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Bekalu A.(BSc N)
Sleep and Rest pattern
10/25/2023
1
Session objectives
10/25/2023
2
At the end of this session the students will be able to:
Define sleep and rest
Identify normal sleep and rest function
Identify altered sleep and rest function
Rest
 Is a state when the body’s physical and emotional
energy expenditure is limited.
Praying, listening to music, watching television,
reading, and engaging in needlework.
Although beneficial, rest is not as restorative/new
strength as sleep because it does not filter external
stimuli by altering the level of consciousness.
10/25/2023
3
Sleep
Sleep is a sedentary state of mind and body.
Is a cyclical physiological process characterized by
decreased perception and motor activity.
Conserves energy, prevents fatigue, allows
physiological processes to slow down,
boosting/enhancing the immune system, stimulating
protein synthesis for tissue repair, increasing RBC
production.
10/25/2023
4
Sleep states/cycles
Sleep is preceded by a 10 to 30 minute period when
an individual begins to feel sleepy(pre-sleep stage)
 Sleep involves two stages:
Non rapid eye movement (NREM), which has four
phases, and
Rapid eye movement (REM)
10/25/2023
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NREM
10/25/2023
6
At this stage sleep is considered the quiet or
restful phase. During non-rapid eye movement
sleep, a person falls asleep and then moves from
a light sleep into a deep sleep. This is when a
person’s brain activity, breathing, and heart rate
slow down, body temperature drops, muscles
relax, and eye movements stop.
NREM sleep plays an important role in helping
the body repair tissues, build bone and muscle,
and strengthen its immune system.
Sleep states/cycles cont…
Once a sleep occurs, an individual usually has four or
five complete sleep cycles per night, lasting 90 to 100
minutes each.
With successive cycles, NREM stage I is excluded,
NREM stages 3 and 4 shorten, and the REM stage
lengthens (common in adults)
Amount of time in each cycle varies over the life span;
infants and children spend more time in stages 3 and 4
than older adults do. 10/25/2023
7
Sleep states/cycles cont…
NREM Stage 1
Time between wakefulness and sleep
 5 to 10 minutes long
 5% of total sleep
Light sleep, easy to awaken
 Relaxed but aware of surroundings
 Regular, deep breathing
 Eyes may open and close slowly
10/25/2023
8
Sleep states/cycles cont…
NREM Stage 2
10 to 15 minutes long
50% of total sleep
Light sleep, easy to awaken
 Muscles are relaxed
 Vital signs slightly decreased
 Eyes closed with almost no movement
10/25/2023
9
Sleep states/cycles cont…
NREM Stage 3
5 to 15 minutes long
 8% of total sleep
Deep sleep, difficult to awaken
Muscles are more relaxed
Vital signs decreased
Snoring/breathe noisily in sleep may occur
Eyes closed with almost no movement
10/25/2023
10
Sleep states/cycles cont…
NREM Stage 4
 20 to 50 minutes long
11% of total sleep
Deepest sleep, difficult to awaken
 Confused when awakened
 Muscles are very relaxed
 Eyes closed with almost no movement
10/25/2023
11
Sleep states/cycles cont…
REM, also called Stage 5
 5 to 30 minutes long, 25% of total sleep
 Reacts normally when awakened
 Large muscle inactivity; small muscles may twitch/jerk,
deep-tendon reflexes are depressed
 Vital signs increase; pulse may be rapid and irregular, periods
of apnea may occur
 Dreaming may occur
10/25/2023
12
10/25/2023
13
Normal Sleep Requirements and Patterns
 Sleep duration and quality vary among people of all
age-groups
Neonates: averages about 16 hours of sleep a day, sleeping
almost constantly during the first week
 The sleep cycle is generally 40 to 50 minutes with
wakening occurring after one to two sleep cycles
10/25/2023
14
Approximately 50% of this sleep is REM sleep, which
stimulates the higher brain centers (essential for
development)
Infants: usually develop a night time pattern of sleep by 3
months of age
 The infant normally takes several naps during the day
but usually sleeps an average of 8 to 10 hours during the
night for a total daily sleep time of 15 hours
10/25/2023
15
about 30% of sleep time is in the REM cycle
Awakening commonly occurs early in the morning
Toddlers: By the age of 2 children usually sleep through
the night and take daily naps
Total sleep averages 12 hours a day
After 3 years of age children often give up daytime naps
