Sleep and Rest: Nursing Study Guide

Sleep and rest are essential for physical restoration, memory consolidation, and immune function. This note reviews the stages of sleep, normal sleep requirements across the lifespan, common sleep disorders, and the nursing interventions you need to know for safe, restorative patient care.

Definitions

• Sleep is a state of decreased consciousness essential for physical restoration, memory consolidation, and immune function.
• Rest is a state of relaxation that reduces fatigue but does not provide the same restorative benefits as sleep.

Stages of Sleep

• NREM Stage 1 — Light sleep. The patient is easily awakened. Transition between wake and sleep.
• NREM Stage 2 — Light sleep. Heart rate decreases. Body prepares for deep sleep.
• NREM Stage 3 — Deep sleep. Delta waves present; patient is hard to awaken. Growth hormone is released for physical restoration.
• REM sleep — Dreaming sleep. Muscle paralysis and rapid eye movements occur. Supports memory consolidation and learning.

Sleep cycles last approximately 90 minutes. Each cycle progresses through NREM Stages 1, 2, and 3, then returns to Stage 2 before entering REM sleep.

Normal Sleep Requirements

• Newborns: 14–17 hours per day.
• Adults: 7–9 hours per night.
• Older adults: 7–8 hours per night. They spend less time in deep sleep and have more nighttime awakenings than younger adults.

Factors Affecting Sleep

• Pain delays sleep onset and causes frequent awakenings.
• Caffeine and nicotine stimulate the nervous system and delay sleep onset. Avoid caffeine for 6–8 hours before bedtime.
• Alcohol may help a person fall asleep initially but suppresses REM sleep and causes early morning awakenings.
• Diuretics cause nocturia (nighttime urination).
• Beta-blockers can cause insomnia as a side effect.
• Hospital environment: noise, light, frequent monitoring, and procedures disrupt sleep cycles.
• Assess and treat pain before bedtime.

Common Sleep Disorders

• Insomnia — Difficulty falling asleep, staying asleep, or waking too early. Identify the underlying cause before recommending treatment.
• Sleep apnea — Breathing pauses during sleep, loud snoring, excessive daytime sleepiness. Position the patient side-lying and ensure use of CPAP as ordered.
• Restless legs syndrome (RLS) — Irresistible urge to move the legs that worsens at rest. Check iron levels, as iron deficiency is a common cause.
• Parasomnias — Include sleepwalking and night terrors. Ensure patient safety. Never wake a sleepwalker; gently guide them back to bed.

Nursing Interventions to Promote Sleep

Non-Pharmacological Interventions (Try First)

• Maintain a consistent sleep-wake schedule.
• Cluster nighttime care (vital signs, medications) to allow longer periods of uninterrupted sleep.
• Create a comfortable environment: reduce noise, dim lights, adjust room temperature.
• Offer warm milk or herbal tea in the evening.
• Provide pain relief before bedtime.
• Limit fluids 2–4 hours before bedtime to reduce nocturia, and ensure easy access to the bathroom or bedpan.

Pharmacological Interventions (When Needed)

• Melatonin — Natural hormone that regulates sleep-wake cycles. Available over the counter.
• Benzodiazepines (e.g., temazepam, lorazepam) — Short-term insomnia only. Risk of dependence.
• Non-benzodiazepine hypnotics (e.g., zolpidem, eszopiclone) — Commonly prescribed for insomnia; may cause sleepwalking or amnesia.
• Sedating antidepressants (e.g., amitriptyline, trazodone) — Used for patients with insomnia and depression.

Do not use sedatives long-term — they lose effectiveness and cause dependence.

Sleep Assessment Questions

• Ask about usual bedtime, wake time, number of nighttime awakenings, and total hours of sleep.
• Ask whether the patient feels rested upon waking and whether they nap during the day.
• Ask about factors interfering with sleep: pain, anxiety, noise, caffeine, alcohol, medications.
• Assess for symptoms of sleep disorders: snoring, gasping during sleep, leg discomfort at rest.
• Review medications — diuretics, beta-blockers, and corticosteroids can interfere with sleep.

Common Exam Traps

• Do not assume older adults need less sleep — they still need 7–8 hours, but with less deep sleep and more awakenings.
• Do not wake a sleepwalker — gently guide them back to bed.
• Do not give sedatives as first-line treatment for insomnia — try non-pharmacological interventions first.
• Do not ignore pain as a cause of sleep disruption.
• Do not serve caffeinated beverages in the evening — offer decaffeinated options.
• Remember: sleep is essential for healing; hospitalized patients need protected sleep time.

Key takeaways

• NREM Stage 3 is deep sleep for physical restoration and growth hormone release; REM is for memory consolidation.
• Adults need 7–9 hours; older adults need 7–8 hours with less deep sleep and more awakenings.
• Promote sleep with consistent schedules, clustered nighttime care, pain relief, and reduced noise/light.
• Position sleep apnea patients side-lying and ensure CPAP use; check iron levels in RLS.
• Never wake a sleepwalker — guide them gently back to bed.
• Try non-pharmacological interventions before sedatives; avoid caffeine 6–8 hours before bed.