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Sleep disorders
Sleep is a normal state of altered consciousness that allows the body to rest. It involves decreased responsiveness and can be characterized by different sleep stages including slow-wave non-REM sleep and REM sleep. Sleep requirements vary by age but most adults need 6-8 hours per night. Disorders can cause difficulties initiating or maintaining sleep (insomnia) or excessive daytime sleepiness (hypersomnia). Treatment depends on the underlying cause but may involve changes to sleep hygiene, medications, or addressing lifestyle factors. Nursing care focuses on establishing regular sleep schedules and routines to support restful sleep.
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Introduces sleep disorders, defines sleep, outlines normal sleep patterns, and discusses sleep phases.
Explores Slow-Wave (nonREM) sleep stages, including physiological changes and characteristics of each phase.
Describes REM sleep, including duration, physiological characteristics, and brain activity indicators.
Covers the physiological effects of sleep and various factors affecting sleep quality and quantity.
Identifies sleep disorders and their categories, specifically focusing on insomnia and its causes.
Discusses diagnostic approaches and treatment methods, including non-pharmacologic strategies for insomnia.
Defines hypersomnia, details symptoms, causes, and self-help strategies to manage excessive sleepiness.
Describes sleep-wake schedule disorders, including specifics like Stage IV sleep disorders and interventions. Discusses additional sleep disorders like nocturnal angina and nocturnal seizures, along with nursing interventions.
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Sleep disorders
- 1.
- 2. What is sleep? Sleepcan be defined as a normal state of altered consciousness during which the body rests; It is characterized by decreased responsiveness to the environment, and a person can be aroused from it by external stimuli.
- 3. NORMAL SLEEP REQUIREMENTS& PATTERNS Sleep duration and quality vary among persons of all age groups • Infants - 16 Hours /Day • Toddlers - 12 Hours /Day • Preschoolers - 11 Hours /Day • Schoolers - 9 - 10 hours /day • Adolescents - 8 – 9 hours /day • Adults - 6 – 8 hours /day
- 4. Phases of sleep 1.Slow-wavesleep (NonREM): Phase 1-4 2. Paradoxical/desynchronized sleep (REM- Rapid Eye Movements)
- 5. Slow-Wave (nonREM) Sleep •Entrance to sleep • Takes appr. 90 minutes with 5-20 minutes intervals • Peripheral vessel tone and body functions decrease • Muscle tone decreases • 10-30% decrease in blood pressure, respiration rate and basal metabolism • Spinal reflexes can be elicited but stretch (deep tendon) reflexes are absent.
- 6. Slow-Wave (nonREM) Sleep •Dreams cannot be remembered • Theta and delta waves in EEG • Duration and frequency decrease with age • Has 4 different stages
- 7. Phase-1 nonREM • Transitionperiod between wakefulness and sleep; • takes approximately 1-15 minutes. – Eyes closed and relaxed... – Light sleep, hallucination-like visions... α (alpha) waves weaken, slower θ (delta) waves emerge.
- 8. Phase-2 nonREM • Firststage of the real sleep; takes about 20 minutes... • Sleep spindles: 12-14 Hz sharp waves appear for 1-2 seconds. • Slow eye movements. • Hard to awaken. • Fragments of dreams may present
- 9. Phase-3 nonREM • Half-waydeep sleep • Body temperature and blood pressure decreases • Harder to awaken • Low frequency δ (theta) waves • Sleep spindles are decreased • No slow eye movements
- 10. Phase-4 nonREM • Deepestsleep; takes about 30-40 mins. • δ (theta) waves predominate • Most reflexes are intact; muscle tone slightly decreased • Sleep-walking; sleep-talking; snoring and bedwetting generally occurs in this stage.
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- 12. REM Sleep • 5-30minutes with 90 minute-intervals • Active dreaming (dreams are remembered) • Active body movements • More difficult to wake up with sensory stimulations • Waking up in the morning generally coincides with the last REM period. • Decrease in muscle tone (except respiratory and eye muscles) • Irregularity in heart and respiration rate. • 20% increase in brain metabolism
- 13. REM Sleep • Atoniain neck muscles • Rapid eye movements • Beta waves in EEG =paradoxical sleep, =desynchronized sleep
- 15. Physiological effects ofsleep Sleep, • Helps the maintenance of normal activity level of CNS. • Helps to maintain the “balance” between the different parts of the CNS. • Increased sympathetic activity and muscle tone during the awake period decreases with sleep. • Body temperature drops, energy loss decreases • Growth hormone and cortisol secretion increases • Phosphate excretion from kidneys increase • Melatonin secretion increases • Skin and tissue repair occurs
- 16. FACTORS AFFECTING SLEEP •Physical illness (eg. Nausea, mood disorders, breathing difficulty, pain) • Drugs and substances • Lifestyle (eg. Daily routines, exercises) • Usual sleep patterns and excessive daytime sleepiness • Emotional stress • Environment ( ventilation) • Sound • Exercise and fatigue • Food and caloric intake
- 17. Sleep disorders 1. Dyssomnias Insomnia Hypersomnia Disorders of sleep –wake schedule 2. Parasomnias Stage IV disorders Other disorders
- 18. Insomnia • Insomnia refersto disorder of initiation and maintenance of sleep. • This includes frequent awakening during the night and early morning awakening.