It is common for toddlers to awaken during the night
The percentage of REM sleep continues to fall
10/25/2023
16
During this period toddlers may be unwilling to go to bed
at night because they need autonomy or fear separation
from their parents
Preschoolers: On average a preschooler sleeps about 12
hours a night (about 20% is REM)
By the age of 5 he or she rarely takes daytime naps
10/25/2023
17
The preschooler usually has difficulty relaxing or quieting
/calming down after long, active days and has bedtime
fears, awakens during the night, or has nightmares
Partial awakening followed by normal return to sleep is
frequent
In the awake period the child exhibits brief crying,
walking around, unintelligible speech, sleepwalking/
walking while sleep, or bed-wetting
10/25/2023
18
School-Age Children: The amount of sleep needed varies
during the school years
The older child often resists sleeping because he or she is
unaware of fatigue or has a need to be independent
Adolescents: On average the majority of teenagers get
about 7 hours or less of sleep per day
10/25/2023
19
Adolescents typically have electronic devices such as
televisions, computers, smart phones, or video games in
their rooms, which further contribute to sleep disruption,
poor sleep quality, and decreased amount of sleep
Leads to reduced performance in school, vulnerability to
accidents, behavior and mood problems and increased
use of alcohol
Young Adults: Most young adults average 6 to 8 hours of
sleep a night
10/25/2023
20
Approximately 20% of sleep time is REM sleep, which
remains consistent throughout life .
Pregnancy increases the need for sleep and rest
Middle Adults: total time of sleeping at night begins to
decline.
The amount of stage 4 sleep begins to fall, a decline that
continues with advancing age
Insomnia is particularly common, probably because of the
changes and stresses of middle age 10/25/2023
21
Anxiety, depression, or certain physical illnesses cause
sleep disturbances
Women experiencing menopausal symptoms often
experience insomnia
Older Adults: Complaints of sleeping difficulties increase
with age
Episodes of REM sleep tend to shorten
10/25/2023
22
Stages 3 and 4 NREM sleep progressively decrease;
some older adults have almost no stage 4, or deep sleep.
 An older adult awakens more often during the night, and
it takes more time for him or her to fall asleep.
The tendency to nap seems to increase progressively with
age because of the frequent awakenings experienced at
night. 10/25/2023
23
Factors Influencing Sleep
Drugs and Substances
 milk, cheese, and meats, promote sleep
Diuretics, antidepressants, caffeine
Lifestyle
Performing heavy work, engaging in late-night social
activities, and changing evening mealtime.
The body’s internal clock set.
Usual Sleep Patterns
10/25/2023
24
 Emotional Stress
Worry over personal problems or a situation
Environment
The physical environment in which a person sleeps
significantly influences the ability to fall and remain
asleep
Good ventilation, size, firmness, and position of the bed,
Exercise and Fatigue
10/25/2023
25
A person who is moderately fatigued usually achieves
restful sleep, especially if the fatigue is the result of
enjoyable work or exercise
Exercising 2 hours or more before bedtime
Food and Caloric Intake
Eating a large, heavy, and/or spicy meal at night often
results in indigestion that interferes with sleep
Caffeine, alcohol, and nicotine consumed in the evening
produce insomnia. 10/25/2023
26
Altered sleep function
Sleep Deprivation: getting less than the needed amount
of sleep, which, for adults, ranges from 6 to 8 hours of
sleep per night.
Insomnia: Inability to fall asleep, remain asleep, or go
back to sleep, resulting in an insufficient quantity or
quality of sleep.
10/25/2023
27
Restless leg syndrome: Uncontrollable movements of the legs
(tingling, itching, creeping, and crawling) when resting or just
before onset of sleep.
Sleep apnea: Periodic interruption of breathing when sleeping.
Narcolepsy: Sudden uncontrollable urge/push to sleep during the
day, lasting seconds to 30 minutes
Parasomnias: types of disturbing disorders that can happen just
before you fall asleep, while you’re sleeping, or as you’re
waking up and it includes sleep walking, sleep talking,
nightmares, bedwetting, sleep apnea (problems with breathing
that cause loud snoring), or nighttime seizures.
