Sleep and rest are normal physiological processes that alternate with periods of wakefulness and are regulated by circadian rhythms and neurotransmitters in the brain. Sufficient sleep promotes health, learning, memory and performance while lack of sleep can cause disturbances in physiological and psychological functioning. Nursing assessment of sleep includes evaluating usual sleep patterns, risks of disturbances, and manifestations of altered sleep. Nursing diagnoses like sleep pattern disturbance address identifying and meeting patients' sleep and rest needs.

1. SLEEP AND REST
By; Firew T.

2. Sleep and Rest
Learning objectives;
• Normal functions of sleep and rest.
• Altered patterns of sleep and rest.
• Applications of nursing process.

3. Sleep and rest
• Sleep and rest is a part of normal physiologic
changes that occur in the body.
• Proper sleep and rest is one of crucial point of
health as good nutrition and adequate exercise.
• Sleep is reversible naturally occurring altered state
of consciousness characterized by decreased
awareness: and response to stimuli.
• Rest is a decreased motor or cognitive response.
With the consequence feeling of being refreshed
and relaxed both physically and psychologically.

4. Cont…
• Sleep and rest mechanism is a cyclical physiological
process that alternates with larger periods of wake
fullness.
• The sleep wake cycle influences and regulates
physiological function and behavioral responses.
• Physiology; physiology of sleep begins with two
systems in the brain stem namely the reticular
activation system and the bulbar synchronizing
region.

5. Cont…
• Also hypothalamus has control centers for several
involuntary activities of the body. One of which
concerns sleeping and waking.
Various neurotransmitters are involved with the
sleeping process.
• Norephinephrine and acethlylcholine, followed by
dopamine serotonin, and histamine are involved
with excitation.
• While Gamma amino butyric acid appears to be
necessary for inhibition.

6. Cont…
• Circadian Rhythms: Sleep is one of the body’s most
complex biologic rhythms.
• It exists when sleep woke patterns follow the inner
biologic clock
• When physiologic and psychological rhythms are
high or most active or completely activated with
stimuli the person is awake , and
• When these rhythms are low or stimuli from high
brain center is minimum the person is asleep.

7. Cont…
• Stages of the sleep cycle;
1. Non rapid eye movement ( NREM); sleep
characterized by different stages from lightest level of
sleep to deepest stage of sleep during which there is a
decreased physiological activity begins with gradual
fall in vital sign and body anabolism also sleep
walking and enuresis may occur.
2. Rapid eye movement (REM) sleep characterized by
period from deep sleep, to full dreaming with, rapid
autonomic eye movement, full color dreaming in
sleeper, this phase mostly begins about 90-minutes
after sleep has begun.

8. Cont…
 Function of normal sleep and rest;
 Promote good reasoning, memory, learning and
interpretation of stimulus; Adequate sleep and rest
gives the body and mind time for normal
functioning with adjustments.
 For adequate circulation, satisfaction and good
performance; With enough sleep and rest the body
vital sign becomes stable and increases the
individual activity in many dimensions with high
satisfaction.
 To keep the normal physiologic function in their
proper ways and restore body vital organs.

9. Cont…
 To prolong healthy and long life; health is mainly
associated with the person regular time for sleep
and rest because of restoration, building of body
tissues.
 To decrease stress and promote competency in
daily task to keep alert and energetic.
 It is good for the welfare of the individual and
society. Those individual having stable pattern of
sleep and rest function will be less harmed by
traffic accident tolerate stressors, function
optimally, benefit to self and society competently.

10. Cont…
 Factors affecting sleep and rest;
 Developmental considerations (stage)-age
 Internal and external stimuli; reduction of
environmental stimuli particularly light and noise
facilitate sleep, whereas nutritional factors hunger,
overeat calorie, fatigue and work load disturbs sleep
pattern.
 Exercise : Frequent healthy life exercise contributes to
dapper and longer sleep. In physically fit people light
intensity exercise seems to decrease sleep latency and
intensive exercise increases the proportion of slow
wave sleep.

11. Cont…
• Life styles and traits; life style pattern influencing
the sleep wake schedule, such as time of rising are
closely linked with societal and occupational
expectations.
• Drugs : Sleep patterns are vulnerable to disturbance
from medications taken to facilitate sleep specially
alcohol taking, using hypnotics , sleeping pills,
smoking can disturb the normal stage of sleep.

