This document discusses the concepts of rest and sleep, detailing the physiological processes involved in sleep regulation, including the roles of the brain and biological rhythms. It outlines the stages of sleep, factors affecting sleep quality and quantity, and various sleep disorders such as insomnia and sleep apnea. Additionally, it provides strategies for improving sleep hygiene and creating conducive sleeping environments.

2.  Rest
 Rest is a condition in which the body is in a decreased state of
activity without physical emotional stress and freedom from anxiety.
 Sleep
 Sleep is a state of rest accompanied by altered level of consciousness
and relative inactivity, and perception to environment are decreased.

3.  The cyclic nature of sleep is thought to be controlled by Centers
located in the brain and by Circadian Rhythms.
 Reticular activating system (RAS) located at the brain stem and
Cerebral Cortex plays an important role in sleep wake cycle.
 Sleep begins with the activation of the pre optic area of the anterior
hypothalamus.
 Sleep promoting neurons act over wake promoting neurons by
releasing Gamma Amino Butyric Acid (GABA).
 The inhibition of wake promoting neurons results in intensifying
sleep process.

4.  Another key factor to sleep is exposure to darkness.
 Darkness and preparing for sleep (e.g., lying down, decreasing noise)
cause a decrease in stimulation of the RAS.
 During this time, the Pineal gland in the brain begins to actively
secrete the natural hormone Melatonin, and the person feels less
alert.
 With the beginning of daylight, Melatonin is at its lowest level in the
body and the stimulating hormone, Cortisol , is at its highest
causing wakefulness.

5.  It is a sort of 24-hour internal biological clock.
 The term circadian is from the Latin “circa dies”, meaning “about a
day.”
 Biological rhythms exist in plants, animals, and humans.
 In humans, these are controlled from within the body and
synchronized with environmental factors, such as light and
darkness.

6.  Electroencephalogram (EEG) patterns, eye movements and muscle
activity are used to identify stages of sleep.
 The stages of sleep are classified into two stages:
1. Non Rapid Eye Movement (NREM) Sleep
o Stage 1
o Stage 2
o Stage 3
o Stage 4
2. Rapid Eye Movement Stage(rem) Sleep.

7. EEG

8.  First stage of sleep is known as NREM sleep.
 About 75% to 80% of sleep during a night is NREM sleep.
 It consists of four stages:
o Stage 1
o Stage 2
o Stage 3
o Stage 4

9.  Stage lasts a few minutes.
 It includes lightest level of sleep.
 Gradual fall in vital signs and metabolism.
 General slowing of EEG frequency.
 Eyes tend to roll slowly from side to side.
 Sensory stimuli such as noise easily arouses person.
 Sleeper may deny he is sleeping.

10.  Stage lasts 10 to 20 minutes.
 It is a period of sound sleep.
 Relaxation progresses.
 Further slowing of EEG.
 Absent eye ball movements.
 Body functions continue to slow.
 Arousal remains relatively easy.

11.  Stage lasts 15 to 30 minutes.
 It involves initial stages of deep sleep.
 Muscles are completely relaxed.
 Large slow waves in EEG .
 Vital signs decline but remain regular.
 Sleeper is difficult to arouse and rarely moves.

12.  Stage lasts approximately 15 to 30 minutes.
 It is the deepest stage of sleep.
 If sleep loss has occurred, sleeper spends considerable portion of
night in this stage.
 Vital signs are significantly lower than during waking hours.
 Further slowing of EEG.
 Sleepwalking and enuresis (bed-wetting) sometimes occur.
 It is very difficult to arouse sleeper.

13.  Stage usually begins about 90 minutes after sleep has begun.
 Dreaming occurs in this stage.
 Stage is typified by rapidly moving eyes, fluctuating heart and
respiratory rates, increased or fluctuating blood pressure, loss of
skeletal muscle tone, and increase of gastric secretions.
 EEG pattern resembles that of awake state.
 It is very difficult to arouse sleeper.

16.  Conservation of energy
 Restoration of tissues and growth
 Thermoregulation
 Regulation of emotions- sleep deprivation causes emotional
disorders like irritability, anxiety, depression etc.
 Neural maturation
 Memory and learning- there will be information transfer between
cerebral cortex and hippocampus during sleep

17.  Newborn: 16-18 hours /day
 Infants: 12-14 hours
 Toddlers: 10-12 hours
 Preschool: 11-12 hours
 School-Age: 8- 12 hours
 Adolescents: 8-10 hours
 Adult: 6-8 hours • Elders: 6 hours

18.  Both the quality and the quantity of sleep are affected by a number
of factors.
 Sleep quality is a subjective characteristic.
 Quantity of sleep is the total time the individual sleeps.
1. Age
2. Illness
- Illness that causes pain or physical distress (e.g., arthritis, back-
pain) can result in sleep problems.
- E.g. Respiratory conditions, Pain, need to urinate during the night

19. 3. Environment
- Environment can promote or hinder sleep
- Any change—for example, noise in the environment—can inhibit
sleep.
- The absence of usual stimuli or the presence of unfamiliar stimuli
can prevent people from sleeping.
- Discomfort from environmental temperature (e.g., too hot or cold)
and lack of ventilation can affect sleep.