10/25/2023
28
Bruxism : Repetitive clenching/clamping together and
grinding of teeth; episode lasts 4 to 5 seconds
Sleepwalking (somnambulism): Episodic walking
around while asleep with minimal awareness of
surroundings; episode lasts 3 minutes or longer
Nightmare disorder: Repeated episodes of frightening
dreams that result in awakening; patients commonly
report that the dreams jeopardize/endanger their
personal safety.
10/25/2023
29
Sleep terrors (night terrors): Repeated episodes of
abrupt awakening along with a panicky/fearful
scream/shout.
Nocturnal enuresis (bed wetting): Repeated episodes of
involuntary urination when sleeping after toilet training
is well established
Caused by hormonal, bladder, and sleep problems;
genetics, small bladder, diabetes mellitus, and urinary
tract infection 10/25/2023
30
Tools for Sleep Assessment
The epworth sleepiness scale: evaluates the severity
The pittsburgh sleep quality index: assesses sleep quality
and patterns
A visual analog scale: draw a straight horizontal line 100
mm (4 inches) long.
“Best night’s sleep” and “worst night’s sleep” are at
opposite ends of the line.
10/25/2023
31
Tools for Sleep Assessment cont…
Ask patients to place a mark on the horizontal line at
the point corresponding to their perceptions of the
previous night’s sleep
A numeric scale with a 0-to-10 sleep rating. Instruct
them to indicate with a number between 0 and 10
their sleep quantity and then their quality of sleep,
with 0 being the worst sleep and 10 being the best
10/25/2023
32
Interventions
Health Promotion
In community health and home settings help patients
develop behaviors conducive to rest and relaxation
Environmental Controls
Create comfortable room temperature and proper
ventilation, minimal sources of noise, a comfortable bed,
and proper lighting
Promoting Bedtime Routines 10/25/2023
33
Same hour for bedtime, snack, or quiet activity used
consistently helps young children avoid delaying sleep
Quiet activities such as reading stories, coloring,
allowing children to sit in a parent’s lap while listening to
music or listening to a prayer
Adults : reading a light novel/story, watching an
enjoyable television program, or listening to music helps,
deep breathing for 1 or 2 minutes relieve tension and
prepare the body for rest 10/25/2023
34
A consistent time for sleep and awakening
At home discourage patients from trying to finish office
work or resolve family problems before bedtime
Promoting safety
A small night-light
To reduce the chance of suffocation, do not place pillows,
stuffed/distended toys, or the ends of loose blankets in
cribs/ sides to keep the child from falling out.
Place an infant on his or her back to prevent suffocation
10/25/2023
35
Establishing Periods of Rest and Sleep
instruct patients to regularly void before rest periods, and
suggest silencing the telephone ringer
encourage patients to stay physically active during the
day so they are more likely to sleep at night
Stress Reduction
When patients are emotionally upset, encourage them to
try not to force sleep.
10/25/2023
36
Encourage a patient who has difficulty falling asleep to
get up and pursue a relaxing activity such as sewing or
reading rather than staying in bed and thinking about
sleep
Keeping a light on in the room also helps some children
Bedtime Snacks
A full meal before bedtime often causes gastrointestinal
upset or reflux and interferes with the ability to fall
asleep
10/25/2023
37
Pharmacological Approaches
Medications that induce sleep are called hypnotics
Sedatives are medications that produce a calming or
soothing/relaxing effect
A patient who takes sleep medications needs to know
about their proper use and their risks and possible side
effects
Long-term use of anti-anxiety, sedative, or hypnotic
agents disrupts sleep and leads to more serious problems
10/25/2023
38
Pharmacological Approaches cont…
 Benzodiazepiness (oxazepam, lorazepam, or
temazepam): have become the treatment of choice for
insomnia
Melatonin : Improving sleep efficiency and decreasing
nighttime awakenings. 0.3 to 1 mg taken 2 hours before
bedtime
Ramelteon (rozerem): Improving sleep by improving the
circadian rhythm and shortening time-to sleep onset
10/25/2023
39
Thank you!!!
