3 sleep management

Objectives
1. Assess client need for sleep/rest and intervene as needed
2. Apply knowledge of client pathophysiology to rest and sleep interventions
3. Schedule client care activities to promote adequate rest
22/07/2019 COMPILEDBY C SETTLEY 2

Sleep, rest and relaxation- pg 222
•Altered state of consciousness
•Reduction in metabolism
•Various changes throughout life
•Functions of sleep/rest/relaxation:
• Brain function
• Memory
• Physical health

Insomnia
•Insomnia
• Insomnia, simply defined, is the absence of sleep.
• Types of insomnia:
• Clients affected with inducement insomnia have difficulty falling asleep.
• Clients with maintenance insomnia have difficulty maintaining sleep and staying
asleep once they have fallen asleep.
• Some clients are affected with both inducement insomnia and maintenance
insomnia.

Insomnia
•Insomnia
• Acute and chronic
• Primary insomnia means that a person is having sleep problems that are not directly
associated with any other health condition or problem.
• Secondary insomnia means that a person is having sleep problems because of
something else, such as a health condition (like asthma, depression, arthritis, cancer,
or heartburn); pain; medication they are taking; or a substance they are using (like
alcohol).

Causes of Insomnia
CAUSES OF ACUTE INSOMNIA CAN INCLUDE:
Significant life stress (job loss or change, death of a loved
one, divorce, moving)
Illness
Emotional or physical discomfort
Environmental factors like noise, light, or extreme
temperatures (hot or cold) that interfere with sleep
Some medications (for example those used to treat colds,
allergies, depression, high blood pressure, and asthma)
may interfere with sleep
Interferences in normal sleep schedule (jet lag or
switching from a day to night shift, for example)
CAUSES OF CHRONIC INSOMNIA INCLUDE:
Depression and/or anxiety
Chronic stress
Pain or discomfort at night

Insomnia
SYMPTOMS OF INSOMNIA
• Sleepiness during the day
• General tiredness
• Irritability
• Problems with concentration or
memory
• Diagnosing Insomnia
• Diagnosing: sleep pattern/diary

Treatment for Insomnia
•Acute insomnia may not require treatment.
•Change habits
• Try to go to sleep at the same time each night and get up at
the same time each morning.
• Avoid day naps.
• Avoid prolonged use of phones or reading devices ("e-
books") that give off light before bed.
• Avoid caffeine, nicotine, and alcohol late in the day.
• Get regular exercise. Try not to exercise close to bedtime,
because it may stimulate you and make it hard to fall
asleep.
• Don't eat a heavy meal late in the day.
• Make your bedroom comfortable. Be sure that it is dark,
quiet, and not too warm or too cold. If light is a problem,
try a sleeping mask.
• If noise is a problem, try earplugs, a fan, or a "white noise"
machine to cover up the sounds.
•Follow a routine to help you relax before sleep. Read a
book, listen to music, or take a bath.
•Avoid using your bed for anything other than sleep or
sex.
•Chronic: underlying cause should be determined and
addressed.

Narcolepsy
• Narcolepsy is defined as excessive day time sleepiness that a person can be
affected with secondary to the paucity of hypocretin within the area of the
central nervous system that controls sleep.
• Genetic factors and abnormal signaling in the brain.
• Narcolepsy causes sudden attacks of sleep.
• Sudden loss of muscle tone and hallucinations might occur.
• Stimulants, antidepressants and other medication can help.

• Parasomnias are disruptive sleep disorders that can occur during arousals from REM sleep or partial
arousals from non-REM sleep.
• Parasomnias include nightmares, night terrors, sleepwalking, confusional arousals, and many others.
• Nightmares are vivid nighttime events that can cause feelings of fear, terror, and/or anxiety.
• Usually, the person having a nightmare is abruptly awakened from REM sleep and is able to describe
detailed dream content.
• Returning to sleep is usually difficult. Nightmares can be caused by many factors, including illness,
anxiety, the loss of a loved one, or negative reactions to a medication.
• A person experiencing a night terror abruptly awakes from sleep in a terrified state, but is confused
and unable to communicate.
• They do not respond to voices and are difficult to fully awaken.
• Night terrors last about 15 minutes, after which time the person usually lies down and appears to fall
back asleep.
• People who have night terrors (sometimes called sleep terrors) usually don't remember the events the
next morning.
• Night terrors are similar to nightmares, but usually occur during deep sleep.

