This document provides an overview of concepts related to sleep including definitions of sleep and rest, the two types of sleep (NREM and REM), sleep cycles and stages, factors that affect sleep, functions of sleep, and common sleep disorders. It also discusses nursing assessments of sleep and potential nursing diagnoses and interventions to promote healthy sleep.

1. Concept Of Sleep
SHAHINA BANO
Lecturer (DION&M, DUHS)
YEAR 1, SEM II.
DATE :23RD
NOV,2022
Objectives
At the end of this unit, learners will be able to:
1. Define rest and sleep pattern
2. Define terms related to rest and sleep.
3. Compare the characteristics of sleep and rest.
4. Discuss the characteristics of two kinds of sleep.
5. Enumerate the functions of sleep.
6. Discuss factors affecting sleep.
7. Identify common sleep disorders.
8. Identify conditions necessary to promote sleep.
9. Discuss nursing process for a patient to promote sleep.
Sleep
• Sleep is a basic human need.
• It is a universal process common to all people.
• Sleep enhances daytime functioning, and is vital for cognitive, physiological, and psychosocial function
(Gruber, 2013).
• We require sleep for many reasons :
• To cope with daily stresses
• To prevent fatigue
• To conserve energy

2. • To restore the mind and body
• To enjoy life more fully
SLEEP
 A state of unconsciousness.
 Sleep is considered an altered state of consciousness in which an individual‟s perception of and reaction
to the environment are decreased.
 Sleep is characterize by minimal physical activity, variable levels of consciousness, change in the bodies
physiological processes and decrease responsiveness to external stimuli.
REST
 Rest is a condition in which the body is in a decreased state of activity without physical emotional stress
and freedom from anxiety.
 Rest refer to the state of relaxation and calmness both physical and mental.
 Awareness of the environment is maintaining but motor or cognitive response is decreased.
Type Of Sleep
 Sleep architecture refers to the basic organization of normal Sleep.
 Electroencephalogram (EEG) patterns, eye movements and muscle activity are used to identify stages of
sleep.
The two types of sleep are:
1) NREM (Non Rapid Eye Movement sleep)
2) REM (Rapid Eye Movement sleep)

3. NREM Sleep
 About 75% - 80% of sleep during night is NREM sleep.
 NREM sleep previously divided into four stages, now divided into three stages.
 Each associated with distinct brain activity and physiology.
 NREM- Stage I
 NREM-Stage II
 NREM-Stage III
 REM

4. Stage – I
 It is the stage of very light sleep and lasts only a few minutes. During this stage person feel:
1. Relax and drowsy
2. Eyes roll from side to side
3. Heart and respiratory rate drop slightly
4. The sleeper can be easily awakened and deny that he or she was sleeping
Stage II
1. Light sleep during which body processes continue to slow down.
2. The eyes are generally still, the heart and respiratory rates drop slightly, and body temperature falls
3. An individual in stage 2 requires more intense stimuli than in stage 1 to awaken such as touching or
shaking
Stage III:
• The deepest stage of sleep
• During deep sleep or delta sleep, the sleeper’s heart and respiratory rates drop 20% to 30% below those
exhibited during waking hours.
• The sleeper is difficult to arouse.
• The person is not disturbed by sensory stimuli
• The skeletal muscles are very relaxed
• Reflexes are diminished
• Snoring is most likely to occur.
• This stage is essential for restoring energy and releasing important growth hormones
PHYSIOLOGICAL CHANGES DURING NREM SLEEP
 Arterial blood pressure falls
 Pulse rate decreases
 Peripheral blood vessels dilates
 Cardiac output decreases
 Skeletal muscles relaxed
 Basal metabolic rate decreases 10% to 30%.

5.  Growth hormones level peak
 Intracranial pressure decreased
REM Sleep
• During REM sleepbrain is highly active and brain metabolism increases as much as 20%.
• Not as restful as NREM– most dream takes place in REM.
Characteristics Of REM Sleep
• Active dreaming- dreams remembered
• May be difficult to arouse or may awake spontaneously
• Muscle tone is depressed
• Heart rate and respiratory rate are often irregular
• A few regular muscle movement occur- in particular, rapid eye movement
• BMR increases
• Lower jaw relaxed
Normal Sleep Cycle
Factors Affecting Sleep
 Age

6.  Environment
 Fatigue
 Life style
 Psychological stress
 Alcohol and stimulants
 Diet
 Illness (respiratory conditions, fever, endocrine disorders)
 Medications
Functions of Sleep
There are many theories about the functions of sleep.
 For example, there is a theory that the major function of sleep is to
conserve our energy.
 Another suggestion is that as the hunger mechanism is suppressed
during sleep, we sleep in order to conserve food supplies.
 In psychological points of view, it stated that our learning processes are largely inactivated during sleep,
this gives the brain a chance to reorganize and store more efficiently the information gathered during
the day.
Common Sleep Disorders
INSOMNIA:
• Inability to fall sleep or remain asleep. Person with insomnia awaken not feeling rested.
• Insomnia is not a disease, but it may be a manifestation of many illnesses
• Treatment for insomnia requires behavioral treatments
• Examples of behavioral treatments include the following:
• Stimulus control: creating a sleep environment that promotes sleep
• Cognitive therapy: learning to develop positive thoughts and beliefs about sleep
• Sleep restriction: following a program that limits time in bed in order to get to sleep and stay
asleep throughout the night
Common Sleep Disorders