10/25/2023
40

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3. Sleep and rest pattern (2).pptx

  • 1. Bekalu A.(BSc N) Sleep and Rest pattern 10/25/2023 1
  • 2. Session objectives 10/25/2023 2 At the end of this session the students will be able to: Define sleep and rest Identify normal sleep and rest function Identify altered sleep and rest function
  • 3. Rest  Is a state when the body’s physical and emotional energy expenditure is limited. Praying, listening to music, watching television, reading, and engaging in needlework. Although beneficial, rest is not as restorative/new strength as sleep because it does not filter external stimuli by altering the level of consciousness. 10/25/2023 3
  • 4. Sleep Sleep is a sedentary state of mind and body. Is a cyclical physiological process characterized by decreased perception and motor activity. Conserves energy, prevents fatigue, allows physiological processes to slow down, boosting/enhancing the immune system, stimulating protein synthesis for tissue repair, increasing RBC production. 10/25/2023 4
  • 5. Sleep states/cycles Sleep is preceded by a 10 to 30 minute period when an individual begins to feel sleepy(pre-sleep stage)  Sleep involves two stages: Non rapid eye movement (NREM), which has four phases, and Rapid eye movement (REM) 10/25/2023 5
  • 6. NREM 10/25/2023 6 At this stage sleep is considered the quiet or restful phase. During non-rapid eye movement sleep, a person falls asleep and then moves from a light sleep into a deep sleep. This is when a person’s brain activity, breathing, and heart rate slow down, body temperature drops, muscles relax, and eye movements stop. NREM sleep plays an important role in helping the body repair tissues, build bone and muscle, and strengthen its immune system.
  • 7. Sleep states/cycles cont… Once a sleep occurs, an individual usually has four or five complete sleep cycles per night, lasting 90 to 100 minutes each. With successive cycles, NREM stage I is excluded, NREM stages 3 and 4 shorten, and the REM stage lengthens (common in adults) Amount of time in each cycle varies over the life span; infants and children spend more time in stages 3 and 4 than older adults do. 10/25/2023 7
  • 8. Sleep states/cycles cont… NREM Stage 1 Time between wakefulness and sleep  5 to 10 minutes long  5% of total sleep Light sleep, easy to awaken  Relaxed but aware of surroundings  Regular, deep breathing  Eyes may open and close slowly 10/25/2023 8
  • 9. Sleep states/cycles cont… NREM Stage 2 10 to 15 minutes long 50% of total sleep Light sleep, easy to awaken  Muscles are relaxed  Vital signs slightly decreased  Eyes closed with almost no movement 10/25/2023 9
  • 10. Sleep states/cycles cont… NREM Stage 3 5 to 15 minutes long  8% of total sleep Deep sleep, difficult to awaken Muscles are more relaxed Vital signs decreased Snoring/breathe noisily in sleep may occur Eyes closed with almost no movement 10/25/2023 10
  • 11. Sleep states/cycles cont… NREM Stage 4  20 to 50 minutes long 11% of total sleep Deepest sleep, difficult to awaken  Confused when awakened  Muscles are very relaxed  Eyes closed with almost no movement 10/25/2023 11
  • 12. Sleep states/cycles cont… REM, also called Stage 5  5 to 30 minutes long, 25% of total sleep  Reacts normally when awakened  Large muscle inactivity; small muscles may twitch/jerk, deep-tendon reflexes are depressed  Vital signs increase; pulse may be rapid and irregular, periods of apnea may occur  Dreaming may occur 10/25/2023 12
  • 14. Normal Sleep Requirements and Patterns  Sleep duration and quality vary among people of all age-groups Neonates: averages about 16 hours of sleep a day, sleeping almost constantly during the first week  The sleep cycle is generally 40 to 50 minutes with wakening occurring after one to two sleep cycles 10/25/2023 14
  • 15. Approximately 50% of this sleep is REM sleep, which stimulates the higher brain centers (essential for development) Infants: usually develop a night time pattern of sleep by 3 months of age  The infant normally takes several naps during the day but usually sleeps an average of 8 to 10 hours during the night for a total daily sleep time of 15 hours 10/25/2023 15
  • 16. about 30% of sleep time is in the REM cycle Awakening commonly occurs early in the morning Toddlers: By the age of 2 children usually sleep through the night and take daily naps Total sleep averages 12 hours a day After 3 years of age children often give up daytime naps It is common for toddlers to awaken during the night The percentage of REM sleep continues to fall 10/25/2023 16
