Sleep and Rest pattern

Bekalu A.(BSc N, ECCN R1)

1 11/12/2024
 Session objectives
At the end of this session the students will be able to:
 Define sleep and rest

 Identify normal sleep and rest function

 Identify altered sleep and rest function

2 11/12/2024
 Rest
 Is a state when the body’s physical and emotional

energy expenditure is limited.

Praying, listening to music, watching television,
reading, and engaging in needlework.
Although beneficial, rest is not as restorative/new

strength as sleep because it does not filter external

stimuli by altering the level of consciousness.

3 11/12/2024
 Sleep
Sleep is a sedentary state of mind and body.

Is a cyclical physiological process characterized by

decreased perception and motor activity.

Conserves energy, prevents fatigue, allows
physiological processes to slow down,
boosting/enhancing the immune system, stimulating
protein synthesis for tissue repair, increasing RBC
production.
4 11/12/2024
 Sleep states/cycles
Sleep is preceded by a 10 to 30 minute period when

an individual begins to feel sleepy(pre-sleep stage)

 Sleep involves two stages:

 Non rapid eye movement (NREM), which has four

phases, and
 Rapid eye movement (REM)

5 11/12/2024
 NREM
At this stage sleep is considered the quiet or
restful phase. During non-rapid eye movement
sleep, a person falls asleep and then moves from
a light sleep into a deep sleep. This is when a
person’s brain activity, breathing, and heart rate
slow down, body temperature drops, muscles
relax, and eye movements stop.
NREM sleep plays an important role in helping
the body repair tissues, build bone and muscle,
and strengthen its immune system.
6 11/12/2024
 Sleep states/cycles cont…
Once a sleep occurs, an individual usually has four or

five complete sleep cycles per night, lasting 90 to 100

minutes each.
With successive cycles, NREM stage I is excluded,

NREM stages 3 and 4 shorten, and the REM stage

lengthens (common in adults)
Amount of time in each cycle varies over the life span;

infants and children spend more time in stages 3 and 4

7 11/12/2024
 Sleep states/cycles cont…
NREM Stage 1
 Time between wakefulness and sleep

 5 to 10 minutes long

 5% of total sleep

 Light sleep, easy to awaken

 Relaxed but aware of surroundings

 Regular, deep breathing

 Eyes may open and close slowly

8 11/12/2024
 Sleep states/cycles cont…
NREM Stage 2
 10 to 15 minutes long

 50% of total sleep

 Light sleep, easy to awaken

 Muscles are relaxed

 Vital signs slightly decreased

 Eyes closed with almost no movement

9 11/12/2024
 Sleep states/cycles cont…

NREM Stage 3
 5 to 15 minutes long

 8% of total sleep

 Deep sleep, difficult to awaken

 Muscles are more relaxed

 Vital signs decreased

 Snoring/breathe noisily in sleep may occur

 Eyes closed with almost no movement

10 11/12/2024
 Sleep states/cycles cont…
NREM Stage 4
 20 to 50 minutes long

 11% of total sleep

 Deepest sleep, difficult to awaken

 Confused when awakened

 Muscles are very relaxed

 Eyes closed with almost no movement

11 11/12/2024
 Sleep states/cycles cont…
REM, also called Stage 5
 5 to 30 minutes long, 25% of total sleep

 Reacts normally when awakened

 Large muscle inactivity; small muscles may twitch/jerk,

deep-tendon reflexes are depressed

 Vital signs increase; pulse may be rapid and irregular, periods

of apnea may occur

 Dreaming may occur
12 11/12/2024
13 11/12/2024
 Normal Sleep Requirements and Patterns
 Sleep duration and quality vary among people of all

age-groups

Neonates: averages about 16 hours of sleep a day, sleeping

almost constantly during the first week
 The sleep cycle is generally 40 to 50 minutes with

wakening occurring after one to two sleep cycles

14 11/12/2024
 Approximately 50% of this sleep is REM sleep, which

stimulates the higher brain centers (essential for

development)