- 19. Causes of Insomnia Medicalillness: • Any painful illness • Heart disease • Respiratory disease • Brainstem lesions • Delirium • Musculo-skeletal disease • Old age
- 20. Alcohol and druguse: • Chronic alcoholism • Delirium tremens • Amphetamines or other stimulants Psychiatric disorders: • Mania • Major depression • Dysthymia • Schizophrenia and other psychosis • Anxiety disorders
- 21. Social causes: • Financialloss • Separation or divorce • Death of a close relative or spouse • Retirement • Stressful life situations Behavioural causes: • Naps during the day • Irregular sleeping hours • Lack of physical exercise • Excessive intake of beverages like coffee. • Disturbing environment
- 22. Treatment • A throughmedical and psychiatric assessment to identify the cause. • Polysomnography: ( also called a sleep study, is a test used to diagnose sleep disorders. Polysomnography records brain waves, the oxygen level in blood, heart rate and breathing, as well as eye and leg movements during the study) • Treat underlying cause • Withdrawal of current medications if any • Transient insomnia can be treated initially with hypnosis.
- 23. Non pharmacologic treatmentfor insomnia • Progressive muscle relaxation • Autosuggestion • Meditation, yoga • Stimulus control therapy: - Do not use the bed for reading and chatting. - Go to bed only for sleep.
- 24. Autosuggestion Autosuggestion are positivewords and sentences use repeatedly to change ones own perception. It is an effective method for ending bad habits. Techniques: • As you lie on your back in bed, rest your hands gently on your chest. Choose a positive suggestion to give yourself -- something short and direct. • Example: "Tonight I will sleep deeply and peacefully... and I'll wake up tomorrow morning feeling great." • Repeat the suggestion 10 times slowly in your mind -- or out loud, if doing so won't disturb a bedmate. • Each time you repeat the suggestion, gently press your fingers into your chest. This helps "anchor" the suggestion in your body. Keep your eyes closed at all times.
- 25. Sleep hygiene • Regular,daily physical exercise in the evening. • Avoid fluid intake and heavy meals before bedtime. • Avoid caffeine intake before sleeping hours. • Avoid reading or watching television while in bed. • Take warm milk before bedtime. • Sleep in comfortable position.
- 26. Hypersomnia • Hypersomnia isa disorder of excessive somnolence (DOES). • It includes excessive day time sleepiness, sleep attacks during day time, sleep drunkenness • (Confusional arousals, also known as sleep drunkenness , consist of mental confusion or confusional behavior during or following arousals from sleep).
- 27. Causes of hypersomnia •Narcolepsy • Sleep apnea:Repeated episodes of apnea during sleep. • Kleine-Levin syndrome:Periodic episodes of hypersomnia. • Not getting enough sleep at night (sleep deprivation) • Being overweight • Drug or alcohol abuse • A head injury or a neurological disease, such as multiple sclerosis • Prescription drugs, such as tranquilizers • Genetics (having a relative with hypersomnia)
- 28. 1. Narcolepsy: Excessivedaytime sleepiness characterized by: • Sleep attacks • Cataplexy- sudden decrease or loss of muscle tone, may lead to sleep. • Sleep paralysis – it occurs either at awakening in the morning or at sleep onset. The person is conscious but unable to move his body. • Hypnogogic hallucination -hallucination occur at the transition from wakefulness to sleep
- 29. Symptoms of hypersomnia: •Feeling unusually tired all the time • The need for daytime naps • Feeling drowsy, despite sleeping and napping – not refreshed on waking up • Difficulty thinking and making decisions – the mind feels ‘foggy’ • Apathy • Memory or concentration difficulties • An increased risk of accidents, especially motor vehicle accidents.
- 30. Self-help strategies • Avoidcigarettes, alcohol and caffeinated drinks near bedtime. • Follow a relaxation routine to prevent night-time anxiety. • Exercise regularly and maintain a normal weight for your height. • Eat a well-balanced diet to prevent nutritional deficiencies. • If possible, change environment to reduce disturbances – for example, don’t watch television in the bedroom. • Be comfortable; make sure you don’t overheat or feel too cold in bed. • Have a regular sleeping routine so that the body ‘knows’ it is time to sleep. • Only go to bed when you feel sleepy.
- 31. Disorder of sleep-wake schedule: The person is not able to sleep when he wishes to, although at other time he is able to sleep adequately. Causes: • Work shifts • Unusual sleep phases
- 32. Stage IV sleepdisorders • Sleep walking (somnobulism) • Night terrors : episodes of screaming, intense fear during sleep. • Sleep related enuresis • Bruxism (tooth grinding) • Sleep talking ( Somniloquy)
- 33. • Sleep-walking: Thisis a common abnormal behaviour during sleep. The person may walk around the house while still asleep. Sleep walking tends to affect children more than adults.
- 34. Other sleep disorders •Nocturnal angina: Angina occurring at night. Rare condition. • Nocturnal Asthma: symptoms like chest tightness, shortness of breath, cough, and wheezing at night, can make sleep impossible and leave you feeling tired and irritable during the day. • Nocturnal Seizures: Nocturnal epilepsy is a seizure disorder in which seizures occur only while sleeping. Several common forms of epilepsy, including frontal lobe epilepsy, can manifest in a nocturnal state.
- 35. Nursing diagnosis • Disturbedsleep pattern related to lack of cues for day- night schedule; manifested by erratic sleep schedule, frequent naps and nocturnal wandering
- 36. Nursing interventions • offermeals at regular times, corresponding to client’s previous pattern • provide active meaningful activities during daytime hours, including exposure to natural light, and an outdoor environment when possible • monitor frequency and duration of naps • create an individualized bedtime ritual that includes a quieting activity, a light carbohydrate snack, going to the bathroom and settling a routine • Do not wake even if incontinent. Change and assist the client to the bathroom when he or she spontaneously awakens • if turning or other care is necessary, try to provide for periods up to 2 hours of undisturbed sleep time whenever possible