  • 17. During this period toddlers may be unwilling to go to bed at night because they need autonomy or fear separation from their parents Preschoolers: On average a preschooler sleeps about 12 hours a night (about 20% is REM) By the age of 5 he or she rarely takes daytime naps 10/25/2023 17
  • 18. The preschooler usually has difficulty relaxing or quieting /calming down after long, active days and has bedtime fears, awakens during the night, or has nightmares Partial awakening followed by normal return to sleep is frequent In the awake period the child exhibits brief crying, walking around, unintelligible speech, sleepwalking/ walking while sleep, or bed-wetting 10/25/2023 18
  • 19. School-Age Children: The amount of sleep needed varies during the school years The older child often resists sleeping because he or she is unaware of fatigue or has a need to be independent Adolescents: On average the majority of teenagers get about 7 hours or less of sleep per day 10/25/2023 19
  • 20. Adolescents typically have electronic devices such as televisions, computers, smart phones, or video games in their rooms, which further contribute to sleep disruption, poor sleep quality, and decreased amount of sleep Leads to reduced performance in school, vulnerability to accidents, behavior and mood problems and increased use of alcohol Young Adults: Most young adults average 6 to 8 hours of sleep a night 10/25/2023 20
  • 21. Approximately 20% of sleep time is REM sleep, which remains consistent throughout life . Pregnancy increases the need for sleep and rest Middle Adults: total time of sleeping at night begins to decline. The amount of stage 4 sleep begins to fall, a decline that continues with advancing age Insomnia is particularly common, probably because of the changes and stresses of middle age 10/25/2023 21
  • 22. Anxiety, depression, or certain physical illnesses cause sleep disturbances Women experiencing menopausal symptoms often experience insomnia Older Adults: Complaints of sleeping difficulties increase with age Episodes of REM sleep tend to shorten 10/25/2023 22
  • 23. Stages 3 and 4 NREM sleep progressively decrease; some older adults have almost no stage 4, or deep sleep.  An older adult awakens more often during the night, and it takes more time for him or her to fall asleep. The tendency to nap seems to increase progressively with age because of the frequent awakenings experienced at night. 10/25/2023 23
  • 24. Factors Influencing Sleep Drugs and Substances  milk, cheese, and meats, promote sleep Diuretics, antidepressants, caffeine Lifestyle Performing heavy work, engaging in late-night social activities, and changing evening mealtime. The body’s internal clock set. Usual Sleep Patterns 10/25/2023 24
  • 25.  Emotional Stress Worry over personal problems or a situation Environment The physical environment in which a person sleeps significantly influences the ability to fall and remain asleep Good ventilation, size, firmness, and position of the bed, Exercise and Fatigue 10/25/2023 25
  • 26. A person who is moderately fatigued usually achieves restful sleep, especially if the fatigue is the result of enjoyable work or exercise Exercising 2 hours or more before bedtime Food and Caloric Intake Eating a large, heavy, and/or spicy meal at night often results in indigestion that interferes with sleep Caffeine, alcohol, and nicotine consumed in the evening produce insomnia. 10/25/2023 26
  • 27. Altered sleep function Sleep Deprivation: getting less than the needed amount of sleep, which, for adults, ranges from 6 to 8 hours of sleep per night. Insomnia: Inability to fall asleep, remain asleep, or go back to sleep, resulting in an insufficient quantity or quality of sleep. 10/25/2023 27
  • 28. Restless leg syndrome: Uncontrollable movements of the legs (tingling, itching, creeping, and crawling) when resting or just before onset of sleep. Sleep apnea: Periodic interruption of breathing when sleeping. Narcolepsy: Sudden uncontrollable urge/push to sleep during the day, lasting seconds to 30 minutes Parasomnias: types of disturbing disorders that can happen just before you fall asleep, while you’re sleeping, or as you’re waking up and it includes sleep walking, sleep talking, nightmares, bedwetting, sleep apnea (problems with breathing that cause loud snoring), or nighttime seizures. 10/25/2023 28