• People experiencing sleep terrors may pose dangers to themselves or others because
of limb movements.
• Night terrors are fairly common in children, mostly between ages 3 and 8.
• Children with sleep terrors will often also talk in their sleep or sleepwalk.
• This sleep disorder, which may run in families, also can occur in adults.
• Strong emotional tension and/or the use of alcohol can increase the incidence of night
terrors among adults.

• Sleepwalking occurs when a person appears to be awake and moving around, but is actually
asleep.
• He or she has no memory of the episode.
• Sleepwalking most often occurs during deep non-REM sleep (stages 3 and 4 sleep) early in
the night and it can occur during REM sleep in the early morning.
• This disorder is most commonly seen in children between ages 5 and 12; however,
sleepwalking can occur among younger children, adults, and seniors.
• Genetic.
• Contrary to what many people believe, it is not dangerous to wake a person who is
sleepwalking.
• The sleepwalker simply may be confused or disoriented for a short time upon awakening.
• Although waking a sleepwalker is not dangerous, sleepwalking itself can be dangerous,
because the person is unaware of his or her surroundings and can bump into objects or fall
down.
• In most children, it tends to stop as they enter the teen years.

• Confusional arousals usually occur when a person is awakened from a deep sleep
during the first part of the night.
• This disorder, which also is known as excessive sleep inertia or sleep drunkenness,
involves an exaggerated slowness upon awakening.
• People experiencing confusional arousals react slowly to commands and may have
trouble understanding questions that they are asked.
• In addition, people with confusional arousal often have problems with short-term
memory; they have no memory of the arousal the following day.

• Rhythmic movement disorder occurs mostly in children under age 1.
• A child may lie flat, lift the head or upper body, and then forcefully hit his or her head
on the pillow.
• Rhythmic movement disorder, which also has been called "head banging," also can
involve movements such as rocking on hands and knees.
• The disorder usually occurs just before a person falls asleep.
• Repetitive movements of large muscle groups immediately before
and during sleep often involving the head and neck, upper torso,
neck, arms.

• Sleep talking is a sleep-wake transition disorder.
• Although it usually is harmless, sleep talking can be disturbing to sleep partners or
family members who witness it.
• Talk that occurs during sleep can be brief and involve simple sounds, or it can involve
long speeches by the sleeper.
• A person who talks during sleep typically has no recollection of the actions.
• Sleep talking can be caused by external factors, including fever, emotional stress, or
other sleep disorders.

• Nocturnal leg cramps are sudden, involuntary contractions most commonly of the calf
muscles during the night or periods of rest.
• The cramping sensation may last from a few seconds to 10 minutes, but the pain from
the cramps may linger for a longer period.
• Nocturnal leg camps tend to be found in middle-aged or older populations, but people
of any age can have them.
• Nocturnal leg cramps differ from restless legs syndrome, because the latter usually
does not involve cramping or pain.
• Sitting for long periods of time
• Over-exertion of the muscles
• Standing or working on concrete floors
• Sitting improperly

• People with sleep paralysis are not able to move their body or limbs either when
falling asleep or waking up.
• Brief episodes of partial or complete skeletal muscle paralysis can occur during sleep
paralysis.
• Sleep paralysis can run in families, but the cause of sleep paralysis is not known.
• This disorder is not harmful, but people experiencing sleep paralysis often are fearful,
because they do not know what is happening.
• An episode of sleep paralysis often is terminated by sound or touch.
• Within minutes, the person with sleep paralysis is able to move again.
• It may occur only once in your lifetime or can be a recurring phenomenon.

• Sleep bruxism- or teeth grinding - involves the involuntary, unconscious, excessive
grinding or clenching of teeth during sleep.
• It may occur along with other sleep disorders.
• Sleep bruxism may lead to problems, including abnormal wear of the teeth and jaw
muscle discomfort.
• The severity of bruxism can range from mild to severe enough to cause dental injury.
• In some cases, grinding can be prevented with the use of a mouth guard.
• The mouth guard, supplied by a dentist, can fit over the teeth to prevent them from
grinding against each other.
• Other: Bedwetting

Sleep Apnea
• Simply stated, sleep apnea is apnea that occurs during sleep. There are a couple of types of sleep apnea
including obstructive sleep apnea that is typically caused by large anatomical structures such as the
tongue and the collapse of the oropharynx when the client is sleeping, central sleep apnea which results
from some deficit of the central nervous system such as an insult to the brain stem, and mixed sleep
apnea, which occurs as the result of the combination of both central and obstructive sleep apnea, and
results from multiple related disorders and diseases.

