PHYSIOLOGICAL NEEDS: SLEEP & REST

1. SLEEP & REST
By:
Mr.Shiva Nagu
M.Sc (N)

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

3. PHYSIOLOGY OF SLEEP
• 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.

4. …PHYSIOLOGY OF SLEEP
• 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.

5. …PHYSIOLOGY OF SLEEP
• 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.

6. …PHYSIOLOGY OF SLEEP
• 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.

7. Circadian Rhythms
• 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.

8. Types/ Stages/ Phases Of Sleep
• Electroencephalogram (EEG) patterns, eye
movements and muscle activity are used to
identify stages of sleep. The stages of sleep are
classified into two stages:
• Non Rapid Eye Movement (NREM) Sleep
o Stage 1
o Stage 2
o Stage 3
o Stage 4
• Rapid Eye Movement Stage(rem) Sleep.
During sleep, NREM and REM sleep alternate in
cycles

9. EEG

10. Non Rapid Eye Movement (NREM) Sleep
• 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

11. NREM Sleep
• Stage 1: NREM
• 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.

12. NREM Sleep
• Stage 2: NREM
• 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

13. NREM Sleep
• Stage 3: NREM
• 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

14. NREM Sleep
• Stage 4: NREM
• 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

15. REM Sleep
• 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. SLEEP CYCLE

17. FUNCTIONS OF SLEEP
• 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

18. Normal Sleep Requirements
• 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

19. FACTORS AFFECTING SLEEP
• 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, backpain) can result in sleep
problems

20. FACTORS AFFECTING SLEEP
• Examples: Respiratory
conditions
• Pain
• need to urinate during the
night

21. FACTORS AFFECTING SLEEP
• 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

22. FACTORS AFFECTING SLEEP
• 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.

23. ..FACTORS AFFECTING SLEEP
• 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.

24. ..FACTORS AFFECTING SLEEP
• 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.

25. …FACTORS AFFECTING SLEEP
• 6. Stimulants and Alcohol
• Caffeine-containing beverages act as
stimulants of the central nervous
system (CNS).
• Drinking beverages containing Caffeine in
the afternoon or evening may interfere
with sleep.
• Even though alcohol induces sleep, it
disturbs REM sleep causing irritability.

26. ..FACTORS AFFECTING SLEEP
• 7. Diet
• Certain foods induces sleep
• Ex: the L- tryptophan present in the
milk induces sleep
• 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

27. ….FACTORS AFFECTING SLEEP
• 9. Motivation
• Motivation can increase alertness in some
situations
• Ex: During the time of examination
Browsing internet in the late night

28. ….FACTORS AFFECTING SLEEP
• 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

29. SLEEP DISORDERS
• Sleep disorders are mainly classified into
3 categories
SLEEP
DISORDERS
DYSOMNIAS PARASOMNIAS
DISORDERS
DUE TO
OTHER
MEDICAL
CONDITIONS

30. DYSOMNIAS
• The sleep itself is pretty normal.
• But the client sleeps too little, too much,
or at the wrong time.
• So, the problem is with the amount
(quantity), or with its timing, and
sometimes with the quality of sleep.

31. DYSOMNIAS
• Common Dysomnias are:
• Insomnia
• Hypersomnia
• Narcolepsy
• Sleep Apnea
• Insufficient Sleep/ Sleep
Deprivation

32. Insomnia
• Insomnia is described as the inability to
fall asleep or remain asleep.
• Persons with insomnia awaken not
feeling rested.
• Insomnia is the most common
sleep complaint.
• Acute insomnia lasts one to several nights
and is often caused by personal stressors
or worry.
• If the insomnia persists for longer
than a month, it is considered

33. ..Insomnia
• Insomnia can result from physicl
discomfort and more often from mental
tension or anxiety.
• People who are habituated to drugs or
who takes large amounts of alcohol are
at high risk for insomnia.

34. Insomnia
Clinical manifestations:
■ 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

35. Insomnia
• Treatment is development of new
behavioral patterns that induces sleep
• Create a sleeping environment that
induces sleep
• Create positive sleep thoughts

36. Hypersomnia
• Hypersomnia refers to conditions where
the affected individual obtains sufficient
sleep at night but still cannot stay awake
during the day.
• Hypersomnia can be caused by medical
conditions, for example, CNS damage
and certain kidney, liver, or metabolic
disorders, such as diabetic acidosis and
hypothyroidism.

