SLEEP VARIATION

SLEEP VARIATION:

For NEONATES- newborns sleep for 16-18 hours divided into 7 sleep periods. They have two sleep states- QUIET sleep (their NREM sleep) is characterized by closed eyes, regular respirations and absence of eye/body movements;
ACTIVE sleep is characterized by eye movements observable through the closed eyelids, with body movements and irregular respirations.
For INFANTS- some infants sleep for 22 hours, while the average is 12-14 hours. Their sleep cycle is shorter (about 50-60 minutes).
The REM sleep is 20-30% (which decreases as the infant grows and will stabilize at 20% until late in adulthood).
About 50% of the sleep is spent during LIGHT sleep (Stage 1).
For TODDLERS- the sleep requirement is 10-12 hours a day. The same 20-30% of sleep is REM. The normal sleep wake pattern is established at age 2-3.
Bedtime rituals often develop and assume great importance in providing nighttime security.
For PRESCHOLERS- they usually require 11-12 hours of sleep per night. The REM sleep is still 20-30%. Many of the preschoolers resist going to sleep
Remember that the preschoolers have fear of the dark that nurses must anticipate to guide the mothers.
Suggested Measures by Pilliteri:
1. Read bedtime stories until patient sleeps
2. Reassure that child is Safe
3. Monitor environmental stimuli such as television and noise

The REM SLEEP

2. THE REM SLEEP

 

• This sleep type usually recurs about every 90 minutes and lasts 5 to 30 minutes.
• Other name: PARADOXICAL Sleep
• The EEG pattern resembles that of the “awake” state.
• This is not as restful as NREM sleep
• Most dreams take place during this period and the dreams are usually remembered or consolidated to memory
• The brain is highly active with metabolic rate increasing as much as 20%
• The sleeper may be very difficult to arouse
• There are rapid conjugate eye movements, muscle tone is depressed, but gastric secretions increase, HR and RR are increased and IRREGULAR
• This sleep period becomes longer as the night progresses.

 

The NREM SLEEP

1. THE NREM SLEEP

• Also referred to as the SLOW wave sleep, because the brain waves of the client are slower than the alpha and beta waves of an awake or alert person.
• It is a deep, restful sleep
• There is a decreased physiologic functions
• All metabolic processes are reduced

It is divided into FOUR stages:1-4

STAGE 1- the stage of very light sleep, sleeper can readily be awakened, lasts for a few minutes. The eyes tend to roll slowly from side to side, and muscle tension remains absent.

STAGE 2- the stage of light sleep, body processes continues to slow down, and lasts about 10-15 minutes. Constitutes 40-45% of TOTAL sleep!

STAGE 3-refers to a medium-depth sleep where vital signs and metabolic processes slow further because of the PARASYMPATHETIC nervous system influence. The sleeper is difficult to arouse.

STAGE 4-this is the deepest sleep or delta sleep. It is the stage where the heart rate and respiratory rate drop 20-30% below those exhibited during waking hours. This stage is thought to restore the body physically. Some dreaming may occur here. This stage may be absent in the elderly.

REST AND SLEEP

REST- a state of calmness, relaxation without emotional stress, and freedom from anxiety
SLEEP- an altered state of consciousness in which the individual’s perception of and reaction to the environment are decreased.
This can be discussed simply by considering the three basic research approaches:

• ELECTROPHYSIOLOGIC
• HORMONAL and
• NEURAL

ELECTROPHYSIOLOGIC

• The Electrophysiological approach centers on the polygraph recordings of electrical changes in the brain waves (EEG), eye movements (EOG) and muscle activity (EMG).
• This approach characterizes sleep as Non-Rapid Eye Movement sleep (NREM) and the Rapid-Eye movement sleep (REM).

Neural

• The Neural approach views sleep as an active process involving the RETICULAR activating system (RAS) and the interaction of Neurotransmitters.
• The RAS is a network of neurons in the medulla, pons and midbrain with projections to the spinal cord, hypothalamus, cerebellum and cerebrum.
• SEROTONIN is said to be the MAJOR neurotransmitter associated with sleep, produced in the median raphe nuclei of the brainstem.
• Serotonin decreases the activity of the RAS inducing sleep. REM sleep appears to be due to the influence of norepinephrine.

Hormonal

• The Hormonal approach views sleep as a pattern affected by hormones. MELATONIN from the pineal gland in the brain is secreted in enormous quantities during sleep.
• Its activity is influenced by the relationship of darkness and light.
• ACTH is also high during the early period of sleep and CORTISOL rises toward the end of the nighttime sleep period.
• GROWTH HORMONE and PROLACTIN also increase during deep sleep. 

Functions of Sleep
1. Restores normal levels of activity and normal balance among parts of the nervous system
2. Necessary for protein synthesis
There are two types of sleep identified:
1. The NREM sleep (or the non-REM sleep) and
2. The REM sleep ( rapid eye movement sleep)

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Sleep Variation

Human Bones

Human are composed of 206 bones which are divided into four categories namely:

1. Long Bones – it is composed of diaphysis (shaft) primarily cortical bone, and epiphyses, primarily cancellous bone. These are designed for weight bearing and movement. The ends of long bones are covered by articular cartilage which is composed of elastic, avascular tissue.

2. Short Bones – these bones are made of cancellous bone layered between compact bone.

3. Flat Bones – mostly it support and cover vital organs which serves as protection. It is usually sites for hematopoeisis.

4. Irregular Bones