Terminology
•Circadian Rhythm
• Circadian rhythm is the human's natural and innate 24 hour a day clock. Circadian rhythms are
sometimes referred to as our body clock. In essence, humans take on cyclical 24 hour periods of time
that are associated not only with sleep, but also in terms of their hormone secretion, their bodily
temperature and other physiological and other psychological variations.
• Good sleep habits and rest promote better health and well-being in people. A lack of sleep and rest do
not. Poor sleep habits can lead to inability to mentally focus, adversely affect moods, and increase the
risk of depression, heart attack, high blood pressure, obesity, and other health problems.

Assessing the Client's Need for Sleep and
Rest and Intervening As Needed
•How much sleep is needed depends upon the individual, their age and their level of wellness.
For example, some individuals just simply require and need more or less sleep than others do
even when the person is not affected with a health related problem or disorder and it varies
according to age and well-being. Clients who are ill and who are experiencing signs and
symptoms related to the illness will need more sleep than they did prior to the illness. The
amount of sleep that is needed also varies among the age groups. Below are some guidelines
that you can use to determine whether or not a client is getting enough sleep and rest for
physiological and psychological health.

Assessing the Client's Need for Sleep and
Rest and Intervening As Needed
•Neonates through 3 months of age typically sleep 14 to 17 hours a day
•Infants from 4 months of age to 11 months of age should normally sleep about 12 to 15 hours a
day
•Older infants and toddlers up to 3 years of age should sleep 11 to 14 hours a day
•Preschool children from 3 to 5 years of age should sleep 10 to 13 years of age
•School age children from 6 to 12 years of age need 9 to 11 hours of sleep each day
•Adolescents from 13 to 17 years of age should sleep about 8 to 10 hours of sleep
•Young adults and middle aged adults need about 7 to 9 hours of sleep
•Older adults over 65 years of age tend to require slightly less sleep than the middle age adults
and only 7 to 8 hours of sleep per night

The factors that impact on sleep, its duration
and its quality are described below:
• Illnesses: Despite the fact that clients with physical diseases and disorders require more sleep than normal for recovery, they tend to get less
because of some of the signs and symptoms of the illness or disorder that they are affected with. For example, pain, respiratory, genitourinary and
gastrointestinal system disorders often interfere with the client's getting enough sleep, hypothyroidism can decrease stage IV sleep, and pyrexia can
impair and reduce the amount of REM and delta sleep that the client gets.
• Medications: Some medications increase the client's sleepiness and the duration of sleep and other medications impair and impede the quality and
quantity of the sleep that the client gets while they are on a particular medication. For example, beta blockers used for hypertension can lead to
insomnia and a decrease in the amount of REM sleep that the client gets; and, narcotic medications, steroid medications, antidepressant
medications, and bronchodilating medications can decrease the duration of sleep and also impair the onset of sleep and the quality of the person's
REM sleep.
• Environment: The environmental factors and forces that can interfere with sleep include things like an uncomfortable environmental temperature,
noise, sleeping in a strange bed, an uncomfortable mattress and/or pillows, the presence or absence of light, and a snoring partner, for example.
• Emotional and Psychological Distress and Stress: The National Sleep Foundation, states that stress is the number one cause of insomnia. Stress
makes it more difficult to relax and, therefore, it can easily lead to sleep induction and sleep maintenance disorders.
• Lifestyle Choices: Consumption patterns such as cigarette smoking and alcohol use interfere with sleep and other life style choices such as those
related to exercise also impact on sleep, the duration of sleep and the quality of sleep. Daily exercise facilitates sleep; however, exercise
immediately before bed time may interfere with the client's sleep.
• Work Schedules: Long work hours and working night time hours interfere with sleep. For example, humans, including nurses, who work the night
tour of duty, are often unable to go to sleep and stay asleep during day time hours when they are off from work. Night time work and activity
disrupts the person's normal circadian rhythms in a similar manner that people suffer from jet lag when they travel across time zones.

