This document discusses sleep, factors that affect sleep, and common sleep disorders. It defines sleep and describes the sleep-wake cycle and sleep stages. Common sleep disorders mentioned include insomnia, hypersomnia, narcolepsy, sleep apnea, and parasomnias. Nursing interventions to promote rest and sleep are also outlined, such as supporting bedtime rituals, creating a restful environment, and promoting relaxation.

1. PROMOTING REST AND
SLEEP

2. SLEEP
• Sleep is the altered level of consciousness
in which the individual’s perception of and
reaction to environment are decreased

3. What regulates sleep and
wakefulness?
• Reticular formation on the Brain Stem
• Ascending nerve fibers
– Reticular Activating System (RAS)
– Sleep Wake Cycle

4. TYPES OF SLEEP
• NREM
– Non-Rapid Eye Movement Sleep
• REM
– Rapid Eye Movement Sleep

5. NON-RAPID EYE MOVEMENT
SLEEP
• When the RAS is inhibited
– Sleep
• BODY RESTORATION
– About 75% to 80% of sleep
– Has 4 stages

6. 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

7. 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

8. 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

9. 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

10. 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

11. REM (Rapid Eye Movement
Sleep)
• Irregular HR and RR
• May be difficult to arouse or wake up
spontaneously

12. 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

13. 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

14. 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

15. Normal Sleep Requirements
• Newborns
– 16 to 18 hours a day
Infants
14 to 15 hours
Toddlers
12 to 14 hours

16. Normal Sleep Requirements
• Preschoolers
– 11 to 13 hours
• School Aged
– 10 to 11 hours
• Adolescents
9 to 10 hours

17. 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

18. Factors Affecting Sleep
• Illness
– Pain or physical distress
• Arthritis, back pain and ulcers
• Respiratory Conditions
– Nasal congestion
• Need to urinate

19. 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

20. 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

21. Factors Affecting Sleep
• Stimulants and alcohol
– Caffeine containing beverages
• Coffee
• Tea
• Chocolate drinks
– Alcohol
• Speed up the onset of sleep
• BUT disrupts REM

22. Factors Affecting Sleep
• Smoking
– Nicotine has a stimulating effect on the body
– Smoker
• Refrain from smoking after the evening meal

23. 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

24. COMMON SLEEP DISORDERS
• Chronic Intermittent Insomnia
– Difficulty sleeping for a few nights
– Followed by a few nights of adequate sleep
– Difficulty sleeping returns

25. COMMON SLEEP DISORDERS
• The affected individual obtains sufficient
sleep at night
• Cannot stay awake during the day
• Caused by
– CNS damage

26. COMMON SLEEP DISORDERS
• Disorder of excessive daytime sleepiness
– Sleep attacks
– Cataplexy
• Sudden weakness or paralysis
• Fragmented nighttime sleep
• Cause
– Lack of chemical hypocretin

27. 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

28. COMMON SLEEP DISORDERS
• Hypersomnia
– refers to conditions where the affected
individual obtains sufficient sleep at night but
still cannot stay awake during the day

29. 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.

30. COMMON SLEEP DISORDERS
• Sleep apnea
– is characterized by frequent short breathing
pauses during sleep

31. 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.

32. COMMON SLEEP DISORDERS
• Arousal disorder
– Sleep walking
• Somnambulism
– Sleep wake transition Disorder
• Sleep talking
– exhaustion

33. COMMON SLEEP DISORDERS
• Associated with REM sleep
– Nightmares
– Bruxism

34. 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

35. 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

36. Nursing interventions to promote
Rest and sleep
• Creating a Restful Environment
– Minimal Noise
– Comfortable room temperature
– Appropriate lighting

37. 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

38. 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

39. 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