Rest and Sleep (Basics in Nursing) Flashcards

Terms Definitions

a pattern based on a 24-hour cycle, especially the repetition of certain physiologic phenomena, such as sleeping and eating
circadian rhythm

sleep during which the person experiences rapid eye movement
REM sleep

a deep restful sleep rate; also called slow wave sleep
NREM sleep (non-REM sleep)

the quantity and pattern of diminished activity for mental and physical rejuvenation

a cluster or pattern of waking behavior that appears during sleep, such as somnambulism, sleeptalking, and enuresis

a state in which an individual experience prolonged periods of time without sleep
sleep deprivation

inner rhythms that appear to control a variety of biologic processes

a stroking massage technique

an altered state of consciousness in which the individual's perception of and reaction to the environment are decreased

an uncontrollable desire for sleep or attacks of sleep during the day

a condition occurring during stage 3 or 4 of nonrapid eye movement sleep that is characterized by complex motor activity, usually culminating in leaving the bed and walking about

the compulsive, unconscious grinding or clenching of the teeth, especially during sleep or as a mechanism for releasing tension during periods of extreme stress in the waking hours

a condition characterized by sudden loss of muscle tone, usually resulting in a fall, caused by strong emotions, such as anger, fear, or surprise; often associated with narcolepsy

when the physiological and psychological rhythms are most active, the person is awake and when they are inactive, the person is asleep
circadian synchronization

the polygraphic recording during sleep of multiple physiologic variables, both directly and indirectly related to the state and stages of sleep, to assess possible biologic causes of sleep disorder

a graphic chart on which is traced the electric potential produced by the brain cells, as detected by electrodes placed on the scalp; the resulting brain waves are called alpha, beta, delta, and theta
_______ implies calmness, freedom from anxiety and stress.
Most people can rest when what (6) needs are met?
1. feel that things are under control
2. feel accepted
3. feel that they know what is going on
4. are free from irritation and discomfort
5. have a satisfying amount of purposeful activity
6. know they will receive help when it is needed

a state of decreased mental and physical activity that leaves one feeling refreshed

a recurrent altered state of consciousness during which there are changes in the body's physiologic processes and decreased responsiveness to external stimuli
What happens if the RAS (reticular activating system) of the brain is severely damaged?
a person will be in a coma
What happens when the RAS (reticular activating system) of the brain is stimulated?
the person stays awake
What happens when there is increased activity in the BSR (bulbar synchronizing region) of the brain?
the person sleeps

Rest is the same as inactivity.
False- the term rest does not imply inactivity.
Sleep is a restorative process that facilitates what 4 processes?
1. cellular growth
2. repair of damaged tissue
3. emotional stability
4. memory and learning
The ______ _______ ________ is part of the upper brain stem and is responsible for wakefulness.
Reticular Activating System
The ______ _______ ________ is part of the median forebrain and is connected with sleep.
Bulbar Synchronizing Region
Sleep depends on a balance between what 2 systems?
The RAS (reticular activating system) and the BSR (bulbar synchronizing region); sleepiness occurs when the RAS decreases and the BSR increases
The ______ _______ is roughly a 24 hour internal clock that is synchronized by environmental cues such as lightness and darkness.
circadian rhythm
What hormone, naturally produced by the body, is sold OTC as a sleep aid?
Melatonin levels rise in response to what?
What part of the brain synthesizes melatonin?
pineal gland
To produce and maintain a sleep-wake pattern, there is a balance between what (5) neurotransmitters?
- serotonin
- norepinephrine
- dopamine
- acetylcholine
What are the 2 types of sleep?
Non-Rapid Eye Movement (NREM)

Rapid Eye Movement (REM)
Which type of sleep is characterized by a deep restful sleep in which metabolic processes are slowed?
NREM (non-rapid eye movement)
Which type of sleep is characterized by high levels of activity in the brain?
REM (rapid eye movement)
Most dreaming occurs during which type of sleep?
REM (rapid eye movement)
Describe Stage 1 NREM sleep.
Very light sleep, drowsy, relaxed

It is difficult to awake someone in Stage 1 NREM sleep.
False- a person is easily awakened
What happens to the body physiologically during Stage 1 NREM sleep?
- eyes roll
- gradual fall in vital signs (heart and respiratory rates drop slightly)
Describe what an EEG will show during stage 1 NREM.
slower alpha and beta waves
How long does Stage 1 NREM last.
only a few minutes