•Clients are assessed by the nurse for their sleep and rest patterns and any sleep disturbances.
After a complete physical assessment of the client is assessed using other subjective and
objective data, as discussed immediately below.
•The physical assessment may reveal some data that can suggest a sleep disorder. Some of this
data can include a deviated nasal septum, enlarged tonsils and obesity, all of which can lead to a
sleep disorder or disturbance.
•Other assessments can include:

•The review of the client's reports about their sleep: The nurse may ask a client to record their sleep patterns and record
it in a sleep log or diary for a week or more, after which, the nurse will assess and analyze this data to determine any
sleep disturbances. Some of the data that is recorded in this sleep log can include:
•The extent of and time of exercise before sleep hours
•Consumption patterns like alcohol and cigarette smoking before sleep hours
•A list of all prescribed and over the counter drugs, herbs and supplements to determine if any of these substances has
the potential to interfere with the client's sleep
•A daily recording of any sleepiness during the day time hours
•A daily recording of any stressors that are impacting on the client
•The time the person went to bed for sleep, how long it took to fall asleep, the duration of the sleep each night, and the
duration and frequency of night time awakenings
•Reports by the sleep partner about any irregularities in terms of sleep such as snoring, periods of apnea, and restless leg
movements which the client is most likely to be unaware of

•Diagnostic studies, such as a polysomnography which is done in a sleep center by a respiratory
therapist, is used to diagnose sleep disturbances. A polysomnography is done in the sleep
laboratory by placing electrodes on the client's head is a combination of three diagnostic studies
which are an electrocephalogram, an electro-oculogram and an electromyogram.
•An electrocephalogram measures and displays the brain waves while the client is sleeping; an
electro-oculogram measures and displays eye movements during sleep; and an electromyogram
to measure muscular movements during sleep. These diagnostic tests, in combination with pulse
oximetry and an electrocardiogram, are used to assess clients for sleep disorders such as sleep
apnea, restless leg syndrome and bruxism.

Some of the nursing diagnoses that the nurse
can arrive at after a complete and thorough
assessment of the client are:
• Readiness for enhanced sleep
• Insomnia related to anxiety
• Insomnia related to the disruption in the amount and quality of sleep
• Sleep deprivation related to jet lag
• Sleep deprivation related to nocturnal work hours
• Sleep deprivation related to prolonged periods of time without sleep
• Impaired sleep related to obstructive sleep apnea
• Impaired sleep related to central sleep apnea
• At risk for injury and accidents relating to somnambulism
• Impaired gas exchange related to central or obstructive sleep apnea
• At risk for disturbed sleep secondary to alcohol use
• Insomnia related to unrelenting pain and the lack of comfort

Interventions for sleep disturbances
• Insomnia: The establishment of and adherence to a regular to bed routine, the avoidance of alcohol and exercise prior to sleep, using the bed for sleep only and not for watching television or
doing work, the use of stress and relaxation techniques, arising from bed if sleep induction does not occur within a reasonable amount of time, pain management, the correction of any assessed
sleep disorders, the avoidance of caffeineand heavy meals prior to bed time, cognitive behavioural therapy, and medicationsto promote sleep as the last resort, and then, only on a temporary
basis.
• Hypersomnia: Since hypersomnia occurs as the result of a physical rather than a psychologicalcause, the underlyingphysical cause, such as hypothyroidism, should be corrected.
• Narcolepsy: Narcolepsy, which is caused by the lack of the chemical hypocretin in the area of the CNS that regulates sleep, leads to day time sleepiness and sleep attacks that cause the person
to fall asleep at unpredictable times, such as when driving an automobile. The client who is assessed as having narcolepsy should be educated about the dangers of using heavy equipment and
motor vehicles and they can also be treated with central nervous system stimulant medications like an amphetamineor an antidepressant to control this sleep disorder and its effects.
• Sleep Apnea: The treatment for sleep apnea depends on the cause. For example if the apnea is related to enlarged oropharyngeal anatomy such as the tongue, tonsils and pharynx, laser
reduction may be indicated, if the cause of the sleep apnea is obesity, the client should be on a weight reduction diet, and if the cause is not treatable, the client will be given a CPAP machine for
daily use while the client is sleeping. CPAP, which is continuous positive airway pressure, is delivered to the client with a CPAP machine, tubing and a full face mask, a nasal prong or a partial face
mask. Full face masks are recommended for clients who are mouth breathers, however, some clients may reject a full face mask because they feel somewhat claustrophobicwhen they are in
place. The treatment and correctionof sleep apnea is necessary because, left untreated, sleep apnea can lead to complications such as pulmonary hypertension, hypertension and cardiac
arrhythmias.
• Parasomnias:Parasomnias like bruxism can be treated with dental correction, stress management techniques, muscle relaxants, or a botulinum toxin A, which is Botox, in severe cases, and the
use of a splint or mouth guard that is a dental appliance that prevents damage to the teeth as the result of bruxism.
• Nocturnal Enuresis: Nocturnal enuresis can be treated with a bed wetting alarm, positive reinforcement and medications such as imipramineand desmopressin.
• Sleepwalking:Sleepwalkingcan be treated with a sleep hygiene program to decrease sleep deprivation, the eliminationof problematicmedications, the avoidance of alcohol and the correction
of any causal underlyingillnesses, all of which can lead to sleep walking.
• PeriodicLimb Movement and Restless Leg Syndrome: These sleep disrupting disorders can be treated with the correction of an underlying disorder, such as peripheralneuropathy, the
avoidance of alcohol and tobacco, the use of some medicationssuch as those that increase dopamine, benzodiazepinesand anticonvulsant medications, when indicated.