  • 29. Bruxism : Repetitive clenching/clamping together and grinding of teeth; episode lasts 4 to 5 seconds Sleepwalking (somnambulism): Episodic walking around while asleep with minimal awareness of surroundings; episode lasts 3 minutes or longer Nightmare disorder: Repeated episodes of frightening dreams that result in awakening; patients commonly report that the dreams jeopardize/endanger their personal safety. 10/25/2023 29
  • 30. Sleep terrors (night terrors): Repeated episodes of abrupt awakening along with a panicky/fearful scream/shout. Nocturnal enuresis (bed wetting): Repeated episodes of involuntary urination when sleeping after toilet training is well established Caused by hormonal, bladder, and sleep problems; genetics, small bladder, diabetes mellitus, and urinary tract infection 10/25/2023 30
  • 31. Tools for Sleep Assessment The epworth sleepiness scale: evaluates the severity The pittsburgh sleep quality index: assesses sleep quality and patterns A visual analog scale: draw a straight horizontal line 100 mm (4 inches) long. “Best night’s sleep” and “worst night’s sleep” are at opposite ends of the line. 10/25/2023 31
  • 32. Tools for Sleep Assessment cont… Ask patients to place a mark on the horizontal line at the point corresponding to their perceptions of the previous night’s sleep A numeric scale with a 0-to-10 sleep rating. Instruct them to indicate with a number between 0 and 10 their sleep quantity and then their quality of sleep, with 0 being the worst sleep and 10 being the best 10/25/2023 32
  • 33. Interventions Health Promotion In community health and home settings help patients develop behaviors conducive to rest and relaxation Environmental Controls Create comfortable room temperature and proper ventilation, minimal sources of noise, a comfortable bed, and proper lighting Promoting Bedtime Routines 10/25/2023 33
  • 34. Same hour for bedtime, snack, or quiet activity used consistently helps young children avoid delaying sleep Quiet activities such as reading stories, coloring, allowing children to sit in a parent’s lap while listening to music or listening to a prayer Adults : reading a light novel/story, watching an enjoyable television program, or listening to music helps, deep breathing for 1 or 2 minutes relieve tension and prepare the body for rest 10/25/2023 34
  • 35. A consistent time for sleep and awakening At home discourage patients from trying to finish office work or resolve family problems before bedtime Promoting safety A small night-light To reduce the chance of suffocation, do not place pillows, stuffed/distended toys, or the ends of loose blankets in cribs/ sides to keep the child from falling out. Place an infant on his or her back to prevent suffocation 10/25/2023 35
  • 36. Establishing Periods of Rest and Sleep instruct patients to regularly void before rest periods, and suggest silencing the telephone ringer encourage patients to stay physically active during the day so they are more likely to sleep at night Stress Reduction When patients are emotionally upset, encourage them to try not to force sleep. 10/25/2023 36
  • 37. Encourage a patient who has difficulty falling asleep to get up and pursue a relaxing activity such as sewing or reading rather than staying in bed and thinking about sleep Keeping a light on in the room also helps some children Bedtime Snacks A full meal before bedtime often causes gastrointestinal upset or reflux and interferes with the ability to fall asleep 10/25/2023 37
  • 38. Pharmacological Approaches Medications that induce sleep are called hypnotics Sedatives are medications that produce a calming or soothing/relaxing effect A patient who takes sleep medications needs to know about their proper use and their risks and possible side effects Long-term use of anti-anxiety, sedative, or hypnotic agents disrupts sleep and leads to more serious problems 10/25/2023 38
  • 39. Pharmacological Approaches cont…  Benzodiazepiness (oxazepam, lorazepam, or temazepam): have become the treatment of choice for insomnia Melatonin : Improving sleep efficiency and decreasing nighttime awakenings. 0.3 to 1 mg taken 2 hours before bedtime Ramelteon (rozerem): Improving sleep by improving the circadian rhythm and shortening time-to sleep onset 10/25/2023 39