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bishnupur PUBLIC SCHOOL AND college of nursing

Lesson Plan on

REST AND SLEEP

Presented by
Poulami Chandra

4/24/2024
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GENERAL OBJECTS
At the end of this unit, the learners
will be able to:
•Define rest and sleep pattern
•Define terms related to rest and
sleep
•Compare the characteristics of
sleep and rest
•Discuss characteristics of two
kinds of sleep
•Enumerate the function of sleep
•Discuss factors effecting sleep
•Identify common sleep disorders
•Identify conditions necessary to
promote sleep
•Discuss nursing process for a
patient to promote sleep
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Lesson Plan

SUBJECT : Fundamental of Nursing

TOPIC : Rest and Sleep

nd
GROUP : BSC 2 sem

UNIT : 9

DURATION : 45min

PLACE : Classroom

METHOD OF TEACHING : Lecture and Discussion

AV AIDS : White board

NAME OF THE TEACHAR : Miss Poulami Chandra

TIME SPECIFIC CONTENT T/L AV AIDS EVA

OBJECT ACTIVITIES

Lecture and White board

4min Definition Defination discussion
• 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.

Physiology of Physiology of sleep Lecture and White board Desc

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5min sleep • The cyclic nature of sleep is thought to be discussion phys

controlled by Centers located in the brain sleep
and by Circadian Rhythms.
• Reticular activating system (RAS) located
at the brain stem and Cerebral Cortex plays
an important role in sleep wake cycle.
Physiology of sleep
•Neurotransmitters, located within the
neurons in the brain effect the sleep wake
cycle . For example serotonin is thought to
lessen the response to sensory stimulation
and GABA gamma aminobutyric acid to shut
off the activity of neurons in RAS.
•Another key factor to sleep is exposure to
darkness.
•Pineal gland in brain secrete melatonin ,
and the person feel less alert.

Circadian rhythms
• It is a sort of 24-hour internal biological
clock. The term circadian is from the Latin
“circadies”, 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.
• Electroencephalogram (EEG) patterns, eye
movements and muscle activity are used to
identify.
5min Stages of sleep stages of sleep. Lecture and White board Wha
The stages of sleep are classified into two discussion stage
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

Non Rapid Eye Movement (NREM) Sleep

• First stage of sleep is known as NREM
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sleep.
• About 75% to 80% of sleep during a night
is
• It consists of four stages:
o Stage 1
o Stage 2
o Stage 3
o Stage 4
• Stage 1: NREM
• Stage lasts a few minutes.
• It includes lightest level of sleep.
• Gradual fall in vital signs and metabolism.
• Eyes tend to roll slowly from side to side
• Sensory stimuli such as noise easily
arouses
person.
• Sleeper may deny he is sleeping.
• Stage 2: NREM
• Stage lasts 10 to 15 minutes.
• 44% to 55 %of total sleep
• It is a period of sound sleep.
• Relaxation progresses.
• Absent eye ball movements
• Body functions continue to slow.
• Arousal remains relative easy

• Stage 3: NREM
• Stage lasts 15 to 30 minutes.
• It involves initial stages of deep sleep.
• Muscles are completely relaxed.
• Vital signs decline but remain regular.
• Sleeper is difficult to arouse and rarely
moves

• Stage 4: NREM
• Stage lasts approximately 15 to 30
minutes.
• It is the deepest stage of sleep.
• Vital signs are significantly lower than
during waking hours.
• Sleepwalking and enuresis (bed-wetting)
sometimes occur.
• It is very difficult to arouse sleeper
Physiological changes during NREM sleep
Arterial blood pressure falls Pulse rate
decreases Peripheral blood vessels dilate
Cardiac output decreases Skeletal muscles
relax Basal metabolic rate decreases 10 % to
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30%. Growth hormone level peak

Intracranial pressure decreases.

Loss of NREM sleep

In a sleep deprived client, the loss of NREM
sleep causes
•Immunosuppressant
•Slows tissue repair
•Lowers pain tolerance
•Triggers profound fatigue
•And increase susceptibility to infection

REM Sleep
• Stage usually begins about 90 minutes
after sleep has begun.
• Dreaming occurs in this stage
• During REM the brain is highly active and
the brain metabolism as much as increase
20%
• 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..
• It is very difficult to arouse sleeper.

