Sleep disorders
Sleep
▪ is a natural, periodically recurring physiological state of rest, characterized by relatively little physical and
nervous activity, various levels of consciousness and lessened responsiveness to external stimuli.
▪ It is a universal phenomenon present in all living things and revolving around biological rhythms called
CIRCADIAN RHYTHM.
▪ It is a biological behavioral process that recurs in approximately 24-hour cycle.
▪ The cyclic nature of sleep is controlled by the center located in the lower part of the brain- mesencephalic
portion of the reticular formation.
STAGES OF SLEEP
1. Non-rapid eye movement (NREM)
4 stages
Stage I-
▪ 5% of the person’s sleep
▪ Transitional stage between wakefulness and sleep
▪ The person is in the relax state but still somewhat aware of his surroundings.
▪ This stage normally lasts for few minutes.
▪ The person can be aroused easily.
▪ Involuntary muscle jerking may occur and may waken the person
Stage II
▪ 50% of the person’s sleep
▪ The person falls into a stage of sleep
▪ The person can be aroused with relative ease
Stage III
▪ deep sleep state
▪ The depth of sleep increases and arousal becomes increasingly difficult
Stage IV
▪ the person reaches the greatest depth of sleep, which is called the DELTA SLEEP
▪ Arousal from sleep is difficult
▪ Physiologic changes in the body include:
Slow brain waves are recorded on an electro encephalogram (EEG)
Pulse and respiratory rates decrease
Muscles are very relax
Metabolism slows and the body temperature is low
2. Rapid Eye Movement (REM)
▪ Sometimes called PARADOXICAL SLEEP
▪ Because it seems that the person is close to wakefulness
▪ 20%-25% of person’s nightly sleep
▪ It is more difficult to wake a person at this stage’
▪ If they are awakened, they always report that they have been dreaming.
▪ Many researchers state that everyone dreams and those who say they don’t simply are unable to recall their
dreams
▪ Characteristics of REM sleep
✓ Eyes dart back and forth
✓ Muscles- small muscle twitching, such as on the face
✓ Large muscles immobility resembling paralysis
✓ Respiration- irregular sometimes there is apnea
✓ Pulse-rapid and irregular
✓ BP- increases or fluctuates
✓ Gastric secretions increase
✓ Metabolism and body temperature increase
✓ Brain waves- EEG tracing active
Functions of sleep
▪ It allows the mind and body to recognize and regenerate in preparation for the coming day.
▪ Physiologically, hormone releases, cellular refreshment and other metabolic changes that occur during sleep are
secondary to reduced body activity and usage.
▪ Psychologically, sleep may assist the person in problem solving, coping and re-energizing his powers of
concentration and interest in the daily tasks.
Factors that influence sleep
▪ Age- the quantity, sleep cycles and sleep quality differs among persons of various ages.
▪ Physical activity- activity and exercise influence sleep by increasing fatigue and in many instances, promoting
relaxation that is followed by sleep.
▪ Psychological stress- illness and daily situations can cause psychological stress and may disturb sleep.
▪ Motivation- a desire to be wakeful and alert helps overcome sleepiness and sleep.
▪ Diet- it is believed that the amino-acid tryptophan – acts to promote sleep
▪ Alcohol intake- alcohol beverages, when used in moderation, seem to help induce sleep in some people.
▪ Caffeine containing beverages
▪ Environmental factors
Causes of sleep disorders
Allergies and respiratory problems
▪ Allergies, colds, and upper respiratory infections can make it challenging to breathe at night.
▪ The inability to breathe through your nose can also cause sleeping difficulties.
Frequent urination
▪ Nocturia, or frequent urination, may disrupt sleep by causing an individual to wake up during the night.
▪ Hormonal imbalances and diseases of the urinary tract may contribute to the development of this condition.
Chronic pain
▪ Constant pain can make it difficult to fall asleep. It might even wake up an individual after falling asleep.
Stress and anxiety
▪ Stress and anxiety often have a negative impact on sleep quality.
▪ It can be difficult to fall asleep or to stay asleep.
▪ Nightmares, sleep talking, or sleepwalking may also disrupt your sleep.
Common sleep disorders
1. Insomnia- inability to obtain an adequate or quality of sleep
3 types
▪ Initial insomnia- difficulty in falling asleep
▪ Intermittent or maintenance insomnia- difficulty in staying asleep because of frequent or prolonged
waking.
▪ Terminal insomnia- early morning or premature waking
2. Hypersomnia- excessive sleep (daytime or night time)
3. Narcolepsy- sudden wave of overwhelming sleepiness (Sleep attack)
4. Sleep apnea- periodic cessation of breathing during sleep and interfere with sleep.
5. Parasomnias- clusters of waking behaviors that appear during sleep and interfere with sleep.
▪ Somnambulism- sleep walking
▪ Night terrors- after having slept for few hours, the child bolts upright, shakes and screams, appears pale and
terrified. Attributed to CNS disorders and infections (no memory of what may have happened)
▪ Nocturnal enuresis- involuntary voiding at night or bedwetting
▪ Soliloquy- sleep talking
▪ Bruxism- clenching and grinding of teeth during sleep. May erode and diminish the height of the dental
crowns and may cause the teeth to become loose.
▪ Nightmares- exceedingly vivid dreams from which the individual wakens in fear. Upon awakening has good
recall of the nightmare content.
▪ Nocturnal erections- wet dreams and experienced by adolescent males.
How are sleep disorders diagnosed?
1. Polysomnography (PSG)
▪ This is a lab sleep study that evaluates oxygen levels, body movements, and brain waves to determine how
they disrupt sleep vs. home sleep study (HST) that is performed in your own and is used to diagnose sleep
apnea.
2. Electroencephalogram (EEG)
▪ This is a test that assesses electrical activity in the brain and detects any potential problems associated with
this activity.
▪ It’s part of a polysomnography.
3. Multiple sleep latency test (MSLT)
▪ This daytime napping study is used in conjunction with a PSG at night to help diagnose narcolepsy.
Medical treatments
Medical treatment for sleep disturbances might include any of the following:
▪ sleeping pills
▪ melatonin supplements
▪ allergy or cold medication
▪ medications for any underlying health issues
▪ breathing device or surgery (usually for sleep apnea)
▪ a dental guard (usually for teeth grinding)
Sleeping Breathing Device
▪ Continuous positive airway pressure (CPAP) therapy is a common treatment for obstructive sleep apnea.
▪ A CPAP machine uses a hose and mask or nosepiece to deliver constant and steady air pressure.
Lifestyle changes
▪ incorporating more vegetables and fish into your diet, and reducing sugar intake.
▪ reducing stress and anxiety by exercising and stretching.
▪ creating and sticking to a regular sleeping schedule
▪ drinking less water before bedtime.
▪ limiting caffeine intake, especially in the late afternoon or evening.
▪ decreasing tobacco and alcohol use
▪ eating smaller low carbohydrate meals before bedtime.
▪ maintaining a healthy weight based on your doctor’s recommendations
Measures to promote sleep
▪ Restrict bed and bedroom to sleep and sexual activity. Do not read, watch TV or do other activities in bed.
▪ Try to get up at the same time each day, regardless of when you went to bed. This will help established a sleep-
wake rhythm
▪ Exercise each day, preferably in late afternoon or early evening.
▪ Make sure the bedroom is quiet, dark and comfortable in temperature.
▪ A light snack may help, possibly warm milk.
▪ Avoid daytime napping.
▪ Caffeine in the evening disturbs sleep.