You have one complete sleep cycle each night.
False- the sleep cycle happens continually throughout the night
How long does stage 2 NREM last?
about 15 minutes
Describe the sleep experienced during stage 2 NREM.
light sleep, relaxation process
What happens to body temperature, heart and respiratory rates as we move onto stage 2 NREM?
they continue to drop
What type of waves appear on an EEG during stage 2 NREM?
theta waves
What nervous system is dominant during stage 3 NREM sleep?
Parasympathetic system
What happens to the metabolic processes during stage 3 NREM?
they continue to slow

A person is difficult to awaken during stage 3 NREM.
What happens to the skeletal muscles during stage 3 NREM?
they are relaxed

Snoring may occur during stage 3 NREM.
What type of waves are shown on an EEG during stage 3 NREM?
How long does stage 3 NREM last?
15-30 minutes
Which stage of NREM is the most restorative?
Stage 4
Describe the sleep that occurs during stage 4 NREM.
Deep sleep
The heart and respiratory rates drop ____-____% during stage 4 NREM.
Which stage of NREM is considered the most important? Why?
Stage 4 - it restores the body physically
How easily can a person be awoken during stage 4 NREM?
They are very difficult to arouse
During the sleep cycle, does Stage 4 NREM get longer or shorter as the night progresses?
It gets shorter
How long does stage 4 NREM last?
between 15-30 minutes
Does stage 4 NREM increase or decrease with age?
What type of dreaming is experienced in REM?
vivid dreaming
How often does each sleep cycle last?
90 minutes
Which is more restful, NREM sleep or REM sleep?
During which sleep stage does most dreaming occur?
What happens to brain activity and gastric secretions during REM?
they increase
How long does REM sleep last?
5-30 minutes
What type of waves does an EEG show during REM sleep?
Delta waves
What happens to heart and respiratory rates during REM sleep?
they become irregular
How easily is a person awoken from REM sleep?
they are very difficult to arouse
What happens to body temperature during REM?
it increases

Some apnea may occur during REM sleep.
What nervous system dominates REM sleep?
During which stage of sleep does irregular muscle movements and erections in men occur?
REM sleep
During which stage of sleep does the sleeper review the days events, process and store the information, and gain perspective on problems (possibly resolving some)?
REM sleep
Does the length of REM sleep become longer or shorter as we progress through sleep cycles?
it becomes longer
List the sleep cycle beginning with Presleep and ending with REM.
Presleep -> NREM Stage 1 -> NREM Stage 2 -> NREM Stage 3 -> NREM Stage 4 -> NREM Stage 3 -> NREM Stage 2 -> REM
Once REM has been completed, the body recycles back to which stage of the sleep cycle?
NREM Stage 2
How many sleep cycles do you typically experience during a 7-8 hour sleep period?
4-6 cycles
As the sleep time progresses, the time spent in NREM Stages 3 and 4 __________ (increases or decreases)?
Time spent in NREM 2 and REM ________ (increase or decrease) prior to waking.
Is the first half or second half of sleep the most restorative?
the second half
What are 9 factors that could affect sleep patterns?
- age
- illness
- environment
- stress
- medications
- lifestyle
- alcohol and stimulants
- diet
- exercise
Gastric ulcers, respiratory issues, increased age, and disorders such as hyperthyroidism may cause sleep disorders. In these cases, the sleep disorder would be considered what?
a secondary sleep disorder
What may happen to a person who is abruptly taken off of morphine or demerol in regards to sleep?
The person may experience rebound REM, a condition that causes arrhythmia or exacerbates a pre-existing heart condition
Newborns spend what % of time in REM?
The elderly and adults spend what % of time in REM?
Why do the elderly experience a decrease in the quality of sleep?
because they have very little stage 4 activity
Excessive alcohol intake disturbs/hastens which stage of sleep?
What effect do stimulants, such as caffeine and nicotine, have on sleep?
they delay sleep and cause the person to experience a lighter sleep
Food products (such as milk, cottage cheese, cashews, turkey) contain what natural substance which promotes sleep?
You should exercise how long before sleep?
at least 2 hours
What does the Electroencephalogram (EEG) measure?
brain waves
What does the Electromyogram (EMG) measure?
muscle movement in the legs
What does the Electro-oculogram (EOG) measure?
eye movement during REM sleep
What does an Electrocardiogram (ECG) measure?
heart rhythm
What is the most common sleep disorder?
What are the 3 different types of insomnia?
1. Initial insomnia
2. Maintenance insomnia
3. Terminal insomnia

type of insomnia characterized by difficulty in falling asleep
initial insomnia

type of insomnia characterized by difficulty staying asleep
maintenance insomnia

type of insomnia characterized by early morning awakening
terminal insomnia

sleep disorder characterized by excessive sleeping, more than 10 hours in a 24 hour period

When treating insomnia, you want to advise the client to go to bed at the same time and awake at the same time each day.
When treating insomnia, what are some things you want to avoid prior to bed? (4)
- avoid large meals (for about 4 hrs. before bed)
- avoid caffeine for 6 hours before bed
- do not consume more than 1 alcoholic drink prior to bed
- avoid exercise for 3 hours prior to sleeping
What are some positive things a person with insomnia can do to promote a good sleep schedule? (4)
- have a bedtime ritual
- have exposure to natural light
- void prior to sleeping
- read a light novel
What is the recommendation for sleeping medications in the treatment of insomnia?
use them sparingly
Hypersomnia can be cause by what?
- neurological or metabolic disorders (depression, CNS damage, diabetes, etc.)

- psychological coping mechanism to avoid stress (may prescribe antidepressants)

sudden wave of overwhelming sleepiness during the day; sleep begins in REM phase
What are 3 causes of narcolepsy?
1. genetics
2. lack of chemical hypocretin
3. malfunction of a human leukocyte antigen
What are (2) types of drugs given to treat narcolepsy?
1. drugs that stimulate the CNS
2. tricyclic antidepressants

periodic cessation of breathing lasting 10 seconds to 2 minutes which is generally preceded by snoring
Sleep apnea
Sleep apnea occurs anywhere from ____-____ times a night.
What effect does sleep apnea have on sleep?
the quantity and quality of sleep is poor
What are 3 common causes of sleep apnea?
- obesity/overweight
- hypertension
- defects in respiratory system (either structurally in the upper region or neurologically in the respiratory center of the brain)

Sleep Apnea can be a secondary condition.
True - it can be caused by conditions such as hypertension, obesity, etc.
What type of treatment is often used for sleep apnea?
Continuous positive airway pressure (CPAP)

a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or arousal from sleep.
What position should a client avoid sleeping in if they have sleep apnea?
on their back
How can bruxism be treated?
with a dental device
What is another term for sleep walking?
What stage of sleep does sleepwalking occur?
Stage 4NREM
How soon after falling asleep does somnambulism usually occur?
1-2 hours

A night terror is an extremely vivid nightmare.
False- a night terror is not the same as a nightmare; the person cannot recall what they were dreaming about upon awaking
What population group is primarily affected by night terrors?

A night terror occurs during REM.
How can restless leg syndrome be treated?
with medication

bed wetting
nocturnal enuresis
What stage of sleep does nocturnal enuresis occur in?
Stage 3 or 4
Is nocturnal enuresis more common in males or females?
What stage of sleep does sleep talking occur in?
Right before REM

Nocturnal erections should be treated with medications.
False- it is part of normal development
What is the most usual cause of bruxism?
What stage of sleep does bruxism occur in?
stage 2
What are 8 possible nursing interventions to promote sleep in a hospital setting?
1. provide clean/dry linens
2. PM hygiene w/back rub
3. optimal room temperature
4. avoid loud talking
5. decrease volume of phone
6. give milk if allowed on diet
7. dim lights
8. close curtains/room door
What is the cause of night terrors?

Bed wetting is often inherited.
What stage of sleep do nocturnal erections occur in?
What nursing diagnosis is used for a change in the quantity or quality of a client's sleep patter that causes discomfort or interferes with desired life style?
Sleep Pattern, Disturbed
What nursing diagnosis is used for a prolonged period of time without sustained, natural sleep?
Sleep deprivation
What are 7 symptoms of sleep deprivation?
- hand tremors
- word loss
- reasoning hindered
- mood changes
- irritability
- decrease in motivation
- agitation
How is nocturnal enuresis sometimes treated?
with medication
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