Rest and sleep

• Rest refers to a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed.
• Sleep is a state of rest accompanied by altered consciousness and relative inactivity. 
• Reticular activating system (RAS) 


  network of neurons in the core of the brainstem, with ascending and descending tracts to other areas of the brain that monitor and regulate incoming sensory stimuli and level of arousal
• Hypothalamus—control center for sleeping and waking
• Melatonin, a hormone, is thought to regulate the sleep–wake cycle and possibly circadian rhythms
• Circadian rhythms are predictable fluctuations in processes that occur in repeated cycles of time, completing a full cycle every 24 hours
• Circadian synchronization exists when a person’s sleep–wake patterns follow the inner biologic clock located in the hypothalamus
• Non-rapid eye movement (NREM) non–rapid eye movement that characterizes four stages of sleep
• Rapid eye movement sleep (REM) stage that constitutes 20% to 25% of a person’s nightly sleep; person is difficult to arouse during this stage
• Throughout the stages of NREM sleep, the parasympathetic nervous system dominates, and decreases in pulse, respiratory rate, blood pressure, metabolic rate, and body temperature
• During REM sleep, the pulse, respiratory rate, blood pressure, metabolic rate, and body temperature increase, whereas general skeletal muscle tone and deep tendon reflexes are depressed. REM sleep is believed to be essential to mental and emotional equilibrium and to play a role in learning, memory, and adaptation.
• Stage I

  • The person is in a transitional stage between wakefulness and sleep.
  • The person is in a relaxed state but still somewhat aware of the surroundings.
  • Involuntary muscle jerking may occur and waken the person.
  • The stage normally lasts only minutes.
  • The person can be aroused easily.
  • This stage constitutes only about 5% of total sleep.
• Stage II

  • The person falls into a stage of sleep.
  • The person can be aroused with relative ease.
  • This stage constitutes 50% to 55% of sleep.
• Stage III

  • The depth of sleep increases, and arousal becomes increasingly difficult.
  • This stage composes about 10% of sleep.
• Stage IV

  • The person reaches the greatest depth of sleep, which is called delta sleep.
  • Arousal from sleep is difficult.
  • Physiologic changes in the body include the following:
  • Slow brain waves are recorded on an EEG.
  • Pulse and respiratory rates decrease.
  • Blood pressure decreases.
  • Muscles are relaxed.
  • Metabolism slows and the body temperature is low.
  • This constitutes about 10% of sleep.
• REM Sleep

  • Eyes dart back and forth quickly.
  • Small muscle twitching, such as on the face
  • Large muscle immobility, resembling paralysis
  • Respirations irregular; sometimes interspersed with apnea
  • Rapid or irregular pulse
  • Blood pressure increases or fluctuates
  • Increase in gastric secretions
  • Metabolism increases; body temperature increases
  • Encephalogram tracings active
  • REM sleep enters from stage II of NREM sleep and re-enters NREM sleep at stage II: arousal from sleep difficult
  • Constitutes about 20% to 25% of sleep
• stages of sleep

  Wakefulness, NREM Stage 1, NREM Stage 2, NREM Stage 3, NREM Stage 4. NREM Stage 3, NREM Stage 2, REM, NREM Stage 2
• Newborn: Sleeps an average of 16 hr/24 hr; averages about 4 hours at a time.
• Toddlers: May require two naps during the day and end this stage sleeping 11 to 14 hours a night and napping once during the day.
• Children in this stage generally sleep 10 to 13 hours at night.
• Younger school-aged children may require 9 to 12 hours nightly, whereas older children in this stage may average 9 to 11 hours
• Sleep needs of teenagers vary widely, but the average requirement is 8 to 10 hours.
• Young Adults The amount of sleep required is 7 to 9 hours.
• Middle Adults The amount of sleep required is 7 to 9 hours.
• Older Adults An average of 7 to 8 hours of sleep is usually adequate for this age group
• How are we affected by inadequate sleep?

  Irritable,

  Sex drive,

  Forgetfulness and concentration 

  Depressed

  Sick 

  Immune system,

  Obesity (weight game)

  Chronic fatigue 

  Accidents 

  Dumbs you down

   ages your skin

  Impaired judgment
• Factors Affecting Sleep


  • Developmental considerations
  • Motivation
  • Culture
  • Lifestyle and habits
  • Environmental factors
  • Psychological stress
  • Illness 
  • Medications
• Common Sleep Disorders


  • Insomnia
  • Narcolepsy
  • Sleep Apnea
  • Sleep Terrors (Night Terrors)
  • Nightmares
• Insomnia


  • -Inability to fall asleep, remain asleep, or go back to sleep. May be short term (less than 1 month) long term (>1 month) Most common sleep disorder
• • Cause of insomnia 


  Disruption of circadian rhythms

  illness, depression, stress, substance abuse, meds, menopause, restless legs syndrome 
• Treatment for Insomnia


  Sleep Hygiene and pharmacokinetics (sedative and hypnotic )
• Obstructive Sleep Apnea (OSA)


  Absence of breathing (apnea) or diminished breathing efforts (hypopnea) during sleep. May last 10 to 20 seconds or as long as 2 minutes.
• Treatment of Obstructive Sleep Apnea (OSA)

  • Oral appliances to push the jaw forward
  • Sleep position changes such as sleeping in the side-lying position and raising the head of the bed (avoidance of supine position)
  • Smoking cessation, if applicable
• Diagnosis of Obstructive Sleep Apnea (OSA)


  Polysomnogram detects five or more episodes of respiratory events per hour
• • Treatment/Patient Teaching for Obstructive Sleep Apnea

  • Lifestyle Modification
  • Non-invasive Positive Airway Pressure  
  • CPAP- Continuous Positive Airway Pressure
  • Surgery
• Narcolepsy


  • Characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep. 
• Cause of Narcolepsy


  Some people with narcolepsy also experience cataplexy, the sudden, involuntary loss of skeletal muscle tone lasting from seconds to 1 or 2 minutes. Additional symptoms include the presence of hallucinations or sleep paralysis
• treatment for Narcolepsy


  At present, there is no cure. However, medications that restore alertness allow near-normal functioning for most patients.
• Nightmare Disorder & Sleep Terrors

  • Both occurs more often in children
• Pharmacologic therapy Sleep Aides

  • ➢Melatonin
  • ➢Herbal sleep aides
  • ➢Chamomile
  • ➢Valerian root
  • ➢Hops
  • ➢Lavender
  • ➢Passionflower