REST AND SLEEP
decreases slightly, and body temperature falls. Only
REST AND SLEEP:
 Rest and sleep are essential for health. People who
are ill frequently requires more rest and sleep than
usual.
 Rest restores a person's energy, allowing the
individual to resume optimal functioning.
 Rest implies calmness and relaxation without
emotional stress, and freedom from anxiety, therefore
rest does not always reply inactivity; in fact some
people may find certain activities such as walking,
restful.
 Sleep is a basic human need, it is a universal biological
process common to all people.
 Historically, sleep was considered a state of
unconsciousness. Recently, it is considered an altered
state of consciousness in which an individual's
perception of and reaction to the environment are
decreased.
PHYSIOLOGY OF SLEEP:
 The cycle nature of sleep is thought to be controlled by
centers located n the lower part of the brain. These
centers inhibit wakefulness, thus casing sleep.
 Biorhythms (rhythmic biologic clock) are controlled
from within the body and synchronized with
environmental factor, such as light and darkness,
gravtiy and electromagnetic stimuli.
 The most common biorhythm is is the circadian
rhythm.
Sleep is a complex biologic rhythm, when a person's
biologic clock coincides with sleep-wake patterns, the
person is said to be in cyrcadian synchronization;
the person is awake when the physiologic and
psychologic rhythms are most active, and is asleep
when they're inactive.
STAGES OF SLEEP:
1. NREM Sleep- also referred to as slow-wave sleep,
because the brain waves of a sleeper are slower the
alpha and beta waves of a person who is awake.
o most sleep during the night is NREM sleep
o it is a deep, restful sleep and brings a decrease in
metabolic process including vital signs,
metabolism, and muscle action.
4 Stages of NREM:
a. Stage I- stage of very light sleep. During this stage,
the person feels drowsy and relaxed, the eyes roll from
side to side, he heart and respiratory rate drops
slightly. Sleeper can be readily awakened and lasts
only a few minutes.
b. Stage II- stage of light sleep during which body
processes continue to slow down. The eyes are
generally still, the heart and respiratory rates
lasts about 10 to 15 minutes but 40% to 45% of total
sleep.
c. Stage III- heart and respiratory rates, as well as other
body processes, slow further because of domination of
the parasympathetic nervous system. The sleeper
becomes more difficult to arouse, and is not disturbed
by sensory stimuli, skeletal muscles are relaxed,
reflexes are diminished, snoring may occur.
d. Stage IV- deep sleep. The sleeper's heart and
respiratory rates drop 20-30% below waking hours,
sleeper is very relaxed, rarely moves, and is difficult to
arouse. Thought to restore body physically. during this
stage, eyes usually roll, and some dreaming occurs.
2. REM Sleep- REM sleep usually recurs about every 90
minutes and lasts 5-30 minutes.
o not a restful sleep as NREM sleep, and most
dreams occur during REM sleep, and these
dreams are usually remembered. Sleeper is
difficult to arouse but may wake spontaneously,
muscle tone is depressed, gastric secretions
increase, heart and respiratory rates are often
irregular.
o the brain is highly active. This type of sleep is also
called paradoxical sleep.
SLEEP CYCLE:
 a complete cycle usually lasts about 1.5 hours in
adults.
 the usual sleeper experiences four to six cycles of
sleep during a 7-8 hours
 the sleeper who is awakened during any stage, begins
again at the beginning
 duration of the stages varies throughout the sleep
period.As the night progresses, the sleeper becomes
less tired and spends less time in Stage III and IV,
REM sleep increases and dreams tends to lengthen.
 if the sleeper is very tired, REM cycles are often short
FUNCTIONS OF SLEEP:
 restores normal levels of activity and normal balance
among parts of the nervous system.
 necessary for protein synthesis, which allows repair
processes.
 persons with inadequate sleep tend to become
emotionally irritable, have poor concentration, and
experience difficulty making decisions
FACTORS AFFECTING SLEEP:
 Quality of sleep refers to the individual's ability to stay
asleep and et the appropriate amounts of REM and
NREM sleep.
 Quantity of sleep is the total time the individual sleeps.
1. Illness- causes pain or physical distress can
result in sleep problems. People who are ill require
more sleep than normal, and the normal rhythm of
sleep and wakefulness is often disturbed.
2. Environment- either promote or hinder sleep. The
absence of usual stimuli or the presence of
unfamiliar stimuli can prevent people from
sleeping.
3. Fatigue- the more tired a person is, the shorter the
first period REM, as the person rests, REM
periods become longer.
4. Lifestyle- People who does shift work and
changes shift frequently must arrange activities to
be ready to sleep at the right time. Moderate
exercise is usually conducive to sleep, nut
excessively done delays sleep.
5. Emotional Stress- anxiety and depression
frequently disturb sleep. A person preoccupied
with personal problems may be unable to relax
sufficiently to get to sleep.
6. Stimulants and Alcohol- Caffeine containing
beverages acts as stimulants of the CNS, thus
interfering with sleep. People who drink an
excessive amount of alcohol often find their sleep
disturbed. Excessive alcohol disrupts REM sleep,
although it hasten the onset of sleep.
7. Diet- weight loss has been associated with an
reduced total sleep time, as well as broken sleep
and earlier awakening. Weight gain, on the other
hand, seems to be associated with an increase in
total sleep time, less broken sleep, and later
waking hours.
8. Smoking- nicotine has a stimulating effect on the
body, and smokers often have more difficulty
falling asleep than nonsmokers.
9. Motivation- desire to stay awake can often
overcome a person's fatigue.
