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PROMOTING REST AND

SLEEP
SLEEP
• Sleep is the altered level of consciousness
in which the individual’s perception of and
reaction to environment are decreased
What regulates sleep and
wakefulness?
• Reticular formation on the Brain Stem
• Ascending nerve fibers
– Reticular Activating System (RAS)
– Sleep Wake Cycle
TYPES OF SLEEP
• NREM
– Non-Rapid Eye Movement Sleep
• REM
– Rapid Eye Movement Sleep
NON-RAPID EYE MOVEMENT
SLEEP
• When the RAS is inhibited
– Sleep
• BODY RESTORATION
– About 75% to 80% of sleep
– Has 4 stages
NREM (Non-Rapid Eye Movement
Sleep)
• Stage I (Very Light Sleep)
– Lasts only a few minutes
– Drowsy and relaxed
– Eyes roll from side to side
– HR and RR drop slightly
– Readily awakened
NREM (Non-Rapid Eye Movement
Sleep)
• Stage II (Light Sleep)
– Last for 10-15 minutes
– Body processes continue to slow down
– HR and RR decrease furthermore
– Body temperature falls
– Eyes are still
NREM (Non-Rapid Eye Movement
Sleep)
• Stage III
– The HR and RR, as well as other body
processes, slow further
– The sleeper becomes more difficult to arouse
– The skeletal muscles are very relaxed
– The reflexes are diminished and snoring ay
occur
NREM (Non-Rapid Eye Movement
Sleep)
• Stage IV (delta sleep or Deep sleep)
– HR and RR drop 20-30% below that exhibited
during waking hours
– Sleeper is very relaxed, rarely moves and is
difficult to arouse
– This stage is thought to restore the body
physically
REM (Rapid Eye Movement
Sleep)
• Occurs about every 90 minutes
• Lasts from 5 to 30 minutes
• “Paradoxical Sleep”
– Resemble wakefulness
– Brain is highly active
– Dreams are usual
REM (Rapid Eye Movement
Sleep)
• Irregular HR and RR
• May be difficult to arouse or wake up
spontaneously
NREM (Non-Rapid Eye Movement
Sleep)
• The person must pass through the NREM
and REM
• 1 cycle lasts for 90 to 110 minutes (1 ½ to 2
hours)
– 1st 3 stages of NREM (20 -30 minutes)
– Stage IV (30 minutes)
– Back to NREM stages III and II (20 minutes)
– REM (10 minutes)
• Very brief
• Skipped entirely
Sleep Cycle
• A sleeper who is awakened at any stage
must begin a new cycle
• In a 7 to 8 hours of sleep
– 4 – 6 cycles
FUNCTIONS OF SLEEP
• Sleep restore normal levels of activity and
normal balance among parts of the
nervous system
• Sleep is necessary for protein synthesis,
which allow repair processes to occur
Normal Sleep Requirements
• Newborns
– 16 to 18 hours a day

Infants
14 to 15 hours

Toddlers
12 to 14 hours
Normal Sleep Requirements
• Preschoolers
– 11 to 13 hours

• School Aged
– 10 to 11 hours

• Adolescents
9 to 10 hours
Normal Sleep Requirements
• Adults
– 7 to 9 hours

Elders
7 to 9 hours
many sleeping problems
tendency toward earlier bedtime and wake times
increase in disturbed sleep
medical conditions
Factors Affecting Sleep
• Illness
– Pain or physical distress
• Arthritis, back pain and ulcers
• Respiratory Conditions
– Nasal congestion

• Need to urinate
Factors Affecting Sleep
• Environment
– Noise
– Absence of usual stimuli or the presence of
unfamiliar stimuli
– Discomfort from environmental temperature
• Too hot or too cold
– Comfort and size of the bed
Factors Affecting Sleep
• Emotional stress
– Considered by sleep experts as the number
one cause of short term sleeping difficulties
• Preoccupied with personal problems
• May be unable to relax sufficiently to get to sleep
Factors Affecting Sleep
• Stimulants and alcohol
– Caffeine containing beverages
• Coffee
• Tea
• Chocolate drinks
– Alcohol
• Speed up the onset of sleep
• BUT disrupts REM
Factors Affecting Sleep
• Smoking
– Nicotine has a stimulating effect on the body

– Smoker
• Refrain from smoking after the evening meal
COMMON SLEEP DISORDERS
• Inability to fall asleep or remain asleep
• Acute Insomnia
– Last 1 to several nights
– Caused by personal stressors
• Chronic
– Persists for longer than month
COMMON SLEEP DISORDERS
• Chronic Intermittent Insomnia
– Difficulty sleeping for a few nights
– Followed by a few nights of adequate sleep
– Difficulty sleeping returns
COMMON SLEEP DISORDERS
• The affected individual obtains sufficient
sleep at night
• Cannot stay awake during the day
• Caused by
– CNS damage
COMMON SLEEP DISORDERS
• Disorder of excessive daytime sleepiness
– Sleep attacks
– Cataplexy
• Sudden weakness or paralysis
• Fragmented nighttime sleep
• Cause
– Lack of chemical hypocretin
COMMON SLEEP DISORDERS
• Frequent short breathing pauses during
sleep
• 10 seconds to 2 minutes
– Obstructive apnea
• Blockage of the flow of air
– Central apnea
• Defect in the respiratory center of the brain
• Medulla oblangata
– Mixed
COMMON SLEEP DISORDERS
• Hypersomnia
– refers to conditions where the affected
individual obtains sufficient sleep at night but
still cannot stay awake during the day
COMMON SLEEP DISORDERS
• 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.
COMMON SLEEP DISORDERS
• Sleep apnea
– is characterized by frequent short breathing
pauses during sleep
COMMON SLEEP DISORDERS
parasomnia
• is behavior that may interfere with sleep
and may even occur during sleep.
• It is characterized by physical events such
as movements or experiences that are
displayed as emotions, perceptions, or
dreams.
COMMON SLEEP DISORDERS
• Arousal disorder
– Sleep walking
• Somnambulism
– Sleep wake transition Disorder
• Sleep talking
– exhaustion
COMMON SLEEP DISORDERS
• Associated with REM sleep
– Nightmares

– Bruxism
Nursing interventions to promote
Rest and sleep
• Supporting Bedtime Rituals
– Most people are accustomed to bedtime or pre
sleep routines
• Adults
– Hygienic routines
» Washing the face
» Brusing teeth
» Voiding
– Relaxation
» Listening to music
» Reading
» Taking a soothing bath
» praying
Nursing interventions to promote
Rest and sleep
• Supporting bedtime rituals
– Children
• Need to be socialized into pre sleep routine
– Bedtime story
– Holding onto a favorite toy or blanket
– Kissing everyone goodnight
Nursing interventions to promote
Rest and sleep
• Creating a Restful Environment
– Minimal Noise
– Comfortable room temperature
– Appropriate lighting
Nursing interventions to promote
Rest and sleep
• Promoting Comfort and Relaxation
– Offer to provide a back massage
– Schedule medication
– For client with pain, administer analgesics 30
minutes before bedtime
Nursing interventions to promote
Rest and sleep
• Promoting Comfort and Relaxation
– Provide loose fitting nightwear
– Assist clients with hygienic routines
– Assist or encourage the client to void before
bedtime
Nursing interventions to promote
Rest and sleep
• Promoting Comfort and Relaxation
– Emotional stress interferes with sleep
• Relaxation techniques
– Deep breathing
– Muscle Relaxation
– Guided Imagery
– Meditation