Psychiatric Nursing: Sleep disorders

1. SLEEP
Disorders
By
Mr. Vincent Ejakait (BScN)

2. Food for thought!!
 Why do you sleep?
 When do you know when to sleep?
 What happens during sleep?
 How long should you sleep?

3. Sleep
 Each of us will spend about 27 years of our
lifetime sleeping…..
 Most adults need 7-8 hours of sleep,
teenagers about 9, and infants about 16
hours a day.
 …..And 1/3 part of the population has sleep
disorder

4. “Why we sleep remains one of nature’s
greatest mysteries”
(MG Frank, 2006)

5. Physiology of Normal sleep
 Sleep is divided into 2 main parts
1. Non-REM (NREM):Before you doze off
and early hours of sleep
 muscle tone ↓, eye movement ↓, HR ↓, BP ↓
2. REM: During deep sleep, established
sleep
 fast eye movements, irregular breathing,
HR ↑

6. Sleep Disorders
 According to DSM-V sleep disorders
are classified into 2 main categories:
 Primary sleep disorders
 Secondary sleep disorders

7. Primary sleep disorders
 Dyssomnias:
 They are associated with difficulty
initiating or maintaining the sleep or
daytime sleepiness.
 Parasomnias:
 abnormal behavioral or physiological
events occurring during sleep

8. 1. Primary Sleep disorders
Dyssomnias
Parasomnias
 Insomnia
 Hypersomnia
 Narcolepsy
 Breathing related sleeping dis.
 Circadian rhythm sleep dis.
 Nightmares
 Sleep terror disorder
 Sleep walking disorder
 Bruxism
 Sleep paralysis
 Restless leg syndrome

9. Dyssomnias

10. I. Insomnias
 Difficulty in initiating sleep or in
maintaining sleep.
Characteristics:
 Fatigue, concentration or memory
impairment
 Mood disturbances, motivation
 Daytime sleepiness
 Tension headache

11. Cont.….
Causes of Insomnia:
Idiopathic
Inadequate sleep hygiene
Insomnia due to mental disorder
Psychophysiological insomnia
Insomnia due to drug or substance
Insomnia due to medical conditions

12. Cont.….
Treatment of insomnia:
 Treat the medical or psychiatric
conditions
 Nonpharmacologic:
 behavioral treatments: normalizing the
circadian rhythm
 sleep hygiene
 cognitive behavior therapy
 sleep restriction therapy
 Pharmacologic treatment
 Benzodiazepines

13. II. Hypersomnia
 Disorder in which the primary complaint
is daytime sleepiness and
 the cause of the primary symptom is
not disturbed nocturnal sleep or
misaligned circadian rhythms.

14. Hypersomnia

15. III. Narcolepsy
 Narcolepsy:
 Disorder that causes periods of
extreme daytime sleepiness due to
 trouble sleeping at night and is
sometimes accompanied by paralysis and
hallucinations

16. Narcoleptic man

17. IV. Breathing related sleeping
disorder
The most common disorder in this
category is sleep apnea:
 Sleep apnea is:
 Sleep disorder that occurs when a
person’s breathing is interrupted during
sleep.
 They stop breathing repeatedly during
their sleep

18. Sleep apnea
There are Two types:
 Obstructive Sleep Apnea:
 Caused by blockage of the airway, usually
when the soft tissue in the back of throat
collapses during sleep.
 Central Sleep Apnea:
 The brain fails to signal the muscles to
breathe due to instability in the
respiratory control center.

19. Sleep apnea

20. V. Circadian rhythm sleep
disorders
When the normal sleep-wake cycle is
affected:
Includes:
 Jet lag type
 Shift work type

21. Cont.….
Treatment of the circadian rhythm sleep
disorder
 Sleep hygiene
 Cronotherapy

22. Parasomnia

23. I. Sleep terrors
 Night terrors (sleep terrors) are sleep
disorder in which a person quickly wakes
from sleep in a terrified state.
 Individuals may be difficult to arouse
from the episode and
 when aroused can be confused and
subsequently amnestic for the episode

24. Sleep terrors

25. II. Nightmares
 Extremely frightening dreams that
occur in REM sleep.
 Less intense than sleep terrors.
 Person rapidly becomes aware and alert
almost immediately after waking up.
 They can remember the dream

26. Cont.…
 The cause is unknown, but night terrors
may be triggered by:
 Fever
 Lack of sleep
 Periods of emotional tension,
 stress, or conflict.
 Frightening movies or TV shows.

27. Nightmares

28. III. Sleep paralysis
 This condition
prevents you from
moving or speaking
while waking up and
sometimes while
falling asleep.
 Last from a few
seconds to a few
minutes.

29. IV. Sleep walking
(somnambulism)
 Sleepwalking is a disorder that
occurs when people walk or do
another activity while they are
still asleep.
 The episode can last from a few
seconds to over 30 minutes.

30. Cont.…
Symptoms of sleepwalking include:
 Confusion/disorientation when woken up.
 A blank look on their face.
 Opening their eyes while still asleep.
 No memory of the episode.
 Performing a detailed activity of any
type while still asleep.

31. Sleep walking

32. V. Sleep enuresis
 Is the recurrent involuntary voiding
that occurs during sleep.
 Enuresis is considered primary in a child
who has never been dry for 6 months or
longer.
 Whereas otherwise, it is called
secondary enuresis.

33. Bedwetting

34. Sleep enuresis

35. VI. Sleep Bruxism
 Is the grinding of the teeth as if you
are crushing or chewing something while
in real essence you are not.
 Done while sleeping.
 Leads to deformed teeth and
 Is uncomfortable for the person
sleeping nearby

36. Bruxism

37. VII. Restless leg syndrome
 Neurological disorder that is
characterized by unpleasant sensations
of legs and an urge to move them when
at the rest and asleep.
 Causes: Mostly unknown (idiopathic)
 Treatment: underlying cause, some
meds, and exercise.

38. 2. Secondary sleep disorders
 Sleep disorders related to another
mental condition.
 Sleep disorder related to General
medical conditions.
 Substance induced sleep disorder

39. General Management of
sleep disorders

40. Management
 Sleep hygiene
 Behavioral treatments: normalizing the
circadian rhythm e.g Cronotherapy
 Cognitive behavior therapy
 Sleep restriction therapy
 Pharmacologic treatment:
 Benzodiazepines e.g. midozelam
 Melatonin receptor agonist e.g. Ramelteon

41. Cont.…
Sleep hygiene includes:
 Try to limit caffeine intake.
 Have a light snack before bedtime. (no big
meals before bedtime)
 Set your bedroom for a comfortable
temperature.
 Minimize light exposure.
 Try to follow a regular and consistent
sleep schedule.

42. END