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Fundamentals · chapter 28 · Sleep and Rest

Concepts of Sleep and Rest

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Sleep neurological control

    Sleep, like respiration, is a basic physiological function, under neurological control and originating in the brain stem.

  2. Glymphatic waste removal

    The glymphatic system is involved in regulation of interstitial fluid movement and subsequent removal of waste from the brain and cerebrospinal fluid (CSF) and is directed by sleep and circadian cycles (Hablitz Nedergaard, 2021; Nunez Lamoreux, 2023).

  3. Adequate sleep and cognition

    Cognitive actions, such as learning, problem-solving, concentration, and creativity, are performed best when the body and brain have had adequate sleep.

  4. Sleep deprivation and coping

    Sleep deprivation inhibits positive adaptations by the brain to stress, resulting in less effective coping responses and negative reactions while awake.

  5. Sleep and organ function

    Proper organ function relies on adequate sleep as do healthy immune systems, use of insulin, effective cognition, and cardiac function.

  6. Homeostasis and circadian rhythm

    Sleep involves coordination of the properties of homeostasis and circadian rhythm. A person tends to associate feelings of fatigue and drowsiness with a need for sleep, which is the homeostatic mechanisms at work.

  7. Melatonin and light

    Melatonin is a modulator involved in circadian rhythm changes, with increasing levels during darkness, and decreasing levels during hours of light.

  8. RAS basic functions

    Located in the anterior of the brain stem, the reticular activating system (RAS) is integral in some of the most basic functions, including consciousness, sensory perceptions and responses, ability to focus, and the sleep-wake cycle.

  9. RAS and REM tone

    Additionally, the RAS moderates muscle tone during different stages of sleep, most particularly contributing to the lack of muscle tone apparent during REM sleep, which prevents movement of the extremities during dreams.

  10. Circadian timing functions

    Wakefulness, metabolism, temperature, and the timing of sleepiness and subsequent sleep, are part of circadian rhythms.

  11. Circadian light response

    The control of circadian rhythms initiate within the hypothalamus, where there are centers for sleep and wakefulness. These are set to respond to light and darkness through messages from the retinas.

  12. Sleep cycle proportions

    These sleep stages happen throughout the sleep session (typically overnight) in a cyclical pattern, with a person spending about 75 percent of sleep time in NREM stages I through III, and 25 percent in stage IV REM sleep (Suni, 2023).

  13. Stage III sleep

    Stage III involves further decrease of temperature, heart and respiratory rates, and relaxation to the point of loss of skeletal muscle tone. This stage of sleep is when the deepest sleep occurs, and it is hard to be awakened, even by loud noise.

  14. REM sleep physiology

    REM sleep, as the name indicates, is characterized by rapid movements of the eyes. Additionally, during this stage, metabolism increases, as noted by increases and changes in respiratory patterns and cardiac rhythms (Nunez Lamoreux, 2023).

Terms to know

reticular activating system (RAS)
Located in the anterior of the brain stem, the reticular activating system (RAS) is integral in some of the most basic functions, including consciousness, sensory perceptions and responses, ability to focus, and the sleep-wake cycle.
circadian rhythms
Wakefulness, metabolism, temperature, and the timing of sleepiness and subsequent sleep, are part of circadian rhythms.
glymphatic system
The glymphatic system is involved in regulation of interstitial fluid movement and subsequent removal of waste from the brain and cerebrospinal fluid (CSF) and is directed by sleep and circadian cycles (Hablitz Nedergaard, 2021; Nunez Lamoreux, 2023).
electroencephalogram (EEG)
An electroencephalogram (EEG), a linear tracing of the electricity of brain waves, is able to identify the different periods or stages of sleep.
narcolepsy
The RAS is also involved in responses to pain and some mental health and neurological disorders, such as schizophrenia, Parkinson disease, post-traumatic stress disorder (PTSD), and narcolepsy, a sleep disorder involving sleep and wakefulness with abnormal episodes of daytime sleep (see Central Disorders of Hypersomnolence).
sleep inertia
If awakened during this stage, it is typical for the person to experience sleep inertia, or slowed processing of thoughts (Patel et al., 2024).
polyphasic sleep pattern
Another is the polyphasic sleep pattern, which is normal for infants and young children, who sleep several times in a twenty-four-hour period.
sleep hygiene
Healthy transitions between the stages of sleep happen more often if an individual has good sleep hygiene, or healthy sleep habits.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A parent reports that a school-age child sleepwalks. The parent asks when during sleep this happens. Which stage should the nurse identify?