Applying a Knowledge of the Client's
Pathophysiology to
Rest and Sleep Interventions
•As mentioned immediately above and in other sections of "Rest and Sleep", many interventions
for sleep disorders and disturbances are based on the needs of the specific client as specific to
their physiological and psychological pathologies. For example, stress and relaxation, in addition
to other complementary and non pharmacological interventions are used when the client is
adversely affected with anxiety that disrupts sleep, continuous positive airway pressure (CPAP) is
used when the client's anatomical structures are abnormally large or they abnormally relax and
collapse during sleep, and analgesics are administered to relieve pain as the result of an acute or
chronic physical disorder or disease.

Scheduling Client Care Activities to
Promote Adequate Rest
• The promotion of sleep and adequate rest depends on correcting any underlying problems, including pain and alcohol use, and then
planning activities and routines that will enhance the duration and the quality of sleep.
• Some of these sleep promotion interventions and schedules include:
• Establishing and adhering to a regular sleep time and wake time for the client based on their patterns and needs
• Limiting the duration and frequency of day time naps
• The promotion of daily exercise
• The avoidance of alcohol, caffeine, heavy meals and exercise at least a couple of hours before bedtime
• The promotion of comfort using techniques such as white noise, dim lighting, pain management, stress reduction techniques, massage
and the elimination of environmental noise
• Many hospitals and nursing homes have established policies and procedures to promote sleep by decreasing the noisiness of client care
areas. For example, the hospital may stop over head paging after a certain hour; they may turn down the telephone ringer volume after a
certain hour and turn down the lights in the hallways.

What Are the Stages of Sleep?
•There are four stages of sleep: Non-REM (NREM) sleep (Stages 1, 2 & 3) and REM sleep. Periods
of wakefulness occur before and intermittently throughout the various sleep stages or as one
shifts sleeping position.
•Wake is the period when brain wave activity is at its highest and muscle tone is active.

•Stage 1 is the lightest stage of NREM sleep. Often defined by the presence of slow eye
movements, this drowsy sleep stage can be easily disrupted causing awakenings or arousals.
Muscle tone throughout the body relaxes and brain wave activity begins to slow from that of
wake. Occasionally people may experience hypnic jerks or abrupt muscle spasms and may even
experience sensation of falling while drifting in and out of Stage 1.
•Stage 2 is the first actual stage of defined NREM sleep. Awakenings or arousals do not occur as
easily as in Stage 1 sleep and the slow moving eye rolls discontinue. Brain waves continue to
slow with specific bursts of rapid activity known as sleep spindles intermixed with sleep
structures known as K complexes. Both sleep spindles and K complexes are thought to serve as
protection for the brain from awakening from sleep. Body temperature begins to decrease and
heart rate begins to slow.

•Stage 3 is known as deep NREM sleep. The most restorative stage of sleep, stage 3 consists of
delta waves or slow waves. Awakenings or arousals are rare and often it is difficult to awaken
someone in Stage 3 sleep. Parasomnias (sleepwalking, sleep talking or somniloquy and night
terrors) occur during the deepest stage of sleep.
•REM sleep, also known as rapid eye movement, is most commonly known as the dreaming
stage. Eye movements are rapid, moving from side to side and brain waves are more active than
in Stages 2 & 3 of sleep. Awakenings and arousals can occur more easily in REM; being woken
during a REM period can leave one feeling groggy or overly sleepy.

