Editing Fundamentals of Nursing (section)

== Rest and sleep ==

Sleep alternates between non rapid eye movement sleep (stages N1, N2, and N3) and rapid eye movement sleep, in cycles of roughly 90 minutes. N3 is deep, restorative slow wave sleep, greatest in the first half of the night, and it is when growth hormone is released and tissue repair is most active. Rapid eye movement sleep, greatest in the second half of the night, supports memory consolidation and is when most vivid dreaming occurs.

Age variation: newborns sleep 14 to 17 hours; school age children about 9 to 11 hours; adults 7 to 9 hours. Older adults need a similar total but obtain less N3 sleep, wake more often, and shift toward earlier sleep and wake times. Reduced deep sleep in older adults is a normal aging change, not automatically a disorder.

Common disorders: insomnia, obstructive sleep apnea, narcolepsy, restless legs syndrome, and circadian rhythm disruption from shift work or hospitalization.

Nursing interventions: cluster care to allow uninterrupted blocks of at least 90 minutes, dim lights and reduce noise and alarms at night, maintain a consistent schedule, encourage daytime light exposure and activity, limit daytime napping to short early afternoon naps, avoid caffeine for at least four to six hours before bed, avoid heavy meals and vigorous exercise close to bedtime, and reserve the bed for sleep. Teach that alcohol may shorten sleep onset but fragments sleep and suppresses rapid eye movement sleep later in the night. Sedative hypnotics are a short term measure and increase fall and confusion risk, especially in older adults.