West Virginia University Parkersburg

Health Sciences Division

Nursing 111
Promoting Rest and Sleep Study Guide
1. Define rest and sleep.
Sleep is a basic human need, universal biological process common to all people. Sleep is an altered state of
consciousness in which the individuals perception of and reaction to the environment are decreased.
2. List the two stages of sleep. NREM and REM.
3. What is the function and purpose of REM sleep?
Brain is highly active and brain metabolism may increase as much as 20%..It is thought that the regions of
the brain that are used in learning, thinking, and organizing information are stimulated during REM sleep.
4. Describe the physiological changes that occur during REM sleep.
Distinctive eye movements, voluntary muscle tone is dramatically decreased, deep tendon reflexes are
absent, sleeper may be difficult to arouse or may wake spontaneously, gastric secretions in crease, heart and
resp, rate are often irregular

5. Loss of REM sleep results in what types of signs and symptoms?

Psychological disturbances like apathy, depression, irritability, confusion, disorientation, hallucination,
impaired memory, and paranoia.
6. What is the function of NonREM sleep?
Responsible for 70-80% of sleep during the night. NREM is essential for restoring energy and releasing
important growth hormones.
7. Stage 1 and 2 of NREM is _light_____________ sleep and the person can be aroused
_____easily______________________________.
Stage 3 and 4 of NREM is ___deepest___________ sleep and is called _______delta
sleep________________________. The arousal threshold is usually greatest during stage __stage
1__________. Which branch of the ANS dominates during sleep? _____________________.
8. Describe the characteristics of stage I and II NREM sleep.
Stage I lasts only a few minutes and person is easily awakened. The person feels very drowsy, and
relaxed, the eyes roll from side to side and the hear t and resp rate drops slightly. The sleeper is easily and
awakened and may deny being asleep.
Stage IIlasts only 10-15 minutes, the body systems continue to slow, the eyes are still, the heart and resp
rates decrease slightly, and the body temperature drops. These people need more stimuli to awaken than stage
1.
9. Describe the characteristics of stage III and IV NREM sleep.
Deepest stages of sleep, the sleepers resp and heart rate drops 20-30% below what is exhibited during
wake hours. Difficult to arouse, not disturbed by sensory stimuli, skeletal muscles relaxed, reflexes are
diminished, and snoring is most likely to be present. Saliva production and swallowing are reduced.
Describe the physiological changes that occur during Stage IV sleep.
1

Arterial blood pressure falls, pulse rate drops, peripheral blood vessels dilate, cardiac output decreases,
skeletal muscles relax, basal metabolic rate decreases 10-30%, growth hormone levels peak, and
intracranial pressure decreases.
10. What type of signs/symptoms would you expect to see in a person that has loss of NREM sleep?
Immunosuppression, slows tissue repair, lowers pain tolerance, triggers profound fatigue, and increases
susceptibility to infection.
11. Explain the sleep cycle as a person progresses through the stages.
Each person goes through _________ cycles per night, lasting an average of
__________________________. Most sleep occurs in the _______________ stage the first part of the
night, and as the night progresses, a sleeper spends more time in the _________________ stage. If a
person is awakened during sleep, they reenter in what stage? ______________________. When sleep
patterns are shortened (awakend early), what type of sleep is lost?
12. Sleep-wake cycle is a circadian rhythm. What does this mean?
The person is awake when the body temp is highest and asleep when the body temp. is lowest
13. What does circadian synchronization mean?
See #12
If circadian synchronization exists, explain the sleep wake pattern that follows.
14. What is a circadian desynchronization?
15. Desynchronized sleep is ____poor______________ quality sleep because
_____________________________________________.
16. How long does it take for our bodys to resynchronize our inner biological clock?
17. Discuss the problems that can occur when sleep desynchronization occurs.

18. Discuss the sleep requirements of adults.

Healthy adults need 7 to 9 hours of sleep a night, varies among individuals,
19. Define sleep latency. What is the normal length of time for sleep latency?
20. What are the effects of sleep loss (sleep deprivation) and the resulting fatigue that occurs?
2

Attention and concentration deficits, reduced vigilance, distractibility, reduced motivation, fatigue, malaise,
and occasionally diplopia, and dry mouth.
21. Identify behaviors indicative of a sleep debt.
Irritability, fatigue, confusion, disorientation, forgetfulness, impaired memory,