What Is a Sleep Cycle?
• A sleep cycle is the progression through the various stages of NREM sleep to REM sleep before beginning the progression again with NREM sleep.
Typically, a person would begin a sleep cycle every 90-120 minutes resulting in four to five cycles per sleep time, or hours spent asleep.
• One does not go straight from deep sleep to REM sleep, however. Rather, a sleep cycle progress through the stages of non-REM sleep from light to
deep sleep, then reverse back from deep sleep to light sleep, ending with time in REM sleep before starting over in light sleep again.
• For a majority of people, a sleep cycle begins with a short period of Stage 1 sleep whereby the body begins to relax and a drowsy state occurs with
slow rolling eye movements. Though arousals or awakenings are prevalent, Stage 1 is important as it allows for the body to enter Stage 2; the first
quantifiable stage of NREM sleep.
• Stage 2 occurs for longer periods than Stage 1. For most, Stage 2 sleep comprises approximately 40-60% of total sleep time.
• Moving through the sleep cycle, Stage 3 is most often found next in the progression. This restorative stage does not last as long as Stage 2, lasting
between 5-15% of total time asleep for most adults. For children and adolescents Stage 3 is much higher in duration.
• REM can occur at at time during the sleep cycle, but on average it begins 90 minutes following sleep onset and is short in duration as it is the first
REM period of the night. Following REM, the process resumes starting with periods of Stage 1, 2 & 3 intermixed before returning to REM again for
longer periods of time as sleep time continues.
• How long is a sleep cycle? The first sleep cycle takes about 90 minutes. After that, they average between 100 to 120 minutes. Typically, an individual
will go through four to five sleep cycles a night.

What Is Deep sleep?
•Deep sleep occurs in Stage 3 of NREM sleep. Brain waves during Stage 3 are called delta waves due to the slow speed and
large amplitude. Of all of the sleep stages, Stage 3 is the most restorative and the sleep stage least likely to be affected by
external stimuli.
•Waking a person from deep sleep can be difficult. Following a period of sleep deprivation, a person experiences extensive
time in Stage 3 sleep. Parasomnias such as sleep walking, sleep talking, night terrors and bedwetting can occur. (There is
muscle activity, that’s how people can talk or kick in their sleep!)
•Deep sleep reduces your sleep drive, and provides the most restorative sleep of all the sleep stages. This is why if you take
a short nap during the day, you’re still able to fall asleep at night. But if you take a nap long enough to fall into deep sleep,
you have more difficulty falling asleep at night because you reduced your need for sleep.
•During deep sleep, human growth hormone is released and restores your body and muscles from the stresses of the day.
Your immune system also restores itself. Much less is known about deep sleep than REM sleep. It may be during this stage
that the brain also refreshes itself for new learning the following day.

When Does REM Sleep Occur?
•A person’s sleep time (approximately 6-8 hours for adults) can be thought of as 2 halves. The first half for a
majority of people consists mostly of Stages 2 and 3 with sporadic periods of Stage 1 and short REM periods.
As the night progresses, Stage 3 begins to diminish in quantity while Stages 1 and 2 remain with lengthening
periods of REM occurring.
•A person typically experiences three to five REM periods throughout sleep time with the longest REM period
right before awakening for the day. If woken prematurely from completing the REM period a person can
experience a period of sleep inertia whereby a heightened sensation of sleepiness can occur for several
minutes or even several hours.
•In the REM period, breathing becomes more rapid, irregular and shallow, eyes jerk rapidly and limb muscles
are temporarily paralyzed. Brain waves during this stage increase to levels experienced when a person is
awake. Also, heart rate increases, blood pressure rises, males develop erections and the body loses some of
the ability to regulate its temperature.

In What Stage of Sleep Do Dreams
Occur?
•As an active sleep state, REM is the time when the most vivid dreams occur. The rapid eye movements
that occur can be seen as sharp, rapid movements. Brain waves during REM sleep are considered to be
of low amplitude and mixed frequency consistent with higher activity than that seen in Stages 2 and 3.
• Muscle paralysis often accompanies REM sleep. This muscle atonia or muscle paralysis occurs as a
protective means to keep one from acting out their dreams. Obstructive Sleep Apnea is often the worst
during REM periods due to the lack of muscle tone within the muscles of the airway. Scientists believe
this may be to help prevent us from injury while trying to act out our dreams.
•During REM respirations are irregular and shallow and irregularities in heart rate and body temperature
also occur.

Reference list
https://www.registerednursing.org/nclex/rest-sleep/
https://www.webmd.com/sleep-disorders/guide/parasomnias#2
https://docplayer.net/42913711-Rhythmic-movement-disorder.html

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