7. HYPERSOMNIA:
 It is a condition where the affected individual obtains sufficient sleep at night but still can not awake
during the day.
NARCOLEPSY:
 It is a disorder of excessive day time sleepiness caused by lack of the chemical Hypocretin in the area of
the central nervous system that regulates sleep.
Common Sleep Disorders
PARASOMNIA:
 Behaviors 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.
Example, you might move around, talk, or do unusual things during sleep.
• ENURESIS:
• Bedwetting in night time, usually occurs when arouse from NREM III and IV.
• Bedwetting during sleep can occur in children over 3 year old.
• More males than females are affected.
• It often occur 1 to 2 hour after falling asleep, when rousing from NREM stage 3.
Common Sleep Disorders
Somnambulism:
 Sleep walking( occur in stage III)
Periodic Limb Movement:
 A condition in which the legs jerk twice or thrice time per minute during sleep.
 During NREM sleep individual moves leg and sometimes arms every 20-30 seconds for minutes or hours.
Sleep Talking
Talking during sleep occurs during NREM sleep before REM sleep.
It rarely presents a problem to the person unless it becomes troublesome to others.
Sleep Deprivation
o Insufficient sleep or sleeplessness

8. BRUXISM
Clenching or grinding of teeth, usually occurs during Stage II.
Common Sleep Disorders
SLEEP APNEA:
 Frequent short breathing pauses during sleep.
Common Sleep Disorders
SLEEP APNEA:

9.  Intermittent stopping of breathing during sleep due to obstruction of the airway or nervous system.
 Apnea during sleep, more than five apneic episodes or five breathing pauses longer than 10 seconds per
hour is considered abnormal and should be evaluated by a sleep medicine specialist.
Types Of Sleep Apnea
Three common types of sleep apnea are:
a) Obstructive apnea
b) Central apnea
c) Mixed apnea.
A) Obstructive apnea occurs when the structures of the pharynx or oral cavity block the flow of air.
Enlarged tonsils and adenoids, a deviated nasal septum, nasal polyps, and obesity predispose the client to
obstructive apnea.
• An episode of obstructive sleep apnea usually begins with snoring; thereafter, breathing ceases, followed
by marked snorting as breathing resumes.
B) Central apnea is thought to involve a defect in the respiratory center of the brain.
• Clients who have brainstem injuries and muscular dystrophy, for example, often have central sleep apnea.
C) Mixed apnea is a combination of central apnea and obstructive apnea
• Treatment for sleep apnea : is directed at the cause of the apnea.
– For example, enlarged tonsils may be removed.
– Other surgical procedures, including laser removal of excess tissue in the pharynx, reduce or
eliminate snoring and may be effective in relieving the apnea.
– The use of a nasal continuous positive airway pressure (CPAP) device at night is effective in
maintaining an open airway.
Assessment of Sleep
 A complete assessment of a client’s sleep difficulty includes a sleep history (sleep pattern, sleep
environment, bedtime rituals), sleep diary, a physical examination (yawning, any dark circles, facial
expression), and a review of diagnostic studies
 sleep is measured objectively in a sleep disorder by laboratory test polysomnography.
 In which an electroencephalogram (EEG), electromyogram (EMG), and electro-oculogram (EOG) are
recorded simultaneously.
 Key questions to ask regarding sleep patterns are include :

10.  When do you usually go to a sleep? Do you nap? If the client is child ask about bed time rituals?
 Do you have any problem with your sleep?
 Do you use any prescribed medicines or natural remedies to help you sleep?
 Is there any thing else I need to know about your sleep?
Nursing Diagnosis
• Risk for Injury related to somnambulism
• Ineffective Coping related to insufficient quality and quantity of sleep
• Fatigue related to insufficient sleep
• Impaired Gas Exchange related to sleep apnea
• Deficient Knowledge (nonprescription remedies for sleep) related to misinformation
• Anxiety related to sleep apnea and/or the diagnosis of a sleep disorder
• Activity Intolerance related to sleep deprivation or excessive daytime sleepiness
Nursing intervention to Promote Sleep
• To establish a regular bedtime and wake-up time for all days of the week to enhance your biologic rhythm
• Establish a regular, relaxing bedtime routine before sleep such as reading, taking a warm bath, or doing
some other quiet activity you enjoy.
• Get adequate exercise during the day to reduce stress, but avoid excessive physical exertion at least 3
hours before bedtime
• Create a sleep-conducive environment that is dark, quiet, comfortable, cool and noise free.
• Music is not recommended because studies have shown that music will promote wakefulness (it is
interesting and people will pay attention to it).
• Sleep on a comfortable mattress and pillows.
Nursing intervention to Promote Sleep
• Avoid heavy meals 2 to 3 hours before bedtime.
• Avoid alcohol and caffeine-containing foods and beverages (e.g., coffee, tea, chocolate) at least 4 hours
before bedtime. Caffeine can interfere with sleep. Both caffeine and alcohol act as diuretics, creating the
need to void during sleep time.
• If a bedtime snack is necessary, consume only light carbohydrates or a milk drink. Heavy or spicy foods
can cause gastrointestinal upsets that disturb sleep.

11. • Take analgesics before bedtime to relieve aches and pains as prescribed by doctor.
Nursing intervention to Promote Sleep
 Assist client with hygienic routines
 Offer back message
 Administer analgesics 30 min before sleep
Safety Measures For Sleep
 Use night lamps/lights
 Place the bed in low position
 Raise side rails appropriately
 Place the call bell within easy reach
References.
• Kozier&Erb’s. (2016). Fundamentals of Nursing: Concepts, Process and Practice (10th ed.) Addison:
Wesley.
• Delaune, S. C., & Ladner, P. K. (2010). Fundamentals of Nursing: Standards and Practice. (4th ed.)
Canada: Delmar.