    1. REM sleep
    2. Stage III (N3), slow-wave sleep
    3. Stage I (N1)
    4. Stage II (N2)

    Answer: Stage III (N3), slow-wave sleep

    Sleepwalking (somnambulism) and enuresis happen during stage III sleep. Stage I is light sleep from which a person wakes easily, and during REM sleep skeletal muscle tone is lost, which eliminates movement.

  2. A nurse wakes a client from deep sleep for a scheduled assessment, and the client is slow to process questions. How should the nurse interpret this?

    1. Normal behavior after waking from stage I sleep
    2. A sign of narcolepsy
    3. An expected effect of REM rebound
    4. Sleep inertia after waking from stage III sleep

    Answer: Sleep inertia after waking from stage III sleep

    Stage III is the deepest sleep, and people awakened during it typically experience sleep inertia, or slowed processing of thoughts. Stage I sleep is easy to wake from, and the section does not describe this finding as narcolepsy or REM rebound.

  3. A 16-year-old client's parent is frustrated that the teen stays up late and is sleepy during the day. How much sleep should the nurse say the teen needs?

    1. Twelve to fifteen hours
    2. Nine to ten hours
    3. Seven to eight hours
    4. Sixteen to eighteen hours

    Answer: Nine to ten hours

    Adolescents need nine to ten hours of sleep, and a preference for staying up and sleeping later is typical. Seven to eight hours is for older adults, twelve to fifteen for infants around 12 months, and sixteen to eighteen for newborns.

  4. A client asks why they sometimes wake from vivid, emotional dreams in the early morning. Which explanation is accurate?

    1. Stage III sleep increases toward morning, when dreams are most vivid.
    2. REM sleep increases in the second half of the night, and it is common to wake during REM.
    3. Dreams happen only in the first sleep cycle.
    4. Stage I sleep lasts longest just before waking.

    Answer: REM sleep increases in the second half of the night, and it is common to wake during REM.

    REM sleep increases during the second half of the night, dreams in REM are clear and emotional, and it is common to wake in the midst of REM. Stage III predominates in the first half of the night, and stage I is not repeated unless the person is wakened.

  5. A client has trouble falling asleep. Which sleep hygiene measures should the nurse include in teaching? Select all that apply.

    1. Keep regular sleep and wake times.
    2. Change bedtime every night to reset the circadian rhythm.
    3. Reduce alcohol, caffeine, and nicotine.
    4. Keep the room dark, quiet, and cool.
    5. Allow enough time for adequate sleep.

    Answer: Keep regular sleep and wake times., Reduce alcohol, caffeine, and nicotine., Keep the room dark, quiet, and cool., Allow enough time for adequate sleep.

    Sleep hygiene includes regular sleep and wake times, a dark, quiet, cool room, enough time for sleep, reducing substance use, and addressing sleep disorders. Changing bedtime every night works against maintaining regular sleep times.

  6. A nurse explains to a client why deep slow-wave (N3) sleep matters. Which processes occur during stage III sleep? Select all that apply.

    1. Increased heart and respiratory rates
    2. Repair of muscle tissue
    3. Regulation of immune function
    4. Production of growth hormones
    5. Rapid movements of both eyes

    Answer: Repair of muscle tissue, Regulation of immune function, Production of growth hormones

    During stage III, growth hormone production, immune regulation, and muscle tissue repair occur while heart and respiratory rates decrease. Rapid eye movements and increased heart and respiratory rates are features of REM sleep.

Where every quote comes from

Section 28.1 Concepts of Sleep and Rest of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.