LAMI G 22
 CONT..
4. Lifestyle

Following an irregular morning and night time schedule can affect sleep.

Night shift workers frequently obtain less sleep than other workers and
have difficulty falling asleep.

Wearing sunglasses & light-blocking shades can minimize the alerting

effects of exposure to daylight

03/02/2025 BY LAMI G 23
CONT...
5. Emotional Stress

Stress is considered to be the major cause of short-term sleeping difficulties

A person preoccupied with personal problems (e.g., school- or job-related pressures,

family or marriage problems) may be unable to relax sufficiently to get to sleep.

6. Stimulants and Alcohol

Caffeine-containing beverages act as stimulants of the central nervous system

(CNS).

Drinking beverages containing Caffeine in the afternoon or evening may interfere

with sleep.

Even though alcohol induces sleep, it disturbs REM sleep causing irritability
03/02/2025 BY LAMI G 24
 CONT...
6. Stimulants and Alcohol

Caffeine-containing beverages act as stimulants of the central nervous system (CNS).

Drinking beverages containing Caffeine in the afternoon or evening may interfere with sleep.

Even though alcohol induces sleep, it disturbs REM sleep causing irritability

7. Diet
 Certain foods induces sleep • Ex: the L- tryptophan present in the milk induces sleep

8. Smoking
 Nicotine has a stimulating effect on the body, and smokers often have more difficulty falling
asleep than non smokers.
 Smokers can be easily aroused

03/02/2025 BY LAMI G 25
 CONT..
9. Motivation

Motivation can increase alertness in some situations (e.g., a tired person can probably
stay alert while attending an interesting concert or surfing the web late at night)

10. Medications:
 Beta-blockers have been known to cause insomnia.

 Narcotics, such as morphine, are known to suppress REM sleep and to cause frequent
awakenings and drowsiness.
 These drugs may disrupt REM sleep, delay onset of sleep or decrease sleep time:

o Alcohol, Amphetamines, Antidepressants, Beta-blockers, Bronchodilators, Caffeine,

Decongestants, Narcotics, Steroids.

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SLEEP DISORDERS

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 DYSOMNIAS
The sleep itself is pretty normal.

 But the client sleeps too little, too much, or at the wrong time.

So, the problem is with the amount (quantity), or with its timing, and sometimes with the
quality of sleep.

Common Dysomnias are:

 Insomnia

 Hypersomnia

 Narcolepsy

 Sleep Apnea

 Insufficient Sleep/ Sleep Deprivation

03/02/2025 BY LAMI G 28
 INSOMNIA
 Insomnia is described as the inability to fall asleep or remain asleep.

 Persons with insomnia awaken not feeling rested.

Insomnia is the most common sleep complaint.

 Acute insomnia lasts one to several nights and is often caused by personal
stressors or worry.

 If the insomnia persists for longer than a month, it is considered Chronic insomnia

 Insomnia can result from physical discomfort and more often from mental tension
or anxiety.

People who are habituated to drugs or who takes large amounts of alcohol are at
high risk for insomnia.
03/02/2025 BY LAMI G 29
 CONT..
Clinical manifestations of Insomnia

■ Difficulty falling asleep

■ Waking up frequently during the night

■ Difficulty returning to sleep

■ Waking up too early in the morning

■ Unrefreshing sleep

■ Daytime sleepiness

■ Difficulty concentrating

■03/02/2025
Irritability BY LAMI G 30
 CONT..
Treatment of Insomnia

frequently requires the client to develop new behavior patterns that

induce sleep and maintain it.

