REST, COMFORT, SLEEP
NUR 102
Module H
Dianne Watts
REST
• When people are at rest, they usually feel
mentally relaxed, free from anxiety, and
physically calm
• Rest does not imply inactivity
SLEEP
• Sleep is a recurrent, altered state of
consciousness that occurs for sustained
periods
• Sleep is a cyclical physiological process
– Circadian rhythm
– Biological clocks
Sleep Regulation
• Sleep involves a sequence of physiological
states maintained by the CNS
• RAS ( reticular activating system) =
wakefulness & BSR (bulbar synchronizing
region) = sleep
STAGES OF SLEEP
• NREM sleep = nonrapid eye movement involves 4 stages
• REM sleep = rapid eye movement
Stage 1: NREM
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Lightest level of sleep
Lasts a few minutes
Easily aroused by sensory stimuli
Waken, person feels as though daydreaming
has occurred
Stage 2: NREM
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Period of sound sleep
Relaxation progresses
Arousal is still relatively easy
Stage lasts 10-20 minutes
Body functions, vital signs & metabolism,
slow
Stage 3: NREM
• Involves initial stages of deep sleep
• Sleeper is difficult to arouse and rarely
moves
• Muscles are completely relaxed
• Lasts 15-30 minutes
Stage 4: NREM
• Very difficult to arouse sleeper
• Deepest stage of sleep
• If sleep loss has occurred, sleeper will
spend considerable portion of night in this
stage
• Vital signs are significantly lower than
during waking hours
• Lasts approximately 15-30 minutes
• Sleepwalking and enuresis may occur
REM SLEEP
• Vivid, full-color
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dreaming may occur
in REM.
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• Usually begins about
90 minutes after sleep •
has begun
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• Typified by autonomic
response of rapidly
moving eyes,
fluctuating heart and
resp rates, increased
BP
Loss of skeletal muscle
tone occurs
Gastric secretions
increase
Very difficult to arouse
Duration of REM sleep
increased with each
cycle and averages 20
minutes
Functions/Purpose of Sleep
• Restoration
– Psychological
– Physiological
• Biological
• Cognitive
• Conservation of energy
FACTORS THAT AFFECT
SLEEP
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Physical illness
Drugs and substances
Lifestyle
Emotional stress
Environment
Exercise and fatigue
Food and caloric intake
SLEEP DISORDERS
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INSOMNIA
SLEEP APNEA
NARCOLEPSY
SLEEP DEPRIVATION
PARASOMNIAS
INSOMNIA
• Chronic difficulty falling asleep
• Frequent awakenings from sleep
• Short sleep or nonrestorative sleep
SLEEP APNEA
• Disorder in which the individual cannot
breath and sleep at the same time
• Lack of airflow through the nose and mouth
for periods from 10 seconds to 1-2 minutes,
there can be 10 or 15 to more than 100
respiratory events per hour of sleep
• Three types: central, obstructive, and mixed
CENTRAL SLEEP APNEA
• Caused by cessation of diaphragmatic and
intercostal respiratory effort as a result of
dysfunction of the brain’s respiratory
control center
• Impulse to breath fails, temporarily
• Least common form
OBSTRUCTIVE APNEA
• Most common form
• Characterized by cessation of airflow
despite the effort to breath
• Occurs when muscles or structures of the
oral cavity or throat relax during sleep
• Usually have loud snoring
NARCOLEPSY
• A CNS dysfunction of mechanisms that
regulate the sleep and wake states
• Falls asleep uncontrollably at inappropriate
times
• Treated with stimulants
SLEEP DEPRIVATION
• S/S: blurred vision, fine motor clumsiness,
decreased reflexes, slowed response time,
decreased reasoning and judgment, cardiac
arrhythmias
• Psychological S/S: confusion,
disorientation, increased sensitivity to pain,
irritable, withdrawn, agitation, decreased
motivation
PARASOMNIAS
• Sleep problems that are more common in
children, one common exception is bruxism
(tooth grinding)
• SIDS
• Somnambulism(sleepwalking)
• Nightmares
• Nocturnal enuresis (bedwetting)
ASSESSMENT
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Normal sleep pattern, restful? sufficient?
Self- reported
Sleep log
Bedtime routines
Bedtime environment
Client expectations
Pain
• Physical sensation
• Involves physical, emotional and cognitive
components
• Stimulus
Physiology of Pain
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Transduction
Transmission
Perception
Modulation
Types of Pain
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Acute
Chronic
Idiopatic
Inferred
– nociceptive
– neuropatic
Pain Assessment
• Scales
• Nonverbal pain indicators
• Behavioral indicators
Pain Management
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Pharmacological interventions
Non-pharmacological interventions
Barriers
Cultural considerations
Reassessment
Environmental factors affecting
common and sleep
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Comfortable room temperature
Proper ventilation
Minimal noise
Comfortable bed
Proper lighting
Promoting Bedtime Routines
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Help client to relax in preparation for sleep
Avoid mental stimulation before bedtime
Relaxation exercises
Guided imagery
Good sleep hygiene
Sleep Hygiene
• Avoid sleeping long hours during weekend
or holiday
• Bedroom should not be used for intensive
studying, snacking, TV watching, or other
nonsleep activity
• Avoid worrisome thinking when going to
bed
• Avoid heavy meals for 3 hours before
bedtime
Promoting comfort
• Encourage client to wear loose-fitting
nightwear
• Instruct family on ways to position client
and support dependent body parts to aid in
muscle relaxation
• Have client void before going to bed
• Back massage
• Keep bed linens dry
Activity
• If client is at home, encourage physical
activity during daytime
• Avoid rigorous exercise at least several
hours before bedtime
Control of noise in hospital
• Close doors to client’s room
• Keep doors to work areas closed
• Reduce volume of nearby telephones and
paging equipment
• Avoid abrupt loud noises
• Keep necessary conversations at low levels