This document defines sleep and rest, compares their characteristics, and discusses sleep patterns and disorders. It outlines two types of sleep - NREM and REM sleep - and explains their stages and functions. Factors affecting sleep and common sleep disorders like insomnia and sleep apnea are identified. Nursing interventions to promote sleep through environmental changes, relaxation techniques, and medication administration if needed are also discussed.

1. By
Rawal Rafiq Leghari
Medicose Nursing Academy

2. OBJECTIVES
 At the end of this presentation you will be able to:
 Define sleep and rest pattern
 Define terms related to rest and sleep
 Compare the characteristics of sleep and rest.
 Discuss the characteristics of two kinds of sleep.
 Enumerate the functions of sleep.
 Discuss factors affecting sleep.
 Identify common sleep disorders.
 Identify conditions necessary to promote sleep.
 Discuss nursing process for a patient to promote sleep.

3. SLEEP AND REST PATTERNS
 Assessment is focused on the person's
sleep, rest, and relaxation practices.
Dysfunctional sleep patterns, fatigue, and
responses to sleep deprivation may be
identified.
 Inquire about Patterns of sleep, rest,
perception of quality and quantity.

4. SLEEP
 sleep is a naturally recurring state characterized by
altered consciousness, relatively inhibited sensory
activity, and inhibition of nearly all voluntary
muscles.
 It is distinguished from wakefulness by a decreased
ability to react to stimuli, and it is more easily
reversible than being in hibernation or a coma.

5. Conti……
 The Oxford English Dictionary defines sleep as:
 “a condition of bodyand mind which typicallyrecurs
for several hours every night, in which the nervous
system is inactive, the eyes closed, the postural
muscles relaxed, and consciousness practically
suspended”.

6. Conti……………..
 In most human societies sleep is conducted during the
night, but in very hot climates it may be done during
the day.

7. Rest
➢A state of calmness, relaxation with out
emotional stress, and freedom from anxiety
OR
➢The word rest comes from the German rasta
meaning “League of miles.” if you walked that
far, you’d need a good rest too

8. DEFINING CHARACTERISTICS
• Verbal complaints of difficulty falling asleep
• Awakening earlier or later than desired
• Interrupted sleep
• Verbal complaints of not feeling rested
• Restlessness
• Irritability
• Tired
• Gaping
• Altered mental status
• Difficulty in arousal
• Change in activity level
• Altered facial expression (e.g., blank look, fatigued
appearance)

9. Types of Sleep
Two types of sleep
✓NREM
✓REM

10. NREM- Non-rapid Eye Movement
 NREM sleep is further divided into progressively
deeper stages of sleep:
 stage N1,
 stage N2,
 stage N3 (deep or delta-wave sleep).
 As NREM stages progress, stronger stimuli are
required to result in an awakening.

11. Conti…..
 Stage 1 (NREM1 or N1)
 is the stage between wakefulness and sleep, sometimes
referred to as somnolence or drowsy sleep, in which the
muscles are still quite active and the eyes roll around
slowly and may open and close from time to time.
 Stage 2 (NREM2 or N2)
 is the first unequivocal stage of sleep, during which
muscle activity decreases still further and conscious
awareness of the outside world begins to disappear
completely. If any sounds are heard, the sleeper is not able
to understand their content at this point

12. Conti…
 Stage 3 (NREM3 or N3)
 is also known as deep or delta or slow-wave sleep
(SWS), and during this period the sleeper is even less
responsive to the outside environment, essentially cut
off from the world and unaware of any sounds or
other stimuli.

13. REM (Rapid Eye Movement)
 REM sleep occurs in cycles of about 90-120 minutes
throughout the night, and it accounts for up to 20-25%
of total sleep time in adult humans,
 The majority of dreams - certainly the most
memorable and colorful dreams - occur during REM
sleep,
 Neurologically, REM sleep is activated by secretion of
the neurotransmitter acetylcholine and inhibited by the
neurotransmitter serotonin, and this effect is
principally generated in the pons region of the
brainstem.

14. Conti…..
 Stage R sleep (REM sleep) has tonic and phasic
components.
 The phasic component is a sympathetically driven
state characterized by rapid eye movements, muscle
twitches, and respiratory variability.
 Tonic REM is a parasympathetically driven state with
no eye movements.

15. FUNCTIONS OF SLEEP
 Restores normal levels of activity
 Lack of sleep results in poor
concentration, irritability, difficult
decision making.
 It use to be thought that a regular sleep
pattern was more important than actual
hours slept but sleep deprivation is
associated with cognitive & health
problems.
 Sleep is required to provide energy for
physical and mental activities.