Examples of behavioral treatments include the following:

Stimulus control: creating a sleep environment that promotes sleep

Cognitive therapy: learning to develop positive thoughts and beliefs

about sleep

 Sleep restriction: following a program that limits time in bed in order

to get to sleep and stay asleep throughout the night (National Sleep
03/02/2025 BY LAMI G 31
 HYPERSOMNIA
refers to conditions where the affected individual obtains
sufficient sleep at night but still cannot stay awake during
the day.

can be caused by medical conditions, for example, CNS

damage and certain kidney, liver, or metabolic disorders,
such as diabetic acidosis and hypothyroidism

03/02/2025 BY LAMI G 32
 NARCOLEPSY
Narcolepsy is a disorder of excessive daytime sleepiness caused by the lack
of the chemical hypocretin in the area of the CNS that regulates sleep.

Clients with narcolepsy have sleep attacks or excessive daytime sleepiness,

and their sleep at night usually begins with a sleep-onset REM period
(dreaming sleep occurs within the first 15 minutes of falling asleep).

 People sleeps several times a day even when they are conversing with
people or while driving.

 CNS stimulants and Antidepressants are the drugs used to treat narcolepsy.

03/02/2025 BY LAMI G 33
 SLEEP APNEA
is characterized by frequent short breathing pauses during sleep.

Although all individuals have occasional periods of apnea during sleep, more than
five apneic episodes longer than 10 seconds in an hour is considered abnormal and
should be evaluated by a sleep medicine specialist.

 is most frequently diagnosed in men and postmenopausal women, it may occur

during childhood.

Three types of apnea based on the cause

1. Obstructive Apnea

2. Central Apnea

3. Mixed Apnea
03/02/2025 BY LAMI G 34
 CONT..
1. OBSTRUCTIVE APNOEA:

 Obstructive apnea occurs when the structures of the pharynx or oral cavity block the

flow of air. Enlarged tonsils and adenoids, a deviated nasal septum, nasal polyps, and
obesity predispose the client to obstructive apnea

Treatment includes surgical removal of tonsils, correcting nasal septum, weight loss

may be helpful.

2. CENTRAL APNEA:

Due to defect in the respiratory center of the brain. • Clients who have brainstem

injuries and often have central sleep apnea.

[Link] APNOEA

 Mixed
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apnea is combination of obstructive and central apnea BY LAMI G 35
 INSUFFICIENT SLEEP/ SLEEP
DEPRIVATION
A prolonged disturbance in quality and quantity of sleep can lead to a syndrome called as sleep
deprivation.

 It is not a sleep disorder but result of prolonged sleep disturbance.

 It produces various physiological and behavioral symptoms based on the severity of deprivation.

Individuals may develop:

o Attention and concentration deficits

o Reduced vigilance
o Distractibility
o Reduced motivation
o Fatigue

o Diplopia and dry mouth.

03/02/2025 BY LAMI G 36
 PARASOMNIAS
Something abnormal occurs during sleep itself, or during the times when the client is
falling asleep or waking up

The quality, quantity, and timing of the sleep are essentially normal.

Most common DISORDERS are:

o Bruxism • Enuresis • Periodic limb movement disorder • Sleep talking • Sleep walking

1. Bruxism:

Usually occurring during stage II NREM sleep, characterized by clenching and grinding of
the teeth.

This clenching and grinding of the teeth can eventually erode dental crowns, cause teeth
to come loose, and lead to deterioration of the temporomandibular (TMJ) joint, called TMJ
syndrome
03/02/2025 BY LAMI G 37
 CONT..
2. Enuresis:

Bed-wetting during sleep occurring in children over 3 years old.

More males than females are affected.

 It often occurs 1 to 2 hours after falling asleep. Periodic limb movement

disorder (PLMD):

 In this condition, the legs jerk twice or three times per minute during sleep.

03/02/2025 BY LAMI G 38
 CONT...
3. Sleep talking:

Talking during sleep occurs during NREM sleep before REM sleep.

 It rarely presents a problem to the person unless it becomes

troublesome to others Sleepwalking: Sleepwalking (somnambulism)
occurs during stages III and IV of NREM sleep. It is episodic and usually
occurs 1 to 2 hours after falling asleep.

Sleepwalkers tend not to notice dangers (e.g., stairs) and often need
to be protected from injury

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 DISORDERS DUE TO OTHER
MEDICAL CONDITIONS
These disorders are associated with Medical or Psychiatric or other illness

 Usually the disorders that cause sleep disturbance includes:

 Depression

Alcoholism

Thyroid dysfunction

 Peptic ulcer

 COPD- chronic obstructive pulmonary disease

03/02/2025 BY LAMI G 40
 NURSING MANAGEMENT
Assessment
o it includes complete sleep history, health history and physical
examination.

 Nursing Diagnosis
o Sleep disturbed pattern ( insomnia)

o Risk for injury related to somnambulism

o Fatigue related to insufficient sleep

o Risk for impaired gas exchange related to sleep apnea

o Anxiety related to sleep apnea

03/02/2025 BY LAMI G 41
 CONT...
If Standardized Assessment is Not available, use “BEARS” Sleep
Assessment as a guide
B - bedtime problems?

E - excessive sleepiness during the day?

A - awakenings at night?

R - regularity of sleep (number of hours)?

S - sleep disorder including sleep apnea & snoring Also, may inquire
about lifestyle factors impacting sleep such as work schedule, alcohol
use, illness, medications, bed sharing arrangements, etc.
03/02/2025 BY LAMI G 42
CONT..
Planning

 The major goal for client with sleep disturbances is to maintain or

develop a sleeping pattern that provide sufficient energy for daily

activities

 The other goal may relate to enhance the client’s feeling of

wellbeing or improving the quality and quantity of client’s sleep

03/02/2025 BY LAMI G 43
CONT..
Nursing intervention

 Reducing environmental distraction • Promoting bedtime

rituals

Providing comfort measures

 Scheduling nursing care to provide for uninterrupted sleep

periods

Teaching stress reduction, relaxation techniques or good

sleep hygiene
03/02/2025 BY LAMI G 44
CONT..
Nursing intervention to Promote Sleep
1. Sleep-Wake Pattern
 Maintain a regular bedtime and wake-up schedule
Eliminate day time naps. If naps are taken, limit to 20 minutes or less
twice a day
Instruct the client to go to bed when sleepy.
Use warm bath and relaxation techniques
Establish a regular, relaxing bedtime routine before sleep such as
reading, listening to soft music, taking a warm bath, or doing some
other quiet activity.
Avoid dealing with office work or family problems before bedtime
 Get adequate exercise during the day to reduce stress,
03/02/2025
but45 avoid
BY LAMI G
CONT...
2. Environment:
 Create a sleep-conducive environment that is dark, quiet, comfortable, and cool.

 Keep noise to a minimum; block out extraneous noise as necessary with white noise
from a fan, air conditioner.
Sleep on a comfortable mattress and pillows.

 Listen to relaxing music

3. Diet:
 Limit alcohol, caffeine, and nicotine in late afternoon and evening

 Consume carbohydrates or milk as a light snack before bedtime.

Avoid heavy and spicy foods. Heavy or spicy foods can cause gastrointestinal upsets
that disturb sleep
 Decrease fluids 2 to 4 hours before sleep
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 CONT...
[Link]:

 use sleeping medications only as a last resort

 Minimize the usage of medicines as much as possible because many

contain antihistamines that cause daytime drowsiness.

Take analgesics 30 mins before bedtime to relieve aches and pains.

03/02/2025 BY LAMI G 47
 CONT...
5. Evaluation

If the desired outcomes are not achieved, the nurse and client should explore the reasons:

 Were etiologic factors correctly identified?

 Has the client’s physical condition or medication therapy changed?

 Did the client comply with instructions about establishing a regular sleep/wake pattern?

 Did the client avoid ingesting caffeine?

 Did the client participate in stimulating daytime activities to avoid excessive daytime
naps?

 Were all possible measures taken to provide a restful environment for the client?

Were the comfort and relaxation measures effective?

03/02/2025 BY LAMI G 48
 THANK YOU

03/02/2025 BY LAMI G 49