20. - Light levels can be another factor.
- Another influence includes the comfort and size of the bed.
- A person’s partner who has different sleep habits, snores, or has
other sleep difficulties may become a problem for the person also.
4. Lifestyle
- Following an irregular morning and night time schedule can affect
sleep.
- Night shift workers frequently obtain less sleep than other
workers and have difficulty falling asleep.

21. 5. Emotional Stress
- Stress is considered to be the major cause of short-term sleeping
difficulties .
- A person preoccupied with personal problems (e.g., school- or job-
related pressures, family or marriage problems) may be unable to
relax sufficiently to get to sleep.
6. Stimulants and Alcohol
- Caffeine-containing beverages act as stimulants of the central nervous
system (CNS).

22. - Drinking beverages containing Caffeine in the afternoon or
evening may interfere with sleep.
- Even though alcohol induces sleep, it disturbs REM sleep causing
irritability.
7. Diet
- Certain foods induces sleep.
- Ex: the L- tryptophan present in the milk induces sleep.

23. 8. Smoking
- Nicotine has a stimulating effect on the body, and smokers often
have more difficulty falling asleep than non smokers.
- Smokers can be easily aroused.
9. Motivation
- Motivation can increase alertness in some situations
- Ex: During the time of examination Browsing internet in the late
night

24. 10. Medications
- Beta-blockers have been known to cause insomnia.
- Narcotics, such as morphine, are known to suppress REM sleep
and to cause frequent awakenings and drowsiness.
- Most Hypnotics suppresses REM sleep

25.  Insomnia is described as the inability to fall asleep or remain asleep.
 Difficulty falling asleep
 Waking up frequently during the night
 Difficulty returning to sleep
 Waking up too early in the morning
 Unrefreshing sleep
 Daytime sleepiness
 Difficulty concentrating
 Irritability

26.  Hypersomnia refers to conditions where the affected individual
obtains sufficient sleep at night but still cannot stay awake during
the day.
 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.
 Sleep Apnea is characterized by frequent short breathing pauses
during sleep.

27.  Sleep deprivation
A prolonged disturbance in quality and quantity of sleep can lead to
a syndrome called as sleep deprivation.
Individual may develop-
Attention and concentration deficits
Reduced vigilance
Distractibility
Reduced motivation
Fatigue
Diplopia and dry mouth.

28.  Parasomnias
Something abnormal occurs during sleep itself, or during the times
when the client is falling asleep or waking up.

29. 1. Sleep-Wake Pattern
 Maintain a regular bedtime and wake-up schedule
 Eliminate day time naps. If naps are taken, limit to 20 minutes or
less twice a day
 Instruct the client to go to bed when sleepy.
 Use warm bath and relaxation techniques
 If unable to sleep in 15 to 30 minutes, get out of bed and pursue
some relaxation activity.

30.  Establish a regular, relaxing bedtime routine before sleep such as
reading, listening to soft music, taking a warm bath, or doing
some other quiet activity.
 Avoid dealing with office work or family problems before bedtime
 Get adequate exercise during the day to reduce stress, but avoid
excessive physical exertion at least 3 hours before bedtime.

31. 2. Environment:
 Create a sleep-conducive environment that is dark, quiet,
comfortable, and cool.
 Keep noise to a minimum; block out extraneous noise as necessary
with white noise from a fan, air conditioner.
 Sleep on a comfortable mattress and pillows.
 Listen to relaxing music
 Increase exposure to bright light during the day

32. 3. Diet:
 Limit alcohol, caffeine, and nicotine in late afternoon and evening
 Consume carbohydrates or milk as a light snack before bedtime.
 Avoid heavy and spicy foods. Heavy or spicy foods can cause
gastrointestinal upsets that disturb sleep
 Decrease fluids 2 to 4 hours before sleep

33. 4. Medications:
 Use sleeping medications only as a last resort
 Minimize the usage of medicines as much as possible because
many contain antihistamines that cause daytime drowsiness.
 Take analgesics 30 mins before bedtime to relieve aches and pains.
 Consult the health care provider about adjusting other
medications that may cause insomnia.