Infants: usually develop a night time pattern of sleep by 3

months of age
 The infant normally takes several naps during the day

but usually sleeps an average of 8 to 10 hours during the

night for a total daily sleep time of 15 hours

15 11/12/2024
about 30% of sleep time is in the REM cycle

Awakening commonly occurs early in the morning

Toddlers: By the age of 2 children usually sleep through

the night and take daily naps
Total sleep averages 12 hours a day

After 3 years of age children often give up daytime naps

It is common for toddlers to awaken during the night

The percentage of REM sleep continues to fall

16 11/12/2024
During this period toddlers may be unwilling to go to bed

at night because they need autonomy or fear separation

from their parents

Preschoolers: On average a preschooler sleeps about 12

hours a night (about 20% is REM)
By the age of 5 he or she rarely takes daytime naps

17 11/12/2024
The preschooler usually has difficulty relaxing or quieting

/calming down after long, active days and has bedtime

fears, awakens during the night, or has nightmares
Partial awakening followed by normal return to sleep is

frequent
In the awake period the child exhibits brief crying,

walking around, unintelligible speech, sleepwalking/

walking while sleep, or bed-wetting

18 11/12/2024
School-Age Children: The amount of sleep needed varies
during the school years
The older child often resists sleeping because he or she is

unaware of fatigue or has a need to be independent

Adolescents: On average the majority of teenagers get

about 7 hours or less of sleep per day

19 11/12/2024
Adolescents typically have electronic devices such as

televisions, computers, smart phones, or video games in

their rooms, which further contribute to sleep disruption,
poor sleep quality, and decreased amount of sleep
Leads to reduced performance in school, vulnerability to

accidents, behavior and mood problems and increased

use of alcohol

Young Adults: Most young adults average 6 to 8 hours of

20 sleep a night 11/12/2024
Approximately 20% of sleep time is REM sleep, which

remains consistent throughout life .

Pregnancy increases the need for sleep and rest

Middle Adults: total time of sleeping at night begins to

decline.
The amount of stage 4 sleep begins to fall, a decline that

continues with advancing age

Insomnia is particularly common, probably because of the

21
changes and stresses of middle age 11/12/2024
Anxiety, depression, or certain physical illnesses cause

sleep disturbances
Women experiencing menopausal symptoms often
experience insomnia

Older Adults: Complaints of sleeping difficulties increase

with age
Episodes of REM sleep tend to shorten

22 11/12/2024
Stages 3 and 4 NREM sleep progressively decrease;

some older adults have almost no stage 4, or deep sleep.

 An older adult awakens more often during the night, and

it takes more time for him or her to fall asleep.

The tendency to nap seems to increase progressively with

age because of the frequent awakenings experienced at

23
night. 11/12/2024
 Factors Influencing Sleep
Drugs and Substances

 milk, cheese, and meats, promote sleep

 Diuretics, antidepressants, caffeine

Lifestyle

 Performing heavy work, engaging in late-night social

activities, and changing evening mealtime.

 The body’s internal clock set.

Usual Sleep Patterns

24 11/12/2024
 Emotional Stress

 Worry over personal problems or a situation

Environment

 The physical environment in which a person sleeps

significantly influences the ability to fall and remain

asleep
 Good ventilation, size, firmness, and position of the bed,

Exercise and Fatigue

25 11/12/2024
 A person who is moderately fatigued usually achieves

restful sleep, especially if the fatigue is the result of

enjoyable work or exercise
 Exercising 2 hours or more before bedtime

Food and Caloric Intake

 Eating a large, heavy, and/or spicy meal at night often

results in indigestion that interferes with sleep

 Caffeine, alcohol, and nicotine consumed in the evening

26
produce insomnia. 11/12/2024
 Altered sleep function

Sleep Deprivation: getting less than the needed amount

of sleep, which, for adults, ranges from 6 to 8 hours of
sleep per night.

Insomnia: Inability to fall asleep, remain asleep, or go

back to sleep, resulting in an insufficient quantity or
quality of sleep.

27 11/12/2024
 Restless leg syndrome: Uncontrollable movements of the legs
(tingling, itching, creeping, and crawling) when resting or just
before onset of sleep.

Sleep apnea: Periodic interruption of breathing when sleeping.