FUNCTIONS OF SLEEP
Lecture and White board Expla
• Conservation of energy
discussion func
• Restoration of tissues and growth
Function of sleep
• Thermoregulation
5min sleep body
• Regulation of emotions- sleep deprivation
causes emotional disorders like irritability,
anxiety, depression etc.
• Sleep is also necessary for protein
synthesis
• Memory and learning- there will be
information transfer between cerebral
cortex and hippocampus during sleep

Normal Sleep Requirements

• Newborn: 16-18 hours /day
Normal sleep Lecture and Wha
• Infants: 12-14 hours
5min requirements discussion White board norm
• Toddlers: 10-12 hours
requ
• Preschool: 11-12 hours
• School-Age: 8- 12 hours
• Adolescents: 8-10 hours
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• Adult: 6-8 hours

• Elders: 6 hours

FACTORS AFFECTING SLEEP

Factor • Both the quality and the quantity of sleep Lecture and Wha
affecting sleep are affected by a number of factors. discussion White board facto
5min • Sleep quality is a subjective characteristic influ
• Quantity of sleep is the total time the sleep
Individual sleeps.

• 1. AGE

• 2. Illness
• Illness that causes pain or physical distress
(e.g.,
arthritis, backpain) can result in sleep
problems
• Examples: Respiratory conditions
• Pain
• need to urinate during the night

• 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
• 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.

• 5. Emotional Stress
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• 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).
• Drinking beverages containing Caffeine in
the afternoon or evening may interfere with
sleep.
• Even though alcohol induces sleep, it
disturbe REM sleep causing irritability.

• 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

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

SLEEP DISORDERS
• Sleep disorders are mainly classified into 3 Expla
Sleep disorder categories Lecture and White board disor
5min 1. DYSOMNIAS discussion
2. PARASOMNIAS
3. DISORDERS DUE TO OTHER MEDICAL
CONDITIONS
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1. 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.

• Common Dysomnias are:

• Insomnia
• Hypersomnia
• Narcolepsy
• Sleep Apnea
• Insufficient Sleep/ Sleep Deprivation

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 Chronic 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.

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

treatment
• Treatment is development of new
behavioral patterns that induces sleep
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• Create a sleeping environment that

induces sleep
• Create positive sleep thoughts

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.
• Treatment of hypersomnias include
treating the underlying disease conditions

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).
• 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.

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.
• Sleep Apnea is most frequently diagnosed
in men and postmenopausal women, it may
occur during childhood.

• Three types of apnoea based on the cause

• a. Obstructive Apnoea
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• b. Central Apnea
• c. Mixed Apnea

• a. 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.

• b. CENTRAL APNEA:
• Due to defect in the respiratory centre of
the brain.
• Clients who have brainstem injuries and
often have central sleep apnea.

• c. MIXED APNOEA
• Mixed apnoea is combination of
obstructive and central apnea
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.
Insufficient Sleep/ Sleep Deprivation
Individuals may develop:
• Attention and concentration deficits
• Reduced vigilance
• Distractibility
• Reduced motivation
• Fatigue
• Diplopia and dry mouth.

2. 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:

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• Bruxism
• Enuresis
• Periodic limb movement disorder
• Sleep talking
• Sleep walking
■ 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
■ Enuresis. Bed-wetting during sleep
occurring in children over 3 years old.
• More males than females are affected.
• It often occurs 1 to 2 hours after falling
asleep.
• 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
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
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

3. 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
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disease

Nursing management
Lecture and White board Wha
Assessment; discussion nurs
10min Nursing it includes complete sleep history, health man
management history and physical examination.

Diagnosis ;
•Sleep disturbed pattern ( insomnia)
•Risk for injury related to somnambulism
•Fatigue related to insufficient sleep
•Risk for impaired gas exchange related
•Anxiety related to sleep apnea

Planning :
•The major goal for client with sleep
disturbances is to maintain or develop a
sleeping pattern that provide sufficient
energy for daily activities
•The other goal may relate to enhance the
client’s feeling of wellbeing or improving the
quality and quantity of client’s sleep

Nursing intervention
•Reducing environmental distraction
•Promoting bedtime rituals
•Providing comfort measures
•Scheduling nursing care to provide for
uninterrupted sleep periods
•Teaching stress reduction, relaxation
techniques or good sleep hygiene

• 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
• 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
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problems before bedtime

• Get adequate exercise during the day to
reduce stress, but avoid excessive physical
exertion at least 3 hours before bedtime.

• 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

• 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

• 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.

Refrences
• Kozier& Erb‘s. Fundamentals of
Nursing: concepts, process and practice, 8th
1min Reference Edition.
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