37. Hypersomnia
• Treatment of hypersomnias include
treating the underlying disease
conditions

38. Narcolepsy
• 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.
• Clients with narcolepsy have sleep attacks
or excessive daytime sleepiness, and their
sleep at night usually begins with a sleep-
onset REM period (dreaming sleep occurs
within the first 15 minutes of falling
asleep).

39. Narcolepsy
• People sleeps several times a day even
when they are conversing with people or
while driving.
• CNS stimulants and Antidepressants are
the drugs used to treat narcolepsy.

40. Sleep Apnea
• Sleep Apnea is characterized by frequent
short breathing pauses during sleep.
• Although all individuals have occasional
periods of apnea during sleep, more than
five apneic episodes longer than 10
seconds in an hour is considered
abnormal and should be evaluated by a
sleep medicine specialist.

41. ….Sleep Apnea
• Sleep Apnea is most frequently diagnosed
in men and postmenopausal women, it
may occur during childhood.
• Three types of apnoea based on the cause
• 1. Obstructive Apnoea
• 2. Central Apnea
• 3. Mixed Apnea

42. …Sleep Apnea
• 1. OBSTRUCTIVE APNOEA:
• 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
• Treatment includes surgical removal of
tonsills, correcting nasal septum, weight
loss may be helpful.

43. ….Sleep Apnea
• 2. CENTRAL APNEA:
• Due to defect in the respiratory centre of
the brain.
• Clients who have brainstem injuries and
often have central sleep apnea.
• 3.MIXED APNOEA
• Mixed apnoea is combination of
obstructive and central apnea

44. Insufficient Sleep/ Sleep Deprivation
• A prolonged disturbance in quality and
quantity of sleep can lead to a
syndrome called as sleep deprivation.
• It is not a sleep disorder but result
of prolonged sleep disturbance.
• It produces various physiological and
behavioural symptoms based on the
severity of deprivation.

45. Insufficient Sleep/ Sleep Deprivation
Individuals may develop:
• Attention and concentration
deficits
• Reduced vigilance
• Distractibility
• Reduced motivation
• Fatigue
• Diplopia and dry mouth.

46. PARASOMNIAS
• Something abnormal occurs during sleep
itself, or during the times when the client is
falling asleep or waking up
• The quality, quantity, and timing of the sleep
are essentially normal.
Most common DISORDERS are:
• Bruxism
• Enuresis
• Periodic limb movement disorder
• Sleep talking
• Sleep walking

47. ….PARASOMNIAS
■ Bruxism. Usually occurring during stage II
NREM sleep, characterized by clenching
and grinding of the teeth.
• This clenching and grinding of the teeth
can eventually erode dental crowns, cause
teeth to come loose, and lead to
deterioration of the temporomandibular
(TMJ) joint, called TMJ syndrome

48. ….PARASOMNIAS
■ Enuresis. Bed-wetting during sleep
occuring in children over 3 years old.
• More males than females are affected.
• It often occurs 1 to 2 hours after falling
asleep.

49. ….PARASOMNIAS
• Periodic limb movement disorder
(PLMD). In this condition, the legs jerk
twice or three times per minute during
sleep.
• It is most common among older adults.
• Respond well to medications such as
levodopa, pramipexole , ropinirole,
and gabapentin

50. ….PARASOMNIAS
• Sleeptalking. Talking during sleep occurs
during NREM sleep before REM sleep.
• It rarely presents a problem to the person
unless it becomes troublesome to others

51. ….PARASOMNIAS
• Sleepwalking. Sleepwalking
(somnambulism) occurs during stages III
and IV of NREM sleep. It is episodic and
usually occurs 1 to 2 hours after falling
asleep.
• Sleepwalkers tend not to notice dangers
(e.g., stairs) and often need to be
protected from injury

52. Disorders due to other medical conditions
• These disorders are associated with
Medical or Psychiatric or other illness
• Usually the disorders that cause
sleep disturbance includes:
• Depression
• Alcolism
• Thyroid dysfunction
• Peptic ulcer
• COPD- chronic obstructive pulmonary
disease

53. Nursing Interventions To Promote Sleep
• 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 persue some relaxation
activity.

54. …..Nursing Interventions To
Promote Sleep
• 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.

55. ..Nursing Interventions To Promote
Sleep
• 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

56. ……..Nursing Interventions To
Promote Sleep
• 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

57. Nursing Interventions To Promote Sleep
• 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.