Narcolepsy: Sudden uncontrollable urge/push to sleep during the

day, lasting seconds to 30 minutes

Parasomnias: types of disturbing disorders that can happen just

before you fall asleep, while you’re sleeping, or as you’re
waking up and it includes sleep walking, sleep talking,
nightmares, bedwetting, sleep apnea (problems with breathing
that cause loud snoring), or nighttime seizures.
28 11/12/2024
 Bruxism : Repetitive clenching/clamping together and
grinding of teeth; episode lasts 4 to 5 seconds

Sleepwalking (somnambulism): Episodic walking

around while asleep with minimal awareness of
surroundings; episode lasts 3 minutes or longer

Nightmare disorder: Repeated episodes of frightening

dreams that result in awakening; patients commonly
report that the dreams jeopardize/endanger their
personal safety.
29 11/12/2024
 Sleep terrors (night terrors): Repeated episodes of abrupt
awakening along with a panicky/fearful scream/shout.

Nocturnal enuresis (bed wetting): Repeated episodes of

involuntary urination when sleeping after toilet training is
well established
Caused by hormonal, bladder, and sleep problems;

genetics, small bladder, diabetes mellitus, and urinary

tract infection
30 11/12/2024
 Tools for Sleep Assessment
The epworth sleepiness scale: evaluates the severity

The pittsburgh sleep quality index: assesses sleep quality

and patterns
A visual analog scale: draw a straight horizontal line 100

mm (4 inches) long.
 “Best night’s sleep” and “worst night’s sleep” are at

opposite ends of the line.

31 11/12/2024
 Tools for Sleep Assessment cont…
 Ask patients to place a mark on the horizontal line at

the point corresponding to their perceptions of the

previous night’s sleep
A numeric scale with a 0-to-10 sleep rating. Instruct

them to indicate with a number between 0 and 10

their sleep quantity and then their quality of sleep,
with 0 being the worst sleep and 10 being the best
32 11/12/2024
 Interventions
Health Promotion

 In community health and home settings help patients

develop behaviors conducive to rest and relaxation

Environmental Controls

 Create comfortable room temperature and proper

ventilation, minimal sources of noise, a comfortable bed,
and proper lighting
Promoting Bedtime Routines
33 11/12/2024
 Same hour for bedtime, snack, or quiet activity used

consistently helps young children avoid delaying sleep

 Quiet activities such as reading stories, coloring,
allowing children to sit in a parent’s lap while listening to
music or listening to a prayer
 Adults : reading a light novel/story, watching an

enjoyable television program, or listening to music helps,

deep breathing for 1 or 2 minutes relieve tension and
34
prepare the body for rest 11/12/2024
 A consistent time for sleep and awakening

 At home discourage patients from trying to finish office

work or resolve family problems before bedtime

Promoting safety

 A small night-light

 To reduce the chance of suffocation, do not place pillows,

stuffed/distended toys, or the ends of loose blankets in

cribs/ sides to keep the child from falling out.
35 11/12/2024
 Place an infant on his or her back to prevent suffocation
Establishing Periods of Rest and Sleep

 instruct patients to regularly void before rest periods, and

suggest silencing the telephone ringer

 encourage patients to stay physically active during the

day so they are more likely to sleep at night

Stress Reduction

 When patients are emotionally upset, encourage them to

try not to force sleep.

36 11/12/2024
  Encourage a patient who has difficulty falling asleep to

get up and pursue a relaxing activity such as sewing or

reading rather than staying in bed and thinking about
sleep
 Keeping a light on in the room also helps some children

Bedtime Snacks

 A full meal before bedtime often causes gastrointestinal

upset or reflux and interferes with the ability to fall

37 asleep 11/12/2024
 Pharmacological Approaches
Medications that induce sleep are called hypnotics

Sedatives are medications that produce a calming or

soothing/relaxing effect
A patient who takes sleep medications needs to know

about their proper use and their risks and possible side
effects
Long-term use of anti-anxiety, sedative, or hypnotic

agents disrupts sleep and leads to more serious problems

38 11/12/2024
 Pharmacological Approaches cont…
 Benzodiazepiness (oxazepam, lorazepam, or
temazepam): have become the treatment of choice for
insomnia
Melatonin : Improving sleep efficiency and decreasing

nighttime awakenings. 0.3 to 1 mg taken 2 hours before

bedtime
Ramelteon (rozerem): Improving sleep by improving the

circadian rhythm and shortening time-to sleep onset

39 11/12/2024
 Thank you!!!

40 11/12/2024