REST COMFORT &

SLEEP

Rest comfort & sleep

Rest, sleep and comfort are all essential
for maintaining health.
Rest
When people are at rest, they usually feel mentally
relaxed, free from anxiety & physical calm.

Sleep
1. Sleep is a recurrent, altered state of consciousness
that occurs for sustained period.
2. Sleep is the cyclical physiological process.
Stages of sleep
1.NREM - Non rapid eye movement - 4 stages.
Slow wave sleep - EEG waves appear as progressively
slower oscillations.

2.REM –Rapid eye movement.

Paradoxical sleep – EEG waves appear similar to those
while awake. Deepest stage.
Stage 1 - NREM
1. Lightest level of sleep
2. Lasts a few minutes
3. Easily aroused by sensory stimuli
4. Waken, person feels as though day dreaming
has occurred
Stage 2 – NREM
1. Period of sound sleep
2. Relaxation progresses
3. Arousal is still relatively easy
4. Stage lasts 10-20 minutes
5. Body functions, vital signs & metabolism, slow
Stage 3 - NREM
1. Involves initial stage of deep sleep
2. Sleeper is difficult to arouse & rarely moves
3. Muscles are completely relaxed
4. Lasts 15 -30 minutes
Stage 4 - NREM
1. Very difficult to arouse sleeper
2. Deepest stage of sleep
3. If sleep loss has occurred, sleeper will spend
considerable portion of night in this stage
4. Vital signs are significantly lower than during waking
hours
5. Lasts approximately 15 - 30 minutes
6. Sleep walking & enuresis may occur
REM Sleep
1. Vivid full-color dreaming may occur in REM
2. Usually begins about 90 minutes after sleep has
begun
3. Typified by autonomic response of rapidly moving
eyes, fluctuating heart, respiratory, & BP increased
4. Loss of skeletal muscle tone occurs
5. Gastric secretions increase
6.Very difficult to arouse
 7.Duration of REM sleep increased with each
cycle
& averages 20 minutes
Functions of sleep
1. Reducing fatigue
2. Stabilizing mood
3. Improving blood flow to the brain
4. Increased protein synthesis
5. Maintaining the disease fighting mechanisms of the
immune system
6. Promoting cellular growth and repair
7. Improving the capacity for learning & memory
storage
Factors affecting sleep
1. Physical illness
2. Drugs & substances
3. Life style
4. Emotional stress
5. Environment
6. Exercise & fatigue
7. Food & calorie intake
8. Light
9. Activity
10.Motivation

Sleep variations
New borns sleep for 16 - 18 h. Divide into 7
sleep periods.
They have two sleep status
1.Quite sleep
2.Active sleep
Quite sleep
Closed eyes, regular respirations & absence of
eye/body movements.

Active sleep
Eye movements observable through the closed
eyelids with body movements & irregular
respirations.
Infant
Some infants sleep for 22 hours, while the
average is 12-14h.
Their sleep cycle is shorter

Toddlers
The sleep requirement is 10-12 hours a day.
The normal sleep awake pattern established at
age 2-3.
Preschoolers
Require 11-12 hours of sleep per night.
The preschoolers have fear of the dark.
Read bed time stories until sleeps.
Reassure the child is safe.
Monitor the environmental stimuli such as
television and noise.
Sleep disorders
1. Insomnia
2. Hypersomnia
3. Sleep apnea
4. Narcolepsy
5. Sleep deprivation
6. Parasomnias
Insomnia
• Most common chronic sleep disorder.
• It is the perceived difficulty or inactivity to obtain an adequate
amount or quality of sleep.
• Usually a result of physical discomfort & often due to anxiety.
• Treatment include developing new behavioral pattern that induce
sleep.
a. Initial insomnia
Difficulty in falling asleep
b. Intermitlent insomnia
Difficulty in staying asleep because of frequent or
prolonged waking.
c. Terminal insomnia
Early morning or premature waking.
Hypersomnia
1. Excessive sleep particularly in the day time.
2. Causes can be medical conditions such as
CNS damage, kidney, liver or metabolic
disorders which include diabetes &
hyperthyroidism.
Sleep apnea
1. Disorder in which the individual cannot breath &
sleep at the same time.
2. Lack of airflow through the nose & mouth for
periods from 10 seconds to 1-2 minutes, there can
be 10-15 to more than 100 respiratory events per
hour of sleep.
3. Three types ; Central
Obstructive
Mixed
Central sleep apnea
•Caused by cessation of diaphragmatic &
inter costal respiratory effort as a result of
dysfunction of the brain’s respiratory
control center.
•Impulse to breathe 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.

Combine method
• Caused by cessation of central apnea & obstructive apnea.
Narcolepsy
• A CSN dysfunction of mechanisms that regulate the sleep &
wake states.
• Falls asleep uncontrollably at inappropriate times.
• Treated with stimulants.

Sleep deprivation
• A prolonged disturbance in amount, quality & consistency of sleep.
• Restlessness, irritability, withdrawl and speech deterioration can
be observed.
Parasomnias
1. Nocturnal enuresis
2. Periodic limb movement disorders
3. Sleep talking
4. Somnambulism

1.Nocturnal enuresis
• Bed wetting occurring during sleep in children over 3 years
old.
• It occurs in the following 1-3 hours after falling asleep &
when rousing from NREM sleep.
2.Periodic limb movement disorders
• The legs jerk twice or three times per minute during sleep & is
most common among elders.