10. Medication- medications affect the quality of
sleep: hypnotics can interfere with stage III and IV
and suppress REM. Beta-blockers can cause
insomnia and nightmares. Narcotics are known to
suppress REM and cause frequent awakenings
and drowsiness.
COMMON SLEEP DISORDERS:
 Sleep Disorders may be categorized as parasomnias,
primary disorder, sand secondary disorder.
Parasomnia is a behavior that may interfere with
sleep or that occurs with sleep. It is subdivided into:
1. arousal disorder- sleep walking, sleep terrors
2. sleep wake transition disorder- sleep talking
3. parasomnias associated with REM-
nightmares, nocturnal erections
PRIMARY SLEEP DISORDER:
 those in which the person's sleep is the main disorder
Insomnia- most common sleep disorder. It is the
inability to obtain an adequate amount or quality of
sleep. There are three types of insomnia:
1.1 difficulty in falling asleep (initial insomnia)
1.2 difficulty in staying asleep because of frequent or
prolonged waking (intermittent or maintenance
insomnia)
1.3 early morning or premature waking (terminal
insomnia)
 Can result from physical discomfort but more often is
a result of mental overstimulation due to anxiety.
 Treatment for insomnia frequently requires the client
to develop new behavior patterns that induce sleep.
Sleep medication is questionable because they do not
deal witht he cause of problems, and prolonged use
can create dependency.
Hypersomnia- excessive sleep, particularly in the
daytime. The affected person often sleeps until noon,
and takes many naps during the day.
Narcolepsy- sudden wave of overwhelming
sleepiness that occurs during the day, referred to as
"sleep attack". Even though people who have
narcolepsy sleep well at night, they nod off several
times a day even when conversing with someone or
driving a car.
Sleep Apnea- periodic cessation of breathing during
sleep.
 Often suspected when the person has loud
snoring, frequent nocturnal awakenings,
excessive daytime sleepiness, insomnia, morning
headaches, intellectual deterioration, irritability,
personality changes and some physiologic
changes such as hypertension and cardiac
arrythmias.
 The periods of apnea, which last from 10seconds
to 2 minutes, which occurs during REM or NREM
sleep. Frequencies ranges from 50 to 600/night,
and drains the person of energy and lead to
excessive day time sleepiness.
4.1 Obstructive apnea- occurs when structures
of the pharynx or oral cavity block the flow of air.
The person still tries to breath.
4.2 Central apnea- thought ti involve a defect in
the respiratory center of the brain. All actions
involving breathing, such as chest rising and
airflow, ceases.
4.3 Mixed apnea- combination of obstructive and
central apnea.
 An episode of sleep apnea usually begins with
snoring; thereafter, breathing ceases, followed by
marked snorting as breathing resumes. Toward
the end of each apneic episode, increased carbon
dioxide levels in the blood causes the client to
wake.
  Treatment for sleep apnea can be directed to the  for clients who have pain, administer analgesias at
cause of the apnea. eg surgeries, CPAP device least 30mins before sleep
Sleep deprivation- caused by prolonged disturbance  listen to client'c concerns and deal with problems as
in amount, quality, and consistency of sleep. This is they arise
not a sleep disorder in itself, but a result of sleep
disturbances.  Emotional stress obviously interferes with a person's
ability to relax, rest and sleep, and the inability to sleep
SECONDARY SLEEP DISORDER: aggravates feelings of tension. Sleep rarely occurs
 Sleep disturbances caused by other conditions. They until a person is relaxed, relaxation techniques can be
may be associated with mental, neurologic or other encouraged as part of nightly routines (deep breathing
conditions. Examples of conditions causing secondary exercises, imagery, meditation, yoga)
sleep disorders include depression, alcoholism,
dementia, Parkinsonism, thyroid dysfunction, chronic 5. Enhancing sleep with Medications- sleep
obstructive pulmonary disease, and peptic ulcer medications often prescribed on a prn basis for clients,
disease. which includes the sedative-hypnotics, which induces
sleep, and the anti-anxiety drugs or tranquilizers,
NURSING INTERVENTIONS: which decreases anxiety and tension. When prn
 Nursing interventions to enhance the quality and medications are ordered in the institutional setting, the
quantity of client's sleep involve largely nurse is responsible for making decisions with the
nonpharmacologic measures. client when to administer them. These medications
1. Client teaching- healthy individuals need to learn the should be administered only with complete knowledge
importance of rest and sleep in maintaining active and of their actions and effects and given only when
productive lifestyle. indicated.
2. Supporting Bedtime Rituals- most people are
accustomed to bedtime rituals and pre-sleep routines  Whenever possible, nonpharmacologic
that are conducive to comfort and relaxation. common interventions, are preferred.
pre-bedtime activities include evening strolls, listening
to music, watching television, taking a shower/baths,
and praying.
 In institutional settings, nurses can provide or assist to
provide similar activities
3. Creating a Restful Environment- people need a
good sleeping environment with minimal noise, a
comfortable room temperature, appropriate
ventilation, and appropriate lighting.
 To create a restful environment, the nurse needs
to reduce environments distractions, reduce sleep
interruptions, ensure safe environment and
provide room temperature that is satisfactory to
the client.
4. Promoting Comfort and Relaxation- comfort
measures are essential to help the client fall asleep
and stay asleep, especially if the effects of the
person's illness interfere with sleep.

Interventions that can significantly promote client

comfort and sleep:
 provide loose fitting nightwear
 assist clients with hygienic routines
 make sure the bed linen is smooth, clean and dry
 assist to encourage the client to void before bedtime
 offer to provide a back massage before sleep
 position dependent clients appropriately to aid muscle
relaxation, and supportive devices to protect pressure
areas.
 schedule medications, especially diuretics, to prevent
nocturnal awakenings