CONCEPT OF SLEEP or the sleep pattern .pptx

Concept Of Sleep
Prepared by : Misbah Khan
Lecturer (DION&M, DUHS)
YEAR 1, SEM II.
DATE :23RD NOV,2022
4/4/2024 MISBAH KHAN 1

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
• 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)

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

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

StageII
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%.
 Growth hormones level peak
 Intracranial pressure decreased

REM Sleep
• During REM sleep brain 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
The average amount of sleep needed according to age.
Age Hours of sleep
 New born
 Infant
 1 year to 4 year
 5year to 13 year
 13 year to 21 year
 Adult younger
 Old age
14-18 hours
12-16 hours
12-13 hours
10-10.5 hours
8-9 hour
7- 8 hours
Only 6 hours at night

Factors Affecting Sleep
 Age
 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

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.

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.

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

BRUXISM
Clenching or grinding of teeth, usually occurs
during Stage II.

SLEEPAPNEA:
 Frequent short breathing pauses during sleep.

SLEEPAPNEA:
 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 :
 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.

• 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.
• Take analgesics before bedtime to relieve aches and pains as
prescribed by doctor.

 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.

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