3.Sleep talking
• Talking during sleep occurs NREM sleep before the REM
sleep.

4.Somnambulism
• Sleep walking occurs during stage 3 & 4 of NREM.
• It is episodic & occurs 1-2 hours after falling asleep.

Pain
1.Physical sensation
2.Involves physical, emotional & cognitive
components
3.Stimulus

Physiology of pain
1. Transduction
2. Transmission
3. Perception
4. Modulation

Types of pain
1. Acute
2. Chronic
3. Idiopathic
4. Inreferred ex: Shoulder tip pain
Ectopic pregnancy

Pain assessment
1. Scales
2. Nonverbal pain indicators
3. Behavioral indicators
Environmental aspect affecting comfort & sleep
1. Comfortable room temperature
2. Proper ventilation
3. Minimal noise
4. Comfortable noise
5. Proper lighting

Promoting bedtime routings

1. Help patient to relax in preparation for sleep.
2. Avoid mental stimulation before bedtime.
3. Relaxation exercise.
4. Guided imagery.
5. Good sleep hygiene.

Sleep hygiene
1. Avoid sleeping long hours during weekends or
holiday.
2. Bedroom should not be used for intensive
studying, snacking, TV watching or other non
sleep activity.
3. Avoid worrisome thinking when going to bed.
4. Avoid heavy meals for 3h before bed time.
Promoting comfort
1. Encourage patient to wear loose - fitting night
ware.
2. Instruct family on ways to position patient &
support dependent body parts to aid in muscle
relaxation.
3. Have patient void before going to bed.
4. Back massage.
5. Keep bed linens dry.
Control noise in the hospital
1. Close doors to patient’s room slowly.
2. Keep doors to work (areas closed) properly.
3. Reduce volume of nearby telephones paging
equipment.
4. Avoid abrupt loud noises.
5. Keep necessary conversations at low levels.
Nursing interventions to promote rest &
sleep
1. Assess the pattern of the sleep of the patient including a
sleep history.
2. Teach the patient about the importance of rest & sleep.
3. Highlight the following facts.
a. The conditions that promote sleep.
b. The safe use of sleep.
c. Effects of medication on sleep.
d. Effects of the disease condition on the sleep.
4. Support the bed time rituals of the patient.
 a. Listening to music
b. Evening walk
c. Taking a bath before sleep
d. Meditation
e. Other religious activities
5. Support the bed time rituals of children.
a. Bed time stories
b. Holding the favorite toy
c. Drinking warm milk
6. Create a restful environment.
a. Provide a darkened room or dim light room for the patient.
b. Reduce noise to the minimum.
 c. Eliminate environmental distractions.
7. Ensure the safety of the patient.
a. Use night lights & keep call bell within reach.
b. restrict fluid intake in the evening.
c. Assist with impaired physical mobility (to void before
resting).
8. Provide comfort & relaxation.
a. Assist in hygienic needs before sleep.
b. Provide loose fitting night wear.
c. Perform back massage.
d. Provide clean, dry linen for bed.
e. Assist the patient to assume a comfortable
 position.
f. Administration of medication according to the
medical advice.
g. Avoid sleep interruptions.
9. Enhance sleep with medication when indicated.
a. Medications include sedatives hypnotics,
tranquillizers & anti anxiety medication.
b. Administer medication at correct time.
c. Observe the patient for sleep.
Meeting the spiritual need of the patient
• Spirituality refers to a belief in a higher power, an
awareness of life.
• Spirituality implies living with moral standards. It
contributes to health in many persons.
• It is expressed through participation in religion and or
belief in good family, naturalism, rationalism, humanism &
the arts.
• All these factors can influence how patients & health care
professionals perceive health & illness & how they interact
with one another.
Religion
•Religion is an organized & public belief system of
worship & practice that generally has a focus on
a god or super natural power.
•It generally offers an arrangement of symbols &
rituals that are meaningful & understood by its
followers.
•Religious in the world are Judaism, Hinduism,
Buddhism, Islamic & Christianity.
Spirituality
• Fulfills specific needs
a. Meaning to life, illness crises & death.
b. Sense of security for present & future.
c. Guides daily habits.
d. Elicits acceptance or rejection of other people.
e. Provides psychosocial support in a group of like
minded people.
f. Strength when facing life’s crises.
g. Healing strength & support.
Spiritual needs
1. May be dynamic in patient understanding of illness.
2. Religious convictions / beliefs may affect health care
decision making.
3. May be a patient need.
4. May be important in patient coping.
5. Integral to whole patient care.

Spiritual care
1. Practice of compassionate presence.
2. Listening to patient’s fears, hopes, pain & dreams.
3. Obtaining a spiritual history.
4. Attentiveness to all dimensions of the patient &
family body, mind & spirit.
5. Incorporation of spiritual practices as appropriate.
6. Involve chaplains as members of the
interdisciplinary health care team.
Need
Need is one of the primary motivators that keeps us going.
The need for love & relationship
• Humans are social beings.
• Love & relationship is met in significant human relationship.

The need for forgiveness

A sense of forgiveness within the context of one’s faith, often brings a
sense of inner peace for that person in their relationship with god, self
& others.
Result in forgiveness
1. Less anxiety & depression.
2. Better health outcomes.
3. Increased coping with stress.
4. Closeness to god & others.
5. Resolves guilt.
6. Restored relationships.

Thank You