22. Discuss how the following factors influence the quality and quantity of sleep.
a. Age
Explain the changes that occur with the sleep patterns of the elderly.
Earlier bedtime and earlier wake time, usually awaken 1.3 hours earlier and go to be approx. 1 hour
earlier, have an increase in disturbed sleep which has a negative effect on mood, quality of life, and
alertness. The amount of sleep required does not decrease with age, the ability to sleep becomes more
difficult.
b. Motivation
Can increase alertness in some situations, not usually sufficient to overcome the normal circadian drive to
sleep.
c. Physical activity and exercise
Increasing physical activity and exercise during the day may help a person sleep at night. Some people may
be able to exercise before bed and go right to sleep while others it stimulates them and keeps them awake.
d. Diet
weight gain may reduce total sleep time, cause broken sleep and earlier awakening.
e. Caffeine
Caffeine is a stimulant and may cause alertness.
f. Alcohol intake
Causes sleep to be disturbed, disrupts REM sleep, and may hasten the onset of sleep.
g. Smoking
Stimulant and may cause more difficulty falling asleep, may be aroused easily.
h. Sleeping environment
May promote or hinder sleep, any change in the normal environment may inhibit sleep.
i. Lifestyles
An irregular morning and nighttime schedule can affect sleep. Doing homework or other work before bed or
after getting into bed may hinder sleep.
j. Psychological stress and illnesses
People under stress may be unable to relax and fall asleep. Anxiety increases norepinephrine blood levels
through stimulation of the SNS. The change results in less deep sleep and REM sleep and more stage
changes and awakenings.
k. Medications
Many medications can disrupt sleep and interfere with deep sleep and suppress REM sleep.
23. Identify factors associated with hospitalization that can affect the quality and quantity of a persons sleep.
3

Strange environment, noises, lights, pain, interruptions from staff to care for pt,, being away from loved
ones, etc
Nurse must assess a patients usual sleep habits on admission and assess how well a patient sleeps each night.
24. What assessments relating to sleep, is it necessary for the nurse to assess on admission to a health care
facility.
Sleep history, health history, physical exam

25. Identify physical assessment findings that would validate that the patient is having a poor quality and/or
quantity of sleep.
Enlarged or reddened uvula and soft palate, enlarged tonsils and adenoids, obesity, and in male pts. A neck
size greater than 17.5 inches
Research has shown approximately 40 million Americans suffer sleep disorders. 1993, President Clinton
signed legislation to create a National Center for sleep disorders at The National Institutes of Health
26. List and define the 4 major categories of sleep disturbances.
Insomnia- Inability to fall asleep or remain asleep. Awaken not feeling rested.
Hypersomnia-refers to conditions where the affected individual obtains sufficient sleep at night but still
cannot stay awake during the day.
Narcolepsy-excessive daytime sleepiness caused by the lack of the chemical hypocretin in the area of the
CNS system that regulates sleep.
Sleep Apnea-characterized by short breathing pauses during sleep.
27. Define insomnia and discuss the difference between transient and chronic insomnia.
Inability to fall asleep or remain asleep. Awaken not feeling rested.
Identify common causes of insomnia
Older age and being female gender increase risk factors, incidence increases with age,
28. Define restless leg syndrome.
Occurs when person is at rest-either at night or awake, may occur during pregnancy or be caused by other
treatable medical conditions.
List measures that have been shown to show relief.
Exercise, medications, relaxation exercises.

29. Define Narcolepsy. Inability to fall asleep or remain asleep. Awaken not feeling rested.
List the common features of narcolepsy.
4

Sleep attacks or excessive daytime sleepiness, cataplexy or the sudden onset of muscle weakness or
paralysis in association with strong emotion, sleep paralysis hypnagogic hallucination, and fragmented
nighttime sleep.
Treatment for narcolepsy usually involves what?
CNS stimulants, antidepressants,
30. Define sleep apnea.
characterized by short breathing pauses during sleep.

Discuss the difference between central and obstructive sleep apnea.

Obstructive occurs when the structures of the pharynx or oral cavity block the flow of air. Central apnea is
thought to be a defect in the resp. center of the brain all actions of breathing cease. There is no treatment.
What is the major complication of sleep apnea?
Can cause an increase in plod pressure and may lead to cardiac arrest.
Identify behaviors exhibited by a person with sleep apnea.

Discuss the treatment for sleep apnea.

31. How does snoring differ from sleep apnea?

32. Define somnambulism.
What is the priority for this patient?
33. Define enuresis?
What is the priority of this patient?
34. Define sundown syndrome.
What interventions can be incorporated to minimize this occurrence?

35. Identify the nursing diagnosis that supports a sleep problem.

General measures to promote sleep in adults.
36. If a patient feels rested they are more apt to sleep better. Six characteristics have been associated with
promoting rest. Identify measures that the nurse can incorporate to ensure that the patient:
a. feels that things are under control

b. feels accepted

c. feels they understand what is going on

d. is free from irritation and discomfort

physical discomfort
emotional discomfort

e. has satisfying amounts of purposeful activity

f. is secure in knowing that help is available when needed

37. Identify actions to improve sleep and decrease insomnia.

38. Discuss the nurses responsibility when preparing a patient for bedtime in order to promote relaxation
and comfort needs.

39. Discuss how a nurse can respect the patients normal sleep-wake pattern.

40. Which classification of drugs is most commonly used to induce sleep?

What effect does long term use of these meds have on a persons sleep?

What is the nurses responsibility when giving hypotics/sedatives?

41. Discuss measures to increase safety of patients during the night.

Revised 1/09