Factors affecting sleep: The quality and quantity of sleep are affected by a number of factors.

The quality of sleep refers to the individual’s ability to stay asleep and to get appropriate amount of REM and NREM sleep. Quantity of sleep is the total time the individual sleeps. • Developmental Considerations:

Variations in sleep pattern are related to age. According to the 2004 NSF Survey, children sleep less than the recommended time for their age- group. • Motivation: A desire to be wakeful and alert helps overcome sleepiness and sleep. For e.g. a tired person may be wakeful and alert when attending an interesting play or concert. The opposite also true: when there is minimal motivation to be awake, sleep generally follows. • Culture: An individual’s cultural belief and practices can influence rest and sleep. Methods to enhance or foster sleep may also be culturally influenced. For e.g. an older asian patient may choose herbal tea rather than a sleeping medication to promote relaxation and sleep medication to improve relaxation and sleep. • Lifestyles and Habits: Various lifestyle factors can affect a person’s ability to sleep well. People working a shift other than the day shift must recognize their priorities, or sleep difficulties may occur. Based on circadian cycle, the body prepares for sleep at night by decreasing the body temperature and releasing melatonin. • Physical Activity & Exercise: Activity and exercise increase fatigue and, in many instances promote relaxation that is followed by sleep. It appears that physical activity increases both REM and NREM sleep.

Moderate exercise is a healthy way to promote sleep, but exercise that occurs within a two- hour interval before normal bedtime can hinder sleep and decrease the quality of sleep.

• Dietary Habits: It has long been believed that the dietary amino acid L- tryptophan acts to promote sleep. A small protein containing snack before bedtime used to be recommended for patient with insomnia. Protein may actually increase alertness and concentration, whereas carbohydrates appear to affect brain serotonin level and promote calmness and relaxation.

Alcohol Intake: Alcohol beverages, when used in moderation, appear to induce sleep in some people. However, large quantities have been found tolimit REM and Delta sleep. This effect may partially explain the phenomena of hangover after excessive alcohol consumption.

○ Caffeine containing Beverages: Caffeine is a central nervous system stimulant. For many people, beverages containing caffeine interfere with the ability to fall asleep. As for e.g. beverages containing caffeine include coffee, tea and most cola- drinks and chocolates. ○ Smoking: Nicotine has a stimulating effect on the body and smokers often have more difficulty falling asleep than non- smoker do. Smokers are usually easily aroused and often describe themselves as lightsleepers. By refraining from smoking after the evening meal, the person usually sleep better, moreover, many former smokers report their sleeping pattern improved once they stopped smoking. • Environmental Factor: Environment can promote or hinder sleep. Most people sleep best in their usual home environment. Sleeping in a strange or new environment can tends to influence both REM and NREM.

Stage I is the lightest and stage III and IV deepest, as a result louder noises are needed to be awake an person in stage III and IV. • Psychological Stress: Illness and various life situation can cause psychological stress, tend to disturb sleep. Psychological stress affect sleep in two ways. 1. The person experiencing stress may find it difficult to obtain the amount of sleep he or she needs. 2. REM sleep decreases in amount which tends to add anxiety and stress.

• Illness: