Summary

Like breathing, sleep seems simple and automatic, but the physiological processes involved in sleep involve coordination of multiple body systems and complicated neurological and physical responses. Originating in the brain stem, and involving other regions of the neurological system, sleep is influenced by factors such as circadian rhythms. Although a person is unaware of much of what happens during sleep, there are four stages that occur in cycles throughout the hours of sleep.

For those whose sleep is uninterrupted, they experience stage I sleep just once as they fall asleep. They then continue through multiple cycles in a predictable fashion every 90 to 110 minutes, until awakening. Throughout the human life span, there are changes in sleep patterns and how they progress through sleep cycles. There are also developmental alterations regarding the amount of sleep necessary at different life stages, with neonates experiencing a slightly different sleep before circadian rhythms are established, and spending most of a twenty-four-hour day sleeping. Sleeping needs of adults tend to be only seven to nine hours. The amounts of sleep within the different stages also change throughout the life span, as the neurological system develops and various other factors influence growth and development.

Many things can affect the quality and quantity of sleep and rest. This section covered physiological considerations affecting sleep and rest, including growth and development, illness, and medications. Lifestyle, habits, and culture also affect sleep. Sedentary lifestyles tend to lead to poor quality and quantity of sleep. Activity and exertion contribute to physical fatigue, which helps the body ready itself, and have a need for, rest and sleep. Choices, such as caffeine, nicotine, and alcohol use, which easily become habitual, have negative effects on sleep, with nicotine having some of the most significant effects. Stress, and its associated physiological responses, tends to cause problems falling asleep or staying asleep. The section also explored several sleep disorders, including insomnia, parasomnias, and breathing and movement disorders.

Insufficient sleep has the potential to cause several psychophysiological effects. For neonates and children, neurological changes can be significant because sleep affects growth and development. Lack of sleep is also a frequent contributor to behavioral and certain mental health concerns. Performance deficits may be apparent at school or in family interactions through the inability to pay attention or remember certain things, in development of intelligence, and in academic accomplishments. Physiologically, sleep increases the pediatric risk for obesity and other related metabolic disorders.

Many of the same issues affecting children who do not achieve adequate sleep affect adults. Poor coping and various mental health diagnoses, including anxiety, mood lability, impaired focus, and memory, can be related to inadequate sleep. Physiologically, results of insufficient sleep show up in gastrointestinal, cardiovascular, metabolic, and immune symptoms and disorders. Lack of sleep and related disorders tend to have bidirectional relationships, making it difficult in some situations to identify whether the insufficient sleep caused the diagnosis or the diagnosis contributed to the poor sleep.

Nursing assessment plays an important role in assisting patients with sleep disturbances. Gathering key information through health history, sleep logs, and effects of insufficient sleep on the patient’s well-being is necessary for the multidisciplinary team to plan and implement next steps. One of the first strategies for patients who experience poor sleep is to explore their sleep hygiene practices. Nurses can help by providing education as to how to improve sleep hygiene through various means. Medications are sometimes helpful for patients to fall asleep and/or stay asleep. Safety is critical. Again, education is vital, so nurses should help patients to understand risks of these medications and their interactions with any other drugs.