12. Cont…
• Mood states: Change of individual mood states
like anxiety, depression and tension are associated
with disturbance of sleep because they cause
neurotransmitter imbalance through the body
systems.
• During acute and chronic illness: patients are
particularly vulnerable to decreased, disrupted
infrequent sleep and loss of sleep.

13. Cont…
Manifestation of altered Sleep function
 Altered sleep associated with medical or
psychiatric conditions are like mood disorder
(Hypomania, mania, depression and severe
depression)
 Sleep walking (somnambulism)
 Sleep talking,
 Bed wetting (enuresis)
 Night mares,
 Sleep bruxism (teeth grinding)
 Natural leg cramps

14. Cont…
 Other physiological and psychological sleep
deprivation symptom includes.
• Slowed response time
• Less sensory perception activity
• Decreased in judgment and reasoning
• Decreased auditory and visual alertness
• Cardiac arrhythmias, confusion and
disorientation
• Apathetic, agitation, hyperactive
• Decreased motivation

15. Cont…
Narcolepsy- excessive day time sleep attacks
characterized by incontrollable derive to sleep.
 Cataplexy- sudden-muscular weakness during
intense emotion such as anger, sadness, laughter,
occurring at least five times per hour.
Night terrors- are repeated; sudden awaking
accompanied by screaming, acute anxiety and
respected disorientation.

16. Cont…
Dreams- images or certain abstract perceived
images which seen during deep sleep.
Sleep deprivation- are less or inability to get
sleep due to emotional stress, medication or other
environmental disturbances

17. Cont…
 Application of Nursing process;
 Assessment;
 Subjective data
 Determine the person’s usual sleep and rest patterns through
question such as: History of:
• How many hours of sleep do you usually get?
• What time do you usually go to bed? Getup?
• What helps you get to sleep?
• How do you feel when you a waken?
• How often do you nap? Take rest periods?
• what has helped and what has made it worse.

18. Cont…
 Risk identification: Look for developmental and
situational changes (environmental, physical and
social) that may increase the need for or interfere
with sleep or rest. Assess caffeine and alcohol
intake, and involvement in shift work.
 Objective data
 observe for circles under the eyes, yawning,
nodding and word. Finding difficulties may be
indicative of sleep pattern disturbance.
 monitor vital signs.

19. Cont…
Nursing diagnoses
• Sleep pattern disturbances (difficulty of falling
asleep is the nursing diagnosis used for
acknowledging and identifying the sleep and rest
needs of patients’).
 Definition: Sleep pattern disturbance is
disruption of sleep time that causes discomfort or
interferes with desired life style.

20. Cont…
 Defining characteristics: Expresses Verbal
complaints of difficulty falling asleep, awakening
earlier or later than desired, interrupted sleep, verbal
complaints of not feeling well rested, changes of
behavior and performance (increase irritability,
restlessness, disorientation, lethargy) physical signs
(mild fleeting, nystagmus (rapid movn’t of eye)
changes in posture, thick speech with
mispronunciation and in correct words).
 Related factors: Sensory alterations, internal (illness,
psychological stress), external (environmental,
social).

21. Cont…
 Related Nursing diagnosis: Some of the related
nursing diagnoses for a patient with altered sleep
function include: fatigue defined as an overwhelming
sense of exhaustion and decreased capacity for
mental and physical work. Other diagnoses such as
inadequate rest are also included
• Patient Goals
 Patient will report fewer problems with falling asleep.
 Patient will report feeling more rested.
 Patient will demonstrate physical signs of being rested.

22. Cont…
Implementation
• Selected nursing intervention for common sleep
and rest problems;
Suggest caffeine and alcohol be removed from
clients diet in the evening
Encourage the client follow bed time ritual, go to
bed at same time each night, drink glass of milk
before bed.
Assist control sources of environmental noise and
be sure that bed room is darkened and well
ventilated.

23. Cont…
• Evaluation
Patient will report fewer problems with falling
asleep
With days patient reports less anxiety regarding
falling a sleep
Patient will report feeling more rested