16. Sleep Cycle

17. FACTORS AFFECTING SLEEP
• Pain/discomfort.
• Environmental changes.
• Anxiety/fear.
• Depression.
• Medications.
• Excessive or inadequate stimulation.
• Abnormal physiological status or symptoms
(Dyspnea, hypoxia, neurological dysfunction, and
others)
• Normal changes associated with aging.

18. SLEEP DISORDERS
A sleep disorder - technically known as a somnipathy
or dyssomnia - is any medical disorder which
negatively affects a person’s healthy sleep patterns.
Humans may suffer from a number of sleep disorders.
These include dyssomnias such as;
✓ Insomnia,
✓ Hypersomnia,
✓ Sleep Apnea
✓Parasomnias (Such As Sleepwalking )
✓Circadian rhythm sleep disorders.

19. Insomnia
 Insomnia is a sleep disorder that is characterized by
difficultyfalling and/or staying asleep.

20. Hypersomnia
 also called hypersomnolence or sometimes
idiopathic hypersomnia (meaning that it
arises from no known cause), is a sleep
disorder characterized by excessive daytime
sleepiness, excessive sleep periods each day
(usually taken to mean more than 10 hours)
and/or an inability to achieve the feeling of
refreshment that sleep usually brings.
Chronic sufferers may sleep up to 18 hours a
day or more and still not feel refreshed upon
waking.

21. SLEEP APNEA
 is a potentially life-threatening sleep disorder
characterized by abnormal pauses (apneas) in
breathing during sleep.

22.  Obstructive Sleep Apnea – caused by occlusion of the
airway during sleep.
 TX: CPAP – Continuous Positive Air Pressure
 Central Sleep Apnea – Dysfunction in central
respiratory control
 Mixed Apnea – combination of Obstructive and
Central Sleep Apneas

23. CPAP

24. Parasomnias
 Parasomnias are a category of sleep disorders involving
abnormalor unnaturalmovements, behaviors, emotions,
perceptions and dreams during sleep

25. Circadian rhythms
 Circadianrhythms are physical, mental and
behavioral changes that follow a roughly 24-hour
cycle, responding primarily to light and darkness in an
organism's environment. They are found in most living
things, including animals, plants and many tiny
microbes.

26. Teaching to promote rest & sleep
▪ Establish regular bedtime & wake up
▪ Eliminate lengthy naps
▪ Exercise just not 2 hrs before bedtime
▪ listen to music,
▪ warm bath,
▪ Avoid heavy meals 3 hrs before bedtime
▪ If you're getting enough sleep, you should wake up
naturally without an alarm.

27. Assesses sleep and rest patterns.
History (subjective data):
 Generally rested and ready for activity after
sleep?
 Sleep onset problems?
 Aids?
 Dreams(nightmares), early awakening?
 Rest / relaxation periods?
 Sleep routine?
 Sleep apnea symptoms?

28.  Examination (examplesof objectivedata):
 Observesleep pattern and rest pattern.

29. Associated Nursing Diagnoses:
➢ Sleep pattern Disturbance: Time-limited disruption of
sleep (natural periodic suspension of consciousness).
➢ Sleep-deprivation: Prolonged periods without sleep.
 other diagnoses:
 Risk for injury
 Ineffective coping
 Fatigue
 Risk for impairedgas exchange
 Deficient knowledge
 Anxiety
 Activityintolerance

30. Implementation
 Nursing interventions are used to enhance the quantity
and quality of sleep & involve largely non-
pharmacologic measures. Interventions include-
✓ guided imagery
✓ therapeutic message
✓ progressive muscle relaxation
✓ uninterrupted sleep periods.

31. Implementation
 Client teaching
✓ Individuals need to learn the
importance of rest and sleep in
maintaining active and productive
lifestyles.
 Supporting bedtime rituals
✓ Many are accustomed to rituals or pre-
sleep routines and if altered can affect
sleep.
 Creating Restful Environment

32. IMPLEMENTATION
 Promoting Comfort and Relaxation
✓ Assist client with hygienic routines
✓ Offer back message
✓ Administer analgesics 30 min before sleep
 Enhancing Sleep with Medications
✓ Nurse responsible for making decisions with the client about
when to administer sedative or hypnotics.

33. References
 Boyle, J.S; and Andrew. M. M. (1998). Trans-cultural
concept in nursing care. USA; Little Brown.
 Long, B.C. (1995). Adult nursing: a nursing process
approach WolfeMedical Publishers