REST AND SLEEP generally still, the heart and respiratory rates

decreases slightly, and body temperature falls. Only

REST AND SLEEP: lasts about 10 to 15 minutes but 40% to 45% of total
 Rest and sleep are essential for health. People who sleep.
are ill frequently requires more rest and sleep than c. Stage III- heart and respiratory rates, as well as other
usual. body processes, slow further because of domination of
 Rest restores a person's energy, allowing the the parasympathetic nervous system. The sleeper
individual to resume optimal functioning. becomes more difficult to arouse, and is not disturbed
 Rest implies calmness and relaxation without by sensory stimuli, skeletal muscles are relaxed,
emotional stress, and freedom from anxiety, therefore reflexes are diminished, snoring may occur.
rest does not always reply inactivity; in fact some d. Stage IV- deep sleep. The sleeper's heart and
people may find certain activities such as walking, respiratory rates drop 20-30% below waking hours,
restful. sleeper is very relaxed, rarely moves, and is difficult to
 Sleep is a basic human need, it is a universal biological arouse. Thought to restore body physically. during this
process common to all people. stage, eyes usually roll, and some dreaming occurs.
2. REM Sleep- REM sleep usually recurs about every 90
 Historically, sleep was considered a state of minutes and lasts 5-30 minutes.
unconsciousness. Recently, it is considered an altered o not a restful sleep as NREM sleep, and most
state of consciousness in which an individual's dreams occur during REM sleep, and these
perception of and reaction to the environment are dreams are usually remembered. Sleeper is
decreased. difficult to arouse but may wake spontaneously,
muscle tone is depressed, gastric secretions
PHYSIOLOGY OF SLEEP: increase, heart and respiratory rates are often
 The cycle nature of sleep is thought to be controlled by irregular.
centers located n the lower part of the brain. These o the brain is highly active. This type of sleep is also
centers inhibit wakefulness, thus casing sleep. called paradoxical sleep.

 Biorhythms (rhythmic biologic clock) are controlled SLEEP CYCLE:

from within the body and synchronized with  a complete cycle usually lasts about 1.5 hours in
environmental factor, such as light and darkness, adults.
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
 the usual sleeper experiences four to six cycles of
psychologic rhythms are most active, and is asleep
sleep during a 7-8 hours
when they're inactive.
 the sleeper who is awakened during any stage, begins
STAGES OF SLEEP: again at the beginning
1. NREM Sleep- also referred to as slow-wave sleep,
because the brain waves of a sleeper are slower the  duration of the stages varies throughout the sleep
alpha and beta waves of a person who is awake. period.As the night progresses, the sleeper becomes
o most sleep during the night is NREM sleep less tired and spends less time in Stage III and IV,
o it is a deep, restful sleep and brings a decrease in REM sleep increases and dreams tends to lengthen.
metabolic process including vital signs,  if the sleeper is very tired, REM cycles are often short
metabolism, and muscle action.
4 Stages of NREM: FUNCTIONS OF SLEEP:
a. Stage I- stage of very light sleep. During this stage,  restores normal levels of activity and normal balance
the person feels drowsy and relaxed, the eyes roll from among parts of the nervous system.
side to side, he heart and respiratory rate drops  necessary for protein synthesis, which allows repair
slightly. Sleeper can be readily awakened and lasts processes.
only a few minutes.  persons with inadequate sleep tend to become
b. Stage II- stage of light sleep during which body emotionally irritable, have poor concentration, and
processes continue to slow down. The eyes are experience difficulty making decisions
FACTORS AFFECTING SLEEP:
 Quality of sleep refers to the individual's ability to stay PRIMARY SLEEP DISORDER:
asleep and et the appropriate amounts of REM and  those in which the person's sleep is the main disorder
NREM sleep. Insomnia- most common sleep disorder. It is the
 Quantity of sleep is the total time the individual sleeps. inability to obtain an adequate amount or quality of
1. Illness- causes pain or physical distress can sleep. There are three types of insomnia:
result in sleep problems. People who are ill require 1.1 difficulty in falling asleep (initial insomnia)
more sleep than normal, and the normal rhythm of 1.2 difficulty in staying asleep because of frequent or
sleep and wakefulness is often disturbed. prolonged waking (intermittent or maintenance
2. Environment- either promote or hinder sleep. The insomnia)
absence of usual stimuli or the presence of 1.3 early morning or premature waking (terminal
unfamiliar stimuli can prevent people from insomnia)
sleeping.  Can result from physical discomfort but more often is
3. Fatigue- the more tired a person is, the shorter the a result of mental overstimulation due to anxiety.
first period REM, as the person rests, REM  Treatment for insomnia frequently requires the client
periods become longer. to develop new behavior patterns that induce sleep.
4. Lifestyle- People who does shift work and Sleep medication is questionable because they do not
changes shift frequently must arrange activities to deal witht he cause of problems, and prolonged use
be ready to sleep at the right time. Moderate can create dependency.
exercise is usually conducive to sleep, nut Hypersomnia- excessive sleep, particularly in the
excessively done delays sleep. daytime. The affected person often sleeps until noon,
5. Emotional Stress- anxiety and depression and takes many naps during the day.
frequently disturb sleep. A person preoccupied Narcolepsy- sudden wave of overwhelming
with personal problems may be unable to relax sleepiness that occurs during the day, referred to as
sufficiently to get to sleep. "sleep attack". Even though people who have
6. Stimulants and Alcohol- Caffeine containing narcolepsy sleep well at night, they nod off several
beverages acts as stimulants of the CNS, thus times a day even when conversing with someone or
interfering with sleep. People who drink an driving a car.
excessive amount of alcohol often find their sleep Sleep Apnea- periodic cessation of breathing during
disturbed. Excessive alcohol disrupts REM sleep, sleep.
although it hasten the onset of sleep.  Often suspected when the person has loud
7. Diet- weight loss has been associated with an snoring, frequent nocturnal awakenings,
reduced total sleep time, as well as broken sleep excessive daytime sleepiness, insomnia, morning
and earlier awakening. Weight gain, on the other headaches, intellectual deterioration, irritability,
hand, seems to be associated with an increase in personality changes and some physiologic
total sleep time, less broken sleep, and later changes such as hypertension and cardiac
waking hours. arrythmias.
8. Smoking- nicotine has a stimulating effect on the  The periods of apnea, which last from 10seconds
body, and smokers often have more difficulty to 2 minutes, which occurs during REM or NREM
falling asleep than nonsmokers. sleep. Frequencies ranges from 50 to 600/night,
9. Motivation- desire to stay awake can often and drains the person of energy and lead to
overcome a person's fatigue. excessive day time sleepiness.
10. Medication- medications affect the quality of 4.1 Obstructive apnea- occurs when structures
sleep: hypnotics can interfere with stage III and IV of the pharynx or oral cavity block the flow of air.
and suppress REM. Beta-blockers can cause The person still tries to breath.
insomnia and nightmares. Narcotics are known to 4.2 Central apnea- thought ti involve a defect in
suppress REM and cause frequent awakenings the respiratory center of the brain. All actions
and drowsiness. involving breathing, such as chest rising and
airflow, ceases.
COMMON SLEEP DISORDERS: 4.3 Mixed apnea- combination of obstructive and
 Sleep Disorders may be categorized as parasomnias, central apnea.
primary disorder, sand secondary disorder.  An episode of sleep apnea usually begins with
Parasomnia is a behavior that may interfere with snoring; thereafter, breathing ceases, followed by
sleep or that occurs with sleep. It is subdivided into: marked snorting as breathing resumes. Toward
1. arousal disorder- sleep walking, sleep terrors the end of each apneic episode, increased carbon
2. sleep wake transition disorder- sleep talking dioxide levels in the blood causes the client to
3. parasomnias associated with REM- wake.
nightmares, nocturnal erections
 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